Top E/M Coding Interview Questions and Answers: Prepare Like a Pro!"

Top E/M Coding Interview Questions and Answers: Prepare Like a Pro!"

 

Evaluation and Management (E/M) coding is a cornerstone of medical billing and compliance. Whether you're an experienced coder or just starting, preparing for an interview on E/M coding can be daunting. This article provides a comprehensive list of E/M coding interview questions and answers to help you stand out. Let's dive in!

 


Basic E/M Coding Questions

1. What is E/M coding?
Answer:
E/M coding refers to a set of Current Procedural Terminology (CPT) codes used to report physician and other provider services, such as office visits, hospital consultations, and more. It captures the complexity of medical decision-making, patient history, and physical examination.

 

2. Can you explain the components of E/M coding?
Answer:
E/M coding involves three key components:

1.     History – Includes the patient's chief complaint, history of present illness (HPI), review of systems (ROS), and past, family, and social history (PFSH).

2.     Examination – Focuses on the extent and detail of the physical exam conducted.

3.     Medical Decision-Making (MDM) – Assesses the complexity of diagnosing and treating the patient, including the risks and data reviewed.

 

3. What are the levels of E/M services?
Answer:
E/M services are categorized into five levels, each with increasing complexity and requirements. These levels determine the appropriate CPT code to use, reflecting the time spent and complexity of the service provided.

 

Intermediate E/M Coding Questions

4. How do you determine the appropriate level of E/M code?
Answer:
The appropriate level is determined by reviewing:

·         The documentation of history, examination, and MDM.

·         Time spent (if time is the key factor in code selection).

·         Specific guidelines set forth by CPT and payer-specific rules.

 

5. What is the difference between 1995 and 1997 E/M guidelines?
Answer:
The 1995 guidelines provide more general documentation requirements for history and examination, while the 1997 guidelines are more specific and include detailed "bullet points" for each organ system. Coders can choose either set, depending on the best fit for the documentation provided.

 

6. How is time used in E/M coding?
Answer:
Time is used as a deciding factor when over 50% of the visit involves counseling or coordination of care. Starting in 2021, time has become a critical element for office visits and outpatient codes, based on total time spent on the day of the encounter.

 

Advanced E/M Coding Questions

7. How do you handle discrepancies in documentation for E/M coding?
Answer:
If discrepancies exist, I:

1.     Cross-check documentation with the provider's notes.

2.     Consult the physician to clarify.

3.     Ensure the final code reflects the service provided while maintaining compliance.

 

8. How do you ensure compliance with E/M coding regulations?
Answer:
I:

·         Stay updated on changes in coding guidelines (e.g., CMS updates).

·         Regularly audit records for accuracy.

·         Ensure proper training for providers and staff.

·         Use official coding tools like the CPT manual and payer-specific guidance.

 

9. What are the 2021 changes to E/M coding, and how do they affect coding?
Answer:
The 2021 changes focus on:

·         Simplifying code selection based on time or MDM.

·         Eliminating the need to document unnecessary information (e.g., ROS and PFSH when irrelevant).

·         Increasing emphasis on patient-centered care and streamlined documentation.

 

10. How do modifiers impact E/M coding?
Answer:
Modifiers provide additional context about a service, such as:

·         Modifier 25: Significant, separately identifiable E/M service on the same day as another procedure.

·         Modifier 24: E/M service unrelated to a surgery during the global period.
Proper use of modifiers is crucial to avoid claim denials.

 

Tips to Ace Your E/M Coding Interview

·         Review common CPT codes and guidelines.

·         Practice interpreting sample medical charts for code selection.

·         Stay updated on CMS guidelines and payer-specific policies.

·         Be prepared to discuss compliance strategies.

 

Mastering E/M coding interview questions is key to showcasing your expertise and securing your desired role. With these questions and answers, you'll feel confident and prepared. Remember, E/M coding requires attention to detail and a commitment to compliance—qualities every employer values.


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