CCEP Lesson 9 Homework FINAL

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Question 1 of 25

1. Question
Smith and Dr. Anderson are in the same cardiovascular practice. Dr. Smith is a cardiologist and Dr. Anderson is a cardiovascular surgeon. Dr. Smith has been seeing this Medicare patient for several years and now sends the patient to Dr. Anderson for consideration of a CABG procedure. What series of codes would doctor Anderson use to code the services provided to this patient?
- a. Established Patient visit: 99211-99215
- b. Office Consultations: 99242 – 99245
- c. Inpatient Consultation: 99252-99255
- d. New Patient visit: 99202-99205
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Question 2 of 25

2. Question
A physician documents that they spent 13 minutes reviewing the patient’s record, 20 minutes with the patient and 7 minutes coordinating a referral, in what instance could this information be used to determine the level of EM code?
- a. Emergency department services
- b. Preventive services
- c. Office or other outpatient services
- d. Chronic care management services
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Question 3 of 25

3. Question
Who determines the nature and extent of the history and exam required for an E/M visit, according to the current CPT guidelines?
- a. The medical coder
- b. The insurance company
- c. The treating provider
- d. The patient
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Question 4 of 25

4. Question
Who should use the E/M Services Guidelines when selecting a CPT code for a service provided?
- a. The patient
- b. The medical coder
- c. The insurance company
- d. The reporting physician or QHP
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Question 5 of 25

5. Question
Which of the following services does not require a face-to-face encounter between the QHP and patient and/or family, according to the E/M coding guidelines?
- a. Office or Other Outpatient
- b. Hospital Inpatient and Observation Care Services
- c. Consultations
- d. Emergency Department
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Question 6 of 25

6. Question
Which of the following is required to indicate where the face-to-face encounter occurred, according to the E/M Services Guidelines?
- a. CPT code
- b. ICD-10 code.
- c. Place of Service (POS) code
- d. Modifier code
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Question 7 of 25

7. Question
According to the E/M Services Guidelines, how is a new patient defined?
- a. One who has received any professional services within the last three (3) years from the QHP or another QHP of the exact same specialty and subspecialty in that practice.
- b. One who has not received any professional services within the last three (3) years from the QHP or another QHP of the exact same specialty and subspecialty in that practice.
- c. One who has received any professional services within the last year from the QHP or another QHP of the exact same specialty and subspecialty in that practice.
- d. One who has not received any professional services within the last year from the QHP or another QHP of the exact same specialty and subspecialty in that practice.
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Question 8 of 25

8. Question
How many types of MDM are recognized in the Level of MDM table?
- a. One
- b. Two
- c. Three
- d. Four
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Question 9 of 25

9. Question
What are the three elements that define Medical Decision Making (MDM)?
- a. Complexity of the Encounter, Data Management, and Patient Risk
- b. Number of Patients, Amount of Data, and Patient Management
- c. Number/Complexity of Problems Addressed, Amount/Complexity of Data, and Risk of Complications/Morbidity/Mortality of Patient Management
- d. Level of Service, Diagnosis Complexity, and Patient Outcome
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Question 10 of 25

10. Question
Which of the following is an example of a low complexity MDM presentation according to Column 1 of the Levels of MDM table?
- a. Chronic illness with exacerbation
- b. Multiple chronic stable conditions
- c. Acute illness with systemic symptoms
- d. Self-limited or minor condition
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Question 11 of 25

11. Question
Which of the following is an example of a high complexity MDM presentation according to Column 1 of the Levels of MDM table?
- a. Acute uncomplicated illness or injury
- b. Chronic illness with stable symptoms
- c. Chronic illness with mild exacerbation
- d. Chronic illness with severe exacerbation
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Question 12 of 25

12. Question
What are the three categories of data to consider for the second element in column 2 on the Levels of MDM Table?
- a. Tests, independent interpretation of tests, and orders of tests
- b. Tests, documents or independent historian, and discussion of management or test interpretation
- c. Tests, review of prior external note(s), and assessments requiring an independent historian(s)
- d. Independent interpretation of tests, documents, and discussions of management
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Question 13 of 25

13. Question
What is the definition of an independent historian according to the E/M GL?
- a. A physician or other qualified health care professional reporting the E/M services.
- b. An individual who provides a history in addition to the history provided by the patient.
- c. An individual who interprets test results that are not reported separately.
- d. A professional who is involved in the management of the patient but is not a healthcare professional.
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Question 14 of 25

