Medical Coding Certification Exam Preparation 2nd Edition By Stewart - Exam Bank
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Medical Coding Certification Exam Preparation 2nd Edition By Stewart - Exam Bank

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: …

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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:

  1. A) 99101-99499
  2. B) 99201-99999
  3. C) 99201-99499
  4. D) 99101-99999

 

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:

  1. A) preventive medicine services
  2. B) care management services
  3. C) psychiatric services
  4. D) emergency services

 

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:

  1. A) office services
  2. B) hospital services
  3. C) critical care services
  4. D) palliative services

 

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):

  1. A) outpatient setting
  2. B) inpatient setting
  3. C) laboratory encounter
  4. D) Both outpatient setting and inpatient setting

 

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:

  1. A) no guidelines are provided for this section
  2. B) this section is based on applying measurements to the provider’s work
  3. C) conflicting guidelines are provided for this section and its subsections
  4. D) this section is newly developed and unfamiliar to coders

 

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:

  1. A) The provider must dictate the appropriate CPT code in the documentation
  2. B) The coder must be able to abstract necessary information from the provider’s dictation
  3. C) The coder must be able to accurately compare services provided by several providers
  4. D) The provider must document time, counseling, and coordination of care for each visit

 

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:

  1. A) outpatient services
  2. B) inpatient services
  3. C) counseling services
  4. D) screening services

 

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:

  1. A) counseling time
  2. B) review of systems
  3. C) face-to-face time
  4. D) personal, family, and social history

 

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:

  1. A) the hours a provider works each day
  2. B) the amount of time a patient spends in the office
  3. C) the actual time a provider or qualified healthcare professional spends with the patient and/or family
  4. D) the amount of time a coder and provider speak about a patient’s case

 

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:

  1. A) the amount of time the physician spends on the floor or unit that is related to the care given to the patient
  2. B) the amount of time the physician spends speaking with the patient and/or family in the hospital room
  3. C) the amount of time the nurse and provider spend speaking about the patient’s case
  4. D) the amount of time the physician spends in that hospital on the date of service

 

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:

  1. A) Four
  2. B) Three
  3. C) Two
  4. D) One

 

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:

  1. A) 99211-99215
  2. B) 99201-99205
  3. C) 99401-99405
  4. D) 99311-99315

 

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?

  1. A) one
  2. B) two
  3. C) three
  4. D) four

 

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:

  1. A) 99215
  2. B) 99214
  3. C) 99212
  4. D) 99211

 

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:

  1. A) the Emergency Room
  2. B) an outpatient, provider’s office
  3. C) a designated observation status room in a hospital
  4. D) an inpatient hospital room

 

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:

  1. A) Subsequent Observation Care
  2. B) Observation or Inpatient Care Services (Including Admission and Discharge Services)
  3. C) Initial Observation Care
  4. D) Observation Care Discharge Services

 

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:

  1. A) there is no key component requirement
  2. B) there is no time requirement
  3. C) this code may be reported with an inpatient initial service
  4. D) instructions for post-discharge care may occur during this service

 

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:

  1. A) final examination, instructions for post-discharge care, and preparation of discharge forms
  2. B) initiation of observation status, final examination, and preparation of discharge forms
  3. C) services provided during observation status after the initial-observation care has occurred
  4. D) services provided when a patient is admitted and discharged on the same day

 

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:

  1. A) assign an Initial Observation Care code and an Initial Hospital Care code
  2. B) assign only an Initial Observation Care code
  3. C) assign only an Initial Hospital Care code
  4. D) assign either an Initial Observation Care code or an Initial Hospital Care code depending on the amount of time the provider spent with the patient in each status

 

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:

  1. A) Initial Observation Care (99218-99220), followed by (99241-99245) Office or Other Outpatient Consultations
  2. B) Inpatient Consultations (99251-99255), followed by Initial Observation Care (99218-99220)
  3. C) Initial Observation Care (99218-99220), followed by Established Patients Office or Other Outpatient Services (99211-99215)
  4. D) Initial Observation Care (99218-99220)

 

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:

  1. A) observation or inpatient care if the patient is admitted and discharged on the same day
  2. B) final examination, instructions for post-discharge care, and preparation of discharge forms
  3. C) services provided during observation status after the initial-observation care has occurred
  4. D) the first encounter a physician has with an observation status patient

 

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:

  1. A) Time must be documented in order to select a code
  2. B) All three key components must be met
  3. C) These codes are used for the attending physician’s initial encounter with the inpatient
  4. D) These may be referred to as the admission versus initial encounter

 

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.

