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CEDC practice questions

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Question 1Emergency Department Facility and Professional Coding Guidelines

A patient is seen in the emergency department for a level 4 visit and receives a splint application for a wrist fracture. Under facility-based emergency department coding guidelines, how are the E/M service and the splint reported?

  1. The splint replaces the E/M service, which is not reported.
  2. The splint is reported separately with the E/M service because it is a distinct procedure. Correct answer.
  3. The splint is reported only when the physician performs it, never by the facility.
  4. The splint is bundled into the E/M service and is not separately reported.

Explanation

Facility ED coding follows a structure in which significant, separately identifiable procedures such as splint application are reported in addition to the E/M level, since the facility's resources are consumed by both. Bundling applies to services integral to another procedure, not to a distinct immobilization device.

Question 2Emergency Department Facility and Professional Coding Guidelines

In emergency department facility coding, which element is used to assign the facility E/M level rather than the physician's medical decision-making?

  1. The physician's medical decision-making complexity
  2. The number of nursing interventions and resources consumed Correct answer.
  3. The physician's documented history and exam
  4. The patient's chief complaint at triage

Explanation

Facility ED E/M levels are driven by the resources the facility expends, such as nursing time, interventions, and staff involvement, not by the physician's history, exam, or medical decision-making. The physician's documentation drives the professional claim.

Question 3Emergency Department Facility and Professional Coding Guidelines

Which code set is used to report diagnoses on an emergency department claim?

  1. ICD-10-CM Correct answer.
  2. ICD-10-PCS
  3. CPT
  4. HCPCS Level II

Explanation

Diagnoses are reported with ICD-10-CM, the classification system for diseases and conditions in all U.S. healthcare settings. CPT and HCPCS report services and supplies, while ICD-10-PCS reports inpatient procedures only.

Question 4Emergency Department Facility and Professional Coding Guidelines

An emergency department visit is coded at level 5 by the facility. Which statement best reflects the relationship between the facility E/M level and the professional E/M level for the same encounter?

  1. The professional level is always higher than the facility level.
  2. They are assigned independently and may differ. Correct answer.
  3. They must always be identical.
  4. The facility level is always lower than the professional level.

Explanation

Facility and professional E/M levels are determined by different criteria (resources versus physician work/MDM) and are assigned independently, so they may legitimately differ. There is no rule forcing them to match or establishing a fixed ordering.

Question 5Emergency Department Facility and Professional Coding Guidelines

What does the term 'critical care' require for reporting in the emergency department?

  1. Care provided only by an intensivist
  2. Any patient admitted to the ICU from the ED
  3. Care for a critically ill or injured patient with high complexity and time documented Correct answer.
  4. A patient with a single unstable vital sign

Explanation

Critical care requires the patient to be critically ill or injured and the care to involve high complexity with time documented, reflecting the physician's full attention. A single abnormal vital sign or an ICU admission alone does not establish critical care.

Question 6Emergency Department Facility and Professional Coding Guidelines

A patient presents with chest pain and the ED physician orders an ECG, troponin, and chest radiograph. Under facility coding, these diagnostic services are:

  1. Bundled into the E/M level and never separately reportable
  2. Reported separately when they are distinct and documented Correct answer.
  3. Reported only if the patient is admitted
  4. Reported only if ordered by a specialist

Explanation

Diagnostic tests such as ECG, laboratory, and radiology are distinct services with their own codes and are reported separately by the facility when performed and documented. They are not folded into the E/M level.

Question 7Emergency Department Facility and Professional Coding Guidelines

Which modifier is used on a professional claim to indicate that a procedure was performed on the same day as an E/M service but was significant and separately identifiable?

  1. Modifier 24
  2. Modifier 59
  3. Modifier 57
  4. Modifier 25 Correct answer.

Explanation

Modifier 25 indicates a significant, separately identifiable E/M service performed on the same day as another procedure or service. It allows the E/M to be paid in addition to the procedure.

