1.
63-year-old man is coming in for a second opinion for his sleep apnea. He has
had it for the past five months. Sleep is disrupted by frequent awakenings and
getting worse due to anxiety and snoring. He feels tired all the time, has some
joint stiffness and night sweats; all other systems were negative. He is going
through a divorce which is causing him anxiety and had a hernia repair two
month ago. Doctor performs a comprehensive exam and orders labs and a sleep
study test. Prescription was given to help with the anxiety. What CPT® code
should be reported?
A.
99203
B.
99204
C.
99244
D.
99214
2.
A 55-year-old established patient is coming in for a pre-op visit; he is
getting a liver transplant due to cirrhosis. The physician performs an expanded
problem focused history, detailed examination, and moderate MDM. Patient agrees
with his physician’s recommendations and the transplantation will take place as
scheduled. After the evaluation, the patient expresses a number of concerns and
questions for the prospective liver transplant. Physician spends an additional
30 minutes, excluding the time spent in doing the E/M service, in counseling
and answering questions regarding the surgery and discussing possible outcomes.
What CPT® codes should be reported?
A.
99213, 99354
B.
99214, 99358
C.
99213, 99358
D.
99214, 99354
3.
Physician performs a medical review and documentation on an 83-year-old patient
still hospitalized for confusion for the last two days. She is alert and
oriented x 3 today. Reviewing her labs from yesterday, her BNP was elevated
suspecting her confusion is due to congestive heart failure. An echocardiogram
is ordered and treatment will be for congestive heart failure. Patient is not
safe to return home. What CPT® code should be reported?
A.
99231
B.
99221
C.
99218
D.
99232
4.
A plastic surgeon is called to the ED at the request of the emergency
department physician to evaluate a patient that arrived with multiple facial
fractures after being in an automobile accident for her opinion on the need for
reconstructive surgery. The plastic surgeon arrives at the ED, obtains a
history of present illness including an extended history of present illness; a
system review, including constitutional, musculoskeletal, integumentary,
neurologic, and EENMT; and the patient’s social history and past medical
history. The plastic surgeon then performs a physical exam including
respiratory, cardiovascular, and an extended examination of the skin and bony
structures of the patient’s face. The plastic surgeon performs moderate medical
decision making, including deciding the patient needs major surgery to repair
the injuries. The plastic surgeon schedules the patient for surgery the next
day and documents her full note with findings in the ED chart.
A.
99284-57
B.
99244
C.
99243-57
D.
99221
5.
At the request of the mother’s obstetrician, the physician was called to attend
the birth of an infant being delivered at 29 weeks gestation. During delivery,
the neonate was pale and bradycardic. Suctioning and bag ventilation on this
1000 gram neonate was performed with 100 percent oxygen. Brachycardia worsened;
endotracheal intubation was performed and insertion of an umbilical line for
fluid resuscitation.Later this critically ill neonate was moved from the
delivery room and admitted to the NICU with severe respiratory distress and continued
hypotension. What are the appropriate procedure codes?
A.
99465, 99468
B.
99465, 99464, 99468-25, 31500, 36510-51
C.
99468, 99464
D.
99465, 99468-25, 31500-59, 36510-59
6.
38-year-old female initial visit, just moved from out of state, has neck and
back pain for the last year and is getting worse. Pain is exacerbated when she
drives, bends, or changes positions, and moderately alleviated with ibuprofen.
Positive for aches and weakness in her muscles and tingling and numbness of the
arms and hands, as well as headaches. All other systems are reviewed and are
negative. She has had a partial hysterectomy and is divorced. Her mother has a
history of breast cancer. The physician performs an exam on the following
systems: constitutional, eyes, ENT, respiratory, cardiovascular,
gastrointestinal, musculoskeletal, and neurologic. X-rays of the cervical and
lumbar spine were taken. Will be sending her to get a MRI and to start physical
therapy. Prescription was given for muscle relaxer. Select the appropriate CPT®
code for this visit?
A.
99203
B.
99204
C.
99214
D.
99244
7.
An initial office visit was made by a 16 year old female with a four day
history of abdominal pain with occasional vomiting. Mother states the patient
has not had fever. A detailed history is obtained. A detailed exam is performed
including GI system, GU system with pelvic, chest, heart, lungs and skin.
Vaginal and cervical cultures were obtained. She was asked to collect stool
specimens for culture over the next few days. Medical decision making is of
moderate complexity. Code this scenario.
a)
99282
b)
99384
c)
99203
d)
99202
8.
A 55 year old male patient recently moved to phoenix and is seeing his new
internist for the first time. He has had a long history of gouty arthropathy,
but he presents today to his new internist’s office for his annual preventive
medical reevaluation and management. Patient has been controlled on diet for
three years. A comprehensive history and physical is performed and the patient
is counseled regarding diet and exercise. Appropriate blood work is ordered.
Code this scenario.
a)
99204
b)
99223
c)
99205
d)
99386
9.
A 55 year old male patient recently moved to phoenix and is seeing his new
internist for the first time. He has had a long history of gouty arthropathy,
but he presents today to his new internist’s office for his annual preventive
medical reevaluation and management. Patient has been controlled on diet for
three years. A comprehensive history and physical is performed and the patient
is counseled regarding diet and exercise. Appropriate blood work is ordered.
Code this scenario.
a)
99204
b)
99223
c)
99205
d)
99386
10.
