Selecting E/M levels by medical decision making or time, new versus established patients, place of service, and modifier 25 usage.
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- Under current CPT guidelines, what are the two methods for selecting an office/outpatient E/M code level?
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Medical decision making (MDM) or total time- What defines a 'new patient' for E/M coding?
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A patient who has not received any professional service from the physician or another physician of the same specialty in the same group within the past 3 years- What defines an 'established patient' for E/M coding?
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A patient who has received a professional service from the physician or a same-specialty group member within the past 3 years- What are the three elements of Medical Decision Making (MDM)?
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Number and complexity of problems addressed, amount and complexity of data reviewed and analyzed, and risk of complications, morbidity, or mortality- How many of the three MDM elements must be met or exceeded to set the overall MDM level?
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At least 2 of 3- What are the four MDM levels, from lowest to highest?
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Straightforward, low, moderate, high- Since 2021, ____ are no longer used to select the level of office or outpatient E/M visit codes.
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history and physical exam- What is the CPT code range for new patient office/outpatient visits?
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99202-99205- What is the CPT code range for established patient office/outpatient visits?
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99211-99215- Why was CPT code 99201 deleted in 2021?
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Its MDM level overlapped with 99202 (both straightforward), making it redundant- What does 'total time' include when using time to select an office/outpatient E/M level?
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All time personally spent by the physician on the date of the encounter, both face-to-face and non-face-to-face (such as chart review and documentation)- Does clinical staff time count toward total time for E/M time-based coding?
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No, only the billing provider's own personal time counts- When selecting an office/outpatient E/M level, can the coder choose whichever of MDM or time gives the appropriate (even higher) level?
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Yes, the method producing the correct level may be used- What is a 'self-limited or minor problem' in MDM problem complexity scoring?
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A problem that runs a definite and prescribed course, is transient, and is unlikely to permanently alter health status- What defines a 'chronic illness with exacerbation' for MDM problem scoring?
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A chronic condition that has become worse, is poorly controlled, or is progressing, requiring additional treatment
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