Dental CDT to CPT: Coding criteria for E/M codes 99201 to 99205

Risk Flag for 99203
A review of the table of risk shows that this encounter qualifies as Low Risk due to the management option of “over-the-counter drugs.”
Risk Level Presenting Problems Diagnostic Procedures Management Options Selected
Low Risk

Requires ONE of these elements in ANY of the three categories listed
Two or more self-limited or minor problems
One stable chronic illness, e.g., well-controlled HTN, DM2, cataract
Acute uncomplicated injury or illness, e.g., cystitis, allergic rhinitis, sprain
Physiologic tests not under stress, e.g., PFTs
Non-cardiovascular imaging studies with contrast, e.g., barium enema
Superficial needle biopsy
Skin biopsies
Over the counter drugs
Minor surgery, with no identified risk factors
Physical therapy
Occupational therapy
IV fluids, without additives