Question 8Emergency Department Facility and Professional Coding Guidelines

An ED physician evaluates a patient and decides to perform an emergency appendectomy. Which modifier supports the E/M service in addition to the surgical procedure?

  1. Modifier 25
  2. Modifier 50
  3. Modifier 57 Correct answer.
  4. Modifier 76

Explanation

Modifier 57 is used when the E/M service results in the initial decision to perform surgery, supporting separate payment for the E/M on the same day or the day before the procedure. It signals the decision for surgery.

Question 9Emergency Department Facility and Professional Coding Guidelines

A patient is treated in the ED and discharged. Which place-of-service code applies to the facility claim?

  1. 23 (Emergency room - hospital) Correct answer.
  2. 22 (On-campus outpatient hospital)
  3. 21 (Inpatient hospital)
  4. 11 (Office)

Explanation

Place of service 23 designates an emergency room in a hospital and is used for ED facility services. Place of service 21 is for inpatient hospital, 11 for physician office, and 22 for hospital outpatient.

Question 10Emergency Department Facility and Professional Coding Guidelines

Which statement correctly describes how the emergency department facility reports observation services?

  1. Observation is reported with its own code set separate from the ED E/M. Correct answer.
  2. Observation is always reported with the ED E/M code on the same claim line.
  3. Observation is reported as an inpatient admission.
  4. Observation cannot be reported by the facility.

Explanation

Observation services have their own codes and are reported separately from the ED E/M service when the patient is placed in observation. They are distinct from both the ED visit and an inpatient admission.

Question 11Emergency Department Facility and Professional Coding Guidelines

A patient is seen in the ED and later admitted as an inpatient on the same day. How is the ED E/M service reported by the facility?

  1. It is not reported because the patient was admitted.
  2. It is converted to an inpatient code.
  3. It is reported with the ED E/M code as a separate service. Correct answer.
  4. It is reported only if the admission occurs after midnight.

Explanation

The ED facility E/M service is reportable when the patient is treated in the ED, even if the patient is subsequently admitted. The ED visit and the inpatient stay are separate services with separate reporting.

Question 12Emergency Department Facility and Professional Coding Guidelines

Which of the following best describes 'medical decision-making' as a component of professional ED E/M leveling?

  1. The number of nursing staff involved in care
  2. The number of tests ordered regardless of results
  3. The complexity of establishing diagnoses and selecting management options Correct answer.
  4. The total time the patient spends in the ED

Explanation

Medical decision-making reflects the complexity of establishing diagnoses, assessing the patient's condition, and selecting management options. It is a physician-work criterion, not a measure of tests ordered or time in the department.

Question 13Emergency Department Facility and Professional Coding Guidelines

A patient receives a tetanus vaccine and wound care in the ED. Under facility coding, the vaccine product is reported:

  1. As part of the E/M level with no separate code
  2. Only if the patient is admitted
  3. With the vaccine administration code only
  4. Separately with a product code in addition to administration Correct answer.

Explanation

The vaccine product and its administration are separately reportable; the product is reported with its own code and the administration with an administration code. Neither is folded into the E/M level.

Question 14Emergency Department Facility and Professional Coding Guidelines

Which statement about reporting supplies used during an ED visit is most accurate?

  1. Supplies are never reportable by the facility.
  2. Supplies are reported with diagnosis codes.
  3. Some supplies may be separately reportable when they meet specific criteria. Correct answer.
  4. All supplies are always bundled into the E/M level.

Explanation

Certain supplies may be separately reportable when they meet specific criteria and are documented, while others are considered routine and bundled. Supplies are not reported using diagnosis codes.

Question 15Emergency Department Facility and Professional Coding Guidelines

A patient is treated in the ED for a laceration requiring complex repair. How does the facility report the repair?

