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 performs preventive medicine counseling for a 35-year-old established patient. No problem-oriented E/M is performed. Which code is reported?
Answer: 99395
99395 is the periodic preventive medicine E/M for an established patient aged 18–39 years.
When a significant, separately identifiable problem-oriented E/M is performed on the same day as a preventive medicine service, how is it reported?
Answer: Report both codes; append modifier 25 to the problem-oriented E/M
Both services may be billed on the same date; modifier 25 is appended to the problem-oriented E/M to indicate it is a significant, separate service.
Which E/M service code is reported when a physician provides critical care to a patient who is NOT in the ICU (e.g., in the ED)?
Answer: 99291 and 99292
Critical care codes 99291 (first 30–74 minutes) and 99292 (each additional 30 minutes) are reported by the service provided, not the physical location.
What is the minimum time required to report 99291 (critical care, initial)?
Answer: 30 minutes
99291 requires at least 30 minutes of critical care time; it covers 30–74 minutes of total critical care.
A patient is seen in the office and the physician spends the majority of the 25-minute visit on counseling. Under pre-2021 guidelines, what drives code selection in this scenario?
Answer: Time, when counseling dominates more than 50% of face-to-face time
Under pre-2021 rules, when counseling exceeds 50% of face-to-face time, total time becomes the controlling factor for E/M level selection.
Which of the following is an example of a 'risk' factor that supports high-complexity MDM under the 2021 framework?
Answer: Drug therapy requiring intensive monitoring for toxicity
Drug therapy requiring intensive monitoring for toxicity (e.g., chemotherapy, warfarin) is listed as a high-risk indicator in the 2021 MDM table.
A physician reviews and verifies data previously entered into the medical record by ancillary staff. Under 2021 MDM, how must this be documented?
Answer: The physician must document that they personally reviewed and verified the data
To receive credit for data reviewed by ancillary staff, the physician must document that they personally reviewed and verified it in the medical record.