1. Regarding the Initial visit to the hospital setting. You spend 44 minutes caring for a patient the ED has recommended you admit with pneumonia.  You review the CXR and see a LLL infiltrate and slight effusion which you note in the record as your independent interpretation.  You review the CBC, order two sets of blood cultures, a Sputum C&S, and a CMET and ABG.  O2 sats on room air are 82% and he has been placed on 2 liters with a sat now of 95%. He does not wear oxygen at home.    HR 93.  RR 15.  Mentation normal in this 77-year-old diabetic (A1c 7.9 on metformin) with a fasting sugar of 311.  You have two options to bill:  time or on medical decision making (MDM).  Based on the hospital E&M grid, your most appropriate call for admission would be to use (choose the one best answer based on clinical grounds and medical economics of the care given – getting optimally paid for the work performed)

2. Time is one mode of billing a patient for care. The following tasks can be counted for the total time performed by the billing provider EXCEPT:

5. With MDM, which carries more “weight”…. Problems, Data, or Risk of decisions?

4. An “independent historian” as defined by the 2023 Evaluation and Management Guidelines includes all the below EXCEPT:

3. Regarding the DATA component of MDM, true statements about the categories used to delineate the “moderate” and “high” MDM. ALL of the following are correct EXCEPT:

6. You are rounding on a patient with COPD exacerbation. You adjust his nebulizer regimen and add a pulse steroid taper due to persistent wheezing on day two of the hospital stay.  Since there is active management ongoing, you write an order to change him from Observation to Inpatient.  He is not clinically unstable, but he is not progressing as quickly as you wished.  The rounding level for this patient would be (even though you spent 15 minutes in total time caring for him)

7. A patient with HFrEF (39% EF) is on day 3. Renal numbers are trending the wrong way (Cr 0.9 à3 to 1.44 this AM) but she has crackles, weight gain, worsening swelling and you feel added diuresis is needed.  K+ this AM was 3.1, up from 2.9 last night.  You document your concerns over failed response to treatment and the need for treatment plan adjustment to stabilize the situation.  The rounding level best for this patient, given that you spent 24 minutes caring for her should be

8. You are called to see an 81-year-old current smoker with COPD for admission. You review standard admit labs, films, EKGs and an ABG.  You look at the EKG yourself and make an interpretation.  You feel the patient should be placed in the hospital in observation status.  The level of admit most appropriate for the medical decision making is

9. Using an NPP in a shared clinical decision-making capacity and billing for such has new rules since 2022. You spend 14 minutes on rounds in review of the PA note and in seeing the patient.  You document a note –“see and agree with above” – even though you have been told that the “medical decision making will drive the charge”.  The billing staff sees the note, realizes the lack of documentation will render only a level one visit at best (99231), but notes that you and the PA both documented your time in the encounter.  In the PA note, she mentions 23 minutes for time to see patient, call family, do a note, and review labs.  The billing staff decides to bill based on time of 37 minutes.  The 37 minutes eclipses the threshold of which rounding visit?

10. Who gets wRVU credit for this encounter?