  1. A) problem-focused
  2. B) expanded problem-focused
  3. C) detailed
  4. D) comprehensive

 

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:

  1. A) request, refer, and render
  2. B) request, render, and report
  3. C) refer, recommend, and report
  4. D) refer, render, and report

 

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:

  1. A) extent
  2. B) intent
  3. C) length
  4. D) significance

 

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:

  1. A) referral
  2. B) transfer or care
  3. C) consultation
  4. D) specialty office visit

 

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:

  1. A) specialty consultation
  2. B) consultation
  3. C) routine office visit
  4. D) referral

 

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):

  1. A) Expert request
  2. B) Consultation
  3. C) Referral
  4. D) Request of opinion

 

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:

  1. A) Inpatient consultations distinguish between new and established patients; office or other outpatient consultations do not distinguish between new and established patients
  2. B) Inpatient consultations require that two 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
  3. C) Both inpatient and office or other outpatient consultations require that all three key components must be met for the level of service
  4. D) Inpatient consultations do not distinguish between new and established patients; office or other outpatient consultations distinguish between new and established patients

 

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:

  1. A) emergency department
  2. B) critical care department
  3. C) intensive care unit
  4. D) urgent care facility

 

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:

  1. A) Critical Care services
  2. B) Emergency Department services
  3. C) Office or Other Outpatient Consultations
  4. D) Nursing Facility Services

 

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:

  1. A) an additional 30 minutes
  2. B) the first 20-60 minutes
  3. C) the first 30-74 minutes
  4. D) an additional 70 minutes

 

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:

  1. A) a patient must be in a critical care unit to be categorized as having a critical illness
  2. B) a critical illness impairs one or more vital organ systems
  3. C) a critical injury presents a high probability of life-threatening deterioration
  4. D) a patient can be in a setting other than a critical care unit and be designated as critically ill

 

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:

  1. A) If less than 30 minutes is documented as time spent with the critically ill patient, code 99291 may not be reported
  2. B) Time spent on the floor but not directly at the bedside is counted as long as it pertains to the critical condition of the patient
  3. C) Time spent outside the unit may be considered in the time documentation
  4. D) Total time spent does not have to be continuous but must be documented

 

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:

  1. A) gastric intubation
  2. B) pulse oximetry
  3. C) vascular access procedures
  4. D) pulmonary function testing

 

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:

  1. A) an Initial Nursing Facility Care code and a hospital discharge code
  2. B) an Initial Nursing Facility Care code only
  3. C) a hospital discharge code and a Subsequent Nursing Facility Care code
  4. D) an observation status discharge code and an Initial Nursing Facility Care code

 

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:

  1. A) Prolonged Services
  2. B) Home Services
  3. C) Critical Care Services
  4. D) Nursing Facility Discharge Services

 

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:

  1. A) Prolonged Services
  2. B) Home Services
  3. C) Critical Care Services
  4. D) Preventive Services

 

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:

  1. A) Well services
  2. B) Home services
  3. C) Preventive services
  4. D) Palliative services

 

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:

  1. A) Type of patient
  2. B) Age of the patient
  3. C) New or established patient
  4. D) Gender of the patient

 

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:

  1. A) documentation of height, weight, and blood pressure
  2. B) performance of electrocardiogram
  3. C) collection of blood sample and urinalysis
  4. D) completion of appropriate forms

 

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:

  1. A) new or established patient
  2. B) whether the examination is performed by the treating or nontreating physician
  3. C) whether the service was mandated by the employer
  4. D) treatment plan or consultative service

 

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:

  1. A) transportation services for critical care pediatric patients
  2. B) outpatient neonatal care
  3. C) initial intensive care services
  4. D) continuing intensive care services

 

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:

  1. A) designated by new or established and by age (0 days – 5 years of age)
  2. B) designated by initial and subsequent and by age (0 days – 5 years of age)
  3. C) designated by new or established and by age (28 days – 5 years of age)
  4. D) designated by initial and subsequent and by age (28 days and younger)

 

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:

  1. A) the reason for the present encounter, usually in the patient’s own words
  2. B) the confirmed diagnosis in the provider’s documentation
  3. C) the diagnosis used to support further laboratory procedures
  4. D) the sign observed and documented by the provider

 

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:

  1. A) observation status
  2. B) inpatient
  3. C) outpatient
  4. D) critical care

 

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:

  1. A) inmate status
  2. B) inpatient
  3. C) outpatient
  4. D) emergency services

 

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:

  1. A) identify the status of the patient, determine the patient’s chief complaint, identify the place of service, identify the type of service.
  2. B) identify the place of service, identify the type of service, identify the status of the patient, determine the patient’s chief complaint
  3. C) determine the patient’s chief complaint, identify the status of the patient, identify the place of service, identify the type of service.
  4. D) determine the patient’s chief complaint, identify the place of service, identify the type of service, identify the status of the patient

 

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?

  1. A) established patient
  2. B) outpatient
  3. C) provider’s office
  4. D) sore throat

 

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):

  1. A) consult
  2. B) new patient
  3. C) established patient
  4. D) existing patient

 

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:

  1. A) established patient
  2. B) new patient
  3. C) consult
  4. D) referral

 

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):

  1. A) new patient
  2. B) referral
  3. C) consult
  4. D) established patient

 

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?

