Apply E/M Time Rules - Certified Professional Coder CPC

1. A physician performs a joint injection (separately reported) at the same encounter as an established patient office visit. The physician documents 35 total minutes. How is time calculated for the E/M service?
   Answer: The time for the separately reported injection must be excluded; only the remaining E/M time counts Per 2021 CPT® E/M guidelines, time spent on separately reported services performed at the same encounter is excluded from the E/M time calculation. If the joint injection required 10 minutes of physician time, only the remaining 25 minutes would count toward the E/M level. This prevents double-billing for time already captured in a separately reported procedure.
2. Under the 2021 E/M guidelines, a physician may select the E/M level based on either medical decision making (MDM) or total time. If the physician chooses to use time, what documentation requirement must be met?
   Answer: The total time spent on the date of the encounter must be documented in the medical record When a physician elects to use total time as the basis for E/M level selection under 2021 guidelines, the total time spent on the date of the encounter must be documented in the medical record. Without this documentation, time cannot support the level billed. The physician may choose either MDM or time — whichever supports the service performed — but must document accordingly.
3. A physician uses time to select an E/M level for a new patient encounter. The physician documents the visit took "about 45 minutes." Is this documentation acceptable for time-based coding?
   Answer: No — the exact total time must be documented; approximations are not sufficient Documentation must state the actual total time spent on the date of the encounter. Phrases like "about 45 minutes" or "approximately" introduce ambiguity and are generally not sufficient to support time-based E/M selection upon audit. The physician should document the specific total time to defend the level billed.
4. A nurse practitioner (NP) performs an office visit and documents 30 total minutes. The supervising physician reviews the note and countersigns but adds no additional time. Whose time counts for E/M level selection?
   Answer: Only the NP's time, since they personally performed the service Under 2021 E/M guidelines, the time counted for E/M level selection is the time of the individual provider who performed and documented the service. In this case, the NP performed the visit and documented 30 minutes — that is the time used for code selection. Time cannot be aggregated between different providers unless they are billing as a split/shared visit under specific guidelines.
5. A physician documents 65 total minutes on the date of an encounter with a new patient. Using time, which codes are reported?
   Answer: 99205 For new patients under 2021 E/M time thresholds, 99205 = 60–74 minutes. A documented 65 total minutes falls within this range, supporting 99205 alone. Add-on code 99417 is only reported when total time exceeds 74 minutes for new patients. No additional code is needed at 65 minutes.
6. Prolonged office visit services (99417) can be reported in addition to which of the following E/M codes?
   Answer: 99205 or 99215 only, when time exceeds the maximum threshold for those codes Add-on code 99417 (prolonged office or other outpatient evaluation and management service) is reported only in conjunction with 99205 (new patient) or 99215 (established patient) — the highest-level office visit codes — when total time exceeds the maximum time threshold for those codes (74 minutes for new patients, 54 minutes for established patients). It cannot be added to lower-level E/M codes.
7. Under CMS teaching physician guidelines for office visits, which statement correctly describes how the teaching physician's time is counted for time-based E/M level selection when a resident is involved in the encounter?
   Answer: The teaching physician may count only the time they personally spent on the encounter on the date of service Under CMS teaching physician guidelines, when time is used as the basis for E/M level selection, the teaching physician may count only the time they personally spent on the encounter on the date of service. The resident's time cannot be added to the teaching physician's time. This differs from the teaching physician rules for MDM-based selection, which have their own documentation standards. The teaching physician's personally documented time is the sole basis for time-based level selection.
8. Under the 2021 E/M guidelines, which of the following activities performed on the date of the encounter counts toward total time for an office visit?
   Answer: Coordinating care with a referring physician via phone after the patient leaves Coordination of care activities performed on the date of the encounter — including phone calls, electronic communications, and consultations with other providers related to the patient's visit — count toward total E/M time. However, time for separately reported services (EKG interpretation, procedures) is excluded. Care coordination on the day of the visit, even after the patient departs, is included.
9. Under the 2021 E/M guidelines, a physician may use either total time or MDM to select the E/M level. If both methods are documented, what is the correct approach to code selection?
   Answer: The higher-level code supported by either method is reported When both total time and MDM are documented, the physician may report the E/M level supported by the higher of the two methods. The 2021 guidelines allow either basis for code selection, and if both are present, the one that supports the higher level of service accurately reflecting the work performed may be used, provided the documentation supports it.
10. A physician documents 80 total minutes on the date of an established patient encounter. Which CPT® codes are reported using time-based selection?
    Answer: 99215, 99417 For established patients, 99215 covers 40-54 minutes. Beyond 54 minutes, add-on code 99417 is reported for each additional 15-minute increment. At 80 total minutes: 80 - 54 = 26 minutes beyond the threshold. The first 15-minute unit (minutes 55-69) supports one unit of 99417. The remaining 11 minutes (70-80) do not complete a second 15-minute increment, so a second unit of 99417 is not reportable. Report 99215 and 99417 x1.
