The Complete Diagnosis Coding Solution 3rd Solution By Shelley Safian – Test Bank

Complete Test Bank With Answers

 

 

Sample Questions Posted Below

 

Chapter 05 – Evaluation and Management Codes, Part 2

Chapter 05

Evaluation and Management Codes, Part 2

Multiple Choice Questions

1. 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

Annual physicals are coded from the preventive management section and are arranged by

new/established patients and by age.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

5-1

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

2. 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

Anticipatory guidance is the physician’s suggestions for behavior modification or other

preventive measures related to a patient’s high risk for a condition.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

3. 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

Effective intervention focuses on reducing risk factors and strengthening those protective

factors that are most closely related to the problem being addressed.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

5-2

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

4. 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.

The preventive management section is arranged by new/established patients and by the age.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

5. 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

Code 99407 is used for smoking cessation counseling visits; intensive, greater than 10

minutes.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Counseling and/or Risk Factor Reduction Intervention

5-3

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

6. 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

Codes 99446–99449 are used for interprofessional telephone/Internet consultations. The

consultant should use codes to report time spent for medical consultative discussion and

review.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Topic: Case Management Services

7. Care plan oversight services are reported with codes:

A. 99487–99489.

B. 98966–98968, 99441–99443.

C. 99339–99340, 99374–99380.

D. 99605–99607.

Codes for care plan oversight services are coded from 99339–99340 and 99374–99380.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Transitional Care Management Services

5-4

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

8. 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

A hospice is designed to provide a caring environment for meeting the physical and

emotional needs of terminally ill patients and their families.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

9. Critical care service codes are determined by which criteria?

A. Time spent

B. Location

C. The age of the patient

D. Severity of injuries

Codes 99291-99292 should be reported for the total duration of time spent in provision of

critical care services to a critically ill or critically injured patient.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.03

Topic: Critical Care Codes

5-5

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

10. 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

Code 99291 is used for the first 30-74 minutes, and code 99292 + 99292 is for each

additional 30 minutes.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 3 Hard

Estimated Time: 0-1 minute

Learning Outcome: 05.03

Topic: Critical Care Codes

11. 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

Code 99363 is used for anticoagulant management, initial 90 days.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Topic: Case Management Services

5-6

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

12. 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

Modifier 24 is used for unrelated evaluation and management services by the same physician

during a postoperative period, for reasons unrelated to the original procedure.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

13. 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

Modifier 32 is for mandated services: services related to mandated consultation and/or related

services.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

5-7

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

14. 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

Modifier 57 is appended to an evaluation and management code during which a decision to

schedule a surgical procedure was made.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 3 Hard

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

15. 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

Code 99024 is used for postoperative follow-up visits, normally included in the surgical

package to indicate that an evaluation and management service was performed during a

postoperative period for a reason(s) related to the original procedure.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.05

Topic: E/M in the Global Surgical Package

5-8

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

16. 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.

A neonate is a baby aged 28 days old or younger.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Newborn and Pediatric Evaluation and Management Care

17. 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

Code 99465 is used for the delivery/birthing room resuscitation, providing positive pressure

ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or

cardiac output.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Newborn and Pediatric Evaluation and Management Care

5-9

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

18. 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

Code 99463 is used for the initial hospital or birthing center care, per day, for evaluation and

management of normal newborn infants admitted and discharged on the same date.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Newborn and Pediatric Evaluation and Management Care

19. 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

Use code 99367 for medical team conference with interdisciplinary team of health care

professionals, patient and/or family not present, 30 minutes or more; participation by

physician.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Topic: Case Management Services

5-10

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

20. 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.

Risk factor reduction intervention is an action taken by the attending physician to stop or

reduce a behavior or lifestyle that is predicted to have a negative effect on the individual’s

health.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

21. 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

Codes 99347-99350 are used to report home services by a physician to an established patient.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Home Services

5-11

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

22. 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

Care plan oversight services provided by a home healthcare agency are coded from 99374-

99375.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

23. 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

E/M codes for a new patient in an assisted living facility range from 99324-99328.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 1-2 minutes

Learning Outcome: 05.02

Topic: Long-Term Care Services

5-12

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

24. 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

Codes for telephone E/M services are coded form 99441-99443.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Topic: Case Management Services

25. Complex chronic care coordination services totaling 75 minutes in one month are

reported by which code?

A. 99443

B. 99607

C. 99363

D. 99487

Codes 99487-99489 are used for patients who require complex chronic care coordination

services that involve multiple illnesses, use of multiple medications, inability to perform

activities of daily living, etc.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Complex Chronic Care Coordination Services

5-13

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

26. 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.

The codes used to report the provision of preventive medicine services will depend on the

age of the patient and whether the patient is new or established to the physician.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

27. 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.

