CPMA Medical Auditor Practice Questions - AAPC Certified Professional Medical Auditor Exam

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Case 004 (E/M MDM and Time Validation): At a revenue-cycle QA checkpoint, an auditor is preparing a formal report to leadership. An office E/M level appears overstated. What is the most defensible validation method?

Reconstruct level selection using documented MDM elements or qualifying total time per current guidance. Downgrade every visit with limited history regardless of MDM evidence. Use billed diagnosis count alone to validate E/M level. Accept provider-selected level when claim payment was successful.

Correct Answer:

Reconstruct level selection using documented MDM elements or qualifying total time per current guidance.

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