Patient Encounter Form Page 6

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Patient Encounter Form Printable pdf

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Documentation of Medical Decision Making (MDM)

CPT Code:_____________

Number of Diagnoses

Amount and/or

Risk of

Type of

or management

complexity of

Complications

Decision

options

data to be

and or Morbidity

Making

reviewed

or mortality

Minimal

Minimal or

Minimal

Straightforward

None

Limited

Limited

Low

Low Complexity

Multiple

Moderate

Moderate

Moderate Complexity

Extensive

Extensive

High

High Complexity

MEDICAL INFORMATION FORM

Select the level of History:

#1

#6

#3-5

HPI

ROS

PFSH

Problem Focused

Brief

N /A

N /A

Expanded Problem

Brief

1 system

N /A

Focused

Detailed

Extended

2 -9 systems

1 history

Comprehensive

Extended

10+

2 / 3 est, 3 new

HISTORY

LEVEL OF CODE

NEW PT OR CONSULT

EST. PT.

1

Problem Focused

N / A

2

Expanded Problem Focused

Problem Focused

3

Detailed

Expanded Problem Focused

4

Complete

Detailed

5

Complete

Complete

EXAM

LEVEL

NEW PT OR

EST. PT.

OF CODE

CONSULT

1

1-5 elements

N / A

6

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