Medical Coding Certification Exam Preparation 2nd Edition By Stewart - Exam Bank Instant Download - Complete Test Bank With Answers Sample Questions Are Posted Below Medical Coding, 2e (Stewart) Chapter 5 Evaluation and Management 1) The Evaluation and Management (E/M) section of the CPT manual contains the codes ranging from: …
$19.99
Medical Coding Certification Exam Preparation 2nd Edition By Stewart – Exam Bank
Instant Download – Complete Test Bank With Answers
Sample Questions Are Posted Below
Medical Coding, 2e (Stewart)
Chapter 5 Evaluation and Management
1) The Evaluation and Management (E/M) section of the CPT manual contains the codes ranging from:
Answer: C
Explanation: The Evaluation and Management (E/M) section of the CPT manual contains the codes ranging from 99201-99499.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
2) All of the following are categories included in the E/M section of the CPT manual except:
Answer: C
Explanation: Preventive medicine, care management, and emergency services are all located in the E/M section of the CPT manual. Psychiatric services are located in the Medicine section of the CPT manual.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
3) All of the following are categories included in the E/M section of the CPT manual except:
Answer: D
Explanation: Office, hospital, and critical care services are all located in the E/M section of the CPT manual.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
4) The E/M section is used to tell the story of the services provided to the patient in a(n):
Answer: D
Explanation: The E/M section is used to tell the story of the services provided to the patient in both the outpatient and inpatient settings
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
5) The E/M section is often the most difficult for coders to understand and use correctly because:
Answer: B
Explanation: E/M section is often the most difficult for coders to understand and use correctly because this section is based on applying measurements to the provider’s work.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
6) To select the appropriate code from this section:
Answer: B
Explanation: To select the appropriate code from this section the coder must be able to abstract necessary information from the provider’s dictation.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
7) Codes 99201-99215 contain:
Answer: A
Explanation: Codes 99201-99215 contain services provided to the patient in an office or other outpatient setting.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
8) The actual time the provider or qualified healthcare professional spends with the patient and/or family in the office or outpatient setting is called:
Answer: C
Explanation: The actual time the provider or qualified healthcare professional spends with the patient and/or family in the office or outpatient setting is called face-to-face time.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
9) Face-to-face time is:
Answer: C
Explanation: Face-to-face time is the actual time the provider or qualified healthcare professional spends with the patient and/or family in the office or outpatient setting.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
10) In the hospital, face-to-face time is calculated by:
Answer: A
Explanation: In the hospital, face-to-face time is calculated by the amount of time the physician spends on the floor or unit that is related to the care given to the patient.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system
ABHES: 7.d Process insurance claims
11) It is required that ________ key component(s) are met when selecting a code from 99201-99205:
Answer: B
Explanation: The code range 99201-99205 contains New Patient office visit codes. To select a code from this range, the documentation must meet all three key components required of that code.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding
ABHES: 7.d Process insurance claims
12) Established patient office visit codes are included in the range:
Answer: A
Explanation: Established patient office visit codes are included in code range 99211-99215.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding
ABHES: 7.d Process insurance claims
13) How many key components must be met in order to select a code from the Established Patient 99211-99215 code range?
Answer: B
Explanation: Two of the three key components must be met in order to select a code from the Established Patient 99211-99215 code range.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding
ABHES: 7.d Process insurance claims
14) The only code in the 99211-99215 range that does not need to meet key component requirements is:
Answer: D
Explanation: Code 99211 may not require the presence of a physician and does not have key component requirements.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding
ABHES: 7.d Process insurance claims
15) Hospital Observation Services codes describe examinations provided in:
Answer: C
Explanation: Hospital Observation Services codes describe examinations provided in a designated observation status room in a hospital.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
16) Code 99217 describes:
Answer: D
Explanation: Code 99217 describes Observation Care Discharge Services.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding
ABHES: 7.d Process insurance claims
17) Select the statement that is not true regarding code 99217, Observation Care Discharge Services:
Answer: C
Explanation: Code 99217, Observation Care Discharge Services, may not be reported with an inpatient initial service (99221-99223) code.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
18) Code 99217, Observation Care Discharge Services, may describe which of the following services:
Answer: A
Explanation: Code 99217, Observation Care Discharge Services, may include final examination, instructions for post-discharge care, and preparation of discharge forms.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding
ABHES: 7.d Process insurance claims
19) If a patient is admitted into observation status and then is admitted to inpatient status on the same day, the coder may:
Answer: C
Explanation: If a patient is admitted into observation status and then is admitted to inpatient status on the same day, only an Initial Hospital Care code may be selected.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
20) Patient Sally by Dr. Lane in the office on January 11. Upon examination, Dr. Lane recommended that Sally be transferred to the hospital for observation of her increasing heart palpitations. Dr. Lane followed up with Sally later that day in the observation room to monitor her progress. Select the appropriate code ranges and sequencing to describe these services:
Answer: D
Explanation: In this scenario, Dr. Lane saw Sally at both the office and the hospital observation settings. Because the observation status was initiated by the encounter at the office, only the Initial Observation Care (99218-99220) code range may be used.
