Certified Professional Coder (CPC®) Exam Prep 2026
Updated Practice Questions – Comprehensive Professional
Medical Coding Review Detailed Explanations – Verified
Answers – Complete Success Workbook
SECTION 1: EVALUATION & MANAGEMENT (E/M) (~10 Questions)
Question 1
A 45-year-old established patient presents to the office with a new complaint of
chest pain. The physician performs a detailed history, a detailed examination,
and the medical decision making (MDM) is of moderate complexity. What is the
correct E/M code?
A) 99212 – Office visit, established patient; straightforward MDM
B) 99214 – Office visit, established patient; moderate MDM
C) 99213 – Office visit, established patient; low MDM
D) 99215 – Office visit, established patient; high MDM
Rationale: For established patient office visits, code selection is based on
either Medical Decision Making (MDM) or total time. A detailed history,
detailed exam, and moderate complexity MDM corresponds to 99214. Established
patient E/M codes range from 99211–99215.
Question 2
A new patient presents to the office for a comprehensive initial visit. The physician
documents a comprehensive history, a comprehensive examination, and high
complexity MDM. What is the correct E/M code?
A) 99202 – New patient; straightforward MDM
B) 99203 – New patient; low MDM
C) 99205 – New patient; high MDM
D) 99204 – New patient; moderate MDM
Rationale: For new patient office visits, codes range from 99202–99205. A
comprehensive history, comprehensive exam, and high complexity MDM
corresponds to 99205. New patient E/M codes are 99202–99205.
,Question 3
A physician spends 45 minutes providing a face-to-face visit with an established
patient. The visit involves moderate complexity MDM. The physician documents
total time. What is the correct E/M code?
A) 99213 – 20–29 minutes
B) 99214 – 30–39 minutes
C) 99215 – 40–54 minutes
D) 99212 – 10–19 minutes
Rationale: When selecting E/M codes based on total time, the code corresponds to
the total time spent on the date of the encounter. For an established patient, 99214
corresponds to 30–39 minutes. Since the physician spent 45 minutes, 99215 (40–
54 minutes) would be the correct code if time-based. However, the scenario states
moderate MDM, which also supports 99214.
Question 4
A physician performs a prolonged service with direct patient contact lasting 75
minutes beyond the typical time for a level 5 established patient visit (40–54
minutes). What is the correct coding approach?
A) Code 99215 only
B) Code 99215 with prolonged service code(s)
C) Code 99215 with modifier -25
D) Code 99214 with prolonged service code(s)
Rationale: When a physician provides prolonged services beyond the typical time
for the primary E/M service, the appropriate prolonged service code(s) are reported
in addition to the primary E/M code. For 2026, prolonged service codes should be
applied according to the current CPT guidelines.
Question 5
A physician performs a consultation in the office for a new patient referred by
another physician. What is the correct coding approach for 2026?
,A) Use consultation codes 99241–99245
B) Use new patient office visit codes 99202–99205
C) Use established patient codes 99211–99215
D) Use inpatient consultation codes only
Rationale: CPT codes for office/outpatient consultations (99241–99245) were
deleted in 2022. For 2026, consultations in the office setting are coded using the
appropriate new patient (99202–99205) or established patient (99211–
99215) E/M codes, depending on whether the patient is new to the practice.
Question 6
A physician performs an E/M service on the same day as a minor procedure. The
E/M service is significant and separately identifiable from the procedure. What
modifier should be appended to the E/M code?
A) Modifier -51
B) Modifier -25
C) Modifier -59
D) Modifier -57
Rationale: Modifier -25 is used when a significant, separately identifiable E/M
service is performed by the same physician on the same day as a minor procedure.
The E/M service must be distinct from the procedure and not part of the
procedure's global package.
Question 7
A physician performs a comprehensive history and comprehensive exam on
a new patient with low complexity MDM. What is the correct E/M code?
A) 99202 – New patient; straightforward MDM
B) 99203 – New patient; low MDM
C) 99204 – New patient; moderate MDM
D) 99205 – New patient; high MDM
Rationale: For new patients, the code is based on MDM or time. Low complexity
MDM corresponds to 99203, regardless of the history and exam levels. New
patient codes are 99202–99205.
, Question 8
A physician performs a telehealth visit with an established patient for
management of diabetes. The physician documents low complexity MDM. What
is the correct E/M code?
A) 99212 – Established; straightforward MDM
B) 99213 – Established; low MDM
C) 99214 – Established; moderate MDM
D) 99211 – Established; minimal service
Rationale: Telehealth visits for established patients are coded using the same E/M
codes as in-person visits. Low complexity MDM corresponds to 99213 for
established patients.
Question 9
A physician performs an E/M service on the same day as a major surgery (global
period 90 days). The E/M service resulted in the decision for surgery. What
modifier should be used?
A) Modifier -25
B) Modifier -51
C) Modifier -57
D) Modifier -59
Rationale: Modifier -57 is used when an E/M service results in the decision to
perform a major surgical procedure (global period 90 days) on the same day or
the day before. The E/M service is considered part of the global surgical package
and is not separately reimbursed unless modifier -57 is used.
Question 10
An established patient presents for a routine follow-up for hypertension. The
physician documents a problem-focused history, a problem-focused
examination, and straightforward MDM. What is the correct E/M code?
