Click here for more sample CPC practice exam questions with Full Rationale Answers

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Practice Exam

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Evaluation and Management (E/M) Effective January 1, 2021


New Patient:

(99201 has been deleted. To report, use 99202)

99202 Office or other outpatient visit for the evaluation and management of a new patient,
which requires a medically appropriate history and/or examination and straightforward
medical decision making.

When using time for code selection, 15-29 minutes of total time is spent on the date of
the encounter.

99203 Office or other outpatient visit for the evaluation and management of a new patient,
which requires a medically appropriate history and/or examination and low level of
medical decision making.

When using time for code selection, 30-44 minutes of total time is spent on the date of
the encounter.

99204 Office or other outpatient visit for the evaluation and management of a new patient,
which requires a medically appropriate history and/or examination and moderate level of
medical decision making.

When using time for code selection, 45-59 minutes of total time is spent on the date of
the encounter.

99205 Office or other outpatient visit for the evaluation and management of a new patient,
which requires a medically appropriate history and/or examination and high level of
medical decision making.

When using time for code selection, 60-74 minutes of total time is spent on the date of
the encounter.

(For services 75 minutes or longer, see Prolonged Services 99XXX)

Established Patient:

99211 Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
professional. Usually, the presenting problem(s) are minimal.

99212 Office or other outpatient visit for the evaluation and management of an established
patient, which requires a medically appropriate history and/or examination and
straightforward medical decision making.

When using time for code selection, 10-19 minutes of total time is spent on the date of
the encounter.

99213 Office or other outpatient visit for the evaluation and management of an established
patient, which requires a medically appropriate history and/or examination and low level
of medical decision making.

When using time for code selection, 20-29 minutes of total time is spent on the date of
the encounter.

99214 Office or other outpatient visit for the evaluation and management of an established
patient, which requires a medically appropriate history and/or examination and moderate
level of medical decision making.

When using time for code selection, 30-39 minutes of total time is spent on the date of
the encounter.

99215 Office or other outpatient visit for the evaluation and management of an established
patient, which requires a medically appropriate history and/or examination and high level
of medical decision making.

When using time for code selection, 40-54 minutes of total time is spent on the date of
the encounter.

(For services 55 minutes or longer, see Prolonged Services 99XXX)

Copyright 2019 American Medical Association. All rights reserved.

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Coding Ahead

More Changes Ahead for Evaluation and Management Services

Changes to payment, coding, and documentation policies for evaluation and management (E/M) services finalized in the 2019 Physician Fee Schedule (PFS) final rule are necessary to align with the American Medical Association’s (AMA) revisions to the 2021 CPT code set for office/outpatient E/M visits, according to the Centers for Medicare & Medicaid Services (CMS). The proposed policy changes for E/M […]

The post More Changes Ahead for Evaluation and Management Services appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

AMA on Evaluation and Management Guidelines

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management (E/M) services (CPT® 99201-99215) provided to Medicare Part B patients beginning in 2021. The Centers for Medicare & Medicaid Services (CMS) indicated […]

The post AMA on Evaluation and Management Guidelines appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Choosing diagnosis codes for PT/OT/ST? – physician referral vs therapist’s evaluation

I work for a therapy company that provides services in various settings (via contracts) and am working toward my CPC certification (been in billing for years all over the specialty spectrum). I notice that some locations code encounters strictly based off of the physician’s referral. Is this an accurate practice? In reviewing the orders versus the therapist’s evaluations, I see a difference quite often as there is usually a medical diagnosis and then also a treatment diagnosis. I guess you could say I’m thoroughly confused at how therapy encounters are supposed to be coded because of what I am seeing compared to what I am studying in the books and guidelines.

Any advice or guidance would be much appreciated!

Thank you,
Lynn

Medical Billing and Coding Forum

Physical therapy insurances that only pay for evaluation on first visit

I’m having a hard time trying to find information about which insurances will only pay for the evaluation code for the patient’s first visit with physical therapy. Does anyone know what the insurances are or where I can find that information? Thank you!

Medical Billing and Coding Forum

CPC Exam – Evaluation & Management

Does the CPC exam currently include questions that require the examinee to know how to level an E/M code?

In other words, for the key components, do the test scenarios include the specific level, i.e., comprehensive history or moderate complexity, or does the student need to calculate this?

Thanks in advance.

Medical Billing and Coding Forum

Observation and evaluation for a Medicare Patient

Hello, I just joined AAPC to start training for CPC certification . I have a question that has been bugging me that I can’t seem to find an answer to and it may be a dumb one but I have to ask..
I work for an oral surgeons office and went to a AAOMS coding course who said we could use the Z03.89 dx for a non medicare patient and if a patient has the 3 criteria’s met: suspected condition, no signs or symptoms of suspected condition and after study, patient does not have the suspected condition. My question is what if its a medicare patient, I know they will deny this diagnosis is there any other to bill? I can’t bill the suspected condition alone do I use the Z03.89 code and let it deny and patient is responsible?

Thanks for any help,
Sandy

Medical Billing and Coding Forum

Transitional Care Management & Evaluation and Managment code SAME DAY?

Hello, just curious to see if other primary care practices are seeing Transitional Care Management Codes being used the same day as an Eval & Management code? Say they address something separate from the hospitalization, and the documentation supports, I don’t see anything that says otherwise that the provider can’t charge out a separate E&M. Thanks!

Medical Billing and Coding Forum