CPMA Evaluation and Management (E/M) Practice Exam

These questions are part of the practice quiz. Start practicing

• A PCP transfers a patient to a cardiologist for management of congestive heart failure. The cardiologist accepts the transfer and sends a report back to the PCP with findings and a treatment plan. The appropriate E/M code is from which subcategory?
• Minimal risk example includes which of the following?
• Which modifier indicates a significant, separately identifiable service from a preventive service?
• Critical care coding: which statement is true?
• Category 3 applies to which scenario?
• Initial Hospital/Observation code for moderate MDM?
• Are uncontrolled and controlled diabetes considered separate chronic conditions under Stable, Chronic illness definitions?
• Which statement correctly describes summing data elements in MDM?
• Which MDM component covers the amount and complexity of data to be reviewed and analyzed?
• Which coding combination is correct in reporting prolong add-on service code 99417?
• Independent historian requirement is met when there is conflict between historians and more than one historian is needed; true or false?
• During an initial visit for smoking cessation, a new patient spends 30 minutes total with 20 minutes of counseling. Using time-based guidelines, which CPT code best describes this visit?
• What is the Medical Decision Making (MDM) complexity for this case?
• Mr. Yates experiences a sudden chest pain; EMS direction time and critical care in ED; CPR time included. What are the appropriate procedure codes?
• Which statement about listing chronic illnesses is correct?
• How can you verify that a written report was provided to the requesting provider?
• Is it required to document the amount of time spent on an encounter to support E/M coding?
• How many levels of risk are defined in the guidelines?
• Operative standby in cesarean or high-risk delivery is associated with which code category?
• What constitutes External (data)?
• When the patient is seen only by clinical staff overseen by the provider, which code should be reported?
• According to CPT guidelines, a patient is considered an outpatient until which event occurs?
• Which item is listed among high-risk decisions that may increase E/M level?
• Moderate level of MDM may be indicated by which of the following problem classifications?
• On the hospital floor, a physician manages a 56-year-old admitted for aspiration pneumonia and is improving; a pulmonary consult is requested. Which CPT code reflects subsequent hospital care?
• A 5-year-old child, established patient, is admitted to the hospital to rule out sepsis. If cultures are negative and afebrile for 48 hours, discharge home. What E/M category is reported for this visit?
• Which ED E/M code may not require the presence of a physician or other qualified health professional?
• Which describes an external data source?
• A general surgeon reviews prior records, ultrasound results, and orders an MRI for a patient. Based on data reviewed/analyzed, what is the level?
• An injury which requires treatment that includes evaluation of body systems not directly part of the injured organ, injury is extensive, or the treatment options are multiple and/or associated with risk of morbidity falls into which category?
• With the elimination of payment for consultations, Medicare directs you to report which type of codes when you are called to the emergency department?
• What is the risk level for the MDM in this case?
• Which scenario would most likely contribute to a higher MDM level?
• What defines an Emergency Department (ED) of a hospital?
• What is the first step in auditing E/M documentation?
• A provider admits a patient to the hospital for five days and sees her each day. Which subcategory of E/M codes would be used for days two, three, and four?
• A problem that may not require the presence of the physician, but the service is performed under supervision (e.g., 99211, 99281) is which MDM category?
• How is a 'Unique' test defined?
• Which statement about Category 2 assessment for limited data is correct regarding an independent historian?
• High risk in E/M evaluation includes which statement?
• A pediatrician is asked to be in the room during the delivery of a baby at risk for complications. The baby is healthy. The pediatrician standby is 45 minutes. What CPT code is reported?
• Medicare pays for consultations.
• Did the American Medical Association update the E/M guidelines in 2023 to align the majority of E/M categories under one set of guidelines?
• In a dental pain case, the medical decision making is described as Low Complexity. Which MDM level corresponds to this scenario?
• What is the first step to determining the correct E/M code?
• A patient is seen in the ED for severe otitis media. The exam is limited; Amoxicillin prescribed. What ED level is reported?
• An essential care visit for a 2-year-old is a new patient with an age-appropriate history, exam, and anticipatory guidance; no tests or immunizations are given. What CPT code is reported?
• Which statement is true regarding prolonged services code 99354 in relation to 99202-99205 or 99212-99215?
• In the definition of acute illness with systemic symptoms, systemic symptoms may be general or may be limited to what?
• During a yearly physical, a 15-year-old boy is treated for a urinary tract infection after a history and exam and U/A. Which CPT codes are reported?
• In the inpatient setting, is a separate consult report required?
• What is required for proper E/M documentation regarding assessment and plan?
• Risk E/M guidelines indicate that the risk of complications and/or mortality of patient management is distinct from what?