11. A physician provides care management services via telephone for 25 minutes with a patient who was seen in the office 4 days ago. The call addresses the same problem as the recent office visit. How is this telephone service reported?
    Answer: It is not separately reportable; it is bundled into the prior office visit Per CPT® guidelines, telephone E/M services (99441–99443) are not reported when they occur within 7 days of a related E/M service. Since the call occurred within 4 days of the related office visit and addresses the same problem, the telephone service is considered part of the pre/post-service work of the prior visit and is not separately reportable.
12. A physician provides an office consultation. The consultation takes 45 total minutes. Medicare does not recognize consultation codes. Which code is reported for this Medicare patient using time-based selection for an established patient?
    Answer: 99215 Medicare does not recognize CPT® consultation codes (99241–99245, 99251–99255). For Medicare patients, the appropriate new or established patient office visit code is reported. For an established patient with 45 documented total minutes, the 2021 time threshold supports 99215 (40–54 minutes for established patients). Consultation codes 99243 and 99244 are not reportable to Medicare regardless of the time documented.
13. A physician sees a new patient and documents 47 total minutes on the date of the encounter. Using time as the basis for code selection, which office visit code is reported?
    Answer: 99204 For new patients under 2021 E/M time thresholds: 99202 = 15-29 minutes; 99203 = 30-44 minutes; 99204 = 45-59 minutes; 99205 = 60-74 minutes. A total of 47 minutes falls within the 45-59 minute range for 99204. Time must be documented in the medical record when used as the basis for E/M level selection.
14. A physician sees a patient for an office visit and then performs a 20-minute preventive counseling service (99401) at the same encounter. The total time documented is 55 minutes. For the E/M office visit, which time is counted?
    Answer: 55 minutes minus the 20 minutes for the separately reported counseling service Time attributable to separately reported services must be excluded from the E/M time calculation. If 20 minutes were spent on the separately reported preventive counseling (99401), then 35 minutes remain for the E/M visit time. For an established patient, 35 minutes supports 99214. The separately reported service captures its own time, and that time cannot also count toward the E/M level.
15. Under the 2021 CPT® E/M guidelines, which of the following activities is included when calculating total time for an office visit?
    Answer: Time spent documenting the visit after the patient leaves Total time for E/M coding under 2021 guidelines includes all time on the date of the encounter: pre-visit review, face-to-face time, and post-encounter documentation/coordination on that same date. Time spent reviewing records on a prior day, time for separately billed services, or time on unrelated patients does not count toward the E/M visit time.
16. A physician provides hospital discharge services that take 35 minutes of total time on the date of discharge. Which discharge day management code is reported?
    Answer: 99239 Hospital discharge day management codes are time-based: 99238 covers 30 minutes or less; 99239 covers more than 30 minutes. At 35 minutes of total discharge management time, 99239 is the appropriate code. These codes are reported for the final hospital discharge and encompass examination, discharge instructions, and preparation of discharge records.
17. A physician's documentation states: "I spent 25 minutes in face-to-face time with this established patient discussing her diagnosis and treatment options." Under 2021 E/M guidelines, is this documentation sufficient for time-based code selection?
    Answer: No — total time on the date of the encounter must be documented, not just face-to-face time Under 2021 CPT® E/M guidelines, it is total time on the date of the encounter that drives level selection — not just face-to-face time. Documentation of face-to-face time alone is not sufficient. The physician must document total time spent on the encounter date, which may include non-face-to-face activities such as record review, test ordering, and documentation.
18. Under the 2021 CPT® E/M guidelines for office and outpatient visits, a physician documents a total of 32 minutes spent on the date of the encounter with an established patient, including reviewing prior records, face-to-face time, and ordering tests after the visit. Which E/M code is supported?
    Answer: 99214 Under 2021 E/M time thresholds for established patients: 99212 = 10–19 minutes; 99213 = 20–29 minutes; 99214 = 30–39 minutes; 99215 = 40–54 minutes. A total of 32 minutes falls within the 30–39 minute range, supporting 99214. Total time includes all physician or QHP time on the date of the encounter related to this patient, not just face-to-face time.
19. A physician's note states: "Reviewed prior labs (5 min), face-to-face with patient (20 min), documented note and ordered follow-up studies (10 min). Total time today: 35 minutes." Which E/M code does this support?
    Answer: 99214 Total documented time of 35 minutes supports 99214 for an established patient (30–39 minutes). The documentation appropriately captures all components of total time on the date of the encounter: pre-visit record review, face-to-face time, and post-visit documentation — all occurring on the same date and all related to this encounter.
20. A physician provides subsequent hospital care for an established inpatient and documents 35 total minutes on the date of service. Which subsequent hospital care code is supported?
    Answer: 99232 For subsequent hospital inpatient or observation care under 2021 time thresholds: 99231 = 25-34 minutes; 99232 = 35-44 minutes; 99233 = 45-59 minutes. A documented 35 minutes falls within the 35-44 minute range, supporting 99232.

Start this quiz