CPC Evaluation & Management (E/M) Coding 3 — Questions and Answers
Question 1: Which E/M service category is used when a physician reviews a patient's record and provides recommendations without seeing the patient?
- Consultation
- Care management service
- Interprofessional telephone/internet consultation (Correct answer)
- Transitional care management
Correct answer: Interprofessional telephone/internet consultation
Interprofessional telephone/internet/electronic health record consultations (99446–99452) allow a specialist to provide recommendations without a face-to-face patient encounter.
Question 2: Preventive medicine services (99381–99397) are selected based on:
- The complexity of medical decision making
- The patient's age and whether they are new or established (Correct answer)
- The number of diagnoses addressed
- The amount of time spent counseling
Correct answer: The patient's age and whether they are new or established
Preventive medicine service codes are selected based on the patient's age range and whether the patient is new or established.
Question 3: When providing care management for a patient with two or more chronic conditions, which code set is typically reported?
- Transitional care management codes (99495–99496)
- Chronic care management codes (99490–99491) (Correct answer)
- Complex chronic care management codes (99487–99489)
- Annual wellness visit codes (G0438–G0439)
Correct answer: Chronic care management codes (99490–99491)
Chronic care management codes (99490–99491) are reported for patients with two or more chronic conditions expected to last at least 12 months.
Question 4: Discharge day management services (99238–99239) are differentiated by:
- Complexity of medical decision making
- Total time spent on the final day (Correct answer)
- Whether the patient is admitted to observation or inpatient
- The number of diagnoses at discharge
Correct answer: Total time spent on the final day
Hospital discharge day management codes are differentiated by total time: 99238 for 30 minutes or less, 99239 for more than 30 minutes.
Question 5: Telehealth E/M services for established patients provided via audio-visual technology are reported with:
- Separate telehealth-specific codes that replace office visit codes
- The same office/outpatient E/M codes with modifier -95 or place of service code 02/10 (Correct answer)
- Telephone service codes only (99441–99443)
- Consultation codes (99241–99245)
Correct answer: The same office/outpatient E/M codes with modifier -95 or place of service code 02/10
Standard office/outpatient E/M codes are used for telehealth visits with modifier -95 (synchronous telemedicine) or the appropriate place of service code.
Question 6: In the context of E/M coding, what does the term 'undiagnosed new problem with uncertain prognosis' represent in MDM?
- Straightforward complexity
- Low complexity
- Moderate complexity (Correct answer)
- High complexity
Correct answer: Moderate complexity
An undiagnosed new problem with uncertain prognosis is classified as moderate complexity in the 'problems addressed' element of MDM.
CPC Evaluation & Management (E/M) Coding 3
Which E/M service category is used when a physician reviews a patient's record and provides recommendations without seeing the patient?