Deck 22: CPT Evaluation and Management Coding

Question 1

Consultations requested by a patient looking for a second opinion are coded from which section of the CPT book?

A) 99201-99205
B) 99221-99226
C) 99251-99255
D) 99241-99245

Answer 1

A

Question 2

In what section of the CPT code book are the E/M codes listed?

A) Medicine
B) Surgery
C) Evaluation and Management
D) Anesthesiology

Answer 2

C

Question 3

A patient history may consist of:

A) a chief complaint.
B) a history of present illness.
C) a review of systems.
D) All of these

Answer 3

D

Question 4

What services do Evaluation and Management codes report?

A) Laboratory test
B) Chest x-ray
C) Physician encounter
D) Biopsy

Question 5

What does the acronym PFSH stand for?

A) Present, Family, and Social History
B) Past, Friend, and System History
C) Past, Family, and Social History
D) Present, Friend, and System History

Question 6

The CPT book categorizes:

A) 11 body areas and six organ systems.
B) five body areas and seven organ systems.
C) seven body areas and 11 organ systems.
D) nine body areas and 12 organ systems.

Question 7

Time can be used to determine an E/M code when:

A) more than 25 percent of the total time is spent counseling the patient.
B) more than 30 percent of the total time is spent counseling the patient.
C) more than 20 percent of the total time is spent counseling the patient.
D) more than 50 percent of the total time is spent counseling the patient.

Question 8

A patient came in to see the specialist in your office for the first time. What is this patient's relationship?

A) Initial visit
B) Subsequent visit
C) New patient
D) Established patient

Question 9

An example of a body area is the:

A) abdomen.
B) skin.
C) eyes.
D) ears.

Question 10

What does the level of medical decision-making describe?

A) How much time and expertise the provider used to determine the diagnosis and treatment plan
B) How much knowledge and expertise the provider used to determine the diagnosis and treatment plan
C) How much knowledge and time the provider used to determine the diagnosis and treatment plan
D) How much time the provider used to determine the diagnosis and treatment plan

Question 11

What code is reported for a physician who provided discharge services for a patient who is being discharged from observation care after a two-day stay?

A) 99224
B) 99217
C) 99354
D) 99236

Question 12

An E/M code to report an office visit with a new patient requires:

A) two of the three key components.
B) one of the three key components.
C) three of the three key components.
D) two of the two key components.

Question 13

An example of an organ system is:

A) genitalia.
B) neurologic.
C) neck.
D) head.

Question 14

A patient was admitted into the hospital by Dr. Alaska. He has been in to see her every day. What would the code range be for his visit on day three?

A) 99218-99220
B) 99224-99226
C) 99221-99223
D) 99231-99233

Question 15

When a patient requires more time than would regularly be spent (at least 30 minutes more), from what code range would a second code be applied in addition to the first-listed E/M code?

A) 99201-99205
B) 99211-99215
C) 99224-99226
D) 99354-99359

Question 16

The amount of detail involved in the documentation of the patient history that has been taken during this encounter will identify the:

A) level of patient history.
B) place of service.
C) consultation given.
D) medical decision-making.

Question 17

Initial Hospital Care E/M service codes range from:

A) 99231-99233.
B) 99221-99223.
C) 99218-99220.
D) 99224-99226.

Question 18

To assign a correct E/M code, you must know:

A) the patient's name.
B) the diagnosis code.
C) the physician's name.
D) the location of the encounter.

Question 19

A consultation is defined as when a physician ________ at the request of another physician.

A) assumes full care of the patient
B) admits a patient
C) provides advice or an opinion on a patient's treatment
D) performs surgery

Question 20

An established patient is defined as:

A) a patient who has never been seen before by the provider.
B) a patient who was seen four years ago.
C) a patient who was seen five years ago.
D) a patient who has been seen within the last three years.

Question 21

A consultation requested by another physician is coded as a(n):

A) new patient visit.
B) established patient visit.
C) consultation.
D) home service.

Question 22

Locations that will help determine an E/M code include all of the following except:

A) surgical operating room.
B) home services.
C) hospital inpatient.
D) office or other outpatient services.

Question 23

Darlene has not seen Dr. Curtis in four years. Today's visit will be coded as a(n):

A) initial visit.
B) subsequent visit.
C) new patient.
D) established patient.

Question 24

All of these body areas are recognized by CPT, except the:

A) skin.
B) neck.
C) abdomen.
D) back.

Question 25

The patient comes in with a broken bone sticking out from his arm. The level of MDM for the physician to determine what to do next is:

A) straightforward.
B) low complexity.
C) moderate complexity.
D) high complexity.

Question 26

The relationship between provider and patient, as described by E/M codes, may be a(n):

A) established patient.
B) new patient.
C) consultation.
D) Any of these

Question 27

Dr. Getter spent one hour with Nancy, 40 minutes of which he spent counseling her on keeping her diabetes under control. The primary factor for this E/M code is the:

A) level of history.
B) level of exam.
C) level of medical decision making.
D) time.

