How Complexity Type is Determined?
Patient > Provider Notes > Provider Note > eSuperBill
Complexity of Medical Decision Making is determined by the number of Diagnoses, Data, and Risk.
Number of Diagnoses: Number of ICD codes that were entered in the provider note.
Data: Determined by the number of CPT codes provided in the provider note.
Risk: Based on number of diagnoses and data; if no ICD or CPT codes are entered, risk is set as Low by default. Only two out of these factors are required
The system picks the ones with highest levels and uses them to calculate the E&M codes. For most encounters, the level of service rendered is determined by taking a sum of the three components (history, physical, and complexity) or by using a time element.
For some encounters (e.g., new patients) all three areas must have documentation in order to reach a higher level of service.
For other encounters (e.g., established patients) the two highest levels, whether they be from history, physical examination or from complexity, are used to make the final determination.
To read more about how complexity of decision making is determined please click on “How is complexity determined?”
