Question 1

Dr. Garner performs a history and exam on Robert Peter Cohen, born 1 hour ago in the hospital delivery room. Happily, Robert is perfectly normal. This is reported with what code?

Accepted Answer

The correct code for a newborn exam is 99460, which includes a comprehensive history and physical exam of a newborn performed in the hospital or birthing center within the first few days after birth. The other codes listed are not appropriate for a newborn exam. 99381 and 99397 are for preventive medicine services for new or established patients, respectively, and are not typically provided for newborns. 99205 is an office or other outpatient visit for the evaluation and management of a new patient, which would not be appropriate for a newborn exam.

Question 2

Dr. Kennedy has been treating Paul Fried for six months. Today the doctor performed a medical disability exam; developed a treatment plan; and completed the documentation, certificate of disability, and a report. This is reported with code:

Accepted Answer

Code 99455 is used for work-related or medical disability evaluation services by the treating physician, which includes completion of a medical disability certificate and report.

Question 3

Critical care services, first day, provided to a patient who is 3 years old will be reported with code:

Accepted Answer

99475 is the correct code for critical care services provided to a patient who is 3 years old on the first day.

Question 4

Codes 99324-99340 are used for reporting services to patients in all except:

Accepted Answer

Codes 99324-99340 are intended for domiciliary, rest home (e.g., boarding home), or custodial care services, which include assisted living and Alzheimer's facilities. They do not cover services provided in long-term care facilities.

Question 5

Care plan oversight services provided to a nursing facility resident, 1 hour total for the month of May, are reported with code:

Accepted Answer

The answer of Care plan oversight services provided to a...

Question 6

E/M services provided by a physician to a critically ill patient are coded by:

Accepted Answer

E/M services provided to a critically ill patient are not coded based on whether the patient is new or established, whether it is initial or subsequent care, or the age of the patient. Instead, they are coded based on the time spent providing care. The highest level critical care code should only be billed when the physician provides direct, personal patient care to a critically ill or injured patient for at least 30 minutes.

Question 7

David, 23 months old, is critically ill, in the NICU at City Hospital. Dr. Katzman provides critical care services, including endotracheal intubation and an umbilical arterial catheter. He saw David yesterday when he admitted him. How are Dr. Katzman's services coded?

Accepted Answer

Dr. Katzman's services should be coded as 99472, which represents "Initial hospital care for a critically ill infant or young child, 29 days through 24 months of age." This code includes services such as endotracheal intubation and umbilical arterial catheter placement. As David is 23 months old, this is the appropriate code. Codes 99469, 99471, and 99476 do not apply to this scenario.

Question 8

Subsequent intensive care services to low birth weight (LBW), VLBW, and recovering neonates are coded by:

Accepted Answer

Subsequent intensive care services for neonates are coded based on the present body weight of the infant.

Question 9

To report E/M services provided by a physician to a patient in a nursing home, the coder must first determine:

Accepted Answer

For reporting E/M (Evaluation and Management) services provided by a physician to a patient in a nursing home, it is crucial to determine whether it is initial or subsequent care. This distinction affects the coding and billing process, as different codes are used for initial versus subsequent visits.

Question 10

Inpatient neonatal critical care services are coded by the patient's age and:

Accepted Answer

Inpatient neonatal critical care services are coded based on whether it is initial or subsequent care, in addition to the patient's age.

Question 11

Maribelle Longene is being discharged today from the Health Center nursing home. Dr. Kenmore spent 20 minutes completing the discharge process (final exam, discussion, etc.). What code is used for nursing home discharge services?

Accepted Answer

Code 99315 is used for nursing home discharge services and includes a final exam, discussion with the patient and/or family, and preparation of discharge records. Code 99215 is for a comprehensive office visit, while codes 99310 and 99316 are not relevant to nursing home discharge services.

Question 12

Dr. Schillinger first saw Mary Lou Renney at the hospital last week, the day she was born. Her mom brings her in today for a checkup. History, exam, and medical decision making are documented. This is coded as a(n):

Accepted Answer

Mary Lou Renney is an established patient since Dr. Schillinger has seen her before. The visit can be coded as subsequent care since it is not the initial visit after her birth.

Question 13

Pediatric critical care codes are measured by:

Accepted Answer

Pediatric critical care codes are measured by days, reflecting the continuous care provided over 24-hour periods.

Question 14

Dr. Olsen evaluates Frank Harrison, currently in the ICU. Mr. Harrison was in a single-engine airplane crash and is in a coma. Dr. Olsen is with Frank for 45 minutes. What is the appropriate CPT code?

Accepted Answer

CPT code 99291 is appropriate for this evaluation as it is billed for critical care services provided to a critically ill or critically injured patient, such as Mr. Harrison, in the ICU. The time requirement for 99291 is at least 30 minutes, and Dr. Olsen spent 45 minutes with the patient.

Question 15

A physician spent 45 minutes counseling on healthy diet and the importance of exercise to a patient with a family history of diabetes. How are the physician's services coded?

Accepted Answer

99403 is the correct code for preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30-60 minutes.

Question 16

Dr. Baez phoned Judy Calder to discuss a new therapy he researched for her 5-year-old son. The call lasted 15 minutes. Judy said she would discuss this with her husband and let him know. Dr. Baez saw the patient two weeks ago. This is coded:

Accepted Answer

99442 is the correct code for a phone consultation by a physician or other qualified health care professional that lasts 11-20 minutes regarding a patient's care.

Question 17

Services reported with codes 99304-99318 identify the location of care as all except a(n):

Accepted Answer

Services reported with codes 99304-99318 do not apply to custodial care centers, as these are not considered a medical facility. The other locations listed (skilled nursing facilities, intermediate care facilities, and psychiatric residential treatment centers) are all medical facilities where medical care can be provided.

Question 18

Dr. Mohammed supervised a hospice patient's care and provided care plan oversight services lasting 25 minutes. This is reported with:

Accepted Answer

99377 is the correct code for care plan oversight services provided by a physician for a hospice patient, covering durations of 15-29 minutes within a calendar month.

Question 19

Dr. Suarez performs a basic disability exam on Zena McIntire. This is coded from which subsection?

Accepted Answer

Basic disability exams fall under special evaluation and management services, which is part of the Evaluation and Management section of CPT coding.

Question 20

Today, Dr. Nepal discharged Emil Stanton from the hospital and admitted him to a nursing facility for continued care. How will Dr. Nepal's services for today be coded?

Accepted Answer

Dr. Nepal provided both a hospital discharge service and an initial nursing facility care on the same day, so both codes need to be reported.

Quiz 22: CPT Evaluation and Management Coding