• Which category includes an acute illness with systemic symptoms, an acute complicated injury, or a chronic illness or injury with exacerbation and/or progression or side effects of treatment that poses a threat to life or bodily function in the near term without treatment?
• Hospital Inpatient services use the same set of E/M codes that are used for Observation Care Services.
• A basic metabolic panel (BMP) CPT 80047 is considered what in data counting?
• Regarding assessment documentation in E/M coding, which approach is correct?
• In the described follow-up visit for a puncture wound on the right foot, what is the appropriate E/M code?
• What are the four levels of MDM?
• A Medicare beneficiary is seen in the emergency department by a cardiovascular surgeon for a consultation. The history, exam, and MDM are performed with moderate complexity. Which CPT E/M code should be reported?
• A patient consults a dermatologist for facial lesions who is an established patient; the patient had seen the dermatologist two years prior. Which E/M category is reported for today’s visit?
• When Medicare requires a consultation service, which code should be billed?
• Which statement best describes an external provider?
• Do Hospital Inpatient Services distinguish between new and established patients?
• According to CPT guidelines, if a history and/or physical examination is medically appropriate and performed, what is true?
• If HPI notes history of UC and patient denies active diarrhea or abdominal cramps, and A/P mentions UC managed by GI, should UC be considered in MDM?
• An established patient in the office visits an 18‑month‑old infant admitted to hospital from the office to rule out sepsis. If cultures are negative and the patient remains afebrile for 48 hours, which CPT code is reported for this visit?
• Acute, uncomplicated illness or injury requiring hospital inpatient or observation level of care indicates what?
• Which codes are used when admission and discharge occur on the same date?
• What does Medicare modifier AI indicate?
• Self-limited or minor problem is defined as what?
• If the stay is 8 hours or more but less than 24 hours, which codes should be used?
• Which problem category corresponds to a new or recent problem for which treatment has been started and the patient is improved, though resolution may not be complete?
• If prolonged time for a 99215 is 115 minutes, how many G2212 units are billed?
• In Category 1 data, which item is explicitly listed as a Category 1 data item for review in MDM?
• Prolonged services are add-on codes reported in addition to one of the designated E/M codes listed in the parenthetical instructions after each code.
• Under Category 2 for Moderate or Extensive data, which statement is true about interpreting tests when billing the CPT code for interpretation?
• Who can initiate a consultation request under Medicare requirements?
• In ICD-10-CM, what does the 7th character A indicate in S39.012A for a lower back strain?
• If a patient sees multiple providers for different aspects of care, the condition being managed by another provider is considered toward the level only if what?
• Which statement best describes data element counting when the professional component is separately reported?
• Medicare outpatient consults should be reported by selecting the appropriate level code from which CPT range?
• Which ICD-10-CM code represents the place of occurrence as apartment kitchen?
• How many MDM elements must meet or exceed for the overall MDM level in this scenario?
• Referring to the MDM table which level is reported for a diagnosis that is an acute uncomplicated illness or injury?
• Which statement about high risk is accurate?
• Which of the following is among the features that can place MDM at moderate level?
• In nursing facility care initial, which code corresponds to Moderate MDM?
• What does MDM most accurately reflect?
• A patient presents with dental pain and sinusitis symptoms; after examination and management, which office visit code is reported if the medical decision making is low complexity?
• Code 99211 may be reported for nurse visits if the service is what?
• Professional services are identified as what kind of contact?
• G2212 calculation for 90 minutes for 99215: which codes apply?
• Which of the following is an example of moderate risk?
• Stable, chronic illness is described as lasting at least one year or until death; uncontrolled diabetes and controlled diabetes are considered a single chronic condition. True or False? Which best describes it?
• Which term describes a chronic illness that is acutely worsening, poorly controlled, or progressing with intent to control progression and requiring additional supportive care or attention to treatment for side effects?
• Which initial nursing facility care code corresponds to High MDM?
• Hospital Discharge Services report the total time spent by the attending or admitting physician discharging the patient on the date of discharge. This service is time-based. The time must be documented in the patient's record to qualify for a discharge time of over 30 min.
• The independent history must be obtained directly from the independent historian. True or False?
• According to CPT guidelines, a new patient is defined as a patient who has not received any professional services from a physician of the exact same specialty and subspecialty in the same group practice within what time frame?
• Low risk includes which of the following examples?
• What was the final diagnosis stated for this patient?
• Which of the following is a common documentation problem in E/M coding?
• What was included in the management plan for the puncture wound?
• Under CPT E/M guidelines, time alone can be used to select codes in which range?
• What is the Minimal level of MDM?
• A provider visits an established patient in the patient’s home monthly; which CPT code is correct for this home visit?
• Are ED visit codes exclusive to ED physicians?