Updated Practice Questions – Comprehensive Professional
Medical Coding Review Detailed Explanations – Verified
Answers – Complete Success Workbook
SECTION 1: EVALUATION & MANAGEMENT (E/M) (~10 Questions)
Question 1
A 45-year-old established patient presents to the office with a new complaint of
chest pain. The physician performs a detailed history, a detailed examination,
and the medical decision making (MDM) is of moderate complexity. What is the
correct E/M code?
A) 99212 – Office visit, established patient; straightforward MDM
B) 99214 – Office visit, established patient; moderate MDM
C) 99213 – Office visit, established patient; low MDM
D) 99215 – Office visit, established patient; high MDM
Rationale: For established patient office visits, code selection is based on
either Medical Decision Making (MDM) or total time. A detailed history,
detailed exam, and moderate complexity MDM corresponds to 99214. Established
patient E/M codes range from 99211–99215.
Question 2
A new patient presents to the office for a comprehensive initial visit. The physician
documents a comprehensive history, a comprehensive examination, and high
complexity MDM. What is the correct E/M code?
A) 99202 – New patient; straightforward MDM
B) 99203 – New patient; low MDM
C) 99205 – New patient; high MDM
D) 99204 – New patient; moderate MDM
Rationale: For new patient office visits, codes range from 99202–99205. A
comprehensive history, comprehensive exam, and high complexity MDM
corresponds to 99205. New patient E/M codes are 99202–99205.
,Question 3
A physician spends 45 minutes providing a face-to-face visit with an established
patient. The visit involves moderate complexity MDM. The physician documents
total time. What is the correct E/M code?
A) 99213 – 20–29 minutes
B) 99214 – 30–39 minutes
C) 99215 – 40–54 minutes
D) 99212 – 10–19 minutes
Rationale: When selecting E/M codes based on total time, the code corresponds to
the total time spent on the date of the encounter. For an established patient, 99214
corresponds to 30–39 minutes. Since the physician spent 45 minutes, 99215 (40–
54 minutes) would be the correct code if time-based. However, the scenario states
moderate MDM, which also supports 99214.
Question 4
A physician performs a prolonged service with direct patient contact lasting 75
minutes beyond the typical time for a level 5 established patient visit (40–54
minutes). What is the correct coding approach?
A) Code 99215 only
B) Code 99215 with prolonged service code(s)
C) Code 99215 with modifier -25
D) Code 99214 with prolonged service code(s)
Rationale: When a physician provides prolonged services beyond the typical time
for the primary E/M service, the appropriate prolonged service code(s) are reported
in addition to the primary E/M code. For 2026, prolonged service codes should be
applied according to the current CPT guidelines.
Question 5
A physician performs a consultation in the office for a new patient referred by
another physician. What is the correct coding approach for 2026?
,A) Use consultation codes 99241–99245
B) Use new patient office visit codes 99202–99205
C) Use established patient codes 99211–99215
D) Use inpatient consultation codes only
Rationale: CPT codes for office/outpatient consultations (99241–99245) were
deleted in 2022. For 2026, consultations in the office setting are coded using the
appropriate new patient (99202–99205) or established patient (99211–
99215) E/M codes, depending on whether the patient is new to the practice.
Question 6
A physician performs an E/M service on the same day as a minor procedure. The
E/M service is significant and separately identifiable from the procedure. What
modifier should be appended to the E/M code?
A) Modifier -51
B) Modifier -25
C) Modifier -59
D) Modifier -57
Rationale: Modifier -25 is used when a significant, separately identifiable E/M
service is performed by the same physician on the same day as a minor procedure.
The E/M service must be distinct from the procedure and not part of the
procedure's global package.
Question 7
A physician performs a comprehensive history and comprehensive exam on
a new patient with low complexity MDM. What is the correct E/M code?
A) 99202 – New patient; straightforward MDM
B) 99203 – New patient; low MDM
C) 99204 – New patient; moderate MDM
D) 99205 – New patient; high MDM
Rationale: For new patients, the code is based on MDM or time. Low complexity
MDM corresponds to 99203, regardless of the history and exam levels. New
patient codes are 99202–99205.
, Question 8
A physician performs a telehealth visit with an established patient for
management of diabetes. The physician documents low complexity MDM. What
is the correct E/M code?
A) 99212 – Established; straightforward MDM
B) 99213 – Established; low MDM
C) 99214 – Established; moderate MDM
D) 99211 – Established; minimal service
Rationale: Telehealth visits for established patients are coded using the same E/M
codes as in-person visits. Low complexity MDM corresponds to 99213 for
established patients.
Question 9
A physician performs an E/M service on the same day as a major surgery (global
period 90 days). The E/M service resulted in the decision for surgery. What
modifier should be used?
A) Modifier -25
B) Modifier -51
C) Modifier -57
D) Modifier -59
Rationale: Modifier -57 is used when an E/M service results in the decision to
perform a major surgical procedure (global period 90 days) on the same day or
the day before. The E/M service is considered part of the global surgical package
and is not separately reimbursed unless modifier -57 is used.
Question 10
An established patient presents for a routine follow-up for hypertension. The
physician documents a problem-focused history, a problem-focused
examination, and straightforward MDM. What is the correct E/M code?