  1. Separately with a repair code in addition to the E/M Correct answer.
  2. As an inpatient procedure
  3. Only with a diagnosis code
  4. Bundled into the E/M level

Explanation

A laceration repair is a distinct procedure reported with its own code in addition to the facility E/M service. It is not bundled into the E/M level.

Question 16Emergency Department Facility and Professional Coding Guidelines

What is the primary purpose of the facility E/M leveling system in the emergency department?

  1. To reflect the patient's insurance type
  2. To reflect the hospital resources required to treat the patient Correct answer.
  3. To reflect the physician's years of experience
  4. To reflect the number of diagnoses coded

Explanation

The facility E/M level reflects the hospital resources required to treat the patient, such as staff time and interventions. It does not reflect physician experience, insurance type, or diagnosis count.

Question 17Emergency Department Facility and Professional Coding Guidelines

Which of the following is an example of a procedure that would typically be reported separately by the facility in addition to the ED E/M service?

  1. Reviewing the patient's medication list
  2. Documenting the chief complaint
  3. Incision and drainage of an abscess Correct answer.
  4. Taking the patient's temperature

Explanation

Incision and drainage of an abscess is a distinct procedure with its own code and is separately reportable in addition to the E/M service. Vital signs, medication review, and documentation are integral to the E/M.

Question 18Emergency Department Facility and Professional Coding Guidelines

Under the professional ED coding framework, which combination of elements may be used to select the E/M level?

  1. Only the history
  2. Only the physical exam
  3. Only the number of tests ordered
  4. History, exam, and medical decision-making (or time) Correct answer.

Explanation

Professional E/M leveling considers the key components of history, exam, and medical decision-making, or time when applicable. A single element or test count alone does not set the level.

Question 19Emergency Department Facility and Professional Coding Guidelines

An ED visit is documented as level 3 by the physician, but the facility resources clearly support a higher level. What is the correct coding approach?

  1. Code the facility level based on facility criteria independently of the physician's level. Correct answer.
  2. Refuse to code the encounter.
  3. Code both at the physician's level 3.
  4. Code both at the higher level.

Explanation

Facility and professional levels are determined independently; the facility level should follow facility resource criteria even if it differs from the physician's assigned level. The two levels need not match.

Question 20Emergency Department Facility and Professional Coding Guidelines

Which of the following situations would most likely justify reporting critical care in the ED?

  1. A patient in respiratory failure requiring prolonged physician attention Correct answer.
  2. A stable patient with a sprained ankle
  3. A patient requesting a work note
  4. A patient with a mild rash

Explanation

Critical care requires a critically ill or injured patient and high-complexity care with documented time. Respiratory failure requiring prolonged attention fits that threshold, whereas stable minor complaints do not.

Question 21Emergency Department Facility and Professional Coding Guidelines

When reporting an ED E/M service, which place-of-service designation is inappropriate for the facility claim?

  1. 11 Correct answer.
  2. 21
  3. 23
  4. 22

Explanation

Place of service 11 designates a physician office and is not appropriate for a hospital emergency department facility claim. Codes 23, 22, and 21 relate to hospital settings.

Question 22Emergency Department Facility and Professional Coding Guidelines

Which code set is used to report the professional services and procedures performed by the emergency physician?

  1. CPT Correct answer.
  2. ICD-10-PCS
  3. DSM-5
  4. ICD-10-CM

Explanation

CPT is the code set for reporting physician and other professional services and procedures. ICD-10-CM reports diagnoses, ICD-10-PCS reports inpatient procedures, and DSM-5 is a diagnostic manual for mental disorders.

Question 23Emergency Department Facility and Professional Coding Guidelines

A patient is seen in the ED for a foreign body removal from the ear. Under facility coding, the removal is:

  1. Reported only with a diagnosis code
  2. Bundled into the E/M level
  3. Reported as an inpatient procedure
  4. Reported separately with a procedure code in addition to the E/M Correct answer.

