Deck 7: Evaluation and Management

Question 1

A 36-year-old woman with a history of multiple complicated ectopic pregnancies presented to her OB/GYN's office. She took an at-home pregnancy test two weeks ago, which was positive, and experienced a heavy bleed in the middle of the night last night. She presented this morning with complaints of excessive vaginal bleeding and pain in the abdominal area. After confirmation of the pregnancy via urinalysis, the physician performed a pelvic examination. After examination, the OB suspected that the pregnancy was ectopic and ordered an ultrasound confirmation. The ultrasound confirmation, performed later that day, showed an advanced interstitial uterine ectopic pregnancy. The estimated age of the pregnancy was 12 weeks. The OB discussed the risks of the ectopic pregnancy with the patient, who then decided to have an excision of the ectopic pregnancy and a total hysterectomy. The OB spent 45 minutes counseling the patient and the patient was scheduled for an abdominal hysterectomy in two days.
How should the OB code for the procedure performed in the office?

A)99214, 76801
B)99215-57, 81025, 76801
C)99214-57, 81025
D)99215, 81025, 76805

Answer 1

99215-57, 81025, 76801

Question 2

A new patient was seen in the office complaining of ear pain, headache and a mild fever. The physician performed a problem-focused history assessment and an expanded problem-focused examination on the patient. The physician diagnosed the patient with an acute inner ear infection. This medical diagnosis was considered to be of low complexity. What is the correct E&M code for the service?

A)99212
B)99202
C)99201
D)99211

Answer 2

99202

Question 3

HOSPITAL CHARGE SHEET PATIENT: Carson, Cason
AGE: 10
DATE OF ADMISSION: 01/02/2014
DIAGNOSIS: Coccidiomycosis Meningitis
DATE OF DISCHARGE: 01/08/2014
The patient was admitted on 01/02/2014 complaining of a severe headache and hyperpyrexia. An lumbar puncture determined on 01/02/2014 that the patient was suffering from coccidiomycosis meningitis. The patient was administered antibiotics and admitted to the hospital for observation and management of the condition. The patient's condition improved slowly with a regression on 01/05/2014, at which time the antibiotics were changed. After the change in medication, the patient's condition rapidly improved and by 01/07/2014, the patient no longer developed a fever or headache when not on pain medications. On 01/08/2012, the physician spent 20 minutes managing patient discharge, with instructions to continue antibiotics and pain medications, as needed.
What E&M service codes would be reported for this service?

A)99222 (X2), 99232 (X3), 99231 (X3), 99238 (X2)
B)99232 (X7)
C)99222, 99232, 99231 (X6)
D)99222, 99232 (X3), 99231 (X2), 99238

Answer 3

99222, 99232 (X3), 99231 (X2), 99238

Question 4

The patient was seen in the emergency department for a severe laceration to the right forearm, following a work injury. The on-call physician performed an expanded problem-focused history assessment and examination, and then sutured the complicated wound using 25-0 vicryl sutures in three subcutaneous layers. The patient was prescribed prophylactic antibiotics and released from the emergency department. The patient was instructed to return to his PCP in one week for a follow-up appointment. The MDM was moderate. What is the correct level of E&M service?

A)99284
B)99282
C)99283
D)99291

Question 5

The physician saw the disabled patient during a home visit. The patient recently moved to be closer to her family therefore she is considered a new patient. The physician performs a detailed history and an expanded problem-focused examination. Due to the lack of risk and small amount of data to be analyzed, the MDM is of low complexity. What is the correct evaluation and management service code?

A)99342
B)99343
C)99348
D)99349

Question 6

A pediatric patient with a history of asthma and pneumonia presented to the office with severe respiratory distress. The pediatrician performed a detailed history and comprehensive examination, and diagnosed the patient with status asthmaticus. A pulse oxygen level was taken and it was determined that the patient's blood oxygen level was at 88%. The patient was started on a nebulizer treatment at 0950 hours, which lasted until 1015 hours. The physician then re-checked the patient and determined that the patient's breathing had only slightly improved. A pulse oxygen level was taken again and it was determined that the patient was at 92%. The physician then ordered another nebulizer treatment, which was started at 1032 and continued until 1054. After this second breathing treatment, an additional pulse oxygen level was taken and the patient's blood oxygen level had risen to 97%. The pediatrician then determined that the patient needed to be sent for chest x-rays to determine whether or not pneumonia was present in the lungs. Due to the resulting amount of data and risk, the pediatrician considered the MDM of high complexity. The total time spent with the patient was 1 hour 45 minutes.
What E&M codes would you use to code for the office visit?

