22 Evaluation & Management (E/M) Practice Questions & Answers

1. 1. For an office or other outpatient visit, on what basis do the current E/M guidelines permit the coder to select the level of service?

   • A.On the number of history and review-of-systems elements the provider recorded
   • B.On the extent of the physical examination and the organ systems examined
   • C.On the medical decision making or total time on the encounter date✓ Answer
   • D.On the number of separate diagnoses listed in the assessment of the note

   Since the 2021 revision of office and outpatient visits and the 2023 revision of the remaining families, the level is selected either by medical decision making or by the total time the physician or other qualified health professional spends on the date of the encounter. History and examination must be medically appropriate but no longer contribute to level selection.

   Source: AMA CPT E/M Guidelines, Guidelines for Selecting Level of Service (office/outpatient 2021; remaining categories 2023); CMS MLN006764Report a problem with this question

2. 2. Medical decision making comprises three elements: number and complexity of problems addressed, amount and complexity of data, and risk of management. How do those elements set the MDM level?

   • A.Two of the three elements must be met or exceeded at the chosen level✓ Answer
   • B.All three elements must be met or exceeded at the chosen level
   • C.The three elements are averaged and rounded up to the chosen level
   • D.The single highest-scoring of the three elements sets the chosen level

   The guidelines require that two of the three MDM elements be met or exceeded at a given level; the remaining element may fall below that level without lowering the service. Averaging the elements or using the single highest one are both misreadings of the rule.

   Source: AMA CPT E/M Guidelines, Levels of Medical Decision Making (two of three elements rule)Report a problem with this question

3. 3. A progress note lists 'hypothyroidism, followed by endocrinology, no change today.' May that condition count toward the number and complexity of problems addressed?

   • A.Yes, because referral of the problem to another specialist is itself a form of management
   • B.Yes, because any chronic illness documented in the assessment is counted as addressed
   • C.No, because the reporting provider neither evaluated nor managed the condition today✓ Answer
   • D.No, because chronic endocrine conditions are excluded from the problem element entirely

   A problem counts as addressed only when the reporting provider evaluates or treats it at that encounter. Noting that another clinician manages the condition, or referring it without evaluating it, does not make it an addressed problem, although it may still count as a comorbidity if it increases the data or risk elements.

   Source: AMA CPT E/M Guidelines, definition of 'Problem addressed' under Number and Complexity of Problems AddressedReport a problem with this question

4. 4. A patient's hypertension has remained above the documented treatment goal for a year despite therapy, although the note calls it 'stable.' How does the MDM problem element classify it?

   • A.It is stable, because the provider's own note describes the condition as stable
   • B.It is stable, because no medication change was made at today's encounter
   • C.It is not stable, because the patient has not reached the documented treatment goal✓ Answer
   • D.It is not stable, because any hypertension diagnosis is inherently unstable

   Stability in the MDM problem element is defined by the patient's treatment goals, not by the word chosen in the chart. A patient persistently not at goal is not stable, so the illness is treated as a chronic illness with exacerbation or progression rather than as a stable chronic illness.

   Source: AMA CPT E/M Guidelines, definition of 'Stable, chronic illness'Report a problem with this question

5. 5. At an office visit the provider orders a basic metabolic panel, a urinalysis, and a chest x-ray. How many unique tests are counted in the data element?

   • A.Ten, because each individual analyte inside the panel is a separately unique test
   • B.Three, because a panel reported under a single code counts as one unique test✓ Answer
   • C.Six, because ordering and later reviewing each test counts as two data points
   • D.Two, because all laboratory orders are grouped and counted as one unique test

   Each unique test is counted once, and a panel identified by a single code is one test no matter how many analytes it contains. Ordering a test and later reviewing its result are also counted only once, and tests with overlapping elements are not unique from one another.

   Source: AMA CPT E/M Guidelines, definitions of 'Unique test' and Category 1 data (tests, documents, or independent historian)Report a problem with this question

6. 6. Which discussion of patient management counts toward the data category for discussion with an external physician or other appropriate source?

   • A.A direct interactive exchange with a cardiologist who is in a different group practice✓ Answer
   • B.A conversation with the nurse practitioner employed by the reporting physician's practice
   • C.A note to a partner in the same practice and same specialty, entered in the chart
   • D.A message left with another physician's office staff that was never returned

   The discussion category requires an interactive, direct exchange with a source outside the reporting provider's group practice or specialty. Chart entries and unanswered messages relayed through staff do not qualify, and a colleague in the same group and same specialty is not external.

