Level of service on a surgery consult

Please explain if mere mention of comorbidies in the assessment can raise a consult that would other wise qualify for 99244 to 99245?

For example; a patient comes with a ventral hernia and decision is made to go to surgery. In the assessment there is a mention that patient's COPD or DM raises the risk for perioperative complications. This statement changes the "risk level" in medical decision making formula....but does it also increase the number of Dx, if the provider does not examine or treat COPD/ MD?

To my mind the only way a hernia patient's consult could turn into 99245 (assuming HPI & exam qualify for it) is if either there is additional work up ordered (a CT or ultrasound) OR complexity of data is 4 points (looks at CT himself and discusses the case with another provider for example) in addition to having high risk due to other Dx.

Thank you for shedding some light on this!