tci Medicare Compliance & Reimbursement - 2021 Issue Q3
Reader Questions: Understand the Differences Between These 2 MDM Tables
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Article Overview
This reader Q&A addresses how to interpret medical decision-making guidance for office and outpatient evaluation and management services in the 2021 CPT® framework. It focuses on the difference between the CPT®-based MDM table and the CMS Table of Risk, why confusion arose after the 2021 revisions, and how published guidance clarified the scope of each table. The article is relevant to coders, auditors, and compliance staff who work with E/M documentation and want to understand the broader context of the 2021 changes.
Why This Topic Matters
Accurate E/M leveling depends on using the correct decision-making framework for the service being coded. Misapplying guidance between CPT® and CMS sources can lead to inconsistent code selection and documentation interpretation.
What You Will Learn
- How the 2021 E/M framework distinguishes between different medical decision-making tables
- Why CPT® and CMS guidance should not be used interchangeably for every E/M service
- How published clarification addressed confusion about office and outpatient visit leveling
- What broad factor changed in the way risk is considered under the updated CPT® approach
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Physician documentation staff
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
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