Question 28

E/M services provided to an assisted living facility resident are coded:

A) new patient.
B) office or hospital.
C) domiciliary subsection.
D) special services.

Question 29

A consultation requested by the patient is coded as a(n):

A) new patient visit.
B) established patient visit.
C) initial consultation.
D) home services.

Question 30

When a patient has several possible diagnoses and has a high risk of significant complications from the standard treatment, the MDM would fall into which category?

A) Straightforward
B) Low complexity
C) Moderate complexity
D) High complexity

Question 31

One of the organ systems recognized by CPT is the:

A) abdomen.
B) psychiatric.
C) neck.
D) genitalia.

Question 32

Key components of some E/M codes include a(n):

A) location.
B) new patient.
C) level of examination.
D) chief complaint.

Question 33

A patient was admitted and discharged on the same date of service. From what range will the physician's E/M services be reported?

A) 99217-99226
B) 99221-99223
C) 99234-99236
D) 99231-99233

Question 34

A patient comes in with one or two possible diagnoses, is on no medication, and has no other co-morbidities. The level of decision making would be:

A) straightforward.
B) low complexity.
C) moderate complexity.
D) high complexity.

Question 35

Consultation services are coded based upon who requested the service and the:

A) length of time of the exam.
B) age of the patient.
C) office or hospital location.
D) initial or subsequent visit.

Question 36

An E/M code is determined first by the encounter's:

A) level of history.
B) location.
C) physician's specialty.
D) time of day.

Question 37

PFSH includes all of these components except:

A) past history.
B) family history.
C) systems history.
D) social history.

Question 38

When a patient has a detailed history, the review of systems must fall into which category?

A) No review of systems
B) Problem-pertinent review of systems
C) Extended problem-pertinent review of systems
D) Complete review of systems

Question 39

George sees Dr. Mallard in his office. Dr. Mallard sends George immediately to be admitted into the hospital. The E/M code will be chosen from subsection:

A) office visit.
B) initial hospital care.
C) subsequent hospital care.
D) emergency department services.

Question 40

Levels of history obtained include:

A) straightforward.
B) low complexity.
C) moderate complexity.
D) comprehensive.

Question 41

Preventive medicine exam codes are based on whether the patient is a new or established patient and:

A) the patient's age.
B) the severity of the illness.
C) the amount of time spent with the patient.
D) the level of history taken.

Question 42

A consultation requested by another physician, occurring in the hospital, is coded from what range?

A) 99251-99255
B) 99241-99245
C) 99201-99205
D) 99221-99223

Question 43

An 18-year-old female went to visit Dr. Green for her annual physical. She has seen Dr. Green every year for her physical since the age of 12. What is the appropriate code to use for this visit?

A) 99384
B) 99395
C) 99385
D) 99394

Question 44

Anticipatory guidance is normally found in which section of the CPT codes?

A) Counseling Risk Factor Reduction and Behavior Change Intervention
B) Newborn Care Services
C) Preventive Medicine Services
D) Care Management Services

Question 45

A small number of possible diagnoses and treatment options are described as medical decision-making that is:

A) straightforward.
B) low complexity.
C) moderate complexity.
D) high complexity.

Question 46

Dr. Smith counseled Mr. Jackson for 30 minutes regarding smoking cessation. What is the appropriate code to use?

A) 99402
B) 99407
C) 99411
D) 99409

Question 47

Giving a patient a prescription for a smoking cessation patch falls into which of the following categories?

A) Counseling
B) Anticipatory guidance
C) Consultation
D) Risk-factor reduction intervention

Question 48

Medical decision-making is measured by the:

A) number of possible diagnoses.
B) number of possible treatments.
C) number of organ systems reviewed.
D) number of possible diagnoses and the number of possible treatments.

Question 49

Dr. Cook spends 45 minutes preparing the papers to discharge Kyle from the hospital. Dr. Cook's evaluation and management services are coded:

A) 99239.
B) 99292.
C) 99238.
D) 99223.

Question 50

A general multisystem examination is described as:

A) problem-focused.
B) expanded problem-focused.
C) detailed.
D) comprehensive.

Question 51

Emergency department E/M codes are determined by:

A) time.
B) new or established patient.
C) two key components.
D) three key components.

Question 52

Dr. Fawzi saw Harrison, his long-time patient, in his home after Harrison's release from the hospital. This E/M service will be coded from the range of:

A) 99231-99233.
B) 99298-99300.
C) 99324-99328.
D) 99347-99350.

Question 53

What type of facility provides care only for terminally ill patients?

A) Intermediate care facility
B) Assisted living facility
C) Skilled nursing facility
D) Hospice

Question 54

Care plan oversight services are reported with codes:

A) 99487-99489.
B) 98966-98968, 99441-99443.
C) 99339-99340, 99374-99380.
D) 99605-99607.

Question 55

Levels of medical decision-making include all of the following except:

A) straightforward.
B) low complexity.
C) comprehensive.
D) high complexity.

Question 56

Critical care service codes are determined by which criteria?

