The 2023 E/M guidelines include a number of changes to the Medical Decision Making (MDM) component. These changes are designed to more accurately reflect the complexity of clinical decision-making in today's healthcare environment.
One of the most significant changes to the MDM component is the removal of the Table of Risk. The Table of Risk was a list of potential complications and risks associated with various medical conditions. Providers used the Table of Risk to help determine the level of MDM required for a given encounter.
In the 2023 guidelines, the Table of Risk has been replaced by a more general discussion of risk. Providers are now expected to consider the following factors when determining the level of MDM:
The severity of the patient's condition
The uncertainty of the diagnosis
The potential for complications
The need for further testing or treatment
The 2023 guidelines also include a number of changes to the way that MDM is documented. Providers are now required to document the following information:
The number and complexity of the patient's problems
The amount and/or complexity of data reviewed and analyzed
The risk of complications and/or death
The changes to the MDM component in the 2023 E/M guidelines are intended to make the coding process more accurate and transparent. By more accurately reflecting the complexity of clinical decision-making, the new guidelines will help to ensure that providers are appropriately reimbursed for their services.
Here is a table comparing the 2023 E/M MDM grid and the 2022 Table of Risk:
As you can see, the 2023 E/M MDM grid is more specific than the 2022 Table of Risk. This is because the grid takes into account the number and complexity of the patient's problems, as well as the amount and/or complexity of data reviewed and analyzed.
The changes to the MDM component in the 2023 E/M guidelines are significant, but they are not insurmountable. By carefully documenting the patient's problems and the data that was reviewed and analyzed, providers can ensure that they are appropriately reimbursed for their services.
If you have any questions about the 2023 E/M MDM grid or the Table of Risk, please consult with your billing and coding specialist.