CPC - Certified Professional Coder Evaluation and Management Coding Questions and Answers

Question 1

According to 2024 CPT guidelines for Evaluation and Management (E/M) services, how is the level of service for an office or other outpatient visit selected when based on time?

Accepted Answer

The provider must meet or exceed a single minimum time threshold for the code.

Answer

By averaging the time spent on two separate encounters on the same day.

Answer

Based on a defined time range (e.g., 30-44 minutes) specified in the code descriptor.

Answer

Only the face-to-face time with the patient is counted towards the total time.

Question 2

A physician performs an extensive history and examination and spends a total of 85 minutes on the date of the encounter for a new patient office visit. The medical decision making (MDM) is of high complexity. The time for CPT code 99205 is 60 minutes. Which of the following is the correct way to report the prolonged service?

Accepted Answer

Report 99205 and add-on code 99417 for the additional time beyond the minimum time for 99205.

Answer

Report 99205 and add-on code 99354 for the additional time.

Answer

Report only 99205 as the additional time is not significant enough to bill separately.

Answer

Report a higher-level office visit code that includes the prolonged time.

Question 3

When determining the level of Medical Decision Making (MDM) for an E/M service, which of the following is NOT one of the three main elements considered?

Accepted Answer

The severity of the patient's chief complaint.

Answer

Number and complexity of problems addressed.

Answer

Amount and/or complexity of data to be reviewed and analyzed.

Answer

Risk of complications and/or morbidity or mortality of patient management.

Question 4

An established patient is seen in the office for two separate, unrelated problems on the same day by the same physician. The first visit in the morning addresses a minor, self-limited issue. The second visit in the afternoon is for an acute, uncomplicated illness. How should these services be coded?

Accepted Answer

Report a single E/M code that combines the complexity and/or time of both encounters.

Answer

Report two separate E/M codes, one for each encounter.

Answer

Bill the first encounter and use a modifier for the second.

Answer

Only the encounter with the higher level of service can be reported.

Question 5

A physician and a non-physician practitioner (NPP) in the same group practice both have face-to-face encounters with a patient on the same day for a shared/split E/M visit. If coding is based on time, who reports the service?

Accepted Answer

The professional who spent the majority of the total time for the service.

Answer

The physician, regardless of the time spent.

Answer

The NPP, as they are designated as the secondary provider.

Answer

Both professionals report a portion of the service.

Question 6

A patient is admitted to the hospital for observation and discharged on the same calendar date. The total time of the stay is 10 hours. Which set of CPT codes should be used to report these services?

Accepted Answer

An admission and discharge on the same day code (99234-99236).

Answer

An initial hospital care code (99221-99223) and a hospital discharge code (99238-99239).

Answer

An emergency department visit code (99281-99285).

Answer

A consultation code (99242-99255).