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Question 1
According to CPT guidelines, if a history and/or physical examination is medically appropriate and performed, what is true?
Correct Answer:
They are included in the service
Explanation:
In CPT coding, the history and physical examination are bundled into the evaluation and management service. When a history and/or physical is medically appropriate and performed during an encounter, those elements help determine the level of service but are not billed as separate codes. The E/M code you choose already accounts for the work of taking history and conducting the exam, along with the medical decision making. Only in cases where a distinctly separate and independently billable service is performed would you bill separately; the H&P itself isn’t billed on its own.
Question 2
Initial Hospital/Observation code for moderate MDM?
Correct Answer:
99222
Explanation:
For an initial hospital encounter, the level of medical decision making (MDM) determines the code, and the hospital inpatient set uses 99221, 99222, and 99223 for increasing complexity. Moderate MDM falls in the middle, which is coded as 99222. If the patient were in observation status, the initial observation codes (99218–99220) apply, with moderate MDM mapped to 99219—not an option here. So, given the scenario and choices, the best match for moderate MDM on an initial hospital encounter is 99222.
Question 3
What does MDM most accurately reflect?
Correct Answer:
The amount of work a provider performs during E/M service.
Explanation:
MDM measures the complexity of the physician's decision making during the encounter. It reflects how much cognitive and interpretive work is required to evaluate problems, review data, and determine management. The level of MDM depends on factors like how many problems are being addressed, the amount and complexity of data reviewed (tests, records, literature), and the risk of complications or morbidity associated with the proposed management. That combination drives how "heavy" the decision making is. This is why the best answer uses language about the amount of work involved in the E/M service—it captures the overall effort and complexity of the decisions the provider must make. It’s not about total time spent (time-based coding), not simply the number of procedures performed, and not patient satisfaction, which do not determine MDM. For example, a single problem with straightforward data and low risk yields low MDM, whereas multiple problems requiring substantial data review and high-risk management yields high MDM.
Question 4
An established patient in the office visits an 18‑month‑old infant admitted to hospital from the office to rule out sepsis. If cultures are negative and the patient remains afebrile for 48 hours, which CPT code is reported for this visit?
Correct Answer:
99222, 99214-25
Explanation:
When a patient is admitted to the hospital from an outpatient office visit, you bill the admission with an initial hospital care code for the day of admission. If there was a separate, identifiable office E/M service on the same day, you also report the office visit code and append modifier -25 to show it’s a distinct service. In this scenario, the 18‑month‑old is an established patient seen in the office and then admitted to the hospital to rule out sepsis. The appropriate initial hospital care level for the admission is 99222. Since there was an office visit on the same day that is a separate service, you also bill the office E/M code 99214 and add modifier -25 to indicate the office visit is distinct from the admission. So, the correct reporting is 99222 and 99214-25. The initial hospital admission code captures the inpatient care, while the Office visit code with the -25 modifier ensures reimbursement for the separate, concurrent office evaluation.
Question 5
Which is a top error in Evaluation and Management coding?
Correct Answer:
The chief complaint is missing
Explanation:
The most fundamental element here is the reason for the visit. The chief complaint anchors the entire encounter—it's what justifies the patient’s visit, guides what history and examination elements are needed, and supports the medical necessity for the level of service reported. When the chief complaint is missing, the chart loses the narrative that ties the patient’s problem to the care provided, making it hard to justify the chosen CPT code and to demonstrate that the visit was medically appropriate. Auditors consistently flag missing chief complaints as a leading documentation error because it undermines the purpose and justification of the encounter. Administrative details like spelling of the patient’s name or the facility address are important for record accuracy, but they do not drive the coding level or medical necessity in the same way. Having the CPT code correct is important, but without a clear chief complaint, the rationale for the service remains unclear, which is why missing the chief complaint is the top error.
Question 1
Exam overview

About this Exam

The Certified Professional Medical Auditor (CPMA) designation is a specialized credential that validates an individual's expertise in reviewing medical records and documentation for accuracy, compliance, and optimal reimbursement. This E/M (Evaluation and Management) Practice Exam is designed for professionals who have already mastered basic medical coding and are now preparing for the critical medical auditing certification. It specifically targets those seeking focused practice on the complex documentation requirements for E/M services, including the significant guideline updates. Successful completion of the actual CPMA exam demonstrates a mastery of medical auditing and compliance concepts, marking you as a vital asset to healthcare organizations