Difficulty: 3 Hard
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
21) Subsequent Observation Care (99224-99226) is used for:
Answer: C
Explanation: Subsequent Observation Care (99224-99226) is used for services provided during observation status after the initial-observation care has occurred.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
22) All of the following are true of Initial Hospital Care (99221-99223) codes except:
Answer: A
Explanation: Time does not have to be documented in order for a coder to select the appropriate Initial Hospital Care (99221-99223) code. However, if time is not used, all three key components must be met.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
23) To obtain a level 99222 or 99223 code, a(n) ________ exam must have been performed and documented.
Answer: D
Explanation: To obtain a level 99222 or 99223 code, a comprehensive exam must have been performed and documented.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
24) The “three R’s” regarding consultations are:
Answer: B
Explanation: The ‘three R’s’ regarding consultations are request, render, and report.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
25) The major factor for using the consultation range of codes is the ________ of the service:
Answer: B
Explanation: The major factor for using the consultation range of codes is the intent of the service.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
26) A visit that is requested in writing and that involves the rendering of an opinion and the compilation of a written report is:
Answer: C
Explanation: A visit that is requested in writing and that involves the rendering of an opinion and the compilation of a written report is called a consultation.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
27) The transferring of care for the patient’s present illness is:
Answer: D
Explanation: A referral is the transferring of care for the patient’s present illness.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
28) A patient presents to the provider’s office with swelling of the face and hands after beginning an amoxicillin treatment three days ago. The patient has no current known drug allergies; the physician requests in writing that an allergist evaluate the patient, render an opinion, and supply a written report stating the opinion. This is an example of a(n):
Answer: B
Explanation: In this scenario, the requesting physician meets all of the requirements to request a consultation from a specialist. This is a consultation service.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
29) Select the true statement regarding consultations:
Answer: C
Explanation: Inpatient consultations require that three of the three key components be met for the level of service; office or other outpatient consultations require that all three key components must be met for the level of service.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
30) Services provided in a 24-hour facility to an unscheduled patient with an immediate concern are provided in:
Answer: A
Explanation: CPT defines emergency department as a hospital-based facility for provision of unscheduled services to patients who present for immediate care.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
31) Code range 99291-99292 is used to describe:
Answer: A
Explanation: Code range 99291-99292 is used to describe Critical Care services.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
32) Code 99291 represents this time frame of Critical Care services:
Answer: C
Explanation: Code 99291 represents the first 30-74 minutes of Critical Care services.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
33) All of the following are true about critical illness/injury except:
Answer: A
Explanation: A patient can be in a critical care unit (CCU), such as an intensive care unit (ICU), and not be designated as critically ill. A patient can also be in a setting other than a critical care unit and be designated as critically ill. It is not the setting but the condition that defines critical care.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
34) Select the statement that is not true regarding critical care code selection:
Answer: C
Explanation: In calculation of Critical Care time, time spent outside the unit may not be considered in the time documentation.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
35) All of the following are included in CPT critical care codes except:
Answer: D
Explanation: Gastric intubation, pulse oximetry, and vascular access procedures are all included in the CPT critical care codes.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
36) If a patient is discharged from inpatient care on the same day as a nursing facility admit, the coder may select:
Answer: A
Explanation: If a patient is discharged from inpatient care on the same day as a nursing facility admit, the coder may select a hospital discharge code as appropriate and an Initial Nursing Facility Care code.
