CPC Evaluation and Management Coding 3

Question 1

A physician sees a patient in a skilled nursing facility for an initial comprehensive assessment. All three key components are at their highest level. Which code applies?

Accepted Answer

99306

Answer

99306 is the highest-level initial SNF/NF visit, requiring comprehensive history, comprehensive exam, and high complexity MDM.

Question 2

What is the key distinction between CPT codes 99241–99245 (outpatient consultations) and regular office visit codes?

Accepted Answer

Consultations require a written or verbal request from another provider and a written report back

Answer

To bill a consultation, there must be a request from an appropriate source and a written report sent back to the requesting provider.

Question 3

A physician spends 35 minutes of total time on an established office patient encounter in 2021. Which E/M code is most appropriate?

Accepted Answer

99214

Answer

Under 2021 guidelines, 99214 covers 30–39 minutes of total time for an established office/outpatient visit.

Question 4

When a physician performs an annual wellness visit and also addresses a new problem requiring additional work, how should this be coded?

Accepted Answer

The preventive medicine code plus the appropriate E/M code with modifier -25

Answer

Both the preventive medicine code and a separate E/M code with modifier -25 may be billed when a separately identifiable problem is addressed.

Question 5

Which factor does NOT contribute to the 'amount and/or complexity of data' element of medical decision making?

Accepted Answer

Patient's vital signs

Answer

Vital signs are part of the physical examination, not the data complexity element of MDM.

CPC - Certified Professional Coder Practice Test

CPC - Certified Professional Coder Practice Test

CPC Evaluation and Management Coding 3