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Effective January 1, 2023, this information is no longer up-to-date. The material on this page covers only the 1995 and 1997 E/M guidelines and is no longer accurate. A new set of E/M guidelines was released in 2021, with some minor modifcations added for 2023. These new guidelines are now used to document all encounters in both the outpatient and inpatient settings. For the most recent E/M coding guidance, visit our home page here.


High Risk

This is the highest level of risk.  This level of risk is required for a level 3 admission H&P (99223), a level 5 office follow-up visit (99215) and a level 3 hospital progress note (99233) .

This level of risk requires ONE element in ANY of the following three categories:

Presenting Problem(s)
  • One or more chronic illness with severe exacerbation or progression
  • Acute or chronic illness or injuries which pose a threat to life or bodily function (e.g.,
    multiple trauma, acute MI, pulmonary embolism, severe respiratory distress, progressive
    severe rheumatoid arthritis, psychiatric illness with potential threat to self or others,
    peritonitis, acute renal failure)
Diagnostic Procedure(s)
  • Cardiovascular imaging studies with contrast with identified risk factors
  • Cardiac EP testing
  • Diagnostic endoscopies with identified risk factors
  • Discography
Management Options Selected
    • Elective major surgery with identified risk factors
    • Emergency major surgery
    • Parenteral controlled substances
    • Drug therapy requiring intensive monitoring for toxicity
    • Decision not to resuscitate or to de-escalate care because of poor prognosis
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