   Source: AMA CPT E/M Guidelines, Category 3 data (discussion of management or test interpretation) and definition of 'External'Report a problem with this question

7. 7. An office note concludes 'chest pain, probable gastroesophageal reflux disease; proton pump inhibitor trial started.' What does ICD-10-CM Section IV direct for the first-listed diagnosis?

   • A.Report the chest pain first, with the probable reflux disease added as a secondary code
   • B.Report the reflux disease first, with the chest pain added as a coexisting symptom code
   • C.Report the chest pain, because a probable condition is not coded in the outpatient setting✓ Answer
   • D.Report the reflux disease, because the clinical impression of the provider is documented

   Section IV forbids coding conditions documented as probable, suspected, questionable, or rule out in the outpatient setting. The coder reports the documented signs, symptoms, or abnormal findings instead, so the chest pain is the first-listed diagnosis and the probable reflux is not coded at all.

   Source: ICD-10-CM Official Guidelines for Coding and Reporting, Section IV.H (Uncertain Diagnosis)Report a problem with this question

8. 8. Which example meets the high-risk MDM criterion of drug therapy requiring intensive monitoring for toxicity?

   • A.Fingerstick glucose checks in a patient maintained on long-acting basal insulin
   • B.Monthly blood pressure readings for a patient taking two antihypertensive drugs
   • C.Quarterly laboratory testing for a serious adverse effect of the drug itself✓ Answer
   • D.An annual electrolyte panel obtained for a patient taking a thiazide diuretic

   Intensive monitoring for toxicity means laboratory, physiologic, or imaging surveillance for a serious adverse effect of the drug, generally at least quarterly when the therapy is long term. Routine glucose checks on insulin and an annual electrolyte panel on a diuretic are expressly excluded by the guidelines.

   Source: AMA CPT E/M Guidelines, definition of 'Drug therapy requiring intensive monitoring for toxicity'Report a problem with this question

9. 9. In the MDM risk element, how are the terms minor surgery and major surgery to be interpreted?

   • A.By whether general anesthesia rather than local anesthesia is used for the procedure
   • B.By whether the procedure is performed in an office rather than a hospital setting
   • C.By the common clinical meaning of the procedure as the treating clinician uses it✓ Answer
   • D.By the global surgical period assigned to the code, zero or ten days versus ninety

   The risk table uses minor and major in their ordinary clinical sense, as the treating clinician would use them. It does not borrow the payer's zero-, ten-, or ninety-day global period classification, which is a payment convention rather than a measure of the risk of management.

   Source: AMA CPT E/M Guidelines, Risk of Complications and/or Morbidity or Mortality of Patient Management (minor/major surgery usage note)Report a problem with this question

10. 10. Which activity by the physician on the date of an office encounter counts toward total time for level selection?

    • A.Travel time from the physician's other office to the location of the encounter
    • B.Documenting the clinical findings of that encounter in the patient's record✓ Answer
    • C.Teaching a resident general principles not specific to that patient's care
    • D.The medical assistant's time taking vital signs and updating the medication list

    Total time counts the physician's or qualified health professional's own qualifying work on the date of the encounter, including documenting the clinical information in the record. Travel, general teaching not specific to that patient, and clinical staff time are expressly excluded from total time.

    Source: AMA CPT E/M Guidelines, Time (activities that count toward total time and activities that do not)Report a problem with this question

11. 11. A physician and an advanced practice provider in the same group each see a hospital inpatient, and for ten of those minutes they are in the room together. How is that joint time handled in a split or shared visit?

    • A.Only one provider's ten minutes counts, because the same time is never counted twice✓ Answer
    • B.The joint time is excluded entirely, because two providers were present in the room
    • C.The joint time counts only for the provider who wrote and signed the progress note
    • D.Both providers' ten minutes are added, producing twenty minutes of total time

    In a split or shared visit only distinct time is summed, so time during which both providers are with the patient simultaneously may be counted once. The visit is then reported by whichever provider performed more than half of the total time, with the split or shared modifier appended.

    Source: AMA CPT E/M Guidelines, Split or Shared Visits (distinct time); CMS MLN006764 split/shared policy (modifier FS)Report a problem with this question

12. 12. Under CPT rules, when may a prolonged services add-on be reported with an outpatient office visit?