Explanation

Foreign body removal is a distinct procedure with its own code and is reported separately by the facility in addition to the E/M service. It is not bundled into the E/M level.

Question 24Emergency Department Facility and Professional Coding Guidelines

Which statement best describes the role of documentation in ED facility coding?

  1. Documentation is optional if the coder knows the typical resource use.
  2. Documentation must support the resources and services reported. Correct answer.
  3. Documentation is replaced by the triage note.
  4. Documentation only matters for the professional claim.

Explanation

Documentation must support the resources and services reported on the facility claim; coders cannot assign levels based on assumptions. It is required for both facility and professional reporting.

Question 25Emergency Department Facility and Professional Coding Guidelines

A patient presents to the ED and is treated and released without admission. Which term describes this encounter type for reporting purposes?

  1. Surgical encounter
  2. Inpatient encounter
  3. Outpatient encounter Correct answer.
  4. Observation encounter

Explanation

An ED visit in which the patient is treated and released without admission is an outpatient encounter. Inpatient status requires admission, and observation is a distinct status.

Question 26Emergency Department Facility and Professional Coding Guidelines

Under the facility coding guidelines for emergency department services, which code set is used to report the facility's emergency department evaluation and management encounter?

  1. Healthcare Common Procedure Coding System Level II codes
  2. Diagnosis codes from the ICD-10-CM manual
  3. Current Procedural Terminology surgical codes only
  4. CPT evaluation and management codes from the 99281-99285 range Correct answer.

Explanation

Facility ED encounters are reported with the CPT ED visit E/M codes (99281-99285), which describe the resources the hospital expends. Diagnosis codes describe the patient's condition but do not replace the E/M encounter code.

Question 27Emergency Department Facility and Professional Coding Guidelines

A patient is brought to the ED and pronounced dead shortly after arrival, with no resuscitative services provided. How should the facility report this encounter?

  1. With no facility charge because the patient died
  2. With an observation code because the patient was not admitted
  3. With a critical care code because the patient was unstable
  4. With an ED E/M code reflecting the resources used for the pronouncement Correct answer.

Explanation

When a patient is pronounced dead in the ED without resuscitation, the facility reports an ED E/M code reflecting the evaluation performed. Critical care requires active delivery of critical care services, and observation requires an observation encounter.

Question 28Emergency Department Facility and Professional Coding Guidelines

Which element distinguishes the professional emergency physician claim from the facility claim for the same ED encounter?

  1. The professional claim never includes procedure codes
  2. The professional claim uses only ICD-10-CM diagnosis codes
  3. The professional claim is submitted by the hospital under the facility NPI
  4. The professional claim reflects the physician's own work and is billed under the physician's NPI Correct answer.

Explanation

The professional claim captures the physician's cognitive and procedural work and is billed under the physician's own NPI. The facility claim captures the hospital's resources and is billed under the hospital's NPI.

Question 29Emergency Department Facility and Professional Coding Guidelines

An ED encounter involves a patient with a life-threatening condition requiring constant physician attention and multiple interventions over 45 minutes. Which reporting approach best reflects this encounter on the facility claim?

  1. Report a consultation code because of the complexity
  2. Report the critical care service in addition to any separately identifiable procedures Correct answer.
  3. Report an observation service for the duration of the encounter
  4. Report only the highest-level ED E/M code with no additional services

Explanation

Critical care is reported when a patient has a critical illness or injury requiring the physician's full attention, and separately identifiable procedures may be reported in addition. The time and intensity described support critical care rather than a standard ED E/M level.

Question 30Emergency Department Facility and Professional Coding Guidelines

A patient is registered in the ED, evaluated, and then kept in the ED for ongoing monitoring beyond the typical ED stay without an inpatient order. How is this time reported by the facility?