Difficulty: 2 Medium
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
37) Code range 99341-99350 represents:
Answer: B
Explanation: Code range 99341-99350 represents Home Services.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
38) Codes in this range are reported when services are provided that are outside the normal services provided for the condition or injury of the present encounter:
Answer: A
Explanation: Codes in the Prolonged Services range are reported when services are provided that are outside the normal services provided for the condition or injury of the present encounter.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
39) Services provided to a patient in order to maintain health and prevent disease are called:
Answer: C
Explanation: Services provided to a patient in order to maintain health and prevent disease are called Preventive Services.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
40) Preventive Services code selection is dependent on all but which of the following:
Answer: D
Explanation: Preventive Services code selection is dependent on the type of patient, new or established, and the age of the patient.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
41) Code 99450 Basic Life and/or Disability Evaluation Services includes all of the following except:
Answer: B
Explanation: Code 99450 Basic Life and/or Disability Evaluation Services includes documentation of height, weight, and blood pressure, collection of blood sample and urinalysis and completion of appropriate forms.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
42) The code range 99455-99456 Work-Related or Medical Disability Evaluation Services has a designation indicating:
Answer: B
Explanation: The code range 99455-99456 Work-Related or Medical Disability Evaluation Services has a designation indicating whether the examination is performed by the treating or nontreating physician.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
43) Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services (99466-99486) include all of the following except:
Answer: B
Explanation: Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services (99466-99486) include transportation services for critical care pediatric patients, initial intensive care services and continuing intensive care services.
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
44) Inpatient Neonatal and Pediatric Critical Care services are:
Answer: D
Explanation: Inpatient Neonatal and Pediatric Critical Care services are designated by initial and subsequent and by age (28 days and younger).
Difficulty: 1 Easy
Topic: Format and Guidelines of the E/M Section of the CPT Manual
Learning Objective: 05.01 Understand the format and guidelines of the Evaluation and Management (E/M) section of the CPT manual.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
45) A chief complaint is:
Answer: A
Explanation: A chief complaint is the reason for the present encounter, usually in the patient’s own words.
Difficulty: 1 Easy
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
46) One who has been formally admitted to a healthcare facility is:
Answer: B
Explanation: One who has been formally admitted to a healthcare facility is inpatient.
Difficulty: 1 Easy
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
47) One who has not been formally admitted to inpatient status is:
Answer: C
Explanation: One who has not been formally admitted to inpatient status is outpatient.
Difficulty: 1 Easy
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
48) Select the correct steps to determining a code for an E/M service, listed in correct order:
Answer: D
Explanation: The correct steps, in order, to determining a code for an E/M service are: determine the patient’s chief complaint, identify the place of service, identify the type of service, identify the status of the patient.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
49) An established patient presents to the outpatient provider’s office with a chief complaint of sore throat. Which piece of information represents the first step in determining a code for an E/M service?
Answer: D
Explanation: The patient’s chief complaint is a sore throat; identifying the chief complaint is the first step in determining a code for an E/M service.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
50) A patient who has not received face-to-face services from the physician or another physician of the exact same specialty and subspecialty in the same group within the past three years is a(n):
Answer: B
Explanation: A new patient is one who has not received face-to-face services from the physician or another physician of the exact same specialty and subspecialty in the same group within the past three years.
Difficulty: 1 Easy
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
51) Stacy is being seen by Dr. Randall for the first time for tingling in her wrist and lower arm. Dr. Randall is part of a multi-physician orthopedic practice. Stacy saw Dr. Furman, another orthopedist in the practice, one year ago for treatment of a broken pinkie finger. Stacy will be a(n) ________ for Dr. Randall:
Answer: A
Explanation: In this scenario, Stacy is seeing another physician of the same specialty within the same practice within the past three years. Stacy meets the criteria for an established patient.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
52) One who has received face-to-face services from the physician or another physician of the exact same specialty and subspecialty in the same group within the past three years is a(n):
Answer: D
Explanation: An established patient is one who has received face-to-face services from the physician or another physician of the exact same specialty and subspecialty in the same group within the past three years.
Difficulty: 1 Easy
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
53) Which of the following is not a true statement?
Answer: D
Explanation: A distinction between new and established patient in the outpatient and inpatient needs to be made before assigning a code from these categories
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
54) The E/M section guidelines regarding new and established patients uses the terminology “same practice.” Payers consider providers to be in the “same practice” when they use:
Answer: B
Explanation: The E/M section guidelines regarding new and established patients uses the terminology ‘same practice.’ Payers consider providers to be in the ‘same practice’ when they use the same tax ID.
