COC Evaluation and Management Coding 1 — Questions and Answers
Question 1: Under the 2021 AMA E/M guidelines, which two methods may be used to select an office/outpatient E/M level?
- Medical decision making or total time (Correct answer)
- History, exam, and medical decision making
- History and time
- Presenting problem and chief complaint
Correct 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.
Question 2: What are the three elements of Medical Decision Making (MDM) in E/M coding?
- Number/complexity of problems, amount/complexity of data, risk of complications (Correct answer)
- Chief complaint, HPI, ROS
- History, physical exam, diagnosis
- Time, complexity, coordination of care
Correct 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.
Question 3: Which E/M code is used for a new patient office visit of moderate complexity?
- 99204 (Correct answer)
- 99213
- 99203
- 99214
Correct answer: 99204
CPT 99204 represents a new patient office or outpatient visit with moderate complexity medical decision making.
Question 4: For outpatient E/M coding, a 'new patient' is defined as one who:
- Has not received professional services from the physician or same group in the past 3 years (Correct answer)
- Has not been seen in any healthcare setting in the past year
- Is visiting the practice for the first time ever
- Has a new diagnosis not previously treated
Correct 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.
Question 5: When using total time to select an E/M level, what does 'total time' include?
- All time on the date of encounter, including pre/post-visit activities (Correct answer)
- Only face-to-face time with the patient
- Time spent in the examination room only
- Documentation time only
Correct 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.
Question 6: Which E/M code is reported for an established patient seen in the emergency department with a high-severity problem?
- 99285 (Correct answer)
- 99215
- 99284
- 99222
Correct 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.
COC Evaluation and Management Coding 1
Under the 2021 AMA E/M guidelines, which two methods may be used to select an office/outpatient E/M level?