  1. As a second ED E/M encounter for each additional hour
  2. As part of the original ED E/M code with no additional reporting
  3. As observation services when the criteria for observation are met Correct answer.
  4. As an inpatient admission from the time of registration

Explanation

When a patient remains in the ED for extended monitoring and observation criteria are met, the facility reports observation services. Observation requires appropriate status and documentation rather than simply extending the ED visit.

Question 31Evaluation and Management Services in the Emergency Department

Under the standard CMS evaluation and management documentation framework, which element is required to report an emergency department visit at a level that reflects moderate medical decision making?

  1. Two or more stable chronic illnesses with mild exacerbation Correct answer.
  2. One acute uncomplicated illness or injury
  3. A chronic illness with severe exacerbation
  4. A single self-limited minor problem

Explanation

The 2021+ E/M framework counts the number and complexity of problems addressed. Moderate complexity includes two or more stable chronic illnesses with mild exacerbation, an undiagnosed new problem with uncertain prognosis, or an acute illness with systemic symptoms. A single self-limited problem reflects low complexity.

Question 32Evaluation and Management Services in the Emergency Department

An emergency physician documents a history and physical that supports a level 4 visit, but the medical decision making documented supports only a level 3. Under the current E/M rules, how should the visit be coded?

  1. Level 3, because either MDM or time may set the level and the lower-supported element governs when both are documented Correct answer.
  2. Level 4, because the history and exam support the higher level
  3. Level 4, because the physician's stated level overrides the elements
  4. Level 5, because emergency visits are presumed high acuity

Explanation

Under the 2021+ rules, the level of service is determined by medical decision making or by total time, whichever is documented and supported. When both are documented, the coder selects the level supported by the element that establishes the code, and the lower-supported element cannot be used to justify a higher code.

Question 33Evaluation and Management Services in the Emergency Department

Which statement best describes how total time may be used to select an emergency department E/M level?

  1. Time includes the entire encounter on the date of service, including bedside care and record review Correct answer.
  2. Time counts only direct face-to-face bedside care
  3. Time counts only the documented history and examination minutes
  4. Time is not a valid basis for ED E/M level selection

Explanation

When time is used to select the level, total time on the date of the encounter includes both face-to-face and non-face-to-face activities performed by the reporting practitioner, such as review of records and order entry. It is not limited to bedside minutes.

Question 34Evaluation and Management Services in the Emergency Department

A patient is seen in the ED and the physician orders a complete blood count, a basic metabolic panel, and a urinalysis, all performed in the hospital laboratory. How are these tests counted for medical decision making?

  1. Only tests that change management are counted
  2. Each test is counted once per order, so repeat orders multiply the count
  3. All laboratory tests are bundled and count as one
  4. Each unique test is counted once regardless of how many times it is ordered Correct answer.

Explanation

For the data element of MDM, each unique test, order, or document is counted once toward the complexity threshold, even if ordered or reviewed multiple times. Bundling all tests into one undercounts the data reviewed.

Question 35Evaluation and Management Services in the Emergency Department

Which of the following best illustrates a prescription drug management element that raises MDM complexity?

  1. The physician orders a new antibiotic and adjusts an existing insulin dose Correct answer.
  2. The physician recommends a saline gargle for a sore throat
  3. The physician instructs the patient to rest and hydrate
  4. The physician advises the patient to use an over-the-counter analgesic

Explanation

Prescription drug management involves decisions about initiating, continuing, or adjusting prescription medications. Ordering a new antibiotic and adjusting an insulin dose both constitute prescription drug management. Over-the-counter advice and supportive measures do not.

Question 36Evaluation and Management Services in the Emergency Department

When selecting an emergency department E/M level using medical decision making, how many MDM elements must be met or exceeded to qualify for a given level?

  1. Two of the three elements Correct answer.
  2. All three of the elements
  3. The highest single element alone
  4. One of the three elements

Explanation

To report a level based on MDM, two of the three elements (problems, data, and risk) must meet or exceed the requirements for that level. Requiring all three is too strict, and using only one element is too lenient.

