CPC Evaluation and Management Coding 3 — Questions and Answers
Question 1: 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?
- 99304
- 99305
- 99306 (Correct answer)
- 99307
Correct answer: 99306
99306 is the highest-level initial SNF/NF visit, requiring comprehensive history, comprehensive exam, and high complexity MDM.
Question 2: What is the key distinction between CPT codes 99241–99245 (outpatient consultations) and regular office visit codes?
- Consultations require a written or verbal request from another provider and a written report back (Correct answer)
- Consultations are only for new patients
- Consultations are only billable by specialists
- Consultations require hospital admission orders
Correct 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.
Question 3: A physician spends 35 minutes of total time on an established office patient encounter in 2021. Which E/M code is most appropriate?
- 99213
- 99214 (Correct answer)
- 99215
- 99212
Correct answer: 99214
Under 2021 guidelines, 99214 covers 30–39 minutes of total time for an established office/outpatient visit.
Question 4: When a physician performs an annual wellness visit and also addresses a new problem requiring additional work, how should this be coded?
- Only the preventive medicine code
- Only the E/M office visit code
- The preventive medicine code plus the appropriate E/M code with modifier -25 (Correct answer)
- The preventive medicine code with modifier -57
Correct 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.
Question 5: Which factor does NOT contribute to the 'amount and/or complexity of data' element of medical decision making?
- Reviewing external records
- Ordering tests
- Patient's vital signs (Correct answer)
- Independent interpretation of a test
Correct answer: Patient's vital signs
Vital signs are part of the physical examination, not the data complexity element of MDM.
Question 6: A neonatologist provides initial care to a normal newborn in the hospital. Which code family is most appropriate?
- 99221–99223
- 99460–99462 (Correct answer)
- 99477–99480
- 99281–99285
Correct answer: 99460–99462
Newborn care codes 99460–99462 are used for initial and subsequent care of normal newborns in a hospital or birthing center.
Question 7: 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?
- 99291 (Correct answer)
- 99292
- 99291 + 99292
- 99233
Correct answer: 99291
99291 covers the first 30–74 minutes of critical care services; 45 minutes falls within this single unit.
CPC Evaluation and Management Coding 3
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?