    • A.When the total time exceeds the highest level by any full five-minute increment
    • B.When the level was chosen by time and the highest level is exceeded by 15 minutes✓ Answer
    • C.When any amount of time beyond the highest level's time is documented in the note
    • D.When the level was chosen by medical decision making and the encounter ran long

    A prolonged services add-on is a two-step decision: the base visit level must have been selected by time alone, and the time of the highest level in that family must then be exceeded by a full additional 15-minute increment. Partial increments are not reportable, and Medicare uses its own G codes with later thresholds.

    Source: AMA CPT E/M Guidelines, Prolonged Service With or Without Direct Patient Contact (add-on reporting rules); CMS MLN006764 prolonged servicesReport a problem with this question

13. 13. How do the published times for office and other outpatient visits differ from the times in the families revised in 2023, such as inpatient and consultation services?

    • A.Both families use ranges, but only office visit ranges permit a prolonged services add-on
    • B.Office visits use a single threshold, while the revised families use ranges of minutes
    • C.Both families use single thresholds that must be met or exceeded to reach a given level
    • D.Office visits use a range of minutes, while the revised families use a single threshold✓ Answer

    The office and outpatient family kept the time ranges written for it in 2021, so a level applies only while the documented time falls inside that level's range. Every family revised in 2023 instead states a single time that must be met or exceeded, which is why generalizing one rule to the other misstates both the base level and any prolonged service.

    Source: AMA CPT E/M Guidelines, time statements for Office or Other Outpatient Services (ranges) versus the 2023-revised categories (met-or-exceeded thresholds)Report a problem with this question

14. 14. A physician sees a patient for the first time while covering for a group partner of the same specialty; that partner saw the patient eight months ago. What is the patient's status?

    • A.Established, but only if the covering physician also reviews the partner's prior note
    • B.New, because this particular physician has never provided a face-to-face service
    • C.Established, because a covering provider is classified as the absent one would be✓ Answer
    • D.New, because a coverage arrangement creates a separate professional relationship

    A patient is new only when no face-to-face professional service was provided within the past three years by that provider or by a provider of the exact same specialty and subspecialty in the same group practice. A physician covering for an unavailable colleague is classified exactly as that colleague would have been.

    Source: AMA CPT E/M Guidelines, New and Established Patient definitions (three-year rule; coverage arrangements)Report a problem with this question

15. 15. Which circumstance satisfies the CPT requirement for reporting a consultation service?

    • A.A patient self-refers to the specialist after reading about the condition online
    • B.An attorney requests an evaluation of the patient for pending litigation purposes
    • C.A patient's spouse asks the specialist for a second opinion about the treatment plan
    • D.A treating physician requests an opinion on a specific problem and documents that request✓ Answer

    A consultation requires a request for an opinion or advice about a specific problem from another physician, qualified health professional, or other appropriate source, and both the request and the reason must be documented. Requests originating with the patient, the family, or a non-clinical party do not qualify.

    Source: AMA CPT E/M Guidelines, Consultation Services (request and documentation requirements)Report a problem with this question

16. 16. A surgeon evaluates a Medicare Part B beneficiary in the office at the written request of the primary care physician. How should the encounter be reported to Medicare?

    • A.With an office visit code plus a consultation code for the opinion that was rendered
    • B.With an office consultation code, because the CPT request requirements were satisfied
    • C.With an office consultation code appended with the modifier for a mandated service
    • D.With an office or other outpatient visit code and no consultation code✓ Answer

    Medicare does not recognize the CPT consultation codes for Part B payment, so the consultant reports the office or other outpatient visit code that the documentation supports even though the CPT consultation criteria were met. This item depends on Medicare payment policy and should be re-verified each year.

    Source: CMS MLN006764, Evaluation and Management Services (Medicare non-recognition of CPT consultation codes)Report a problem with this question

17. 17. An emergency department note documents 55 minutes of provider time and moderate medical decision making. What determines the level of that ED visit?

    • A.Either time or decision making, whichever of the two supports the higher level
    • B.Medical decision making alone, because time is not a component of ED visit levels✓ Answer
    • C.Decision making, plus a prolonged services add-on covering the extra documented time
    • D.Total time alone, because the documented time supersedes decision making here

    Emergency department visit levels are selected by medical decision making only; time is expressly not a descriptive component of that family because ED care is typically provided in variable, interrupted intervals. Documented minutes are therefore irrelevant, and prolonged services are never added to an ED visit.

    Source: AMA CPT E/M Guidelines, Emergency Department Services (time is not a descriptive component)Report a problem with this question

18. 18. Which statement correctly describes a requirement for reporting critical care services?