Question 37Evaluation and Management Services in the Emergency Department

An ED physician evaluates a patient with chest pain and orders an electrocardiogram and troponin, then reviews the results and admits the patient. Which MDM element most directly captures the decision to admit?

  1. Total time on the date of the encounter
  2. Number and complexity of problems addressed
  3. Risk of complications and morbidity or mortality Correct answer.
  4. Amount and complexity of data reviewed

Explanation

The risk element addresses the risk of complications, morbidity, and mortality associated with the patient's condition and the management selected, including decisions such as hospital admission. Data and problems elements describe other dimensions of MDM.

Question 38Evaluation and Management Services in the Emergency Department

Which encounter is appropriately reported with an emergency department E/M code rather than an office or outpatient code?

  1. A patient receiving a scheduled infusion in an outpatient center
  2. A patient seen in a freestanding clinic for a routine physical
  3. A patient evaluated in a physician office for a rash
  4. A patient treated in the hospital ED for an acute asthma exacerbation Correct answer.

Explanation

Emergency department E/M codes are reported for services provided in the ED of a hospital or in a facility that meets the definition of an emergency department, such as a freestanding ED. Routine office and clinic visits use outpatient E/M codes.

Question 39Evaluation and Management Services in the Emergency Department

A patient presents to the ED with a complex laceration requiring layered repair. Which factor most affects whether a separate procedure code can be reported with the ED E/M service?

  1. Whether the procedure was performed by the same physician on the same day
  2. Whether the patient arrived by ambulance
  3. Whether the hospital is a trauma center
  4. Whether the procedure is separately identifiable and the E/M service is significant and separately documented Correct answer.

Explanation

When a procedure is performed on the same day as an E/M service by the same physician, a separate E/M code may be reported only if the E/M service is significant, separately identifiable, and documented beyond the usual pre- and post-procedure work. Arrival mode and facility type do not control this.

Question 40Evaluation and Management Services in the Emergency Department

During an ED visit the physician reviews outside hospital records from a prior admission and independently interprets an ECG. How are these counted in the data element of MDM?

  1. Both are bundled into a single data point
  2. Neither counts because they were not ordered during this visit
  3. Review of outside records and independent ECG interpretation each count as data reviewed Correct answer.
  4. Only the ECG interpretation counts because records review is bundled

Explanation

The data element counts review of records from an outside source and independent interpretation of a test the physician did not order as separate categories of data. Bundling them understates the data complexity.

Question 41Evaluation and Management Services in the Emergency Department

An ED physician treats a patient with a simple finger sprain, providing a brief history, a limited exam, and an over-the-counter analgesic recommendation. Which MDM level is best supported?

  1. High
  2. Straightforward Correct answer.
  3. Low
  4. Moderate

Explanation

A single self-limited minor problem with no prescription drug management, minimal data, and low risk supports straightforward medical decision making. Low complexity would require a low-level problem or some data/risk element.

Question 42Evaluation and Management Services in the Emergency Department

A physician documents a level 5 ED visit based on high MDM and also documents 45 minutes of total time. The time thresholds for the reported code require 60 minutes. Which statement is correct?

  1. The time must be discarded and the level set by history and exam
  2. The visit cannot be reported because time and MDM conflict
  3. The visit must be downcoded because documented time is below the threshold
  4. The level may still be supported by the MDM even though the documented time is below the threshold for that level Correct answer.

Explanation

MDM and time are alternative bases for level selection. If the MDM supports the reported level, a documented time below that level's time threshold does not require downcoding, because the level is supported by MDM.

Question 43Evaluation and Management Services in the Emergency Department

A patient presents with an undiagnosed new problem with an uncertain prognosis, such as a new suspected malignancy. How does this affect the problem element of MDM?