• If all three requirements of the consultation are not met, what should be reported instead?
• What does the 'Number and Complexity of Problems' component identify?
• Which scenario qualifies for monitoring of drug therapy requiring intensive monitoring for toxicity?
• Which statement about the discussion is true?
• Independent interpretation does not apply when the reporting clinician has previously reported the test. True or false?
• Which of the following is not counted toward E/M time?
• If pediatric standby lasts 60 minutes, how many units of 99360 should be reported?
• In E/M high risk decisions, which decision is included?
• Observation Care Services include admission and discharge services.
• In documentation where UC history exists and the patient has no current symptoms but UC is managed by GI, with attention to OTC medications, how is UC treated in MDM?
• Which two criteria do the guidelines specify for selecting the appropriate level of service?
• If a hospital stay lasts less than 8 hours, which codes should be used?
• How should a combination of data elements be treated?
• Which documentation issue is classified as an E/M coding error related to authorship?
• For Medicare prolonged service, which code is used instead of 99417?
• The level of an E/M office visit can be determined by which of the following?
• A 45-year-old established female with dizziness and vertigo; EKG ordered; labs drawn; final diagnosis suspected benign paroxysmal positional vertigo. What CPT code is reported for the established patient visit?
• Which category explicitly includes conditions that pose a threat to life or bodily functions in the near term if untreated?
• In Emergency Department services, is there a distinction between new and established patients?
• Which CPT code represents an initial hospital inpatient admission (first hospital encounter for this admission)?
• For Medicare nurse visits when the provider is out of the office, can these services be billed based on incident-to guidelines?
• In E/M coding, what is required regarding the diagnosis references?
• In nursing facility care subsequent, which code corresponds to Low MDM?
• If multiple CBC-related tests with overlapping elements are performed, how should they be counted as unique tests?
• In MDM, what does Analyzed mean for data?
• Which ED E/M code corresponds to Straightforward medical decision making (MDM)?
• Observation or Inpatient Care Services (including Admission and Discharge) are reported using which CPT code range?
• Which option best describes a Low level of MDM?
• When a provider is called to the emergency department, Medicare recommends reporting which codes?
• Which best describes 'Tests (data)' for MDM?
• If a patient is admitted to the hospital and then discharged on the same day, which CPT code range would be used?
• A 50-year-old male is brought by EMS to the Emergency Department for an unresponsive patient. The ED provider stabilizes the patient and transfers to ICU. The ED provider documents total critical care time of 25 minutes. What E/M category is reported by the ED provider?
• For reporting the prolonged add-on service code 99417, which E/M codes may be reported with it?
• The amount and complexity of data for review is measured by which of the following?
• Initial Hospital/Observation code for straightforward or low MDM?
• The time spent overseeing clinical staff is included in the time.
• Which procedure is described as high risk when performed with risk factors?
• Which source provides tables for proper reporting time when using prolonged service codes?
• Which category includes an illness that causes systemic symptoms and has a high risk of morbidity without treatment?
• True or False: The history and exam should be documented, but they are not used in determining the level of the code.
• To apply the correct prolonged service code, first determine the location of the service and if the service was performed on the same day as the E/M service.
• Which scenario qualifies for a CPT consultation code?
• What is the minimum minutes needed to reach one unit of Medicare prolonged time for a 99205?
• Services performed on the same date, when related to the admission, may be reported separately appending modifier 25 to the other E/M service (ER visit or office visit).
• A 75-year-old established patient presents for a preventive physical before joining a group home; comprehensive history and examination; no new problems. What CPT code is reported?
• Which statement about time spent with the patient is true in relation to MDM level?
• A Medicare patient with heart palpitations and shortness of breath is seen by a cardiology consultant in the office. The patient is new to the cardiologist and the cardiologist sends a report back to the referring physician. Which E/M category is selected for the visit?
• When a provider reports a test with a separate CPT code, the ordering, performance, and interpretation is not included in the MDM for E/M visits. Which tests are considered in the MDM despite this rule?
• Social determinants of health refer to economic and social conditions that influence health.
• For the MDM in this encounter, the number of diagnoses or treatment options is described as which level?
• When either the personal physician or ED physician admits and continues care on the admission, may an ED visit code be reported separately with modifier 25?
• Can a patient receive critical care treatment in the emergency department?
• Which setting is considered an office or other outpatient service setting?
• For a problem to be counted in the 'number of problems' component, what must be true?
• Time can be an element of code selection for a variety of E/M services.
• What is the amount and/or complexity of data for this case?
• In critical care coding, is the place of service the sole determinant of eligibility for critical care codes?
• Standby services: which CPT code is used to report standby service requiring prolonged attendance?
