CPC Evaluation and Management Coding 2 — Questions and Answers
Question 1: A physician performs a comprehensive history, comprehensive examination, and medical decision making of high complexity for a new patient in the office. Which E/M code is most appropriate?
- 99201
- 99203
- 99205 (Correct answer)
- 99215
Correct answer: 99205
99205 is used for new office patients requiring comprehensive history, comprehensive exam, and high complexity MDM.
Question 2: Under the 2021 E/M guidelines, which element is NO longer required to select the level of an office/outpatient E/M visit?
- Medical decision making
- Total time on the date of the encounter
- Physical examination (Correct answer)
- Number of diagnoses or management options
Correct answer: Physical examination
Under 2021 AMA guidelines, the physical examination component was removed as a factor for selecting office/outpatient E/M level.
Question 3: A patient is seen in the emergency department and the physician documents a detailed history, detailed examination, and moderate complexity MDM. Which ED E/M code applies?
- 99281
- 99283
- 99284 (Correct answer)
- 99285
Correct answer: 99284
99284 corresponds to an ED visit with detailed history, detailed exam, and moderate complexity MDM.
Question 4: Which of the following correctly describes 'straightforward' medical decision making?
- Multiple chronic illnesses with exacerbation
- One self-limited or minor problem (Correct answer)
- One stable chronic illness plus one acute uncomplicated illness
- Undiagnosed new problem with uncertain prognosis
Correct answer: One self-limited or minor problem
Straightforward MDM involves a minimal number of diagnoses/problems, such as one self-limited or minor problem.
Question 5: A cardiologist provides inpatient subsequent hospital care, reviewing a problem focused interval history, expanded problem focused exam, and low complexity MDM. Which code is used?
- 99231 (Correct answer)
- 99232
- 99233
- 99221
Correct answer: 99231
99231 is the subsequent hospital care code requiring at least two of three key components at problem focused/expanded problem focused/low complexity MDM.
Question 6: When time is used to select the level of a 2021 office/outpatient E/M visit, what does 'total time' include?
- Only face-to-face time with the patient
- Face-to-face time plus time spent on the floor reviewing records
- All time on the date of the encounter related to that visit, including pre- and post-service work (Correct answer)
- Only time spent in medical decision making activities
Correct answer: All time on the date of the encounter related to that visit, including pre- and post-service work
Under 2021 guidelines, total time includes all physician/QHP time on the date of encounter related to the visit, not just face-to-face time.
Question 7: Which modifier is appended to an E/M code to indicate that a significant, separately identifiable E/M service was performed on the same day as a procedure?
- -25 (Correct answer)
- -57
- -59
- -24
Correct answer: -25
Modifier -25 indicates a significant, separately identifiable E/M service was performed by the same physician on the same day as a minor procedure.
CPC Evaluation and Management Coding 2
A physician performs a comprehensive history, comprehensive examination, and medical decision making of high complexity for a new patient in the office.
Which E/M code is most appropriate?