14. Question
What does the term “risk” refer to in the context of MDM guidelines?
- a. Risk from the condition when appropriately managed
- b. Risk from the condition when inappropriately managed
- c. Risk from diagnostic procedures and treatments
- d. Risk from the patient's overall health status
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Question 15 of 25

15. Question
Which of the following is an example of a decision associated with moderate risk of morbidity from additional diagnostic testing or treatment?
- a. Decision re: emergency major surgery
- b. Drug therapy requiring intensive monitoring for toxicity.
- c. Decision re: elective major surgery w/o risk
- d. Diagnosis or treatment significantly limited by social determinants of health.
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Question 16 of 25

16. Question
What is the definition of risk as used in the E/M guidelines?
- a. The probability and/or consequences of an event
- b. The level of morbidity associated with a procedure or treatment.
- c. The level of complication associated with a patient's condition.
- d. The potential for a patient to experience harm during management.
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Question 17 of 25

17. Question
What affects the assessment of level of risk according to the E/M guidelines?
- a. The clinician's experience and training
- b. The clinician's specialty
- c. The nature of the event under consideration
- d. The patient's medical history
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Question 18 of 25

18. Question
According to the E/M guidelines, what is the basis for determining the level of risk in MDM?
- a. Probability and/or consequences of an event
- b. Severity of the patient's condition
- c. Likelihood of success of treatment
- d. Complexity of the diagnostic tests required.
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Question 19 of 25

19. Question
Which of the following is an example of a high-risk situation in MDM according to the Levels of MDM Table in the E/M guidelines?
- a. Prescription drug management
- b. Decision re: minor surgery with identified risks
- c. Decision re: elective major surgery w/o risk
- d. Decision not to resuscitate or to de-escalate care because of poor prognosis.
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Question 20 of 25

20. Question
Based on CPT, which of the following is true about time-based reporting for E/M services?
- a. Emergency department services require time to be documented in the code descriptor.
- b. Total encounter time includes F2F time with the patient and non-F2F time personally spent by clinical staff on the date of the encounter.
- c. Clinical staff time is counted as part of countable time.
- d. Shared and/or split visits are reported without summing the time personally spent by the physician and QHP responsible for assessing and managing the patient.
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Question 21 of 25

21. Question
Based on information in CPT, which of the following is a rule for time-based coding?
- a. Apply this method to all visits regardless of the length of the encounter.
- b. Count all time spent by the clinician dedicated to this patient on the date of service, including time spent performing separately reimbursable services.
- c. Use unlisted codes frequently to report unusual services.
- d. Reserve time-based reporting for time-consuming encounters such as hospital follow-ups, complex illnesses, and extensive prescription work.
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Question 22 of 25

22. Question
How many elements on the Levels of MDM table must be captured to support the complexity indicated when calculating MDM?
- a. 1/3 elements
- b. 2/3 elements
- c. 3/3 elements
- d. 4/4 elements
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Question 23 of 25

23. Question
What are the four things that should be documented when a consultation is performed?
- a. The consultation request, the reason for the request, the patient's insurance information, the consultant physician's license number
- b. The consultation request, the reason for the request, the services rendered, the consultant physician's favorite color.
- c. The consultation request, the reason for the request, the services rendered, the report from the consultant physician.
- d. The consultation request, the reason for the request, the patient's favorite color, the report from the consultant physician
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Question 24 of 25

24. Question
How are the codes for inpatient or observation consultations selected?
- a. Based on the patient's insurance information
- b. Based on the number of consultations performed
- c. Based on the total encounter time or level of MDM
- d. Based on the consultant physician's license number
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Question 25 of 25

25. Question
What is the main difference between CPT codes 99221-99239 and office visit services?
- a. CPT codes 99221-99239 are for hospital inpatient and observation care services, while office visit services are for outpatient services.
- b. CPT codes 99221-99239 are for initial and subsequent visits, while office visit services are categorized as new or established patient visits.
- c. CPT codes 99221-99239 are identified by an admit and discharge on the same day, while office visit services are not.
- d. CPT codes 99221-99239 require the use of total time or MDM for code selection, while office visit services do not.
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CCEP Lesson 9 Homework FINAL

Evaluation and Management Services

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