Evaluation & Management (E/M) Coding Flashcards

For E/M time-based coding, what must be documented to support billing based on total time?

Answer: Total time on the date of the encounter including all activities performed by the provider

Under the 2021 guidelines, total time includes all time spent by the provider on the date of the encounter, not just face-to-face time.

Which E/M code is used for a hospital inpatient initial care service with high complexity MDM?

Answer: 99223

CPT code 99223 is used for initial hospital inpatient care requiring high complexity medical decision making or 75+ minutes of total time.

A physician counsels a patient for 30 minutes of a 40-minute office visit. Can time be used to select the E/M level?

Answer: Yes, under the 2021 guidelines, total encounter time can always be used

Under the 2021 AMA guidelines, the provider may use total time on the date of the encounter to select the E/M level for office visits.

Which modifier is used when a physician decides to perform surgery during an E/M visit on the day before or the day of the surgery?

Answer: Modifier -57

Modifier -57 indicates the E/M service resulted in the initial decision to perform a major surgery (global period 90 days).

What is the definition of a 'new patient' for E/M coding purposes?

Answer: A patient who has not received professional services from the physician or group within the past 3 years

A new patient is one who has not received any professional services from the physician/qualified health care professional or another in the same group of the same specialty within the past 3 years.

Critical care services (99291, 99292) are typically reported when the provider spends what minimum time with the critically ill patient?

Answer: 60 minutes (first 30–74 min not separately reported)

Code 99291 covers the first 30–74 minutes of critical care; the minimum threshold before the first code can be reported is 30 minutes.