Evaluation & Management Services I

1. To code a professional service as a new patient, the patient must meet what requirements?
a. The patient has not received services from the provider or from another provider within the same
group
b. The patient has not received services from the provider or from another provider within the same
group for three years
c. The patient is only required to have a new problem to be considered a new patient
d. None of the above
e. Both a and b

2. A subsequent inpatient consultation that may be rendered in response to a change in the patient status
after the initial consultation during the same inpatient admission should be reported from which code
range?
a. 99221 99223
b. 99231 99233
c. 99241 99245
d. 99251 - 99255

3. Which of the following is NOT considered an organ system?

a. Respiratory
b. Psychiatric
c. Back
d. Musculoskeletal

4. A physician performs a preventive care service, the extent of the exam is determined by the
a. patient's gender.
b. length of time elapsed since last exam.
c. patient's gender and age.
d. patient's age.

5. A patient was admitted yesterday to the hospital for possible gallstones. The following day the
physician who admitted the patient performed a detailed history, a detailed exam and a medical
decision making of low complexity. The physician tells her the test results have come back positive for
gallstones and is recommending having a cholecystectomy. What code should be reported for this
evaluation and management service?

a. 99253
b. 99221
c. 99233
d. 99234

6. When the critically ill neonate or pediatric patient improves and is transferred to a lower level of care
to another individual in another group within the same facility, the transfering individual will report
codes from the following series.

a. 99231 99233
b. 99291 99292
c. Both a & b
d. None of the above

7. Inpatient critical care service provided to a 14 day old child is reported using CPT codes:

a. 99471 99476
b. 99468 99469
c. 99291 99292
d. 99466

8. A patient came in to the ER with wheezing and a rapid heart rate. The ER physician documents a
comprehensive history, comprehensive exam and medical decision of moderate complexity. The patient
has been given three nebulizer treatments. The ER physician has decided to place him in observation
care for the acute asthma exacerbation. The ER physician will continue examining the patient and will
order additional treatments until the wheezing subsides. Select the appropriate code(s) for this visit.

a. 99284, 99219
b. 99219
c. 99284
d. 99235

9. Mr. Smith presents to the Emergency Department at the local hospital for chest pain and is seen by
the ED physician on duty. The physician obtains an extended HPI, an extended ROS, and a pertinent
PFSH. What is the level of history?
a. Problem-focused.
b. Comprehensive
c. Expanded problem-focused.
d. Detailed
10. Are hospitalists eligible to bill these TCM codes?

a. YES
b. NO

1. The risk of morbidity without treatment is moderate or an uncertain prognosis:

a. The risk of morbidity without treatment is moderate or an uncertain prognosis
b. There is a high probability of severe prolonged functional impairment
c. The problem may not require the presence of a physician
d. The risk of morbidity without treatment is low and full recovery is expected

2. In order to bill critical care services, what elements listed below must be met?
a. Service must be rendered by a physician to a critically ill patient
b. The physician must spend at least 30 minutes of time with the critically ill patient
c. The patient does not have to be critical but the physician must spend a great amount of time
reviewing records, labs, diagnostic tests with the patient
d. Both a and b

3. Time can be used to determine the level of E&M service:

a. if the patient has commercial insurance

b. if the patient is covered by a managed care plan
c. when counseling and/or coordination of care occupies more than 50% of the encounter (face-
to-face time with the patient)
d. when the patient encounter is longer than 45 minutes

4. An expanded problem focused exam is:

a. A limited examination of the affected body area or organ system

b. A limited examination of the affected body area or organ system and other symptomatic or
related organ systems.
c. A complete exam of the affected body area only.
d. An extended examination of the affected body area(s) and other symptomatic or related organ
systems

5. 80-year-old patient is returning to the gynecologists office for pessory cleaning. Patient
offers no complaints. The nurse removes and cleans the pessory, vagina is swabbed with
betadine, and pessory replaced. For F/U in 4 months. What CPT and ICD-9 should be used for
this service?

a. 99201, V45.59
b. 99211, V52.8
c. 99202, V53.99
d. 99212, 996.65

6. 50-year-old patient is coming to see her primary care physician for hypertension. Her
physician performs an expanded problem focused exam and low medical decision making.
After the exam the patient discusses with her physician that the OBGYN office had just told her
that her Pap smear came back with an abnormal reading and is worried since her aunt had
passed away with cervical cancer. The physician spends an extra 45 minutes face-to-face time
discussing with her the awareness, other screening procedures and treatment if it turns out to be
cervical cancer. What code(s) should be used for this visit?

a. 99215
b. 99213, 99354
c. 99213
d. 99213, 99403

7. Telephonic services can be reported

a. when the call is initiated by the established patient's gaurdian

b. when the patient is advised to see the physician the next day within 24 hrs
c. consultation regarding the operation held prior to 5 days
d. when the call is initiated by the physician

8. Care plan oversight services of new patient in the home, domiciliary, or rest home (eg:
assisted living) are reported with

a. 99374 99380
b. 99339 99340
c. 99377 99378
d. 99341 99345

9. Which of the following is a factor determining level of complexity of medical decision-

making?
 a. the number of diagnoses in the patients problem list
b. the risk of complications, morbidity or mortality
c. the amount of time spent with the patient
d. patient age greater than 65

10. The reason given by a patient for seeking health care is referred to as the
a. brief history.
b. primary diagnosis.
c. morbidity factor.
d. chief complaint.