  1. It supports high complexity
  2. It supports low complexity
  3. It supports moderate complexity Correct answer.
  4. It supports straightforward complexity

Explanation

An undiagnosed new problem with uncertain prognosis is explicitly listed in the moderate complexity tier for the problem element. It does not rise to high complexity, which requires a threat to life or severe exacerbation.

Question 44Evaluation and Management Services in the Emergency Department

A physician orders a drug that carries a moderate risk of morbidity when the patient's condition is stable. How is this classified in the risk element of MDM?

  1. High risk
  2. Low risk
  3. Moderate risk Correct answer.
  4. Minimal risk

Explanation

The risk element classifies prescription drug management with a moderate risk of morbidity under the moderate risk tier. High risk involves drugs with severe risk or decisions such as emergency major surgery.

Question 45Evaluation and Management Services in the Emergency Department

How does the ED E/M framework treat a patient who is critically ill and requires immediate intervention?

  1. Critical care cannot be reported in the ED
  2. Critical care requires a separate procedure code for each intervention
  3. Critical care codes may be reported when the physician provides critical care, with time documented Correct answer.
  4. The visit must be reported as a level 5 ED E/M code only

Explanation

Critical care services are reported using critical care codes when the physician provides critical care to a critically ill patient, with time documented. Critical care is distinct from the ED E/M level codes and may be reported in the ED setting.

Question 46Evaluation and Management Services in the Emergency Department

A patient is brought to the ED by ambulance after a motor vehicle collision and is stabilized and discharged. Which factor most influences the MDM complexity for this encounter?

  1. The number and complexity of problems addressed and the risk of the workup Correct answer.
  2. The patient's insurance status
  3. The mode of arrival by ambulance
  4. The time spent waiting for a bed

Explanation

MDM complexity is driven by the problems addressed, the data reviewed, and the risk of complications. Mode of arrival, insurance status, and wait times do not factor into MDM.

Question 47Evaluation and Management Services in the Emergency Department

A physician performs a bedside ultrasound and independently interprets it to guide management. How is this captured in MDM?

  1. Independent interpretation of the test counts as data reviewed Correct answer.
  2. Only the order for the ultrasound counts, not the interpretation
  3. Ultrasound interpretation is excluded from MDM
  4. The ultrasound is bundled with the physical exam and not counted

Explanation

Independent interpretation of a test the physician did not order, including bedside ultrasound, counts as data reviewed under the data element. It is not bundled into the physical exam.

Question 48Evaluation and Management Services in the Emergency Department

An ED physician evaluates a patient with two stable chronic illnesses, each with mild exacerbation, and orders no tests. Which MDM level is best supported by the problem element alone?

  1. High
  2. Low
  3. Straightforward
  4. Moderate Correct answer.

Explanation

Two or more stable chronic illnesses with mild exacerbation fall in the moderate complexity tier for the problem element. However, two of three MDM elements must meet the level, so the data and risk elements must also be assessed.

Question 49Evaluation and Management Services in the Emergency Department

A patient is seen in the ED for a work-related injury. Which statement about reporting the ED E/M service is correct?

  1. The service is reported as a preventive visit
  2. The ED E/M service is reported based on the documented elements regardless of the payer source Correct answer.
  3. The service cannot be reported if the injury is work-related
  4. The service must be reported with a workers' compensation code only

Explanation

The ED E/M level is selected based on the documented elements of the encounter. Payer source, including workers' compensation, does not change how the E/M level is determined, though billing may involve separate coordination.

Question 50Evaluation and Management Services in the Emergency Department

A physician documents a history and exam that would support a level 3 visit and MDM that supports a level 4 visit. Which statement reflects the current E/M framework?

  1. The level may be selected based on MDM, which supports level 4 Correct answer.
  2. The visit must be reported as level 5
  3. The level must be level 3 because history and exam are lower
  4. The level must be averaged between the two

Explanation

Under the current framework, the level is selected by MDM or time, not by history and exam. When MDM supports level 4, that level may be reported even if the history and exam would have supported a lower level under the old framework.