Certified Professional Coder (CPC) Quiz: Apply E M Time Rules
20 questions · exam conditions
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Apply E M Time RulesQuestion 1 of 20

A physician documents 80 total minutes on the date of an established patient encounter. Which CPT® codes are reported using time-based selection?

99215 only
99215, 99417 x2
99205, 99417
99215, 99417
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Certified Professional Coder (CPC) Quiz

Certified Professional Coder (CPC) Quiz: Apply E M Time Rules

Practice Apply E M Time Rules in Certified Professional Coder (CPC) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Apply E M Time Rules, giving you a quick way to practice the rules, question types, and explanations that matter most for Certified Professional Coder (CPC).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A physician documents 80 total minutes on the date of an established patient encounter. Which CPT® codes are reported using time-based selection?

  1. 99215 only
  2. 99215, 99417 x2
  3. 99205, 99417
  4. 99215, 99417 (correct answer)
Explanation: 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.

Question 2

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?

  1. 99204 (correct answer)
  2. 99203
  3. 99417
  4. 99205
Explanation: 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.

Question 3

For a new patient office visit, a physician documents 22 total minutes on the date of the encounter. Which E/M code is supported by time?

  1. 99201
  2. 99203
  3. 99202 (correct answer)
  4. 99204
Explanation: Under 2021 E/M time thresholds for new patients: 99202 = 15-29 minutes; 99203 = 30-44 minutes. A documented total of 22 minutes falls within the 15-29 minute range, supporting 99202. Note that 99201 was deleted from CPT® in 2021; the lowest new patient office visit code is now 99202.

Question 4

A physician is treating a patient in the ICU and provides critical care services. The physician documents 90 total minutes of critical care time. Which CPT® codes are reported?

  1. 99291 only
  2. 99291, 99292 (correct answer)
  3. 99291, 99292 x2
  4. 99292 x3
Explanation: CPT® 99291 covers the first 30-74 minutes of critical care time. Add-on code 99292 is reported for each additional 30 minutes or part thereof, requiring at least 15 minutes beyond the prior threshold to report an additional unit. At 90 total minutes: 99291 accounts for the first 74 minutes; the remaining 16 minutes exceeds the 15-minute minimum, supporting one unit of 99292. Report 99291 and 99292 x1. A second unit of 99292 would require total critical care time of at least 120 minutes.

Question 5

Under the 2021 CPT® E/M guidelines, which of the following activities is included when calculating total time for an office visit?

  1. Time spent reviewing the patient's chart the day before the visit
  2. Time spent on a separately reported procedure performed at the same encounter
  3. Time spent documenting the visit after the patient leaves (correct answer)
  4. Time spent on a phone call with a specialist about a different patient
Explanation: 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.

Question 6

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?

  1. 99212
  2. 99213
  3. 99214 (correct answer)
  4. 99215
Explanation: 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.

Question 7

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?

  1. 99441 — telephone E/M service, 5–10 minutes
  2. 99442 — telephone E/M service, 11–20 minutes
  3. 99443 — telephone E/M service, 21–30 minutes
  4. It is not separately reportable; it is bundled into the prior office visit (correct answer)
Explanation: 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.

Question 8

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?

  1. All 55 minutes
  2. 55 minutes minus the 20 minutes for the separately reported counseling service (correct answer)
  3. Only the face-to-face time with the patient
  4. 55 minutes, but the counseling code reduces the E/M level by one
Explanation: 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.

Question 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?

  1. The higher-level code supported by either method is reported (correct answer)
  2. The lower-level code supported by either method must be reported
  3. The physician must use only one method; using both is a compliance violation
  4. The payer determines which method is applied
Explanation: 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.

Question 10

A physician's note states that a new patient encounter required 50 total minutes, but the MDM documentation supports only a low complexity level (99203). May the physician report 99204 based on the time documented?

  1. No — the lower of the two methods must always be used
  2. No — time and MDM must agree for a code to be reported
  3. Yes, but only with modifier -22 to indicate the discrepancy
  4. Yes — under 2021 guidelines, the physician may use either MDM or total time, and 50 minutes supports 99204 for a new patient (correct answer)
Explanation: Under 2021 CPT® E/M guidelines, the physician may choose either MDM or total time as the basis for E/M level selection — they are independent, alternate pathways. If total time of 50 minutes supports 99204 (45–59 minutes for new patients), the physician may report 99204 even if MDM alone would have supported only 99203. Documentation of the total time must be present in the note.

Question 11

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?

  1. All 35 minutes count toward the E/M code since it was the same encounter
  2. The time for the separately reported injection must be excluded; only the remaining E/M time counts (correct answer)
  3. Only the face-to-face time during the injection is excluded
  4. The E/M cannot be reported on the same day as a procedure
Explanation: 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.

Question 12

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?

  1. 99212
  2. 99213
  3. 99214 (correct answer)
  4. 99215
Explanation: 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.

Question 13

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?

  1. 99243
  2. 99214
  3. 99244
  4. 99215 (correct answer)
Explanation: 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.

Question 14

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?

  1. Yes — face-to-face time alone is sufficient under 2021 guidelines
  2. No — the physician must document both face-to-face and non-face-to-face time separately
  3. No — total time on the date of the encounter must be documented, not just face-to-face time (correct answer)
  4. Yes, but only if MDM also supports the same level
Explanation: 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.

Question 15

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?

  1. Yes — approximate time is acceptable under 2021 guidelines
  2. Yes — approximate time is acceptable as long as the note is otherwise detailed
  3. No — only start and end clock times are acceptable
  4. No — the exact total time must be documented; approximations are not sufficient (correct answer)
Explanation: 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.

Question 16

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?

  1. The teaching physician may count only the time they personally spent on the encounter on the date of service (correct answer)
  2. The combined time of the resident and teaching physician is used regardless of whether the teaching physician was present during the resident's portion
  3. The resident's time may be added to the teaching physician's time if the teaching physician reviews and countersigns the resident's note
  4. Time-based E/M coding cannot be used for teaching physician encounters under CMS rules
Explanation: 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.

Question 17

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?

  1. Only the supervising physician's time
  2. The combined time of both the NP and the supervising physician
  3. Only the NP's time, since they personally performed the service (correct answer)
  4. Time cannot be used by non-physician providers for E/M coding
Explanation: 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.

Question 18

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?

  1. The total time spent on the date of the encounter must be documented in the medical record (correct answer)
  2. Only the start and end time of the face-to-face portion must be documented
  3. Time documentation is optional since MDM is the primary selection method
  4. The physician must document that time was the basis for the visit only when complexity warrants it
Explanation: 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.

Question 19

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?

  1. Reviewing results from a test performed three days ago by a different provider
  2. Independently reviewing and interpreting an EKG that is separately billed
  3. Coordinating care with a referring physician via phone after the patient leaves (correct answer)
  4. Performing a separately reported surgical procedure at the same visit
Explanation: 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.

Question 20

A hospitalist documents initial hospital inpatient care with a total time of 60 minutes on the date of the encounter. Under time-based selection, which initial hospital care code is supported?

  1. 99222 (correct answer)
  2. 99221
  3. 99232
  4. 99223
Explanation: For initial hospital inpatient or observation care under 2021 time thresholds: 99221 = 40-54 minutes; 99222 = 55-69 minutes; 99223 = 70-84 minutes. A documented 60 minutes falls within the 55-69 minute range for 99222. These thresholds apply when using time as the basis for initial hospital care code selection.