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CPC- Evaluation and Management
Questions
A 33 year-old white male was admitted to the hospital on 12/17/XX from the ER, following a motor vehicle accident, to have a splenectomy done. Patient is being discharged from the hospital on 12/20/XX. During his hospitalization he was experiencing pain and shortness of breath, but with an antibiotic regimen of Levaquin, he improved. Physician performed final examination and reviewed chest X-ray that revealed possible infiltrates and a CT of the abdomen that ruled out any abscess. He was given a prescription of Zosyn. Patient told to follow up care with PCP or return back to the hospital for any pain or bleeding. Physician spent 20 minutes. Select the appropriate CPT® code for 12/20 visit: A. 99283 B. 99221 C. 99231 D. 99238 - Answer-The patient is being discharged from the hospital. Hospital discharge codes are determined based on the time documented that the physician spent providing services to discharge the patient. The provider documented 20 minutes, which is reported with 99238. The physician was notified to go to the hospital floor for medical management of a 56-year-old patient admitted one day ago for aspiration pneumonia and COPD. An expanded problem focused history was documented indicating no chest pain at present, but still SOB and some swelling in his lower extremities. Was tachypneic yesterday. Problem focused exam with the lungs revealing course crackles in both bases, right worse than left. MDM was moderate with the continuation of intravenous antibiotic
treatment and respiratory support, reviewed chest X-ray and labs. Patient is improving and a pulmonary consultation has been requested. What CPT® code should be reported? A. 99221 B. 99231 C. 99218 D. 99232 - Answer-Physician is providing subsequent hospital care to an inpatient. This eliminates answer choices A and C. The physician performed an expanded problem focused interval history, problem focused examination, and moderate MDM. Subsequent hospital codes require two out of three key components to meet or exceed. The two key components that meet are: expanded problem focused history and medical decision of moderate complexity. The code is a 99232. An established patient presents to the office with a recurrence of bursitis in both shoulders to have a scheduled injection. Examination is only limited to the shoulder in which range of motion is good and full, but he has tenderness in the subdeltoid bursa. Both shoulders were injected in the deltoid bursa with 120mg Depo-Medrol. Select the appropriate CPT® coding for this visit: A. 99212-25, 20610- B. 20610- C. 99212-25, 20611- D. 20611-50 - Answer-For this encounter, no additional work in evaluating the patient has been performed to support that an E/M service is significant and separately identifiable from the procedure. Only the procedure should be billed. To perform an arthrocentesis, the physician inserts a needle through the skin and into a joint or bursa. A fluid sample may be removed from the joint or a fluid may be injected for lavage or drug therapy. In the CPT® Index, look for Shoulder/Arthrocentesis referring you to 20610, 20611. Code 20610 is correct because ultrasound was not used for the procedure. Modifier 50 is appended to indicate both shoulders were injected. A 75 year-old established patient is brought in by his son to have a physical screening done to be enrolled in a group home. No new complaints. The patient has an established diagnosis of Cerebral Palsy and Type 2 diabetes and is currently on his meds. A comprehensive history and examination is performed along with a moderate MDM. Blood work was ordered. PPD was done and flu vaccine given. Patient already had a vision exam. No abnormal historical facts or finding are noted. What CPT® code should be reported? A. 99397
D. 99212, Z46.9 - Answer-Scenario documents patient returning to the gynecologist guiding you to the codes for established patient office visit. This eliminates multiple choices A and C. For this scenario, the patient did not have any complaints that required the presence of a physician. There was no examination or medical making decision performed for the patient guiding you to code 99211. There must be an order for the patient to come in for the office visit. For the diagnosis code, the pessary was removed for cleaning reporting Z46.89 Encounter for fitting and adjustment of other specified devices. (Refer to ICD-10-CM guideline I.A.9) Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision making of moderate complexity. Which E/M service is reported? A. 99285 B. 99284 C. 99221 D. 99222 - Answer-According to CPT® guidelines: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (example, hospital emergency department, observation status in a hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date of service. Meaning for this scenario the patient's physician had come to the ER and also admitted the patient on the same date of service, eliminating multiple choices A and B. All three of the key components of an initial hospital care code must be met or exceeded. 99221 requires: detailed or comprehensive history, detailed or comprehensive examination, and straightforward or low complexity medical decision making. Because the lowest key component in the question is a detailed history, the highest level that can be reached is 99221. To report code 99222 you would need a comprehensive history. A 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct codes for the physician service.
