Medical Coding

Category - Evaluation and Management

A patient who requires complex chronic care management services must meet certain criteria. What degree of medical decision making and how many minutes of care management must be provided for these patients?
  1. Straightforward medical decision making, at least 60 minutes of clinical care management.
  2. Low-complexity medical decision making, at least 45 minutes of clinical care management.
  3. Moderate- or high-complexity medical decision making, at least 45 minutes of clinical care management.
  4. Moderate- or high-complexity medical decision making, at least 60 minutes of clinical care management.
Explanation
Answer: D - Complex chronic care management patients must be considered to require moderate- or high-complexity medical decision making, as well as at least 60 minutes of clinical staff care management.
Straightforward and low-complexity medical decision making isn’t complicated enough to entitle these patients to be considered eligible for using the evaluation and management codes for complex chronic care management. At least 60 minutes must be spent by a physician or other qualified healthcare professional in clinical staff care management to use these codes.
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