Evaluation and Management Coding Flashcards

Under the 2021 AMA E/M guidelines, which two methods may be used to select an office/outpatient E/M level?

Answer: Medical decision making or total time

The 2021 E/M guidelines allow office/outpatient E/M code selection based on either medical decision making (MDM) or total time spent on the date of the encounter.

What are the three elements of Medical Decision Making (MDM) in E/M coding?

Answer: Number/complexity of problems, amount/complexity of data, risk of complications

MDM is assessed by evaluating the number/complexity of problems addressed, the amount/complexity of data reviewed, and the risk of complications and/or morbidity or mortality.

Which E/M code is used for a new patient office visit of moderate complexity?

Answer: 99204

CPT 99204 represents a new patient office or outpatient visit with moderate complexity medical decision making.

For outpatient E/M coding, a 'new patient' is defined as one who:

Answer: Has not received professional services from the physician or same group in the past 3 years

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

When using total time to select an E/M level, what does 'total time' include?

Answer: All time on the date of encounter, including pre/post-visit activities

Under 2021 guidelines, total time for office E/M includes all physician/QHP time on the date of encounter: preparing, face-to-face, and post-visit documentation.

Which E/M code is reported for an established patient seen in the emergency department with a high-severity problem?

Answer: 99285

CPT 99285 is the highest-level emergency department E/M code, used for visits requiring high-severity MDM or presenting problems posing immediate threat to life.