A)99214, 99354, 99355 (X2)
B)99215, 99354, 99355
C)99215, 99355 (X3)
D)99215, 99354, 99355 (X2)

Question 7

If a physician performed a female pelvic examination under general anesthesia, you should code for the procedure using an appropriate code from the female genital system subsection of the surgery chapter of the CPT manual. If the physician performed a pelvic examination without general anesthesia, from what chapter or subsection of the CPT manual should you code?

A)Anesthesia
B)Maternity Care and Delivery
C)Evaluation and Management
D)Female Genital

Question 8

A 32-year-old married female presents to her OB/GYN office for diaphragm fitting. After performing a pelvic examination and routine physical, the OB measures the cervix and adjusts the diaphragm so that it fits neatly over the cervical opening. The OB then instructs the patient in how to place the diaphragm for most effective birth control, as well as how to remove, clean, and store the diaphragm. Satisfied that the patient understands how to use the device properly, she allows the patient to leave the office with a follow-up appointment scheduled in one month. How should the OB/GYN code for this visit?

A)99395
B)99395, 57170-59
C)57170
D)99395, 57170

Question 9

The nurse practitioner returned a phone call from a concerned daughter regarding her ailing mother's health. She spent 20 minutes counseling the daughter on how to provide hospice care during the last stages of her mother's life. It had been three weeks since the patient had been seen in the office, and her next scheduled appointment was in two weeks. What E&M service can be reported for this phone call?

A)You cannot report an E&M service for this phone call
B)99442
C)98967
D)99443

Question 10

A patient is admitted to the hospital for observation for possible dehydration. A detailed history is performed with a detailed examination of the patient on the unit. The medical decision making was low complexity and straightforward, so the physician was only on the unit for about 20 minutes. What is the best code to be used for this observation patient?

A)99218
B)99219
C)99220
D)99224

Question 11

A patient is admitted to the telemetry unit for observation for chest pain, directly from his physician's office. The hospitalist spent a little more than 50 minutes on the unit after the patient arrived, performing a comprehensive examination and obtaining a comprehensive history on the patient. The hospitalist performed moderate complexity medical decision making when ordering labs, telemetry, stress testing and echocardiogram. What is the appropriate code for initial observation care of this patient?

A)99218
B)99219
C)99220
D)99224

Question 12

A patient admitted in the afternoon for 24-hour observation, after complaining about chest pain in his PCP's office, has worsened during the evening. He now has increasing chest pain, requiring medication for relief; his EKG has changed from his PCP's office; and he is being prepped for a cardiac catheterization because his labs are returning indicating an acute MI. What is the appropriate code for a patient who is unstable after initial observation?

A)99220
B)99224
C)99225
D)99226

Question 13

A patient admitted to the hospital three days ago is getting ready to be discharged this morning. The attending physician spent more than 30 minutes arranging home health services and talking with the patient and family regarding outpatient rehabilitation and care after right hip replacement. What code should be used for the discharge day management of this patient?

A)99235
B)99236
C)99238
D)99239

Question 14

A 54-year-old woman is being set up for consultation with general surgery for follow up after a large lump was identified on mammography by the woman's PCP. This office consultation will include a comprehensive history, a comprehensive examination, and moderate-complexity medical decision making because it will involve discussing options, additional tests, and surgery. The surgeon allowed for a 60-minute visit with this woman and her family. What is the appropriate code for consultation?

A)99242
B)99243
C)99244
D)99245

Question 15

A speech therapist is asked to consult on a stroke patient in the hospital. She spends 45 minutes with the patient assessing and performing an expanded problem-focused history and examination, but that only required straightforward medical decision making. What consultation code should be used for this patient?

A)99251
B)99252
C)99253
D)99254

Question 16

An emergency room physician has to talk emergency medical systems (EMS) personnel through advanced life support, including telemetry of cardiac rhythm, endotracheal intubation and electrical conversion of arrhythmia. This is done by two-way voice communication with EMS outside of the hospital. What code should be used for this service?

