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2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes)

Couple E/M question gray aeas to me. Advice please?!

My first question is in regard to the 95 and 97 guidelines and when Medicare -RAC does an audit.
Will they use the guidelines that suits THEM or will they always use the guidelines that benefits the physicians?

Also, if it’s an established patient and you need 2 out of 3…history and exam are perfect-comprehensive but MDM lacks complexity, can you still do a moderate using the history and exam, and not MDM?

And if I’m in a urology specialty but the patient has diabetes, CHF, COPD, basically things that the dr doesn’t necessarily treat, but might need to make medical decisions around that, can I bill those diagnoses? Or is it a matter of IF they put it in the assessment and plan? What if they put it there and list it. Can I count those as a point for established problem?
Do they actively have to be treating it on that encounter date? Where I’m struggeling is that they are not ‘treating’ the diabetes, etc. but it could be a factor in decision making.

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