Codes 99381-99397 include counseling/anticipatory guidance/risk factor reduction

interventions that are provided at the time of the initial periodic comprehensive preventive

medicine examination.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Remember

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

5-14

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

28. What do anticipatory guidance recommendations include?

A. Diagnostic testing

B. Behavior modification

C. Surgery

D. Medicine

Behavior modification is recommended for patients who have a behavior that is often

considered an illness itself, such as tobacco use and addiction or substance abuse/misuse.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

29. 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

Modifier 25 should be added to the Office/Outpatient code to indicate that a significant,

separately identifiable evaluation and management service was provided on the same day as

the preventive medicine service. The appropriate preventive medicine service is reported first,

followed by the E/M code with modifier 25.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Preventive Medicine

5-15

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

30. 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

Codes 99341-99345 are used to report evaluation and management services provided in a

private residence of a new patient.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 1 Easy

Estimated Time: 0-1 minute

Learning Outcome: 05.01

Topic: Home Services

31. Dr. Olsen evaluates Frank Harrison, currently in the ICU. Mr. Harrison was in a single-

engine airplane crash and is in a coma. Dr. Olsen is with Frank for 45 minutes. What is the

appropriate CPT code?

A. 99291

B. 99292

C. 92953

D. 94662

Code 99291 reports critical care services of 30-74 minutes.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.03

Topic: Critical Care Codes

5-16

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

32. Maribelle Longene is being discharged today from the Health Center nursing home. Dr.

Kenmore spent 20 minutes completing the discharge process (final exam, discussion, etc.).

What code is used for nursing home discharge services?

A. 99215

B. 99310

C. 99315

D. 99316

Codes 99315-99316 are used for nursing facility discharge day management to report the

total duration of time spent by a physician or other qualified healthcare professional for the

final nursing facility discharge of a patient.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

33. Dr. Garner performs a history and exam on Robert Peter Cohen, born 1 hour ago in the

hospital delivery room. Happily, Robert is perfectly normal. This is reported with what code?

A. 99381

B. 99397

C. 99460

D. 99205

Codes 99460-99465 are used to report services provided to newborns (from birth through the

first 28 days) in several different settings. Use a normal newborn code in the first days after

birth prior to home discharge.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

5-17

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

34. Dr. Suarez performs a basic disability exam on Zena McIntire. This is coded from which

subsection?

A. Rick factor reduction

B. Special evaluation and management services

C. Preventive medicine

D. New patient, office/outpatient visit

Special evaluation and management services are used to report evaluations performed to

establish baseline information prior to life or disability insurance certificates being issued.

ABHES: 8.c.1. Differentiate between procedures of private, federal, and state payers

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

35. To report E/M services provided by a physician to a patient in a nursing home, the coder

must first determine:

A. whether the patient is new or established.

B. the length of time spent.

C. whether it is initial or subsequent care.

D. the age of the patient.

Two major subcategories of nursing facility services are recognized: Initial Nursing Facility

Care and Subsequent Nursing Facility Care.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

5-18

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

36. E/M services provided by a physician to a critically ill patient are coded by:

A. whether the patient is new or established.

B. the length of time spent.

C. whether it is initial or subsequent care.

D. the age of the patient.

Codes 99291 and 99292 are used to report the total duration of time spent in provision of

critical care services to critically ill or critically injured patients, even if the time spent

providing care on that date is not continuous.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.03

Topic: Critical Care Codes

37. Inpatient neonatal critical care services are coded by the patient’s age and:

A. whether the patient is new or established.

B. the length of time spent.

C. whether it is initial or subsequent care.

D. the age of the patient.

Codes 99468 and 99649 are used to represent care starting with the date of admission to a

critical care unit and subsequent days that the neonate remains in critical condition.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

5-19

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

38. Subsequent intensive care services to low birth weight (LBW), VLBW, and recovering

neonates are coded by:

A. the age of the infant.

B. the length of time spent.

C. whether the patient is new or established.

D. the present body weight.

Subsequent intensive care services to LBW neonates are coded by present body weight.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

39. Dr. Baez phoned Judy Calder to discuss a new therapy he researched for her 5-year-old

son. The call lasted 15 minutes. Judy said she would discuss this with her husband and let him

know. Dr. Baez saw the patient two weeks ago. This is coded:

A. 99441

B. 99442

C. 99443

D. 99444

Use code 99442 for non-face-to-face evaluation and management services provided using the

telephone by a physician to a patient not seen within the previous 7 days, lasting 11-20

minutes.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Topic: Case Management Services

5-20

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

40. Dr. Mohammed supervised a hospice patient’s care and provided care plan oversight

services lasting 25 minutes. This is reported with:

A. 99350

B. 99377

C. 99337

D. 99362

Code 99377 is for the supervision of a hospice patient (patient not present) requiring complex

and multidisciplinary care modalities, 15-29 minutes.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 1-2 minutes

