Chapter 15 — Quiz

26 questions. Answers and explanations are in the instructor guide.

1. An E/M code measures:

  • A. The severity of the patient's illness
  • B. The volume of documentation in the note
  • C. The cognitive work of the reporting professional, by MDM or by total time
  • D. The length of the appointment slot

2. Since January 1, 2021, history and examination:

  • A. Are counted as two of the three key components
  • B. Determine the level for new patients only
  • C. Are not used for level selection, but a medically appropriate history and/or examination is still required
  • D. Are no longer required in any form

3. Which code was deleted effective January 1, 2021?

  • A. 99211
  • B. 99201
  • C. 99202
  • D. 99215

4. A patient last received a professional service from a physician of the same specialty in the same group three years and one day ago. Today the patient is:

  • A. Established
  • B. New
  • C. New only if the prior service was in the office
  • D. Determined by the payer, not by CPT

5. A patient was operated on by this surgeon in a hospital two years ago and has never been seen in the office. At today's office visit the patient is:

  • A. New, because the office has no record of them
  • B. New, because hospital services do not count
  • C. Established, because any professional service within three years counts
  • D. Established only if the surgeon billed the hospital service

6. The two-of-three rule means:

  • A. All three MDM elements must reach the level
  • B. Two of the three elements must meet or exceed the level
  • C. The two highest elements are averaged
  • D. Two elements are scored and the third is optional documentation

7. An encounter scores problems high, data minimal, risk low. The MDM level is:

  • A. High
  • B. Moderate
  • C. Low
  • D. Straightforward

8. For MDM purposes, "stable" means:

  • A. Unchanged since the last visit
  • B. At the treatment goal
  • C. Not requiring medication
  • D. Documented as stable by the physician

9. A patient's hemoglobin A1c has been 10.2 for two years, unchanged. For the problems element, this chronic illness is:

  • A. Stable, because nothing has changed
  • B. Not stable, because it is not at treatment goal
  • C. Not scorable without a specialist's note
  • D. Self-limited

10. Two or more stable chronic illnesses in the problems element is:

  • A. Straightforward
  • B. Low
  • C. Moderate
  • D. High

11. "CKD stage 3a — followed by nephrology" appears in the assessment with nothing else about the kidney disease anywhere in the note. For the problems element it is:

  • A. A stable chronic illness addressed
  • B. A chronic illness with exacerbation
  • C. Not addressed — notation of a problem managed by another without additional assessment or care coordination
  • D. An undiagnosed new problem

12. A comprehensive metabolic panel is ordered. For Category 1, this counts as:

  • A. One unique test
  • B. One item per analyte
  • C. Two items — one for the order, one for the review
  • D. It does not count unless the results are documented

13. A physician orders a test today and reviews the result of that same test at the next visit. On this encounter, the number of Category 1 items is:

  • A. Two — the order and the review
  • B. One — review is included in the order
  • C. Zero until the result returns
  • D. Two, but only if the result is abnormal

14. For the data element, "external" means:

  • A. Any physician other than the reporting one
  • B. A physician in a different group practice, or a different specialty or subspecialty
  • C. Any physician not present at the encounter
  • D. A physician outside the patient's insurance network

15. The physician independently interprets an outside electrocardiogram and bills the professional component with modifier 26. For the data element, the interpretation:

  • A. Counts under Category 2
  • B. Counts under Category 3
  • C. May not be counted, because it is separately reported
  • D. Counts under Category 1 as a unique test

16. Category 3 requires:

  • A. A letter sent to another physician
  • B. A report received from another physician
  • C. A documented interactive discussion with an external professional, not separately reported
  • D. A referral order

17. For the risk element, options considered but not selected:

  • A. Do not count
  • B. Count only if the patient requested them
  • C. Count, if documented
  • D. Count only at the high level

18. Prescription drug management reaches which risk level?

  • A. Minimal
  • B. Low
  • C. Moderate
  • D. High

19. Which of the following documents prescription drug management?

  • A. "Metformin 1000 mg BID" in the medication list
  • B. "Type 2 diabetes, at goal — continue metformin 1000 mg BID" in the assessment and plan
  • C. A prescription drug appearing anywhere in the chart
  • D. The pharmacy's refill record

20. Total time on the date of the encounter includes:

  • A. Clinical staff time
  • B. Documentation completed the following morning
  • C. The reporting professional's own non-face-to-face time on that calendar date
  • D. Travel time to the office

21. A physician spends 40 minutes on an established patient, 12 of which are performing a separately reported procedure. The countable total time is:

  • A. 40 minutes
  • B. 28 minutes
  • C. 12 minutes
  • D. 52 minutes

22. An established patient encounter has documented moderate MDM and documented total time of 26 minutes. You should report:

  • A. 99213, because time is the more objective measure
  • B. 99214, because the two methods are alternatives and MDM supports it
  • C. 99213, because time caps the level
  • D. 99214 only with a prolonged services code

23. CPT's office prolonged service code 99417 may be added to:

  • A. Any office visit level
  • B. 99214 and 99215 only
  • C. 99205 and 99215 only
  • D. New patient codes only

24. Regarding Medicare and office prolonged services:

  • A. Medicare uses 99417 like every other payer
  • B. Medicare uses G2212, with a different starting threshold
  • C. Medicare does not recognize prolonged services in the office
  • D. Medicare requires both codes on the same claim

25. Incident-to billing in the office requires all of the following EXCEPT:

  • A. An established patient
  • B. An established plan of care for the problem
  • C. That the physician be physically present in the examination room
  • D. That no new problems be addressed at the encounter

26. An established patient sees a nurse practitioner for three established conditions and a new rash. The encounter:

  • A. May be billed incident-to, because most problems are established
  • B. May not be billed incident-to; it must be billed under the NPP's own NPI at 85%
  • C. May be billed incident-to if the physician signs the note
  • D. May be billed incident-to if the rash is minor