• Mr. Flintstone is seen after Hodgkin's lymphoma work-up; time totals 11 minutes for exam and 45 minutes for discussion, plus 15 minutes CPR. What CPT coding is reported?
• For an admit and discharge on the same date in observation status or as inpatient, which codes should be used?
• An established patient follow-up for pneumonia includes an expanded problem-focused exam, CBC review, independent chest X-ray interpretation, and a new follow-up X-ray order. What CPT code is reported?
• What category of codes should be used to report an evaluation and management service provided to a patient in a psychiatric residential treatment center?
• The term Acute, uncomplicated illness or injury refers to what?
• Initial Hospital Care should be reported when
• Which of the following is an example of an appropriate data source, according to the guidelines?
• If documentation only states that the patient has a condition treated by another provider, how is this treated for MDM leveling?
• Discharge time must be documented in the patient's record to qualify for a discharge time greater than 30 minutes.
• When tests ordered are not listed in the documentation but billed, what should be done?
• Add on code 99417: Only use with highest E/M level codes 99205, 99215. Also refer to the tables in the Prolonged Service guidelines for proper reporting time.
• Which individual qualifies as an independent historian?
• Subsequent Hospital/Observation code for high MDM?
• E/M categories represent what?
• Which term is used to describe a problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment?
• A patient admitted from observation for chest pain and discharged on the same date of service. Which CPT code best reports this observation/admission and discharge event?
• Which statement best captures the relationship between UC history and MDM when no active disease symptoms are documented?
• Domiciliary, Rest Home or Custodial Care: true or false: services merged with Home Visit CPT codes 99341-99350.
• For claims processing, which identifiers must be reported as the referring provider?
• Which statement best describes how data complexity is determined in MDM?
• Which CPT code range is used for the initial hospital care evaluation and management on hospital admission?
• Which is an example of a self-limited or minor problem given in MDM examples?
• A 28-year-old female patient is returning to her provider's office with RLQ pain, diarrhea, and headache. The provider diagnoses colitis and prescribes antibiotics. Which CPT and ICD-10-CM codes would be reported?
• Three days after a hospital admission, a primary care physician examines the patient to assess improvement. Which E/M category is appropriate for today’s visit?
• Which item is NOT typically counted as a Category 1 data credit for MDM?
• When would you report the 99211 code?
• For a 75-minute encounter, which codes apply for Medicare prolonged time with 99215?
• Discharge services: which code corresponds to more than 30 minutes?
• Medicare no longer pays for consultations except for telehealth consults. Which statement correctly describes Medicare's payment for consultations?
• Which MDM component includes the risk of complications and morbidity or mortality of patient management?
• Standby services are reported for what scenario?
• What does the term double billing refer to in E/M practice?
• For ED services, is time a concept that applies to the codes?
• Subsequent Hospital Care is used to report visits after the date of the initial hospital admission visit to the patient during that hospital stay. This E/M category can be reported by more than one physician or other qualified healthcare professional from different specialties or subspecialties on the same date of service, but each provider can only report code once per day.
• Which three components determine the MDM level?
• Independent interpretation applies under which condition?
• Which statement best describes consultations in CPT coding?
• Risk is measured based on which of the following?
• True or False: The final diagnosis alone does not determine the complexity or risk to the patient.
• In MDM, if a patient has a history of ulcerative colitis in the HPI but the rest of the note contains no UC-related symptoms or management notes, is UC considered in the encounter’s MDM?
• For Medicare payment, which codes are used for inpatient/observation services?
• To report a significant, separately identifiable service provided on the same date as a hospital admission, which modifier is appropriate to use?
• An established 47-year-old patient presents after a fall with lower back strain. The codes reported are 99213, S39.012A, W01.0XXA, Y92.030. Which option is correct for E/M and ICD-10-CM codes?
• Which type of tests are explicitly considered in MDM despite not being billed with separate CPT codes?
• Which management decision is associated with poor prognosis and is considered high risk?
• Hospital Inpatient Services are subcategorized into which of the following groups?
• For Category 2 assessment with Moderate or Extensive data, what is true about the role of an independent historian?
• Which of the following is NOT a requirement for a Medicare consultation?
• Medicare inpatient consultations should be reported using which ranges for initial and subsequent care?
• If a service is reported separately with another CPT/HCPCS code, how is its time treated in the E/M time calculation?
• Which is a top error in Evaluation and Management coding?
• Observation or Inpatient Care Services, including Admission and Discharge Services codes, should be used to report An admit and discharge on the same date of service for patients in observation status or as inpatient.
• Which procedure decision is considered high risk due to identified risk factors?
• Which of the following is NOT a minimal risk example?
• Which category describes the severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require escalation in level of care?
• Which scenario qualifies as High level MDM?