CPC - Certified Professional Coder Evaluation and Management (E/M) Questions and Answers

Question 1

According to 2023 CPT guidelines for Evaluation and Management (E/M) services, how is the level of service selected for most categories like office visits, hospital care, and consultations?

Accepted Answer

Based solely on the level of medical decision making (MDM) or the total time spent on the date of the encounter.

Answer

Based on the three key components of history, examination, and medical decision making.

Answer

Based on the complexity of the history and physical examination documented.

Answer

Based on a point system that scores the number of diagnoses, data reviewed, and risk.

Question 2

An established patient is seen for a follow-up visit for two stable chronic illnesses and one new, uncomplicated problem. The physician performs a medically appropriate history and exam. The medical decision making involves a limited amount of data to be reviewed and a low risk of morbidity from patient management. How many of the three MDM elements must be met or exceeded to qualify for a particular level of MDM?

Accepted Answer

Two of the three elements must be met or exceeded.

Answer

All three elements (problems, data, and risk) must be met.

Answer

Only the number and complexity of problems addressed must be met.

Answer

The level is determined by the single highest element documented.

Question 3

A physician spends a total of 65 minutes with an established patient for an office visit, which includes reviewing records, the face-to-face exam, and documenting in the EHR after the patient leaves. The time is properly documented. The highest level office visit code for an established patient, 99215, has a time threshold of 40 minutes. Which of the following is the correct way to report the prolonged service time?

Accepted Answer

Report CPT code 99215 and add-on code 99417.

Answer

Report CPT code 99354 for the additional 25 minutes.

Answer

Bill for two separate E/M visits on the same day.

Answer

It is not possible to report time beyond the highest level code.

Question 4

Which of the following activities performed by a physician on the date of an E/M encounter can be included when calculating total time for time-based coding?

Accepted Answer

Counseling and educating the patient and/or family.

Answer

Time spent by clinical staff taking the patient's vitals and history.

Answer

Reviewing test results from a visit that occurred the previous day.

Answer

General teaching with residents not directly related to the patient's care.

Question 5

A patient is admitted to hospital inpatient care and discharged on the same date of service. Which CPT code range should be used to report these services?

Accepted Answer

99234-99236 for hospital inpatient or observation care, including admission and discharge services on the same date.

Answer

99221-99223 for initial hospital care only.

Answer

99238-99239 for hospital discharge services only.

Answer

An initial hospital care code and a separate discharge code with modifier 25.

Question 6

Which E/M category is unique in that the level of service is NOT selected based on either Medical Decision Making (MDM) or total time?

Accepted Answer

Emergency Department Services

Answer

Office or Other Outpatient Services

Answer

Hospital Inpatient and Observation Care Services

Answer

Consultations