    • A.The provider must give full attention to that patient and to no other during the time✓ Answer
    • B.The patient must be physically located in an intensive care unit during the service
    • C.The service must be furnished by an intensivist or a pulmonary critical care physician
    • D.The provider must document at least 60 minutes of continuous bedside attendance

    Critical care requires a critically ill or injured patient with acute impairment of one or more vital organ systems, high complexity decision making, and the provider's exclusive attention during the reported time. The time need not be continuous, and the physical setting alone never makes care critical.

    Source: AMA CPT E/M Guidelines, Critical Care Services (definition and exclusive attention requirement)Report a problem with this question

19. 19. During an annual preventive medicine visit the provider also evaluates and adjusts therapy for newly worsening asthma. How is that problem-oriented work reported?

    • A.As a separate office visit code with the modifier reporting a mandated service
    • B.As a separate office visit code with the modifier for a significant, separate service✓ Answer
    • C.As a separate office visit code carrying the modifier that reports a decision for surgery
    • D.As part of the preventive visit alone, because one code covers all work on that date

    When a significant, separately identifiable problem-oriented service is performed at the same encounter as a preventive medicine visit, both services are reported and modifier 25 is appended to the problem-oriented visit. An insignificant problem addressed in passing does not earn a second code.

    Source: AMA CPT E/M Guidelines, Preventive Medicine Services (reporting a separate problem-oriented service); CPT Appendix A, modifier 25Report a problem with this question

20. 20. A surgeon evaluates a patient in the office and decides to perform a procedure carrying a 90-day global period the next morning. Which modifier belongs on the E/M service?

    • A.The modifier reporting the decision for surgery, used with major procedures✓ Answer
    • B.The modifier reporting an unrelated procedure during the global period
    • C.The modifier reporting an unrelated E/M during the postoperative period
    • D.The modifier reporting a significant, separately identifiable E/M encounter

    Modifier 57 identifies the E/M visit at which the decision for major surgery was made, on the day of or the day before a procedure with a 90-day global period. Modifier 25 belongs instead with minor procedures carrying 0- or 10-day global periods, which is the pair candidates most often reverse.

    Source: CPT Appendix A, modifiers 25 and 57; CMS global surgery package (major versus minor procedures)Report a problem with this question

21. 21. A long-term nursing facility resident is transported to her physician's office and examined there. Which E/M category applies to the encounter?

    • A.Home or residence services, because the facility is the patient's living place
    • B.Nursing facility services, because a facility resident keeps that status all year
    • C.Office or other outpatient services, because the encounter occurred in the office✓ Answer
    • D.Nursing facility services, because the patient's residence remains that facility

    Category selection follows the place where the face-to-face encounter actually occurs, not where the patient ordinarily lives. A nursing facility resident examined in the physician's office is therefore reported with office or other outpatient visit codes for that date.

    Source: AMA CPT E/M Guidelines, category and subcategory selection by place of service; Nursing Facility Services guidelinesReport a problem with this question

22. 22. A physician conducts a synchronous audio-video visit with a Medicare beneficiary who is at home. How is the professional service most appropriately reported to Medicare?

    • A.With a virtual check-in code, because this encounter did not occur in person
    • B.With a telemedicine evaluation and management code from the audio-video code series
    • C.With an office visit code appended with the modifier identifying an audio-only visit
    • D.With an office or outpatient visit code, a telehealth place of service and a modifier✓ Answer

    Medicare treats the CPT telemedicine E/M codes as non-covered and instead expects the office or other outpatient visit code with the telehealth place of service and the modifier identifying the audio-video mode. This item rests on Medicare telehealth policy, which has changed recently and should be re-verified each year.

    Source: CMS MLN006764 and Medicare Telehealth Services list (telehealth POS 02/10 and modifiers 93/95); CPT telemedicine E/M services guidelinesReport a problem with this question

Practice questions based on the ICD-10-CM Official Guidelines for Coding and Reporting, the AMA CPT guidelines, the CMS HCPCS Level II system, and federal healthcare compliance law. CPC is a mark of the AAPC and CPT is a mark of the American Medical Association; this site is not affiliated with or endorsed by either. ICD-10-CM, CPT, and HCPCS Level II are revised every year, so these questions test coding rules and conventions rather than code values — always verify actual code selection against the current code books and your payer's published policy. Nothing here is medical, legal, or billing advice. About the CPC exam →