CPC Evaluation & Management (E/M) Coding 1 — Questions and Answers
Question 1: Under the 2021 AMA E/M guidelines for office visits, what primarily drives code selection?
- History and physical examination components
- Medical decision making (MDM) or total time on the date of encounter (Correct answer)
- Number of diagnoses documented
- Number of organ systems reviewed
Correct answer: Medical decision making (MDM) or total time on the date of encounter
The 2021 AMA guidelines base office/outpatient E/M code level on either medical decision making (MDM) or total time on the date of the encounter.
Question 2: Which CPT code range covers office or other outpatient E/M services for established patients?
- 99201–99205
- 99211–99215 (Correct answer)
- 99221–99223
- 99241–99245
Correct answer: 99211–99215
CPT codes 99211–99215 are used for established patient office or other outpatient E/M services.
Question 3: In E/M coding, what does 'MDM' stand for?
- Multiple diagnosis management
- Medical decision making (Correct answer)
- Medication dosage management
- Medical documentation method
Correct answer: Medical decision making
MDM stands for medical decision making, one of the key components used to determine E/M code level.
Question 4: A patient presents with a new problem that requires additional workup. What level of MDM complexity does this represent?
- Straightforward
- Low complexity
- Moderate complexity (Correct answer)
- High complexity
Correct answer: Moderate complexity
A new problem to the provider that requires additional workup meets the moderate complexity level for the 'number and complexity of problems' element of MDM.
Question 5: Which modifier is appended to an E/M code when a significant, separately identifiable E/M service is provided on the same day as a procedure?
- Modifier -51
- Modifier -25 (Correct answer)
- Modifier -59
- Modifier -57
Correct answer: Modifier -25
Modifier -25 indicates a significant, separately identifiable E/M service was provided on the same day as a procedure.
Question 6: Which of the following is NOT one of the three elements of medical decision making (MDM)?
- Number and complexity of problems addressed
- Amount and complexity of data reviewed
- Risk of complications and/or morbidity or mortality
- Number of organ systems examined (Correct answer)
Correct answer: Number of organ systems examined
Number of organ systems examined is part of the physical examination component, not MDM; MDM consists of problems, data, and risk.
CPC Evaluation & Management (E/M) Coding 1
Under the 2021 AMA E/M guidelines for office visits, what primarily drives code selection?