CPC - Certified Professional Coder Evaluation and Management Coding Questions and Answers — 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?
- By averaging the time spent on two separate encounters on the same day.
- The provider must meet or exceed a single minimum time threshold for the code. (Correct answer)
- Based on a defined time range (e.g., 30-44 minutes) specified in the code descriptor.
- Only the face-to-face time with the patient is counted towards the total time.
Correct answer: The provider must meet or exceed a single minimum time threshold for the code.
For 2024, the AMA revised the time-based coding guidelines for office and other outpatient E/M services (99202-99205, 99212-99215). The previous time ranges were removed from the code descriptors and replaced with a single minimum total time that must be met or exceeded on the date of the encounter.
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?
- Report 99205 and add-on code 99354 for the additional time.
- Report only 99205 as the additional time is not significant enough to bill separately.
- Report 99205 and add-on code 99417 for the additional time beyond the minimum time for 99205. (Correct answer)
- Report a higher-level office visit code that includes the prolonged time.
Correct answer: Report 99205 and add-on code 99417 for the additional time beyond the minimum time for 99205.
CPT add-on code +99417 is used to report prolonged office or other outpatient E/M services. It is used when the total time on the date of the encounter exceeds the minimum time for the highest-level service (99205 or 99215) by at least 15 minutes. In this case, 85 minutes exceeds the 60-minute threshold for 99205 by 25 minutes, justifying the use of 99417.
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?
- Number and complexity of problems addressed.
- Amount and/or complexity of data to be reviewed and analyzed.
- The severity of the patient's chief complaint. (Correct answer)
- Risk of complications and/or morbidity or mortality of patient management.
Correct answer: The severity of the patient's chief complaint.
The three elements of Medical Decision Making (MDM) are: 1) Number and Complexity of Problems Addressed, 2) Amount and/or Complexity of Data to be Reviewed and Analyzed, and 3) Risk of Complications and/or Morbidity or Mortality of Patient Management. The patient's chief complaint is the reason for the visit but is not one of the three formal elements for leveling MDM.
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?
- Report two separate E/M codes, one for each encounter.
- Report a single E/M code that combines the complexity and/or time of both encounters. (Correct answer)
- Bill the first encounter and use a modifier for the second.
- Only the encounter with the higher level of service can be reported.
Correct answer: Report a single E/M code that combines the complexity and/or time of both encounters.
For E/M services, when multiple visits occur on the same calendar date in the same setting by the same provider, a single E/M service is reported. If coding based on MDM, the coder should use the aggregated MDM for the entire day. If coding based on time, the total time for the day should be summed.
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?
- The physician, regardless of the time spent.
- The NPP, as they are designated as the secondary provider.
- The professional who spent the majority of the total time for the service. (Correct answer)
- Both professionals report a portion of the service.
Correct answer: The professional who spent the majority of the total time for the service.
For split/shared E/M services, when the code selection is based on total time, the service is reported by the professional (physician or NPP) who spent more than half of the total face-to-face or non-face-to-face time performing 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?
- An initial hospital care code (99221-99223) and a hospital discharge code (99238-99239).
- An emergency department visit code (99281-99285).
- A consultation code (99242-99255).
- An admission and discharge on the same day code (99234-99236). (Correct answer)
Correct answer: An admission and discharge on the same day code (99234-99236).
CPT codes 99234-99236 are specifically designated for reporting hospital inpatient or observation care services, for admission and discharge on the same date of service. A key requirement for using these codes is that the patient's stay must be for more than 8 hours.
CPC - Certified Professional Coder Evaluation and Management Coding Questions and Answers
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?