A)99281
B)99284
C)99285
D)99288

Question 17

A 10-year-old boy lacerated his chin while chasing his baby brother. He requires stitches. What would the evaluation and management CPT code be for this patient, who is being seen in the emergency department?

A)99281
B)99282
C)99283
D)99284

Question 18

What CPT code should be used for a patient that requires 68 minutes of evaluation and management while in critical care?

A)99285
B)99288
C)99291
D)99292

Question 19

In the evaluation and management of a critical care patient, timing is most important. What code should be used for a patient that requires two hours of evaluation and management?

A)99291
B)99292
C)99291, 99292
D)99291, 99292 x 2

Question 20

A patient in critical care requires 190 minutes of evaluation and management time. What CPT code(s) should be used to indicate this evaluation and management of critical care patients?

A)99291
B)99291, 99292
C)99291, 99292 x 2
D)99291, 99292 x 4

Question 21

An 82-year-old woman is admitted to a nursing facility for rehabilitation after having had a stroke. The admitting physician spent 35 minutes at the nursing home completing a comprehensive history and examination and moderate complexity medical decision making. What evaluation and management CPT code should be used for this patient?

A)99304
B)99305
C)99306
D)99307

Question 22

A 76-year-old man has completed his rehabilitation at a nursing facility after bilateral knee replacements. He is being discharged from the nursing facility and the discharging physician spends 35 minutes completing this process. What is the correct evaluation and management code for this patient?

A)99304
B)99307
C)99315
D)99316

Question 23

An 86-year-old woman at a nursing facility develops confusion and becomes combative. It is discovered that she has a urinary tract infection, which is causing her confusion. She has been in the nursing facility for five days already and the attending physician is called in to assess the patient and manage her care. He comes and does a detailed interval history, a detailed examination and moderate-complexity medical decision making, spending about 25 minutes with the patient and writing orders. What is the correct evaluation and management code for this patient?

A)99307
B)99308
C)99309
D)99310

Question 24

A down's syndrome 40 year old is being admitted to a domiciliary home. She does not have any known medical conditions, but is being removed from her home due to inadequate care with social services being the custodians of her care at this time. The physician spends 20 minutes with the patient and facility staff and the medical decision making is straightforward as he completes a problem-focused history and examination. What would the correct evaluation and management code be for this new patient?

A)99324
B)99325
C)99326
D)99327

Question 25

A patient in an assisted living facility is under the care of a physician for atrial fibrillation requiring Coumadin, which requires frequent laboratory checks. She is also a brittle diabetic requiring frequent blood sugar checks and insulin adjustments, which routinely involves telephone calls to the physician from the facility. Because of COPD, she is on continuous oxygenation and routinely needs medication adjustments and breathing machine adjustments to maintain her oxygen levels. The physician is typically called 3-4 times a week, despite routine orders onsite for the nurses, and he then has to spend time talking with his patient's daughter about the changes to her mother's care. He spends more than 30 minutes a month doing all of this. What is the correct evaluation and management code for this type of encounter?

A)99324
B)99334
C)99339
D)99340

Question 26

An established patient at an assisted living facility develops a cough that is diagnosed as pneumonia after radiology was performed. The physician was called in to assess her and ordered the x-ray as an outpatient. Because of her history of congestive heart failure, this acute diagnosis is more complex. The physician does a detailed interval history, a detailed examination and considers his medical decision making to be of moderate complexity because he has spent 40 minutes with the patient, at the assisted living facility and talking with the patient's family when they come for a visit. What is the correct evaluation and management CPT code for this patient?

A)99334
B)99335
C)99336
D)99337

Question 27

A rural doctor is called to the home of a friend of one of his elderly patients, who is a new patient to him. She was having difficulty breathing and has had a cough for more than three weeks. He performed a detailed history and a detailed examination and spent more than 45 minutes with the patient, causing his encounter to be considered moderate complexity. What is the correct CPT evaluation and management code for a new patient receiving a home visit?

A)99341
B)99342
C)99343
D)99344

Question 28

A physician visits one of his homebound patients, who has been complaining about right hip pain after she fell three days ago. She is now unable to bear weight and pain is worsening. He performs a comprehensive examination and his medical decision making is considered moderate complexity because he is organizing transportation for the patient to the hospital for suspected hip fracture and has spent 40 minutes with the patient and the patient's son discussing her care. What is the correct evaluation and management code for this patient?

