COBGC Evaluation and Management Coding 3 — Questions and Answers
Question 1: A patient is classified as 'established' for E&M purposes if she has received professional services from the same physician or a physician of the same specialty in the same group within the past:
- 1 year
- 2 years
- 3 years (Correct answer)
- 5 years
Correct answer: 3 years
CPT guidelines define an established patient as one who has received professional services from the physician/qualified clinician or group within the past three years.
Question 2: Under the 2021 revised E&M guidelines, which of the following lists the Medical Decision Making complexity levels in correct ascending order?
- Low, Straightforward, Moderate, High
- Straightforward, Low, Moderate, High (Correct answer)
- Minimal, Low, Moderate, High
- Straightforward, Moderate, Low, High
Correct answer: Straightforward, Low, Moderate, High
The four MDM levels in ascending order are Straightforward, Low, Moderate, and High complexity.
Question 3: A patient returns to an OB/GYN practice for the first time in four years. She is best classified as:
- Established patient, because she has been to the practice before
- New patient, because more than three years have passed (Correct answer)
- Established patient if her records are still on file
- Consultation patient
Correct answer: New patient, because more than three years have passed
If more than three years have elapsed since the patient received professional services from any physician of that specialty in the group, she is classified as a new patient.
Question 4: Which initial hospital care code requires high-complexity Medical Decision Making or 75 or more minutes of physician time?
- 99221
- 99222
- 99223 (Correct answer)
- 99224
Correct answer: 99223
CPT 99223 represents initial hospital care requiring high-complexity MDM or 75+ minutes of total physician time on the date of service.
Question 5: A new OB/GYN patient visit documents 45 minutes of total physician time on the date of service. Based on time alone under 2021 guidelines, which code should be reported?
- 99203
- 99204 (Correct answer)
- 99205
- 99202
Correct answer: 99204
CPT 99204 covers new patient office/outpatient visits when total time on the date of service is 45–59 minutes.
Question 6: Under the 2021 E&M guidelines, which two elements primarily determine the level of an office/outpatient E&M service?
- History and physical examination
- Medical decision making or total time on the date of service (Correct answer)
- Chief complaint and review of systems
- Number of diagnoses and medications reviewed
Correct answer: Medical decision making or total time on the date of service
The 2021 guidelines removed history and exam as level-determining factors; the level is now driven by Medical Decision Making or total physician time on the date of service.
Question 7: A gynecologic oncologist evaluates a new inpatient with suspected ovarian cancer and documents high-complexity MDM. Since Medicare eliminated consultation codes, the correct code is:
- 99245
- 99223 (Correct answer)
- 99255
- 99215
Correct answer: 99223
For Medicare patients, inpatient consultation code 99255 is replaced by initial hospital care code 99223 when high-complexity MDM is documented.
COBGC Evaluation and Management Coding 3
A patient is classified as 'established' for E&M purposes if she has received professional services from the same physician or a physician of the same specialty in the same group within the past: