CPC Evaluation and Management (E/M) 3 — Questions and Answers
Question 1: Which code range is used for Emergency Department E/M services regardless of patient status (new vs. established)?
- 99201–99205
- 99281–99285 (Correct answer)
- 99241–99245
- 99221–99223
Correct answer: 99281–99285
ED E/M codes 99281–99285 apply to all ED patients; the new/established distinction does not apply in the ED setting.
Question 2: A hospitalist admits a patient and provides an initial hospital care service requiring comprehensive history, comprehensive exam, and high-complexity MDM. Which code is reported?
- 99221
- 99222
- 99223 (Correct answer)
- 99231
Correct answer: 99223
99223 is used for initial hospital care requiring all three key components at the comprehensive/high-complexity level.
Question 3: Subsequent hospital care codes (99231–99233) require how many of the three key components to meet the documented level?
- All 3 key components
- At least 2 of 3 key components (Correct answer)
- Only 1 key component
- History alone is sufficient
Correct answer: At least 2 of 3 key components
Like established office visits, subsequent hospital care requires at least 2 of the 3 key components to meet or exceed the reported level.
Question 4: Which modifier is appended to an E/M code when a physician other than the surgeon provides a medically necessary E/M service during the global surgical period?
- Modifier 24 (Correct answer)
- Modifier 25
- Modifier 57
- Modifier 32
Correct answer: Modifier 24
Modifier 24 indicates an unrelated E/M service by the same physician during a postoperative period.
Question 5: A physician decides to perform a major surgery during an E/M visit. Which modifier is appended to the E/M code to indicate the visit resulted in the decision for surgery?
- Modifier 24
- Modifier 25
- Modifier 57 (Correct answer)
- Modifier 59
Correct answer: Modifier 57
Modifier 57 is appended to the E/M service when the visit results in the decision to perform a major surgery (90-day global period).
Question 6: Prolonged service code 99417 may be reported with which office E/M codes under 2021 guidelines?
- Any office E/M code 99202–99215
- Only with 99205 or 99215 when total time exceeds the threshold (Correct answer)
- Only with inpatient codes 99221–99223
- Only when time exceeds 60 minutes for new patients
Correct answer: Only with 99205 or 99215 when total time exceeds the threshold
99417 is reported for each additional 15 minutes beyond the maximum time threshold for 99205 (74 min) or 99215 (54 min).
Question 7: Which type of E/M visit is used when a physician is asked by the attending to evaluate a patient and provide a written report of findings and recommendations?
- Office consultation (99241–99245)
- Inpatient consultation (99251–99255)
- Confirmatory consultation
- Inpatient consultation — but Medicare no longer recognizes consult codes (Correct answer)
Correct answer: Inpatient consultation — but Medicare no longer recognizes consult codes
Medicare eliminated consultation codes in 2010; consultations for Medicare patients are reported using the appropriate new or established patient or inpatient E/M codes.
CPC Evaluation and Management (E/M) 3
Which code range is used for Emergency Department E/M services regardless of patient status (new vs. established)?