Evaluation and Management Coding Flashcards

A physician sees a patient in a skilled nursing facility for an initial comprehensive assessment. All three key components are at their highest level. Which code applies?

Answer: 99306

99306 is the highest-level initial SNF/NF visit, requiring comprehensive history, comprehensive exam, and high complexity MDM.

What is the key distinction between CPT codes 99241–99245 (outpatient consultations) and regular office visit codes?

Answer: Consultations require a written or verbal request from another provider and a written report back

To bill a consultation, there must be a request from an appropriate source and a written report sent back to the requesting provider.

A physician spends 35 minutes of total time on an established office patient encounter in 2021. Which E/M code is most appropriate?

Answer: 99214

Under 2021 guidelines, 99214 covers 30–39 minutes of total time for an established office/outpatient visit.

When a physician performs an annual wellness visit and also addresses a new problem requiring additional work, how should this be coded?

Answer: The preventive medicine code plus the appropriate E/M code with modifier -25

Both the preventive medicine code and a separate E/M code with modifier -25 may be billed when a separately identifiable problem is addressed.

Which factor does NOT contribute to the 'amount and/or complexity of data' element of medical decision making?

Answer: Patient's vital signs

Vital signs are part of the physical examination, not the data complexity element of MDM.

A neonatologist provides initial care to a normal newborn in the hospital. Which code family is most appropriate?

Answer: 99460–99462

Newborn care codes 99460–99462 are used for initial and subsequent care of normal newborns in a hospital or birthing center.

A physician is called to the bedside of a hospitalized patient experiencing a sudden change in condition requiring critical care. The physician spends 45 minutes. Which code applies?

Answer: 99291

99291 covers the first 30–74 minutes of critical care services; 45 minutes falls within this single unit.