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19 multiple-choice questions and 7 flashcards on CPT Coding — Evaluation & Management, about 11% of the Medical Coder bank. Every one carries a written rationale.
CPT Coding — Evaluation & Management is one of 6 chapters in CoStudy's Medical Coder (CPC/AAPC) bank, and it holds 19 of the bank's 173 multiple-choice questions — roughly 11% of the total. That proportion is not arbitrary: chapters follow the certifying body's published exam outline, and the number of questions in each is set by that domain's published weight, so the share of your practice time this chapter takes matches the share of the real exam it accounts for.
Studying by chapter is worth doing once you have a diagnostic score. A single overall percentage tells you whether you are close; it does not tell you which domain is dragging. Working a weak chapter in isolation, and re-testing it in isolation, is the fastest way to move a score that has stalled — and it is why the mock exams in CoStudy report by domain rather than as one number.
10 questions drawn from this chapter, with the full rationale shown — the controlling principle behind the right answer, and why each wrong option tempts and fails.
Incident-to billing in a physician office requires:
Answer: B — Physician direct supervision in the office suite
Direct supervision (physician immediately available in the office suite, not necessarily in the same room) for incident-to billing under physician NPI at 100% Medicare rate.
Subsequent hospital care, moderate complexity MDM, is:
Answer: D — 99232
99231 low, 99232 moderate, 99233 high. 99238 is hospital discharge day management (30 min or less).
Office consultation request from another provider — for Medicare patients in 2010+, the coder should report:
Answer: B — Appropriate office/outpatient E/M codes (99202-99215)
A) Consultation codes 99241-99245 were eliminated from Medicare payment policy in 2010. B) Correct — Medicare directs coders to the appropriate new or established office/outpatient E/M code (99202-99215) based on visit level. C) Initial hospital codes apply to inpatient consultations in specific settings, not this office scenario. D) CMS did not create a replacement code for consultations; it redirected billing to existing E/M code sets.
A physician provides E/M to a patient on the same date as a minor procedure with a 10-day global. To bill the E/M separately, the coder should append:
Answer: B — Modifier -25 to E/M
-25 = significant, separately identifiable E/M on same day as minor procedure. -57 is for major surgery (90-day global). -24 is in global period for unrelated E/M.
In 2021, outpatient E/M (99202-99215) selection is based on:
Answer: D — Medical Decision Making OR total time
A) Pre-2021. B) Correct — major change. C/D) Wrong.
Physician spends 55 minutes on date of encounter for an established patient visit (face-to-face + chart review + ordering). Which time-based code applies?
Answer: C — 99215 + 99417
99215 covers 40-54 min established. At 55 min you've crossed into prolonged service. 99417 add-on for each additional 15 min beyond the minimum of the highest-level code.
Telehealth synchronous service modifier:
Answer: B — -95 (current standard)
A) Older. B) Correct. C/D) Other.
Preventive medicine, new patient age 12-17 years:
Answer: D — 99384
New patient preventive: 99381 <1, 99382 1-4, 99383 5-11, 99384 12-17, 99385 18-39. Established uses 99391-99397.
Established patient seen in office with two stable chronic conditions and a refill of a prescription drug. MDM most likely supports which code?
Answer: C — 99214
Two stable chronic problems + prescription drug management = moderate MDM = 99214. 99213 = low MDM (one stable chronic).
New patient (E/M) means not seen by physician (or same-specialty group) in:
Answer: D — 3 years
A/C/D) Wrong. B) Correct — 3-year rule.
4 cards from the 7 in this chapter.
2021 E/M revision?
Outpatient E/M (99202-99215) now selected by Medical Decision Making (MDM) OR total time. History + exam no longer drive code level. Major change.
E/M codes?
Evaluation + Management (99202-99499). Office visits, hospital visits, consults, ED visits, preventive care. Most common codes in outpatient billing.
Modifier -25?
Significant, separately identifiable E/M service by same physician on same day as procedure. Allows E/M billing alongside procedure.
New vs. established patient?
New: not seen by physician (or same-specialty group) in 3 years. Established: seen in past 3 years.
These are a sample. The full CPT Coding — Evaluation & Management chapter runs 26 items with per-chapter progress tracking, on the web and in the iOS app.
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