Rheumatology Coding Corner Question: Coding & Billing Basics

1. When reporting E/M service levels, if time spent counseling and/or coordinating care dominates the session, which of the following is true?
   • Total time must be documented
   • Greater than 50% of the time must be for face-to-face counseling and/or coordinating care
   • The extent of the counseling and/or coordinating care must be documented
   • All of the above
2. Which of the following is true when applying modifier -25?
   • This modifier can always be used when the diagnoses are different
   • Never use this modifier when the diagnoses are the same
   • It should only be appended to an E/M service code
   • Always use this modifier for a new patient
3. Which formula would you use to calculate the unadjusted RVUs for a procedure performed in the office setting?
   • Work RVUs + Facility Practice Expense RVUs + Malpractice RVUs
   • Work RVUs + Facility Practice Expense RVUs + GPCI
   • Work RVUs + Non-Facility Practice Expense RVUs + Malpractice RVUs
   • Work RVUs + Non-Facility Practice Expense RVUs + GPCI
4. You may append modifier XS for a secondary procedure within the same anatomic site (for example, when reporting two arthrocentesis procedures in the same knee).
   • True
   • False
5. When determining an E/M service level, which is the single most important factor to be determined from the documentation?
   • Medical necessity
   • Medical decision making
   • History
   • Exam
6. Using the General Equivalent Mappings (GEMs) is an acceptable method to implement ICD-10-CM in a small practice.
   • True
   • False

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