A. 99468-25, 93303-
B. 99471-25, 31500, 94002, 93303-
C. 99460-25, 31500, 94002, 93303-
D. 99291-25, 93303-26 - Answer-According to CPT® subsection guidelines under Inpatient Neonatal and Pediatric Critical Care: If the same physician provides critical care services for a neonatal or pediatric patient in both the outpatient and inpatient setting on the same day, report only the appropriate Neonatal or Pediatric Critical Care codes 99468-99476 for all critical care services provided on that day. This eliminates multiple choice answers C and D. The baby is 20 days-old and you cannot bill intubation (31500) and ventilation management with the neonatal and pediatric critical care codes, eliminating multiple choice B. A 50-year-old patient is coming to see her primary care physician for hypertension. The patient also discusses with her physician that the OBGYN office had just told her that her Pap smear came back with an abnormal reading and is worried because her aunt had passed away with cervical cancer. The physician documents she spent 55 minutes face-to-face counseling on the awareness, other screening procedures and treatment if it turns out to be cervical cancer. What E/M code(s) is (are) reported for this visit? A. 99215, 99417 B. 99213, 99358 C. 99214, 99354 D. 99213 - Answer-The overall time spent with patient is 55 minutes. Prolong services codes can be reported. There is one specific prolong code that is only reported with the office visit codes, add-on code
- There is a parenthetical instructional note given under 99417 that this add-on code is only reported on codes 99205 and 99215. There is also a parenthetical note for codes 99356 and 99358 that indicates which codes are reported with them and code 99215 is not listed. A patient was admitted yesterday to the hospital for possible gallstones. The following day the physician who admitted the patient performed a detailed history, a detailed exam and a medical decision making of low complexity. The physician tells her the test results have come back positive for gallstones and is recommending having a cholecystectomy. What code is reported for this evaluation and management service for the following day? A. 99253 B. 99221
B. 99202-25, 90707, 90716
C. 99382-25, 90471, 90710
D. 99212-25, 90471, 90472, 90707, 90716 - Answer-C Modifier 25 is appended to the E/M service because additional services (vaccine) are performed during the same encounter An established 45-year-old woman is seen today at her doctor's office. She is complaining of being dizzy and feels like the room is spinning. She had palpitations on and off for the past 12 months. She reports chest tightness and dyspnea but denies nausea, edema, or arm pain. She drinks two cups of coffee per day. Her sister has Wolfe Parkinson-White (WPW) syndrome. A medically appropriate history and exam are performed. An EKG is ordered. The provider does not document a final diagnosis. What CPT code is reported? A. 99203 B. 99213 C. 99214 D. 99204 - Answer-B A 33-year-old white male was admitted to the hospital 12/17/16 from the ER, following a motor vehicle accident, to have a splenectomy done. The patient is being discharged from the hospital on 12/20/16. During his hospitalization, he was experiencing pain and shortness of breath, but with an antibiotic regimen of Levaquin, he improved. The physician performed final examination and reviewed chest x ray that revealed possible infiltrates and a CT of the abdomen that ruled out any abscess. He was given a prescription of Zosyn. The patient was told to follow up care with PCP or return back to the hospital for any pain or bleeding. The physician spent 20 min. What CPT code is reported for the 12/20 visit? A. 99283 B. 99221 C. 99231 D. 99238 - Answer-D
The physician was notified to go to the hospital floor for medical management of a 56-year-old patient admitted one day ago for aspiration pneumonia and COPD. No chest pain at present, but still SOB and some swelling in his lower extremities. He was tachypneic yesterday. The physician performed an expanded problem focused interval history. The exam is problem focused in which the lungs reveal course crackles in both bases, right worse than left. He is continuing with intravenous antibiotic treatment and respiratory support, reviewed chest x ray and labs. The overall medical decision making is low. The patient is improving, and a pulmonary consultation has been requested. What CPT code should be reported? A. 99221 B. 99225 C. 99218 D. 99231 - Answer-D A 25-year-old male is brought in by the EMS to the for nausea and vomiting. The patient has elevated blood sugars per EMS. EMS and the physician are unable to get a history due to patients altered mental status. The ED physician performed a comprehensive eight organ system exam, and a high-level MDM. Patient was transferred to ICU in stable condition. Total critical care time 25 minutes. What CPT code is reported? A. 99285 B. 99291 C. 99236 D. 99223 - Answer-A A physician makes a home care visit on a 63-year-old patient that is a hemiplegic having insomnia for the last two weeks. The patient has been home bound for the last year. The visit from this physician was four months ago to control his DM. The physician performs and expanded problem focused examination and a low MDM. The physician then speaks with the spouse about the possibility of placing the patient in a nursing facility. What CPT code is reported? A. 99213 B. 99342 C. 99348
D. 99221, 99238 - Answer-C 3-year-old critically ill child is admitted by the same physician to the PICU from the ER with respiratory failure due to an exacerbation of asthma not manageable in the ER. The physician starts continuous bronchodilator therapy and pharmacologic support along with cardiovascular monitoring and is thinking about the need for possible mechanical ventilation support. The physician documents a comprehensive history and exam, and orders are written after treatment is initiated. What is the CPT code for this encounter? A. 99475 B. 99291 C. 99284 D. 99476 - Answer-A A 65-year-old non-Medicare established patient sees his regular primary care provider for a physical screening prior to joining a group home. He has no new complaints. The patient has an established diagnosis of cerebral palsy and type 2 diabetes and is currently on his meds. Split virus, preservative free flu vaccine is given. Patient already had had a vision exam. What CPT codes are reported? A. 99215, 90658, 90471 B. 99397, 90662, 90471 C. 99214, 90662, 90471 D. 99387, 90658, G0008 - Answer-B A pediatrician is asked to be in the room during the delivery of a baby at risk for complications. The pediatrician is in the room for 45 min. The baby is born and is completely healthy, not requiring the services of the pediatrician. What CPT code/s is/are reported by the pediatrician? A. 99360 B. 99219 C. 99252 D. 99360 x2 - Answer-A
The physician provided standby services. 99360 is reported based on time. Each 30 min is reported if only the entire 30 min is met, which eliminates D B is for initial observation care and C is for an inpatient consultation After moving to a new state, a mother took her two-year-old daughter to a new pediatric clinic for an annual physical. The provider completed an age/gender appropriate history, exam, and provided anticipatory guidance. He ordered no additional tests or immunizations. What CPT code is reported? A. 99391 B. 99392 C. 99381 D. 99382 - Answer-D Preventative medicine/new patient 99391 and 99392 are for established patients 99381 is for a patient who is an infant or less than 1 year old A female patient comes into the ED with complaints of RLQ pain, heartburn, and with a temperature of 100.2. The ED physician performs a detailed history, detailed exam and a moderate MDM. The physician places the patient in observation status and wants to keep this patient in observation status to rule out appendicitis. What is the correct CPT coDe for this encounter? A. 99219 B. 99218 C. 99284