A)99347
B)99348
C)99349
D)99350

Question 29

When is a prolonged service code able to be used?

A)When prolonged service involving direct patient care contact is provided beyond the usual service in the outpatient setting or inpatient setting
B)When face-to-face or non-face-to-face services are performed on the patient's unit during the same session
C)Reported as an "add-on" code in addition to the initial evaluation and management services code for that patient
D)All of the above are correct regarding a prolonged service code

Question 30

A cancer patient who has had a relapse after moving states is an inpatient at the cancer floor of the local hospital. Her current oncologist has obtained her previous medical records from oncology, pulmonology, general surgery, transplant team, and cardiology and is spending a significant amount of time reviewing her previous care and how the cancer was treated by her previous doctors. He has spent an additional hour going over the charts from her previous providers and has spent time on the phone with her previous oncologist. This prolonged service did not involve face-to-face time with the patient but was necessary for review of her medical history and previous treatments and responses. What evaluation and management code should be used for this encounter?

A)99356
B)99357
C)99358
D)99359

Question 31

A 54-year-old patient on Warfarin is being routinely followed by having international normalized ratio (INR) testing done, with the physician reviewing and adjusting medication dosing as needed. This is done through the physician's office on an outpatient basis. The patient is in her first 90 days of therapy and has had nine INR measurements done at this time. What is the correct evaluation and management code for this encounter?

A)99360
B)99363
C)99364
D)99366

Question 32

A patient who has a complicated medical history and presentation of cancer relapse has met with cardiology, pulmonology, oncology and general surgery. The main physician from each of these specialties is going to have a medical team conference with the patient and her family regarding her medical plan of care. This conference is estimated to take two hours to discuss all aspects of their recommendations. What is the correct evaluation and management CPT code for this type of medical conference?

A)99363
B)99366
C)99367
D)99368

Question 33

To be considered a medical team conference, what is the minimum number of healthcare professions from different specialties or disciplines that must participate?

A)One
B)Two
C)Three
D)Four

Question 34

A physician provides supervision of a 49-year-old patient, in a domiciliary environment, requiring complex and interdisciplinary care changes and revisions to care plans, due to having been diagnosed with cancer and having uncontrolled hypothyroidism and diabetes. This supervising physician spends more than 35 minutes per month talking with the legal guardian, the in-home nurse, and reviewing laboratory results and making changes to her medications. What evaluation and management CPT code should be used for this patient's care plan oversight?

A)99374
B)99375
C)99377
D)99378

Question 35

A hospice patient's supervising physician spends 28 minutes a month reviewing labs, making care plan changes, and talking with hospice staff and family members of the patient. What is the correct evaluation and management CPT code for this patient?

A)99374
B)99375
C)99377
D)99378

Question 36

An 87-year-old patient in a nursing home requires more than 60 minutes of supervised care per month. What is the correct evaluation and management CPT code for this patient's care?

A)99374
B)99377
C)99379
D)99380

Question 37

A young college student uses email to communicate with her family physician because she is living away from home. She has developed acne while she has been away from home and various over-the-counter medications are no longer helping. She sends her physician an email requesting a prescription because she won't be able to come back to see him until the next school holiday, which is in 2 ½ months. The physician copies her email into her electronic medical record and sends a prescription for medication to the pharmacy nearest to her. He also copies his response to her through email into her electronic medical record as well, documenting his care. What is the correct evaluation and management code for this type of an encounter?

A)99441
B)99442
C)99444
D)99446

Question 38

A patient's mother calls, asking to speak with the physician, because her three year old is having behavioral problems at school and at home, including biting and sudden bedwetting. It was recommended that she set up an appointment, but the mother reports that, due to work schedule, she won't be able to get her son in until next week, but will set up an appointment to follow up in the office. The physician spends 15 minutes on the phone with her discussing the behavior, and that this may be related to life changes because there have been some changes going on with the patient's dad no longer living in the home. He recommends following up tomorrow due to the increased bedwetting, but due to the mother's schedule, she is unable to do this. What is the correct evaluation and management code for this patient encounter?

