CPC Evaluation & Management (E/M) Coding 2 — Questions and Answers
Question 1: For E/M time-based coding, what must be documented to support billing based on total time?
- Only the face-to-face time with the patient
- Total time on the date of the encounter including all activities performed by the provider (Correct answer)
- Time spent reviewing the electronic health record only
- Counseling time that exceeds 50% of the visit
Correct answer: Total time on the date of the encounter including all activities performed by the provider
Under the 2021 guidelines, total time includes all time spent by the provider on the date of the encounter, not just face-to-face time.
Question 2: Which E/M code is used for a hospital inpatient initial care service with high complexity MDM?
- 99221
- 99222
- 99223 (Correct answer)
- 99232
Correct answer: 99223
CPT code 99223 is used for initial hospital inpatient care requiring high complexity medical decision making or 75+ minutes of total time.
Question 3: A physician counsels a patient for 30 minutes of a 40-minute office visit. Can time be used to select the E/M level?
- No, time can only be used when counseling exceeds 50% under old guidelines
- Yes, under the 2021 guidelines, total encounter time can always be used (Correct answer)
- No, counseling time is excluded from E/M time calculations
- Yes, but only for established patients
Correct answer: Yes, under the 2021 guidelines, total encounter time can always be used
Under the 2021 AMA guidelines, the provider may use total time on the date of the encounter to select the E/M level for office visits.
Question 4: Which modifier is used when a physician decides to perform surgery during an E/M visit on the day before or the day of the surgery?
- Modifier -25
- Modifier -57 (Correct answer)
- Modifier -24
- Modifier -51
Correct answer: Modifier -57
Modifier -57 indicates the E/M service resulted in the initial decision to perform a major surgery (global period 90 days).
Question 5: What is the definition of a 'new patient' for E/M coding purposes?
- A patient who has never been seen at the facility
- A patient who has not received professional services from the physician or group within the past 3 years (Correct answer)
- A patient establishing care for the first time in their life
- A patient with a new insurance plan
Correct answer: A patient who has not received professional services from the physician or group within the past 3 years
A new patient is one who has not received any professional services from the physician/qualified health care professional or another in the same group of the same specialty within the past 3 years.
Question 6: Critical care services (99291, 99292) are typically reported when the provider spends what minimum time with the critically ill patient?
- 15 minutes
- 20 minutes
- 30 minutes
- 60 minutes (first 30–74 min not separately reported) (Correct answer)
Correct answer: 60 minutes (first 30–74 min not separately reported)
Code 99291 covers the first 30–74 minutes of critical care; the minimum threshold before the first code can be reported is 30 minutes.
CPC Evaluation & Management (E/M) Coding 2
For E/M time-based coding, what must be documented to support billing based on total time?