A) Time spent
B) Location
C) The age of the patient
D) Severity of injuries

Question 57

Dr. Brady saw Lee Ann in the hospital for the second day in a row. This visit will be coded from:

A) 99221-99223.
B) 99231-99233.
C) 99234-99236.
D) 99251-99255.

Question 58

Dr. Chou provided a total of 2 hours and 10 minutes of critical care services to Mrs. James in the coronary care unit. What is the appropriate code assignment for Dr. Chou's services?

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

Question 59

Dr. John, a cardiologist, consults for 22 minutes with cardiology specialist Dr. Lowell over the phone regarding a critically ill hospitalized patient. What is the appropriate code to use for Dr. Lowell?

A) 99443
B) 99442
C) 99448
D) 99449

Question 60

The amount of time spent may be used as the key element to determine an E/M code when counseling takes more than:

A) 25 percent.
B) 50 percent.
C) 75 percent.
D) 80 percent.

Question 61

Dr. Henderson went to see Sam Callahan, a patient living in an assisted living facility, for the first time. A comprehensive, highly complex E/M visit is reported with which code?

A) 99339
B) 99374
C) 99337
D) 99328

Question 62

The term neonate refers to a baby from the moment of birth until age:

A) 30 days old.
B) 29 days old.
C) 28 days old.
D) 31 days old.

Question 63

The medical team conference attended by Dr. Mulford lasted 45 minutes. The patient and his wife were not present. What code is reported for Dr. Mulford?

A) 99441
B) 99363
C) 99367
D) 99448

Question 64

During an annual well-woman examination, Dr. Komen discovered a lump in Serita's breast. Dr. Komen then documented a problem-focused E/M, which should be appended with which modifier?

A) 22
B) 24
C) 25
D) 26

Question 65

Baby Jane was delivered and needed chest compressions for resuscitation by the neonatologist in the delivery room because the baby's cardiac output was insufficient. What is the appropriate code to assign for this service?

A) 99465
B) 99464
C) 99463
D) 99461

Question 66

Codes for preventive medicine visits, also known as annual physicals, include all of these factors except:

A) length of time spent face-to-face.
B) counseling.
C) anticipatory guidance.
D) risk-factor reduction intervention.

Question 67

Dr. Nelson provides medical care to Mrs. Blackberry in her home. He has been her physician for two years and obtained a problem-focused interval history, problem-focused exam. His medical decision making was straightforward. What E/M code is reported?

A) 99341
B) 99347
C) 99375
D) 99213

Question 68

Complex chronic care coordination services totaling 75 minutes in one month are reported by which code?

A) 99443
B) 99607
C) 99363
D) 99487

Question 69

Dr. Williams completed a physical for Mr. Jones. The physical is required by the insurance company prior to issuing a life insurance policy. What modifier should be appended to the E/M code?

A) 25
B) 22
C) 57
D) 32

Question 70

Preventive medicine visit codes are determined by the age of the patient and:

A) length of the exam.
B) whether the patient is new or established.
C) location of the visit.
D) number of physicians involved.

Question 71

A non-face-to-face E/M service provided over the telephone is reported from which range of codes?

A) 99363-99364
B) 99366-99368
C) 99441-99443
D) 99444-99448

Question 72

Which modifier is used to indicate that a decision for surgery was made during an evaluation and management visit?

A) 57
B) 32
C) 25
D) 22

Question 73

What code is reported for the initial hospital care for a normal newborn infant admitted and discharged on the same date?

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

Question 74

Dr. Rosin meets with Mr. Barry to talk to him about the importance of testing his glucose regularly. This is coded as (a):

A) counseling.
B) risk-factor reduction intervention.
C) consultation.
D) anticipatory guidance.

Question 75

What do anticipatory guidance recommendations include?

A) Diagnostic testing
B) Behavior modification
C) Surgery
D) Medicine

Question 76

Dr. Johnson, a member of the Hill Home Healthcare Agency, provided care plan oversight services for Mr. Matthews, who is living with his daughter and diagnosed with Alzheimer's disease. He spent 55 minutes on this plan. What code is used to report these services?

A) 99340
B) 99375
C) 99378
D) 99380

Question 77

Mr. Rodgers has seen his physician for management of his use of warfarin during the first 90 days of therapy. The physician took 9 INR measurements during this time. What is the appropriate code for these services?

A) 99363
B) 99366
C) 99364
D) 99444

Question 78

Dr. Thomas Matthews did a thorough E/M of Suzette Connors at her home. Dr. Matthews has not seen Suzette in five years. What range of codes should be used for the visit?

A) 99341-99345
B) 99201-99205
C) 99347-99350
D) 99211-99215

Question 79

Dr. Johnson performed surgery on Ms. Nelson's right foot at the ASC. One week later, she came into the office about a problem with her left leg. Which modifier would be appended to the evaluation and management code for the office visit?

A) 59
B) 26
C) 24
D) 66

Question 80

Dr. Newell meets with Ms. Dickens in his office a week after performing her appendectomy to check on her healing progress. What is the appropriate code for this follow-up evaluation and management visit?

A) 99211
B) 99024
C) 99212
D) 99213