  1. A) No distinction is made between new and established patient for the emergency department
  2. B) No distinction is made between new and established patient for critical care codes
  3. C) No distinction is made between new and established patient for care management codes
  4. D) No distinction is made between new and established patient in the outpatient and inpatient setting

 

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:

  1. A) the same facilities
  2. B) the same tax ID
  3. C) the same Social Security number
  4. D) the same billing company

 

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:

  1. A) a new patient service in the office
  2. B) an established patient service in the office
  3. C) an initial inpatient service
  4. D) a subsequent inpatient service

 

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:

  1. A) 2
  2. B) 3
  3. C) 1
  4. D) 4

 

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:

  1. A) an emergency service
  2. B) a critical care service
  3. C) a subsequent inpatient service
  4. D) an initial inpatient service

 

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:

  1. A) 2
  2. B) 3
  3. C) 4
  4. D) 5

 

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:

  1. A) an emergency service
  2. B) a critical care service
  3. C) a consultation service in the office
  4. D) a consultation service in the hospital

 

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:

  1. A) 4
  2. B) 5
  3. C) 8
  4. D) 9

 

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:

  1. A) a consultation service in the office
  2. B) a consultation service in the hospital
  3. C) an emergency service
  4. D) a critical care service

 

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:

  1. A) 0
  2. B) 9
  3. C) 2
  4. D) 8

 

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:

  1. A) history
  2. B) coordination of care
  3. C) nature of presenting problem
  4. D) vital signs

 

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:

  1. A) medical decision making
  2. B) dictation time
  3. C) counseling
  4. D) time

 

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:

  1. A) Counseling, coordination of care, and time
  2. B) History, medical decision making, and time
  3. C) Counseling, history, and examination
  4. D) History, examination, and medical decision making

 

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.

  1. A) factor
  2. B) component
  3. C) issue
  4. D) consideration

 

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?

  1. A) 20 minutes
  2. B) 30 minutes
  3. C) 40 minutes
  4. D) 50 minutes

 

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:

  1. A) coordination of care
  2. B) medical decision making
  3. C) examination
  4. D) history

 

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:

  1. A) history of present illness, body areas, and past, family, and social history
  2. B) amount and complexity of data, history of present illness, and number of diagnoses and management options
  3. C) history of present illness, review of systems, and past, family, and social history
  4. D) body areas, review of systems, and amount and complexity of data

 

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?

  1. A) organ system
  2. B) amount and complexity of data
  3. C) number of diagnosis and treatment options
  4. D) history of present illness

 

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?

  1. A) cardiovascular
  2. B) constitutional
  3. C) eyes
  4. D) musculoskeletal

 

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:

  1. A) 1991
  2. B) 1997
  3. C) 1995
  4. D) 1998

 

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?

  1. A) four
  2. B) three
  3. C) two
  4. D) one

 

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:

  1. A) personal, family, and social history
  2. B) past, former, and surgical history
  3. C) personal, family, and surgical history
  4. D) past, family, and social history

 

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):

  1. A) examination
  2. B) review of systems
  3. C) history of present illness
  4. D) past, family, and social history

 

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:

  1. A) family’s past surgeries, allergies, and illnesses
  2. B) patient’s past surgeries, allergies, and family illnesses
  3. C) family’s marital status and allergies
  4. D) spouse’s risk factors, marital status, allergies, and family illnesses

 

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:

  1. A) element
  2. B) subcategory
  3. C) subelement
  4. D) subsection

 

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:

  1. A) 4-6
  2. B) 5-7
  3. C) 4-7
  4. D) 5-8

 

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?

  1. A) 2-5
  2. B) 3-7
  3. C) 2-9
  4. D) 3-8

 

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:

  1. A) chief complaint
  2. B) past history
  3. C) history of present illness
  4. D) review of systems

 

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?

  1. A) high risk of complications
  2. B) multiple diagnosis and management options
  3. C) moderate amount of data reviewed
  4. D) moderate risk of complications

 

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:

  1. A) history of present illness
  2. B) exam
  3. C) medical decision making
  4. D) no key component is located here

 

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:

  1. A) no key component is located here
  2. B) exam
  3. C) history of present illness
  4. D) medical decision making

 

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:

  1. A) Unrelated E/M service by the same physician during a postoperative period
  2. B) Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service
  3. C) Mandated services
  4. D) Decision for surgery

 

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?

  1. A) 57
  2. B) 24
  3. C) 32
  4. D) 25

 

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:

  1. A) 24
  2. B) 25
  3. C) 32
  4. D) 57

 

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.

  1. A) 24
  2. B) 25
  3. C) 57
  4. D) 32

 

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:

  1. A) Unrelated E/M service by the same physician during a postoperative period
  2. B) Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service
  3. C) Mandated services
  4. D) Decision for surgery

 

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:

  1. A) Patient presents to the office with a cough and while in the office shows the provider a wart on her foot and the provider removes the wart
  2. B) Third-party payer requires a second opinion
  3. C) Surgeon is asked to see a patient in the ED for severe abdominal pain. He diagnoses the patient with appendicitis and decides to perform an appendectomy that evening.
  4. D) Surgeon performs appendectomy, and the patient returns to the office during the 90 day global period with abdominal pain that is diagnosed as gallstones

 

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?

  1. A) 24
  2. B) 25
  3. C) 32
  4. D) 57

 

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

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