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OST-249 - Chapter 12 - Evaluation and Management Exam Q’s and A’s
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OST-249 - Chapter 12 - Evaluation and Management Exam Q’s and A’s
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OST-249 - Chapter 12 - Evaluationand Management Exam Q’s and A’s
Premature newborn admitted to the hospital NICU. Baby remains unstable
and critical for 2 days after admission. - -99468, 99469 x 2
(Initial critical care neonatal day is assigned 99468, subsequent days of
neonatal critical care is assigned 99469.)
-Patient admitted to inpatient hospital for possible stroke. History of right-
sided numbness and weakness, 2-week duration. No cough, no chest pain.
Exam of respiratory, cardiovascular, neurological. CT of brain with contrast
performed as well as labs, x-rays. Patient admitted for cardiovascular
accident with neurologic symptoms. Hx/exam detailed. - -99221
(Visit was performed as Initial Hospital Visit; therefore, 99221 would be the
only appropriate answer for this scenario.)
-Established outpatient consultation requiring comprehensive history and
exam, moderate MDM. All the components needed for a consultation were
met (i.e., referring physician, written referral, and written report back to the
requesting physician). - -99244
(All three elements meet 99244 consultation.)
-Office visit for dressing change to leg performed by physician's nurse.
Patient seen previously for wound, result of fall from bike. - -99211
(Office visits may be performed by the nurse if the provider of record is in
the office and supervising the services. Nurse visits are typically assigned
99211 as there is usually minimal history and exam performed. These visits
are usually to perform "re-checks" or nursing duties such as
bandage/dressing changes, injections, etc.)
-Patient arrives in the physician's office for exacerbation of asthma. During
the wait to see the physician, the patient experiences extreme SOB and goes
into respiratory arrest. The physician examines the patient, begins IV meds,
and continues treating the patient until an ambulance arrives. Time
documented treating the patient is 45 minutes. - -99291
(Critical care is assigned for attending to the patient for 45 minutes, code
99291. Critical care may be assigned regardless of the location of service as
long as the patient is critically ill.)
-New patient presents for consultation with ENT physician. After determining
the patient is self-referred, the physician performs a problem-focused history
and exam, and MDM is low. - -99201
(Visit is limited by problem-focused history and exam. Assign 99201 only.
Does not qualify for consultation as patient was self-referred.)
, -What requirements are necessary for a consultation?
Written Report
all components listed
Referring Physician
Request for Consultation - -all components listed
(A referring physician, request for a consultation, and written report are all
required for a consultation.)
-Patient is readmitted to the skilled nursing facility after recent
hospitalization. Readmission requires comprehensive reassessment and
establishment of a new treatment plan. Additional medications, physical
therapy, and changes in her daily treatment protocol are established by the
physician with moderate MDM. - -99304
(Without regard to the level of elements required, only one answer, 99304, is
for an initial skilled nursing facility. When a patient is readmitted, CPT
guidelines indicate an initial skilled nursing facility visit should be assigned.
Therefore, the correct answer would be 99304.)
-Office visit for an established patient. Problem-focused history and exam,
straightforward MDM. - -99212
(Problem-focused history and exam would only qualify for 99212.)
-Patient referred for consult by PCP regarding right knee pain. Expanded
problem-focused history and exam and low MDM were performed and no
significant orthopedic diagnosis was made following diagnostic x-rays. A
prescription for pain medication was written and the patient was discharged
back to their PCP for additional evaluation and treatment if needed. Written
documentation of referral, requesting physician, and written report to PCP
are documented. - -99242
(Visit would qualify as consultation as seen for request for expert opinion and
sent back to PCP. Expanded PF Hx and exam, therefore, visit would be
assigned 99242.
-An established patient is seen in the office for suture removal from a
laceration repaired by the same physician 7 days ago. Patient is seen by
physician's nurse only and sutures are removed without difficulty. - -99024
(While no E/M level is assigned, 99024 for postoperative follow-up visit is
assigned to track the encounter. Surgical follow-up period for ALL surgical
procedures is 10 days minimum.) WRONG
-Patient arrives for office visit for the first time in 4 years; has been out of
the country until recently. A comprehensive reevaluation, comprehensive
exam, and high MDM are performed. - -99205
, (Per CPT a new patient is any patient who has not seen provider in same
group in same specialty in 3 years. Therefore, qualifies for new patient. Hx,
exam, and MDM qualify for 99205.)
-Hospital admission for asthma exacerbation. Detailed history, detailed
exam, and high MDM were performed. - -99221
(Limited by detailed Hx (99221) and detailed exam (99221), all three
elements must be met, therefore, 99221 only.) WRONG
-Patient admitted on 01/5, seen 01/06-01/09, and discharged on 01/10.
Assign code(s) appropriately. - -99221, 99231 x 4, 99238
(Without regard to the level for each date of service, the scenario should
have one (1) admit code, a total of four (4) subsequent visit codes, and one
(1) discharge code. Therefore, the only answer that meets that criteria is
99221, 99231 x 4, 99238.)
-Physician called to the intensive care unit at the hospital for a patient in
coronary crisis. The physician spent 90 minutes stabilizing the patient. - -
99291, 99292 x 1
(A total of 90 minutes of critical care time qualifies as 99291 and 99292 x 1
as listed in CPT critical care grid.)
-Patient met in ER by his regular physician complaining of chest pain. After
comprehensive history and exam and high MDM, the patient is admitted by
his physician to rule out myocardial infarction. - -99223
(Only one E/M assigned per physician per day, therefore, admit would be
assigned. Qualifies for 99223 as all three components (Hx, exam, and MDM)
were met.) WRONG
-Patient is referred by their insurance carrier for a second opinion
consultation regarding osteoarthritis as her orthopedist has recommended a
knee replacement. The evaluation consists of a comprehensive history,
comprehensive exam, and moderate MDM. - -99244-32
(All three elements qualify for 99244 level of service. Also assign modifier -
32 as mandated service by insurance carrier.)
-Patient seen in the ER for laceration to hand, laceration to head with head
trauma, concussion with loss of consciousness. Lacerations are repaired and
physician examines the head, eyes, and ENT as well as takes a history
regarding loss of consciousness, review of systems involves eyes, ears,
neurological status. Medical decision-making is low. What code(s) would be
appropriate? - -99281-25, laceration/closure code
(Visit took place in the ED, therefore, 99281-25 would be assigned as well as
laceration/closure. HPI qualifies as straightforward only, therefore. Since all
three components, such as Hx, exam, and MDM, must be met, the visit
qualifies for 99281-25 only.)
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