Learning Outcome: 05.02

Topic: Long-Term Care Services

41. Dr. Schillinger first saw Mary Lou Renney at the hospital last week, the day she was

born. Her mom brings her in today for a checkup. History, exam, and medical decision

making are documented. This is coded as a(n):

A. new patient.

B. established patient.

C. initial care.

D. subsequent care.

The visit would be considered an established patient visit because the patient was initially

seen by the physician while in the hospital.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Learning Outcome: 05.06

Topic: Case Management Services

Topic: Evaluation and Management Modifiers

5-21

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

42. David, 23 months old, is critically ill, in the NICU at City Hospital. Dr. Katzman provides

critical care services, including endotracheal intubation and an umbilical arterial catheter. He

saw David yesterday when he admitted him. How are Dr. Katzman’s services coded?

A. 99469

B. 99471

C. 99472

D. 99476

Code 99472 is for subsequent inpatient pediatric critical care to a patient who is 29 days

through 24 months of age.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Learning Outcome: 05.06

Topic: Case Management Services

Topic: Evaluation and Management Modifiers

43. Codes 99324–99340 are used for reporting services to patients in all except:

A. assisted living facilities.

B. domiciliaries.

C. long-term care facilities.

D. Alzheimer’s facilities.

Codes 99324-99340 are used for services provided for domiciliary, rest home (e.g., boarding

home), or custodial care services. Long-term care facilities are reported with codes from the

Nursing Facility Services subsection (codes 99304-99318).

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

5-22

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

44. Services reported with codes 99304-99318 identify the location of care as all except a(n):

A. skilled nursing facility.

B. custodial care center.

C. intermediate care facility.

D. psychiatric residential treatment center.

Codes 99304-99318 cover services provided in skilled nursing facilities, intermediate care

facilities, and psychiatric residential treatment centers. Codes 99324-99340 are used for

services provided for domiciliary, rest home (e.g., boarding home), or custodial care services.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

45. A physician spent 45 minutes counseling on healthy diet and the importance of exercise to

a patient with a family history of diabetes. How are the physician’s services coded?

A. 99401

B. 99402

C. 99403

D. 99406

Codes 99401–99404 are used to report services provided face-to-face by a physician or other

qualified healthcare professional for the purpose of promoting health and preventing illness or

injury.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Learning Outcome: 05.06

Topic: Case Management Services

Topic: Evaluation and Management Modifiers

5-23

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

46. Today, Dr. Nepal discharged Emil Stanton from the hospital and admitted him to a

nursing facility for continued care. How will Dr. Nepal’s services for today be coded?

A. Hospital discharge service + initial nursing facility care

B. Initial nursing facility care only

C. Hospital discharge service only

D. Subsequent hospital care

When a patient is discharged as an inpatient and admitted to a nursing facility on the same

day, the physician can code both the hospital discharge and the initial nursing facility care

service codes.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.02

Topic: Long-Term Care Services

47. Critical care services, first day, provided to a patient who is 3 years old will be reported

with code:

A. 99296.

B. 99298.

C. 99292.

D. 99475.

Codes 99475-99476 are used for neonatal or pediatric critical care services.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.03

Topic: Critical Care Codes

5-24

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

48. Care plan oversight services provided to a nursing facility resident, 1 hour total for the

month of May, are reported with code:

A. 99318.

B. 99307.

C. 99304.

D. 99380.

Care plan oversight services are reported separately from codes for office/outpatient, hospital,

home, nursing facility or domiciliary, or non-face-to-face services.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.04

Learning Outcome: 05.06

Topic: Case Management Services

Topic: Evaluation and Management Modifiers

49. Dr. Kennedy has been treating Paul Fried for six months. Today the doctor performed a

medical disability exam; developed a treatment plan; and completed the documentation,

certificate of disability, and a report. This is reported with code:

A. 99455.

B. 99456.

C. 99450.

D. 99215.

Code 99455 is used for work-related or medical disability examinations by the treating

physician.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Apply

CAAHEP: IX.P.1. Perform procedural coding

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 3 Hard

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

5-25

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.Chapter 05 – Evaluation and Management Codes, Part 2

50. Pediatric critical care codes are measured by:

A. minutes.

B. hours.

C. days.

D. total length of stay.

Pediatric critical care codes are measured by days and not the amount of time spent with the

patient.

ABHES: 8.c.3. Perform diagnostic and procedural coding

Accessibility: Keyboard Navigation

Blooms: Understand

CAAHEP: IX.C.1. Describe how to use the most current procedural coding system

CAHIIM: I.A.1. Apply diagnosis/procedure codes according to current guidelines

Difficulty: 2 Medium

Estimated Time: 0-1 minute

Learning Outcome: 05.06

Topic: Evaluation and Management Modifiers

5-26

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of

McGraw-Hill Education.