Evaluation and Management Coding Flashcards

A physician provides prolonged office services beyond the typical time for a 99215 (54 minutes). The physician spends a total of 80 minutes. Which additional code is reported?

Answer: 99417

99417 is reported for each 15 minutes of prolonged office/outpatient E/M service beyond the minimum time for 99215 under 2021 guidelines.

Which of the following scenarios qualifies as 'high complexity' medical decision making?

Answer: Drug therapy requiring intensive monitoring for toxicity

High complexity MDM includes high risk situations such as drug therapy requiring intensive monitoring for toxicity.

For subsequent nursing facility care, which key components are required?

Answer: At least two of three key components

Subsequent nursing facility care codes (99307–99310) require at least two of three key components to be met or exceeded.

A physician performs a home visit for an established patient with an expanded problem focused history, expanded problem focused exam, and low complexity MDM. Which code applies?

Answer: 99347

99347 is the established patient home visit code requiring at least two of three key components at problem focused/expanded problem focused/straightforward-to-low complexity.

A patient's mother calls the office and the physician spends 8 minutes on the phone addressing a new problem. The decision was made to see the patient. Which code applies?

Answer: No code — telephone services are bundled

Telephone E/M codes are not reported if the call results in a decision to see the patient within 24 hours, as the call is bundled into the visit.

Which statement best describes the 'problem' element for moderate complexity MDM under 2021 AMA guidelines?

Answer: One or more chronic illnesses with exacerbation, progression, or side effects of treatment

Moderate complexity MDM problems include one or more chronic illnesses with exacerbation, progression, or side effects, or one undiagnosed new problem with uncertain prognosis.

Under the 2021 E/M guidelines, which of the following is an example of 'independent interpretation of tests' that contributes to data complexity?

Answer: Personally reviewing and interpreting an EKG without a separate report being generated

Independent interpretation means the physician personally interprets a test and the interpretation is not separately reported by another provider.