CPC Evaluation and Management Coding 4 — Questions and Answers
Question 1: 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?
- 99354
- 99358
- 99417 (Correct answer)
- 99416
Correct 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.
Question 2: Which of the following scenarios qualifies as 'high complexity' medical decision making?
- Prescription drug management for a chronic stable illness
- A minor surgical procedure without risk factors
- Drug therapy requiring intensive monitoring for toxicity (Correct answer)
- Review of test results with no change in treatment
Correct answer: Drug therapy requiring intensive monitoring for toxicity
High complexity MDM includes high risk situations such as drug therapy requiring intensive monitoring for toxicity.
Question 3: For subsequent nursing facility care, which key components are required?
- All three key components
- At least two of three key components (Correct answer)
- One key component
- Time alone determines the code level
Correct 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.
Question 4: 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?
- 99341
- 99342
- 99347 (Correct answer)
- 99348
Correct 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.
Question 5: 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?
- 99441
- 99442
- 99421
- No code — telephone services are bundled (Correct answer)
Correct 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.
Question 6: Which statement best describes the 'problem' element for moderate complexity MDM under 2021 AMA guidelines?
- One self-limited problem
- Two or more self-limited problems
- One or more chronic illnesses with exacerbation, progression, or side effects of treatment (Correct answer)
- An undiagnosed problem with uncertain prognosis
Correct 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.
Question 7: Under the 2021 E/M guidelines, which of the following is an example of 'independent interpretation of tests' that contributes to data complexity?
- Ordering a chest X-ray
- Reviewing a radiology report already interpreted by a radiologist
- Personally reviewing and interpreting an EKG without a separate report being generated (Correct answer)
- Discussing results with a patient
Correct 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.
CPC Evaluation and Management Coding 4
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?