1. Evaluation & Management services are comprised of what three key components?
a. History, counseling, time
b. History, examination, coordination of care
c. Nature of presenting problem, examination, medical decision making
d. History, examination, medical decision making

2. Which of the following codes is used to report an evaluation & management service provided in a
physician's office?
a. 99204
b. 99218
c. 99223
d. 99281

3. In order to report a comprehensive history, the review of systems includes only a review directly
related to the presenting problem(s) and a review of a related organ system.
a. True
b. False

4. Prolonged services (amount of time over and above the usual):

a. cannot be reported or the claim will be denied

b. must be over 30 minutes to be charged
c. must be over an hour to be charged
d. none of the above
5. A problem focused history should include:

a. the presenting complaint and its symptoms

b. family history
c. review of systems
d. social history
e. a and c

6. S: Patient states her chest pain a couple of nights ago was relieved by ginger ale, she now says the
pain lasted a few minutes and shes had no chest pain since. She says she is feeling fine and wants to
continue living with her husband. In discussion with her husband, the family is very concerned about
the patients increasing levels of dementia and confusion. Husband questions whether he will be able to
handle her, and the ABC Retirement Home first wanted to put her in XYZ Care, which is the nursing
home, but then decided she would do fine in assisted living. Notes from ABCs infirmary show that she
does wander a lot and has disturbed other patients. Current medications: Multivitamin, Dulcolax,
Calcium 800 mg daily, Synthroid 0.1 mg daily, Norvasc 2.5 mg daily, Aricept 10 mg at hs. Needs a flu
shot.

O: Lungs are clear. Heart RRR without murmur. No pedal edema. Recent TSH was normal at 1.2.

A: Alzheimer's, Hypothyroidism, Chest pain, resolved

P: In discussion with the family decided to place the patient in the assisted living facility. He will go
and have lunch and dinner with her as he wishes, and we will reassess when she comes back in January.

Refill Synthroid 0.1 mg #30, 1 daily, 6 refills.

Reassurance that episode was not consistent with angina, though we will be alert for other episodes and
do further evaluation if indicated.

7. Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax
for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted
him to the hospital for intravenous therapy and management of this problem. His physician
documented a detailed history, comprehensive examination and a medical decision making of moderate
complexity. Which E/M service is reported?

a. 99285
b. 99284
c. 99221
d. 99222

8. How often can TCM services be billed for the same patient?
a. Twice within 30 days
b. Once within 15 days
c. Once within 30 days
d. Once in 7 days

9. Which of the following criteria is not mandatory for coding 99496?

a. Communication with the patient or caregiver within 2 days of discharge

b. Face to face visit, with in 14 calendar days of discharge
c. MDM of high complexity during the service period
d. Face to face visit, with in 7 calendar days of discharge

10. Prolonged services codes 99358 99359 are billed

a. Only when there is a direct patient contact

b. For services less than 30 mis
c. The same day than the primary service to which it is related
d. It must relate to a service or patient where face to face care has occurred or will occur

11.A nephrologist sees a patient for the first time. The patient's primary care physician referred the
patient to this specialty, but did not request an opinion from the nephrologist. How would you
code this visit?
a. Consultation
b. Established patient
c. New patient
d. Preventive

12.Which of the following describes the three components of an evaluation and management (E/M)
code?

a. History, medical decision-making (MDM), and nature of presenting illness

b. History, counseling, and nature of presenting illness
c. History, counseling, and time
d. History, exam, MDM

13.An established patient presents to his provider, and the provider documents that he spent 25
minutes counseling the patient on proper diabetic management. How should you code this visit?
a. Code the visit based on time as the key controlling factor.
b. Report 99214 for this visit.
c. Code this as a consult because the provider gives his opinion on how to manage the diabetes.
d. Code this based on the key elements since the physician does not state the total time of the
face-to-face visit.

14.Which of the following must a provider document to bill an established patient?

a. Only the MDM that supports the E/M level assigned

b. Appropriate history, exam, and MDM (minimum of two elements) or proper time
documentation
c. Type of visit
d. The fact that the patient is established

15.Which of the following statements is false?

a. Established patient visits can be billed based on time only when the provider documents the
time of the total visit, as well as the total time spent face-to-face with the patient.
b. Preventive medicine visits can be coded based on the patient's age.
c. New patient visits can be billed based on time only when the provider documents the time of
the total visit, as well as the total time spent face-to-face with the patient.
d. Preventive medicine can be coded based on time.