CPC - Certified Professional Coder Evaluation and Management Coding Questions and Answers

Question 1

According to 2024 CPT guidelines for Evaluation and Management (E/M) services, how is the level of service for an office or other outpatient visit selected when based on time?

Accepted Answer

The provider must meet or exceed a single minimum time threshold for the code.

Answer

For 2024, the AMA revised the time-based coding guidelines for office and other outpatient E/M services (99202-99205, 99212-99215). The previous time ranges were removed from the code descriptors and replaced with a single minimum total time that must be met or exceeded on the date of the encounter.

Question 2

A physician performs an extensive history and examination and spends a total of 85 minutes on the date of the encounter for a new patient office visit. The medical decision making (MDM) is of high complexity. The time for CPT code 99205 is 60 minutes. Which of the following is the correct way to report the prolonged service?

Accepted Answer

Report 99205 and add-on code 99417 for the additional time beyond the minimum time for 99205.

Answer

CPT add-on code +99417 is used to report prolonged office or other outpatient E/M services. It is used when the total time on the date of the encounter exceeds the minimum time for the highest-level service (99205 or 99215) by at least 15 minutes. In this case, 85 minutes exceeds the 60-minute threshold for 99205 by 25 minutes, justifying the use of 99417.

Question 3

When determining the level of Medical Decision Making (MDM) for an E/M service, which of the following is NOT one of the three main elements considered?

Accepted Answer

The severity of the patient's chief complaint.

Answer

The three elements of Medical Decision Making (MDM) are: 1) Number and Complexity of Problems Addressed, 2) Amount and/or Complexity of Data to be Reviewed and Analyzed, and 3) Risk of Complications and/or Morbidity or Mortality of Patient Management. The patient's chief complaint is the reason for the visit but is not one of the three formal elements for leveling MDM.

Question 4

An established patient is seen in the office for two separate, unrelated problems on the same day by the same physician. The first visit in the morning addresses a minor, self-limited issue. The second visit in the afternoon is for an acute, uncomplicated illness. How should these services be coded?

Accepted Answer

Report a single E/M code that combines the complexity and/or time of both encounters.

Answer

For E/M services, when multiple visits occur on the same calendar date in the same setting by the same provider, a single E/M service is reported. If coding based on MDM, the coder should use the aggregated MDM for the entire day. If coding based on time, the total time for the day should be summed.

Question 5

A physician and a non-physician practitioner (NPP) in the same group practice both have face-to-face encounters with a patient on the same day for a shared/split E/M visit. If coding is based on time, who reports the service?

Accepted Answer

The professional who spent the majority of the total time for the service.

Answer

For split/shared E/M services, when the code selection is based on total time, the service is reported by the professional (physician or NPP) who spent more than half of the total face-to-face or non-face-to-face time performing the service.

CPC - Certified Professional Coder Practice Test

CPC - Certified Professional Coder Practice Test

CPC - Certified Professional Coder Evaluation and Management Coding Questions and Answers