Difficulty: 1 Easy
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
55) In the E/M section, a 0 in the fourth place identifies:
Answer: A
Explanation: In the E/M section, a 0 in the fourth place identifies a new patient service in the office.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
56) An established patient service in the office is indicated by a ________ fourth place digit:
Answer: C
Explanation: An established patient service in the office is indicated by a 1 fourth place digit.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
57) In the E/M section, a 2 in the fourth place identifies:
Answer: D
Explanation: In the E/M section, a 2 in the fourth place identifies an initial inpatient service.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
58) A subsequent inpatient service is identified by a ________ fourth digit:
Answer: B
Explanation: A subsequent inpatient service is identified by a 3 fourth digit.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
59) In the E/M section, a 4 in the fourth place identifies:
Answer: C
Explanation: In the E/M section, a 4 in the fourth place identifies a consultation service in the office.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
60) A consultation service in the hospital is represented by a ________ fourth digit:
Answer: B
Explanation: A consultation service in the hospital is represented by a 5 fourth digit.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
61) In the E/M section, an 8 in the fourth place identifies:
Answer: C
Explanation: In the E/M section, an 8 in the fourth place identifies an emergency service.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
62) A critical care service is identified by a ________ fourth digit:
Answer: B
Explanation: A critical care service is identified by a 9 fourth digit.
Difficulty: 2 Medium
Topic: Determining the Range of E/M Codes Required for the Service Provided
Learning Objective: 05.02 Determine the range of E/M codes required for the service provided.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
63) All of the following are components of an E/M service except:
Answer: D
Explanation: History, coordination of care, and the nature of presenting problem are all components of an E/M service.
Difficulty: 2 Medium
Topic: Components of an E/M Service
Learning Objective: 05.03 Define the components of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
64) All of the following are components of an E/M service except:
Answer: B
Explanation: Medical decision making, counseling, and time are all components of an E/M service.
Difficulty: 2 Medium
Topic: Components of an E/M Service
Learning Objective: 05.03 Define the components of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
65) The three key components used to select an appropriate E/M code are:
Answer: D
Explanation: The three key components used to select an appropriate E/M code are history, examination, and medical decision making.
Difficulty: 1 Easy
Topic: Components of an E/M Service
Learning Objective: 05.03 Define the components of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
66) Time can be a key ________ for the codes within the E/M section requiring either two or three key components.
Answer: A
Explanation: Time can be a key factor for the codes within the E/M section requiring either two or three key components.
Difficulty: 1 Easy
Topic: Components of an E/M Service
Learning Objective: 05.03 Define the components of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
67) A patient is seen by a provider today for 80 minutes. Based on the E/M guideline regarding time as a key factor, how many minutes at a minimum must the provider document spending in face-to-face counseling and coordination of care with the patient?
Answer: C
Explanation: In order for time to be a key factor in selection of the level of an E/M code, a provider must document the total amount of time spent with the patient and the total amount of time spent in face-to-face counseling and coordination of care. This time must equal or exceed fifty percent of the total time.
Difficulty: 3 Hard
Topic: Components of an E/M Service
Learning Objective: 05.03 Define the components of an E/M code.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
68) The key component which includes the number of management options or diagnoses is:
Answer: B
Explanation: Medical decision making is the key component which includes the number of management options or diagnoses.
Difficulty: 2 Medium
Topic: Components of an E/M Service
Learning Objective: 05.03 Define the components of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
69) The elements of the History component in E/M code selection are:
Answer: C
Explanation: The elements of the History component in E/M code selection are history of present illness, review of systems, and past, family, and social history.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
70) Location, duration, quality, and severity are all subelements of which element?
Answer: D
Explanation: Location, duration, quality, and severity are all subelements of the history of present illness element.
Difficulty: 2 Medium
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
71) The descriptive words “gait, range of motion, inspect nails, and digits” are used to describe which subelement?
Answer: D
Explanation: The descriptive words ‘gait, range of motion, inspect nails, and digits’ are used to describe the musculoskeletal subelement of the Organ system element.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
72) The ________ documentation guidelines are followed for the CPC exam:
Answer: C
Explanation: The 1995 documentation guidelines are followed for the CPC exam.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
73) How many subelements are needed to achieve an Extended history of present illness?
