Evaluation and Management (E/M) Flashcards
7 cards from real CPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Evaluation and Management (E/M) flashcards as text
A physician documents a detailed history, detailed examination, and medical decision making of moderate complexity for an established office patient. Which E/M code level is most appropriate?
Answer: 99214
99214 requires at least 2 of 3 key components at the detailed/moderate complexity level for an established patient.
Under the 2021 E/M guidelines for office visits, what primarily drives code selection for established patients?
Answer: Medical decision making or total time
The 2021 AMA guidelines base office/outpatient E/M level selection on either MDM or total time on the date of the encounter.
Which element is NOT part of Medical Decision Making (MDM) in the 2021 E/M framework?
Answer: Number of organ systems examined
MDM consists of three elements: problems, data, and risk — physical examination organ systems are not part of MDM.
A physician spends 45 minutes of total time on the date of service with a new patient. Which office E/M code is reported?
Answer: 99204
99204 covers 45–59 minutes of total time for a new patient office visit under 2021 guidelines.
What does the term 'total time' mean in the context of 2021 office E/M coding?
Answer: Time spent on all work related to the encounter on that calendar date
Total time includes all physician work on the date of service — pre-visit review, face-to-face time, and post-visit documentation.
A patient presents with three chronic conditions, each requiring ongoing management. Under 2021 MDM guidelines, how are these classified for the 'problems' element?
Answer: Multiple chronic illnesses — supports high complexity
Multiple chronic conditions each requiring management meets the threshold for high complexity in the problems element of MDM.
Which of the following services may be reported separately on the same day as an E/M visit?
Answer: A separately identifiable surgical procedure with modifier 25 on the E/M
A significant, separately identifiable E/M service on the same day as a procedure may be billed with modifier 25 appended to the E/M code.