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
Which E/M code is used to report a nursing facility annual assessment requiring comprehensive history, comprehensive exam, and high-complexity MDM?
Answer: 99318
99318 is the annual nursing facility assessment code, distinct from the initial care (99304–99306) and subsequent care (99307–99310) codes.
A physician provides care plan oversight of a home health agency patient for 35 minutes in a calendar month. Which code is reported?
Answer: 99375
99375 covers care plan oversight for home health patients when physician time is 30 minutes or more in a calendar month.
Under the 2021 E/M guidelines, which of the following counts as an independent interpretation of a test for the data element of MDM?
Answer: Independently interpreting an EKG beyond the automated reading
Independent interpretation means the physician personally interprets a test (e.g., reads an EKG rhythm strip) in addition to any automated or technician interpretation.
A new patient presents to a specialist's office. The patient was referred by the primary care physician. Under current CPT and Medicare guidelines, which code set is appropriate for the office visit?
Answer: New patient office codes 99202–99205
Medicare eliminated consultation codes; the new patient office E/M codes (99202–99205) are used for patients who have not been seen in the practice within three years.
What does the 'three-year rule' determine in E/M coding?
Answer: Whether a patient is classified as new or established for office E/M purposes
A patient is considered new if no professional services have been provided by the physician or same-specialty group within the past three years.
Which of the following is included in the time calculation for 2021 office E/M total time?
Answer: Physician time reviewing test results before the visit on the date of service
Total time under 2021 guidelines includes all physician or QHP time on the calendar date, including pre-visit review of records and test results.
A patient presents with an undiagnosed new problem with uncertain prognosis. Under 2021 MDM, this falls under which level of problem complexity?
Answer: Moderate
A new problem with uncertain prognosis is classified as moderate complexity in the problems element of 2021 MDM.