A)99441
B)99442
C)99443
D)99444

Question 39

A physician has a mother who is concerned about her daughter having cancer. He does preliminary labs to help alleviate the mother's fears, but some of the labs are coming back abnormal. He contacts the pediatric oncologist located more than an hour away by phone, requesting a telephone consultation regarding the abnormal labs and patient's presentations. He spends 15 minutes on the phone consulting and obtaining recommendation for follow up labs and plan of care within his office. The oncologist does not believe this is related to cancer and has recommended additional work up. However, if subsequent labs are abnormal, he recommends follow up in his office. The subsequent labs are all within normal range and the primary physician repeats the labs again within his office in one month. What is the correct evaluation and management code for this consultation encounter?

A)99446
B)99447
C)99448
D)99449

Question 40

A 45 year old needs a basic life exam that includes height, weight, blood pressure, medical history, urinalysis and/or blood samples, and completion of necessary documentations/certificates. What is the correct evaluation and management code for this type of encounter?

A)99449
B)99450
C)99455
D)99456

Question 41

A patient needs a work-related examination and it will be performed by the treating physician. What is the correct evaluation and management code for this type of encounter?

A)99444
B)99450
C)99455
D)99456

Question 42

A patient needs a medical disability examination performed, but it will be performed by a different physician other than his treating physician. What is the correct evaluation and management CPT code for this encounter?

A)99449
B)99450
C)99455
D)99456

Question 43

A home birth newborn is seen for the first time in her pediatrician's office on the same day as her delivery at home. What is the correct CPT code for this initial encounter of the newborn?

A)99460
B)99461
C)99462
D)99463

Question 44

What is the correct evaluation and management code for a normal newborn infant who was born at 1 am and then discharged by 6 pm that same day?

A)99460
B)99461
C)99462
D)99463

Question 45

What is the correct evaluation and management code for a 2-day old infant who began breathing rapidly and had elevated heart rate, without any known cause? He is admitted to the neonatal critical care after interfacility transport is provided. What is the correct code for the interfacility transport that lasted 35 minutes?

A)99466
B)99467
C)99485
D)99486

Question 46

An 18 month old is rushed to critical care after being critically injured during a motor vehicle accident. What is the correct evaluation and management code for initial inpatient pediatric critical care evaluation?

A)99468
B)99469
C)99471
D)99472

Question 47

A three year old who was critically injured during a firecracker accident has been in intensive care for two days now. What is the correct evaluation and management CPT code for this patient?

A)99468
B)99471
C)99475
D)99476

Question 48

A patient who requires complex chronic care management services must meet certain criteria. What degree of medical decision making and how many minutes of care management must be provided for these patients?

A)Straightforward medical decision making, at least 60 minutes of clinical care management.
B)Low-complexity medical decision making, at least 45 minutes of clinical care management.
C)Moderate- or high-complexity medical decision making, at least 45 minutes of clinical care management.
D)Moderate- or high-complexity medical decision making, at least 60 minutes of clinical care management.

Question 49

A leukemia patient who is on 10 medications suffered a heart attack. He is receiving physical therapy and occupational therapy as well as chemotherapy and radiation therapy. He meets the requirements for complex chronic care management services and his attending physician has spent one hour and 45 minutes in the direct care of this patient's management. What is the correct evaluation and management code for this complex patient?

A)99487
B)99489
C)99487, 99489
D)99487, 99489 x 2

Question 50

How many chronic continuous or episodic health conditions must a patient have to qualify for complex chronic care management services?

A)One
B)Two
C)Three
D)Four

Question 51

What is the timeframe for transitional care management services?

A)Begins when the patient enters the hospital and ends 30 days after this date
B)Begins when the patient enters the hospital and ends 29 days after their discharge from the hospital
C)Begins on the day of discharge and ends 60 days after this date
D)Begins on the day of discharge and ends 29 days after this date

Question 52

A congestive heart failure patient is discharged from the hospital and has a follow up appointment with his primary care physician five days after discharge. The primary care physician's office calls him within 36 hours after discharge to follow up by phone to see how he is doing. Because he has had weight gain since leaving the hospital, the primary care office requests to see him that same day to see if this gain is from fluid retention and related to his congestive heart failure. He is seen in their office and the medical decision making is considered moderate complexity. What is the correct evaluation and management code for this patient?

A)99495
B)99496
C)99497
D)99498

Question 53

A preoperative patient needs to have an antibiotic started before his operation. He is given 500 mg Ceftriaxone sodium through his IV. What is the correct HCPCS code for this medication?

A)J0715
B)J0696
C)J0696 x2
D)J0697