Question 1

What are the three key components used to select E&M levels for office visits under the 1995/1997 guidelines?

Accepted Answer

History, Examination, and Medical Decision Making (MDM). All three are considered for new patients; only two of three are required for established patients.

Question 2

Under the 2021 E&M guidelines for office visits, what are the two acceptable bases for selecting the level of service?

Accepted Answer

Medical Decision Making (MDM) or total time spent on the date of the encounter. History and exam are no longer used to determine the level.

Question 3

What is the CPT code range for Office or Other Outpatient Services E&M codes?

Accepted Answer

99202–99215. Codes 99202–99205 are for new patients; 99211–99215 are for established patients.

Question 4

How is a 'new patient' defined for E&M purposes?

Accepted Answer

A patient who has not received any professional services from the physician or another physician of the same specialty and subspecialty in the same group practice within the past three years.

Question 5

Which E&M code level does NOT require a medically necessary encounter to be reported and is typically performed by clinical staff?

Accepted Answer

99211 – This is the lowest established patient office visit code and does not require a physician or qualified health care professional to be present.

Evaluation & Management (E&M) – CPC Medical Coding Certification

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