After being called to the emergency room to treat one of his patients suffering
from multiple injuries, a provider is asked to examine another one of his
patients already registered in the ER, presenting with acute respiratory
distress symptoms including a productive cough. The ER is very busy, therefore
the ER provider has the patient’s provider see and treat this patient. The
provider ordered a CBC and chest x-ray. An expanded history of the present
illness was taken, an expanded problem focused examination performed and
medical decision making was of moderate complexity. Overall level of medical
decision making was moderate. The patient was given a prescription and written
instructions for continued home care and told to make an appointment in the
office if the symptoms persist. Code the provider’s service for the second
patient.
a)
99212
b)
99283
c)
99284
d)
99243
11.
The patient is a 23 year old male who needs a prescription refill for Ventolin
tabs and Proventil inhaler. The patient moved here two months ago from Florida.
He was diagnosed with asthma at age eight and he says his asthma is well
controlled on his current medication regimen. He says he usually uses the
inhaler two to four times a week, generally after performing activities like
tennis or skating. Px: WDWN male in no acute distress; temp 98.6, pulse 65, BP
110/70; respiration 18; HEENT within normal limits; lungs clear to
auscultation, no rales or wheezing. Impression: Asthma stable on present
medication Plan: Rx written for three months for current medications; recheck
in three months, sooner if problems. Patient was advised to schedule baseline
physical upon next visit. According to CPT guidelines, which correctly reports
this service?
a)
99202
b)
99211
c)
99212
d)
99201
12.
An established patient is defined as,
a)
Family member of a regularly treated patient receiving services within past
three years.
b)
Patient over the age of 21
c)
One who has received services from the provider or another provider from the
same specialty within same group practice in the past three years
d) Patient
with verified insurance coverage.
13.
CPT code 99382 is age related. What is the age range designed in this code.
What is the age range designated in this code?
a)
Early childhood (age 1 through 4 years)
b)
Late childhood (age 5 through 11 years)
c)
Adolescent (age 12 through 17 years)
d)
Young adult (age 18 through 39 years)
14.
How does CPT apply the term consultation in relation to the provider?
a)
The provider gives professional advice ad /or instruction
b)
The provider responds to a request from another provider for a medical
evaluation, opinion, and plan of treatment
c)
The provider is part of a team of specialists available for advice on a patient
in a long-term care setting
d)
The provider is available on-call to respond to a medical crisis that may occur
in a patient with a chronic disease
15.
In clinical terms, chief complaint refers to which of the following?
a)
Definitive diagnosis
b)
Provider documentation of medical decision making
c)
Patient reason for seeking medical advice
d)
Payer response to inaccurate coding on submitted claim.
16.
Which of the following distinguishes E/M emergency service coding:
a)
E/M emergency services must be provided in an emergency room setting of a
hospital and time is documented separately by each provider involved in patient
care.
b)
E/M emergency service must include ambulance transport considered part of the
surgical package) and place of service at hospital-based emergency care
facility.
c)
E/M emergency services must be hospital-based and involve traumatic injury to
either the new or established patient (as distinguished in documentation)
d)
Emergency E/M service codes do not distinguish between new or established
patients and time is not considered to be a component in the coding of the ED
visit.
17.
Counseling and coordination of care coding for billing purposes require which
one of the following in terms of E/M service patient/provider contact?
a)
Counseling and coordination of care must constitute more than 50 percent of the
face to face encounter between the physician and patient
b)
Counseling and coordination of care must be divided equitably among the
providers involved in the patient’s care.
c)
Counseling and coordination of care services are included in the surgical
packaging of an E/M visit and never billed separately.
d)
Counseling and coordination of care requires a plan of care approved in advance
by the payer and signed by the physician; any services offered beyond those in
the plan are automatically denied payment.
18.
The provider has admitted a patient for observation & got discharged on the
same day. The provider has performed detailed history, detailed examination
& moderate complexity MDM .The correct CPT code is:
a)
99234
b)
99218
c)
99218, 99217
d)
99238
19.
Inpatient neonatal care code applies to what age of patient?
a)
29 days to 24 months of age
b)
29 days or less following premature gestational birth
c)
28 week gestational period, birthing age irrelevant
d)
28 days or less
20.
The provider provides a complex/lengthy telephone call of 20 minutes to a
patient regarding the results of his lab work. The correct CPT code is:
a)
99441
b)
99442
c)
99444
d)
96161
21.
The provider provided hospital discharge day management for 65 minutes. How do
you code this discharge management?
a)
99238, 99354
b)
99217
c)
99238, 99358
d)
99239
22.
The nurse saw an established patient in the provider’s office ad checked the
patient’s blood pressure.What is the correct CPT code?
a)
99212
b)
99211
c)
99401
d)
96160
23.
The provider admits a two-day-old infant into the NICU and spends 2.5 hours
providing critical care.What is the correct way to code this scenario?
a)
99461, 99221
b)
99468, 99291, 99292 x 3
c)
99460, 99291, 99292 x 3
d)
99468
24.
A pediatrician performs a history, examination and other newborn care for an
infant that was delivered at home by a mid wife. The physician also informs the
parents on how to care for the newborn.What code would the pediatrician report
for this service?
a)
99460
b)
99461
c)
99462
d)
99463
25.
What is the code for direction of EMS service?
a)
99288
b)
99360
c)
99285
d)
99358
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