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Additional Information

What the Course Entails and Exam Details

To effectively utilize this practice exam, you must first understand the core topics covered in a CPMA E/M course. The practice test focuses intensely on auditing Evaluation and Management services, including:

  • In-Depth E/M Guidelines: Master the application of both historical (1995 and 1997) and current (2021 and 2023) E/M documentation guidelines for both office/outpatient and inpatient settings.
  • Medical Decision Making (MDM): Analyze the components of MDM—the number and complexity of problems addressed, the amount and/or complexity of data reviewed and analyzed, and the risk of complications and/or morbidity or mortality—as the primary driver for E/M leveling.
  • Time-Based Leveling: Understand and apply the criteria for using time as the basis for selecting E/M levels when counseling and/or coordination of care dominates the encounter.
  • Key Service Types: Auditing specific service locations, including Emergency Department services, hospital inpatient services, consultations, critical care, and nursing facility services.
  • Auditing Methodologies: Applying systematic review techniques to identify errors, patterns, and areas of non-compliance within medical records.

This practice exam will likely contain approximately 50 to 100 multiple-choice questions focusing purely on Evaluation and Management services. It is an indispensable tool for simulating the pressure and content of the specialization section of the main certification.

 

 

What to Expect in the Final Exam

While this tool is a practice exam, it is crucial to understand the structure of the actual CPMA certification exam administered by AAPC (American Academy of Professional Coders). Here is what you should expect in the official proctored environment:

  • Exam Format: The full CPMA exam is a computer-based, proctored examination consisting of 100 multiple-choice questions.
  • Proctoring: You will be required to select either an approved local chapter or an accredited testing center, where a live proctor will oversee the session.
  • Time Limit: You are allotted exactly 4 hours to complete the entire examination.
  • Passing Score: To obtain your CPMA credential, you must achieve a score of 70% or higher.
  • Specific Rules: This is a comprehensive exam covering multiple domains, with only approximately 20?dicated explicitly to Evaluation and Management auditing. The remain percentage focuses on compliance, regulation, and other medical auditing methodologies. Be prepared for a mix of case studies and direct knowledge questions.

Your E/M Practice Exam should be taken under similar timed conditions to build stamina and speed.

 

How to Study and Exam Centers

Preparation for the specialized E/M auditing requirements of the CPMA exam is vital. Because the 2021 and 2023 guideline changes are recent and significant, dedicated study is required for success.

Actionable Study Strategies:

Master the Guidelines: Make the current AAPC E/M audit tool and the official 2021/2023 guidelines your daily companions. Understand the nuances between office and facility requirements.

Practice on Real Records: Seek permission to audit redacted or sample medical records within your organization or from educational resources. Practice determining the MDM level and identifying missing documentation.

Take the E/M Practice Exam Seriously: Time yourself. Mimic the exam environment. Review all incorrect answers, even the ones you got right but felt uncertain about. Understand the "why" behind the correct application.

Official CPMA Study Guide: Utilize the official study guide provided by the AAPC, as it contains targeted content and end-of-chapter quizzes that are highly relevant to the actual test questions.

Exam Centers:

For the actual CPMA certification, you will not need to find a specialized CPMA center, as AAPC utilizes standard testing pathways. You will register and schedule your proctored exam through the AAPC website. Your options generally include:

  • Authorized Schools: Many approved medical coding schools and colleges serve as test sites for their students and the public.
  • Online Proctoring: AAPC offers the ability to take the exam remotely from the comfort of your home or office, provided you meet strict technical and physical environment requirements, and use their specific proctoring software.
  • Local Chapters: Some local chapters of the AAPC hold scheduled proctored exam dates.

The E/M Practice Exam is typically taken online, on-demand, from any location with internet access, once purchased.

 

Job Opportunities from the Course

Earning your CPMA certification drastically enhances your profile, signaling specialized skills in demand by healthcare providers, hospital systems, and payers. This qualification unlocks various high-level career paths in medical auditing and compliance, including:

  • Certified Professional Medical Auditor (CPMA)
  • Medical Compliance Officer
  • Healthcare Fraud Investigator
  • Clinical Documentation Improvement (CDI) Specialist
  • Medical Coding Manager/Auditor
  • External Audit Consultant for Payer Organizations
  • Coding Quality Analyst
  • Internal Auditor for Physician Practices

This certification is your ticket to a career focused on accuracy, revenue integrity, and regulatory compliance.

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