2026 E/M Coding Cheat Sheet
AMA 2021 MDM Guidelines — Office & Outpatient Visits (99202–99215)
From CodeItRight.ai — AI-Powered E/M Coding for Physicians
MDM Table — Meet 2 of 3 Elements
| MDM Level | Problems | Data | Risk |
|---|---|---|---|
| Straightforward | 1 self-limited/minor problem | Minimal or none | Minimal risk (rest, OTC drugs) |
| Low | 2+ self-limited OR 1 stable chronic | Limited (1 data category) | Low risk (Rx drugs, minor surgery) |
| Moderate | 1 undiagnosed new problem OR chronic with exacerbation | Moderate (2+ categories OR independent interpretation) | Moderate risk (Rx monitoring, elective surgery) |
| High | Severe exacerbation OR threat to life/function | Extensive (2+ categories + interpretation) | High risk (IV drugs, hospitalization, DNR) |
MDM Level → E/M Code
| MDM Level | New Patient | Established Patient | Medicare Avg |
|---|---|---|---|
| Straightforward | 99202 | 99212 | $67–$76 |
| Low | 99203 | 99213 | $109–$111 |
| Moderate | 99204 | 99214 | $167–$170 |
| High | 99205 | 99215 | $211–$224 |
Time-Based Coding Thresholds
Use total time (all activities on encounter date) when it yields a higher code than MDM.
| Code | New Patient | Established Patient |
|---|---|---|
| 99202/99212 | 15–29 min | 10–19 min |
| 99203/99213 | 30–44 min | 20–29 min |
| 99204/99214 | 45–59 min | 30–39 min |
| 99205/99215 | 60–74 min | 40–54 min |
| 99417 (add-on) | Each additional 15 min beyond 99205/99215 | |
Top 5 Audit Traps
1
Defaulting to 99213
Run MDM AND time — take the higher code.
2
Ordering ≠ Interpreting
Document "I independently interpreted the EKG" for Category 2 data credit.
3
Missing chronic condition management
2+ stable chronic conditions = Moderate MDM, not Low.
4
Ignoring prescription drug management risk
Any Rx drug management qualifies as Moderate risk (not Low).
5
No documented time
If you spent 35+ min, document total time — it may upgrade your code.
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Source: AMA 2021 MDM Guidelines, CMS Table of Risk, 2024 Medicare Physician Fee Schedule. For educational purposes only — not legal or medical advice.