Thirty-one eligible minutes

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Office professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Synthetic encounter and reporting party

Fictional patient: Rowan Ellis, age 56. Date: September 9, 2026. Dr. Mina Shah, primary care, provides an established-patient office encounter for active asthma management. A separately documented skin procedure occurs during the same appointment. The exercise supplies the time eligibility decisions for arithmetic practice.

Clinical history and evaluation

The patient reports recent intermittent symptoms during outdoor activity and asks to review the existing asthma plan. The clinician reviews the symptom pattern, current inhaler use and technique, examines the patient and discusses management and follow-up. No emergency respiratory deterioration is described. The diagnosis and degree of asthma severity are not the scored task in this excerpt.

Same-day preparation: 08:43–08:50

Dr. Shah spends seven minutes reviewing the relevant history and existing treatment information for this visit. This is the reporting practitioner’s work on the encounter date. The exercise stipulates that this interval qualifies under the applicable office E/M time instructions.

Evaluation and counseling: 09:05–09:23

The physician spends eighteen non-overlapping minutes evaluating the active problem and counseling the patient about the reviewed plan. No time in this interval is assigned to the separately reported skin procedure.

Separate procedure: 09:23–09:31

A distinct procedure note documents destruction of a symptomatic wart on the left index finger. The eight-minute interval is devoted solely to that procedure and its associated work. The exercise expressly excludes all eight minutes from E/M time. It does not ask the reader to determine the procedure entry or modifier from this excerpt.

Documentation and coordination: 12:10–12:16

The reporting physician spends six additional minutes on same-day documentation and coordination for the active-problem E/M service. No separately reported work is included, and this interval does not overlap the earlier ones.

Time attestation and scope

Dr. Shah attests to the three qualifying E/M intervals and the separate excluded procedure interval. No waiting, staff, travel or other time is included. Time is an allowed selection method for this exercise. Calculate the E/M total and then consult the actual family/status threshold; the supplied eligibility assumptions do not establish that every real-world activity with the same label qualifies.

Your coding worksheet

Make a ledger of included and excluded intervals.
Calculate the eligible E/M total.
Explain why the separate procedure interval is not counted again.
Verify the applicable entry threshold in the current authorized reference.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The three eligible intervals are seven, eighteen and six minutes.
Their sum is thirty-one minutes.
Adding the eight-minute procedure interval would inflate the E/M total to thirty-nine by counting expressly excluded work.
Use the supported total with the correct family and status; do not round to a threshold that has not been met.

Reference sections: CMS E/M Services pp.24–25; original supplied qualifying-interval arithmetic

Practice the linked chart questions