High Complexity MDM

High complexity MDM is the highest level of MDM. To qualify for high complexity MDM, the requirements for two out of the three dimensions of MDM listed below must be satisfied.

Problems addressed (any of the following)
- Severe exacerbation of chronic illness
- Acute or chronic illnesses that may pose a threat to life or bodily function, e.g., multiple trauma, acute MI, pulmonary embolus, severe respiratory distress, progressive rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute renal failure, abrupt change in neurological status
Data reviewed (must meet the requirements for 2 of 3 of the categories below)
- Category 1: Tests and documents
  (Requires any combination of 3 of the following)
  - Review of prior external notes
  - Review of results or each unique test
  - Ordering of each unique test
  - Assessment requiring an independent historian
- Category 2: Interpretation of tests
  - Independent interpretation of a test performed by another physician/NPP
- Category 3: Discuss management/tests
  - Discussion of management or tests with an external physician/NPP
Risk: high risk
- Drug therapy requiring intensive monitoring for toxicity
- Decision for elective major surgery with identified patient or procedure risk factors
- Decision regarding hospitalization or escalation of level of care
- Decision for DNR or to de-escalate care
- Parenteral controlled substances

When coding based on the MDM, moderate complexity MDM is required for:

level 5 established office visits (99215)
level 5 new office visits (99205)
level 3 admission H&Ps (99223)
level 3 hospital progress notes (99233)
level 5 outpatient or inpatient consults (99245, 99255)
level 5 ER visits (99284)
The highest level of care for initial nursing facility care visits (99207)
The highest level of care for subsequent nursing facility care visits (99310)

For detailed explanations and examples consider taking our courses or something to that effect.