ICD-10-CPT Coding Practice Exam 2025 – 400 Free Practice Questions to Pass the Exam

When selecting an Evaluation and Management (E/M) code, the key components that are typically considered include the history of present illness, examination, and medical decision making. These components are essential in determining the complexity and the level of care provided during the patient encounter.

Coordination of care, while an important aspect of patient management and can influence the overall treatment plan, is not classified as a key component in the same manner as the other three. It does not directly impact the coding levels of E/M services as outlined in the coding guidelines.

For instance, the history of present illness involves documenting the details of the patient’s current condition, which significantly contributes to justifying the code level selected. The examination assesses the patient physically to further inform the health status and necessary interventions. Medical decision making evaluates the complexity of the medical condition treated and the necessary follow-up, which is critical for proper coding.

Therefore, selecting coordination of care as not being a key component recognizes that while it contributes to patient care management, it does not affect the technicalities of E/M coding as do the components that specifically measure the service rendered.