E/M Nature of Presenting Problem

Aka: E/M Nature of Presenting Problem, E/M Minimal Problem, E/M Self Limited or Minor Problem, E/M Low Severity Problem, E/M Moderate Severity Problem, E/M High Severity Problem

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II. Nature of Problem: Minimal

  1. Criteria
    1. Problem does not require physician presence
    2. Service provided under supervision of a physician
  2. Related Codes
    1. E/M Established Outpatient: CPT 99211

III. Nature of Problem: Self limited or Minor

  1. Criteria
    1. Minimal number of diagnoses or management options
    2. Minimal or no data to be reviewed
    3. Minimal risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99201
    2. E/M Established Outpatient Visit
      1. CPT 99212
    3. E/M Emergency Services
      1. CPT 99281
    4. E/M Consultation Services
      1. CPT 99241

IV. Nature of Problem: Low Severity

  1. Criteria
    1. Limited number of diagnoses or management options
    2. Limited amount or complexity of data to be reviewed
    3. Low risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99202
    2. E/M Established Outpatient Visit
      1. CPT 99213
    3. E/M Emergency Services
      1. CPT 99282
    4. E/M Consultation Services
      1. CPT 99242

V. Nature of Problem: Moderate Severity

  1. Criteria
    1. Multiple diagnoses or management options
    2. Moderate amount or complexity of data to be reviewed
    3. Moderate risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99202
      2. CPT 99203
      3. CPT 99204
      4. CPT 99205
    2. E/M Established Outpatient Visit
      1. CPT 99213
      2. CPT 99214
      3. CPT 99215
    3. E/M Emergency Services
      1. CPT 99283
    4. E/M Consultation Services
      1. CPT 99243
      2. CPT 99244
      3. CPT 99245

VI. Nature of Problem: High Severity

  1. Criteria
    1. Extensive diagnoses or management options
    2. Extensive amount or complexity of data to be reviewed
    3. High risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99204
      2. CPT 99205
    2. E/M Established Outpatient Visit
      1. CPT 99214
      2. CPT 99215
    3. E/M Emergency Services
      1. CPT 99284
      2. CPT 99285
    4. E/M Consultation Services
      1. CPT 99244
      2. CPT 99245

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