American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Element 1: Problems Addressed

1. The number and complexity of problem(s) addressed.

CPT defines a problem as "…a disease, condition, illness, injury, symptom, sign, finding, complaint, or other matter addressed at the encounter, with or without a diagnosis being established at the time of the encounter."

Office/Outpatient E/M CPT Code

1) Number and Complexity of Problems Addressed

99211 Not applicable
99202
99212

Minimal

1 self-limited or minor problem

99203
99213

Low

2 or more self-limited or minor problems;
 -or-
1 stable chronic illness;
 -or-
1 acute, uncomplicated illness or injury

99204
99214

Moderate

1 or more chronic illnesses with exacerbation, progression, or side effects of treatment;
-or-
2 or more stable chronic illnesses;
-or-
1 undiagnosed new problem with uncertain prognosis;
-or-
1 acute illness with systemic symptoms;
-or-
1 acute complicated injury

99205
99215

High

1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment;
-or-
1 acute or chronic illness or injury that poses a threat to life or bodily function

View the Office E/M Coding Changes Guide