Answer: A
Explanation: Four subelements are needed to achieve an Extended history of present illness.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
74) PFSH stands for:
Answer: D
Explanation: PFSH stands for past, family, and social history.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
75) A series of questions presented to the patient which identify any signs and symptoms or contributing factors relevant to the present encounter is a(n):
Answer: B
Explanation: A series of questions presented to the patient which identify any signs and symptoms or contributing factors relevant to the present encounter is a review of systems.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
76) Past, family, and social history (PFSH) encompasses which of the following:
Answer: B
Explanation: Past, family, and social history (PFSH) encompasses the patient’s past surgeries, allergies, and family illnesses.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
77) In the table of risk, the highest level in any one ________ determines the overall risk:
Answer: C
Explanation: In the table of risk, the highest level in any one subelement determines the overall risk.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
78) In the Exam component, organ system element, a detailed exam is made up of ________ body areas and/or organ systems:
Answer: B
Explanation: In the Exam component, organ system element, a detailed exam is made up of 5-7 body areas and/or organ systems.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
79) In the History component, review of systems element, how many subelements must be documented for an extended ROS?
Answer: C
Explanation: In the History component, review of systems element, 2-9 subelements must be documented for an extended ROS.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
80) The description of the illness or injury which precipitated the present encounter is the:
Answer: C
Explanation: The description of the illness or injury which precipitated the present encounter is the history of present illness.
Difficulty: 1 Easy
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
81) Which of the following is not included in the Moderate decision making subelement of the Medical decision making element?
Answer: A
Explanation: High risk of complications is found in the High decision making subelement of the Medical decision making element.
Difficulty: 2 Medium
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
82) In the SOAP note format, the assessment contains which key component in E/M selection:
Answer: C
Explanation: In the SOAP note format, the assessment contains the medical decision making key component in E/M selection.
Difficulty: 2 Medium
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
83) In the SOAP note format, the objective section contains which key component in E/M selection:
Answer: B
Explanation: In the SOAP note format, the objective section contains the exam key component in E/M selection.
Difficulty: 2 Medium
Topic: Determining the Level of an E/M Code
Learning Objective: 05.04 Apply the guidelines for determining the level of service of an E/M code.
Bloom’s: Understand
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
84) Modifier 57 signifies:
Answer: D
Explanation: Modifier 57 signifies ‘Decision for surgery.’
Difficulty: 2 Medium
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Remember
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
85) A patient presents with worsening lower back pain after receiving an epidural injection intended to provide relief just one week ago. Upon examination, the provider determines the patient is a candidate for laminectomy at the L5-S1 facet. The provider discusses the procedure, including preoperative instructions and performs a complete physical examination to clear the patient for surgery. Which modifier will be appended to this E/M service?
Answer: A
Explanation: During this E/M encounter, the provider made the decision to proceed with surgery. Modifier 57 describes an E/M service in which the provider makes a decision for surgery.
Difficulty: 3 Hard
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
86) An unrelated E/M service by the same physician during a postoperative period is described by modifier:
Answer: A
Explanation: Modifier 24 is used to describe an Unrelated E/M service by the same physician during a postoperative period.
Difficulty: 3 Hard
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
87) Which E/M modifier is appropriate to use with this scenario: A patient presents to the orthopedist’s office with a complaint of severely sore knee while in the post-operative period for a carpal tunnel decompression performed by the same provider.
Answer: A
Explanation: In this scenario, the patient is being seen for a separate problem that is not related to the diagnosis supporting the surgical procedure recently performed. Because the patient is being seen in the post-operative global period for the surgery, and the provider should receive reimbursement for today’s visit because it is to treat an unrelated problem, the coder should append modifier 24 to today’s E/M service.
Difficulty: 3 Hard
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
88) Modifier 25 signifies:
Answer: B
Explanation: Modifier 25 signifies a Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service.
Difficulty: 3 Hard
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
89) Modifier 32, Mandated services, is used when:
Answer: B
Explanation: Modifier 32, Mandated services, is used when a third-party payer requires a second opinion, such as in a worker’s compensation or other liability claim.
Difficulty: 3 Hard
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
90) Gerald fell 6 feet from a ladder while running wire at work today. He presents to the provider’s office with complaints of low back pain and left knee pain. He arrives with a paper copy of the notes from a visit with his primary care physician about these problems. His employer requested Gerald receive a second opinion from another provider to confirm the diagnosis. What E/M modifier would be appended to the code for today’s service?
Answer: C
Explanation: In this scenario, the patient is seeking treatment at the request of a third party. This is a Mandated service and warrants the use of modifier 32.
Difficulty: 3 Hard
Topic: Modifiers Commonly Used with E/M Codes
Learning Objective: 05.05 Review the modifiers commonly used with E/M codes.
Bloom’s: Apply
CAAHEP: IX.C.1 Describe how to use the most current procedural coding system; IX.P.1. Perform procedural coding; IX.C.5 Define medical necessity as it applies to procedural and diagnostic coding
ABHES: 7.d Process insurance claims
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
