E/M Coding

Question 1

Requires written request, referring provider, written report

Answer 1

Consultation

Question 2

Time-driven, requires doc critically ill/injured, full attention of MD

Answer 2

Critical care

Question 3

When counseling/coordination > 50% of time

Answer 3

E/M based on time

Question 4

Patient has not seen MD or other MD in practice with the same specialty in the years

Answer 4

New patient definition

Question 5

Visits assigned levels

Answer 5

Should be assigned based on MDM or time

Question 6

MDM

Answer 6

Medical decision making, includes diagnosis/management options, amount/complexity of data, and risk of complications and/or morbidity and mortality

Question 7

E/M per day

Answer 7

Typically one per day per provider

Question 7

MDM categories

Answer 7

Straightforward, low complexity, moderate complexity, high complexity

Question 8

Encounters based on time elements that may be used

Answer 8

Preparing to see patient, obtaining/reviewing history, performing medically appropriate exam, counseling/educating patient, ordering medications, tests, procedures, referring/communicating with other providers, documenting clinical information, independently interpreting/communicating results, care coordination

Question 9

Determining level based on MDM (2 of 3 must be met)

Answer 9

Number/complexity of problems, amount/complexity of data, risk of complications and/or morbidity or mortality

Question 10

Modifier 24

Answer 10

Unrelated E/M during postoperative period

Question 11

Modifier 25

Answer 11

Significantly, separately identifiable E/M service

Question 12

Modifier 32

Answer 12

Mandated services

Question 13

Modifier 52

Answer 13

Reduced services

Question 14

Modifier 57

Answer 14

Decision for surgery

Question 15

Office or other outpatient services

Answer 15

Office encounters, outpatient hospital encounters

Question 16

Hospital inpatient/observation services

Answer 16

Assign admit code for the admitting physician only for inpatient services, admit codes are most significant of day

Question 17

Consultations

Answer 17

When care is assumed, visits no longer qualify as consultations

Question 18

Billing for a consultation

Answer 18

During a consultation, the provider may initiate treatment and still bill for a consultation

Question 19

Inpatient consultation

Answer 19

Acute care only

Question 20

Outpatient consultation

Answer 20

Used for in office, observation, emergency, or other outpatient settings

Question 21

Emergency department encounters

Answer 21

Always considered a new patient

Question 22

Non documented history/exam

Answer 22

Assign level 5 if history and exam are not documented due to patient’s condition

Question 23

ED diagnostic services

Answer 23

Physicians may bill for interpretation if they provide services without the assistance of another physician

Question 24

Critical care codes

Answer 24

Patient must be documented as critically ill and/or injured

Question 25

Skilled nursing facilities

Answer 25

SNF

Question 26

Intermediate care facilities

Answer 26

ICF

Question 27

Long term care facilities

Answer 27

LTCF

Question 28

Coding for services preformed at SNF, ICF, and LTCF

Answer 28

Use E/M codes for services performed

Question 29

Psychiatric residential treatment centers

Answer 29

Use E/M codes for services performed

Question 30

Initial nursing facility care

Answer 30

Assign for admission to skilled nursing facilities

Question 31

Medical team conferences

Answer 31

Must include a minimum of three providers from different specialties

Question 32

Plan care oversight

Answer 32

In order to assign, services must be beyond regular physician communication

Question 33

Treatment/evaluation of problem during preventative care visit

Answer 33

Assign appropriate E/M code and modifier 25

Question 34

Non face to face services

Answer 34

Includes synchronous audio-video or audio only

Question 35

Synchronous communication

Answer 35

Intended for established patients only

Question 36

More than one contract required

Answer 36

Report all interprofessional telephone/internet consultations as a single code

Question 37

Newborn

Answer 37

Defined as birth to 28 days

Question 38

Services other than routine care (newborns)

Answer 38

Use hospital visit or neonatal/pediatric care

Question 39

Chronic care management elements

Answer 39

Two or more chronic illnesses expected to last at least 12 months or until patient's death, comprehensive care plan established, minimum documented 20 minutes per calendar month

Question 40

Complex chronic care

Answer 40

MDM of at least 60 minutes per calendar month of moderate to high level, patient difficulty accessing care, patient inability to perform activities, psychiatric or other medical comorbidities

Question 41

Principal care management

Answer 41

Single complex chronic issue (longer than 3 months), establish, implement, revise, maintain care plan, 30 minutes per calendar month

Question 42

Advance care planning

Answer 42

Codes may not be assigned without the completion of relevant legal forms