CPC Chapter 20- Medicine Review Questions

Question 1

A child was bitten by a dog that tested positive for rabies and is seen for an injection of rabies immune globulin. What are the appropriate procedure codes for this service?
A. 90396, 96365
B. 90375, 96372
C. 90384, 96369
D. 90389, 90471

Answer 1

B. 90375, 96372

Rationale: Code for the product and the administration of rabies immune globulin. In the CPT® Index, see Immune Globulins/rabies, you are directed to 90375-90376. Because there is no mention of heat-treated, 90375 is the appropriate code. Reading the guidelines for immune globulins, a code from 96365-96372, 96374, or 96375 is reported as appropriate for the administration. This is an injection, and 96372 is the appropriate code. In the CPT® Index, look for Injection/Intramuscular/Therapeutic.

Question 2

A diabetic patient visited a neighborhood clinic to receive influenza and pneumonia intramuscular immunizations. The patient received the influenza, trivalent (IIV3) spilt virus 0.5 mL and pneumococcal polysaccharide vaccine, 23-valent (PPSV23). What are the appropriate procedure codes for this service?
A. 90658, 90732, 90471, 90472
B. 90660, 90732, 90472
C. 90736, 90657, 90471, 90472
D. 90660, 90732, 90471

Answer 2

A. 90658, 90732, 90471, 90472

Rationale: The patient received two vaccines: influenza and pneumonia. Each is charged separately. In the CPT® Index, look for Vaccines and Toxoids/Influenza/for Intramuscular Use. A review of the code choices indicates 90658 is the correct code. For the pneumonia vaccine look in the index for Vaccines/and Toxoids/Pneumococcal/23-valent (PPSV23) which leads to 90732. Code 90471 describes injection of one vaccine. The add-on code +90472 describes each additional vaccine. Add-on codes (+) may not be reported independently but are a composite of the basic code. In the CPT® Index look for Administration/Immunization One Vaccine/Toxoid and Administration/Immunization/Each Additional/Vaccine/Toxoid.

Question 3

A 35-year-old patient plans to travel to a country with a high incidence of yellow fever. The patient receives the yellow fever immunization. What are the appropriate procedure codes for this service?
A. 90717, 90471
B. 90749, 90472
C. 90717, 90460
D. 90749, 90471

Answer 3

A. 90717, 90471

Rationale: Code for both the vaccine and the administration. Codes 90717 and 90471 describe the yellow fever vaccine and the immunization administration for one vaccine. In the CPT® Index look for Vaccines and Toxoids/Yellow Fever and Administration/Immunization One Vaccine/Toxoid.

Question 4

A patient is referred to a psychiatrist for management after displaying erratic and unusual behavior at work. The patient discloses a difficult family situation. The psychiatrist meets with the family and the patient for 50 minutes. What is the correct code for the family psychotherapy session?
A. 90849
B. 90833
C. 90847
D. 90853

Answer 4

C. 90847

Rationale: A family therapy session with patient present is reported with 90847. The payer may request documentation of those present and areas of discussion. In the CPT® Index look for Psychotherapy/Family of Patient. Code choice is based on with or without the patient present, and time.

Question 5

A patient receiving psychotherapy is ready to begin mainstream efforts into the community. The psychiatrist discusses the patient’s mental health history with a social agency that assists in locating employment and living arrangements. What is the correct code for this service?
A. 90887
B. 90882
C. 90889
D. 90875

Answer 5

B. 90882

Rationale: The services performed by the psychotherapist include environmental interventions by communicating with the social agency. In the CPT® Index locate Psychiatric Treatment/Environmental Intervention. Code 90882 describes intervention on a psychiatric patient’s behalf with agencies, employers, or institutions.

Question 6

A patient experienced a stressful personal event and meets with her psychiatrist in his office for 45 minutes for the purpose of evaluating her potential to return to work. Which CPT® code accurately reports the service?
A. 90839
B. 90845
C. 90792
D. 90834

Answer 6

D. 90834

Rationale: Code 90834 describes a 45-minute outpatient/office encounter for psychotherapy. In the CPT® Index look for Psychotherapy/Individual Patient.

Question 7

A patient with long-time stress urinary incontinence undergoes biofeedback training for improvement of urine leakage. The physician spends 15 minutes one-on-one with the patient. Which CPT® code(s) accurately report(s) the service?
A. 90912
B. 90901
C. 53899
D. 90912, 90913

Answer 7

A. 90912

Rationale: Code 90912 describes biofeedback training for the urethral sphincter for the initial 15 minutes of provider time. In the CPT® Index, look for Biofeedback Training/Anorectal.

Question 8

An inpatient with ESRD is placed on a regular schedule of hemodialysis treatments. The patient receives dialysis at the hospital and is re-evaluated once by the physician for possible revision of the prescribed treatments. On re-evaluation, the physician determines no change in regimen is needed. What is the correct code for the dialysis and physician re-evaluation?
A. 90937
B. 90940
C. 90945
D. 90947

Answer 8

A. 90937

Rationale: Code 90937 describes hemodialysis requiring physician re-evaluation with or without substantial revision of dialysis. In the CPT® Index, look for Hemodialysis/Procedure/with Evaluation.

Question 9

An 18-year-old ESRD patient is receiving dialysis services and has had two face-to-face visits with her physician within 25 days. On the 26th day, she is admitted to the hospital for inpatient management without a complete assessment. She remains in the hospital until the end of the month. What is the code for the physician services for the 25 days?
A. 90969
B. 90960
C. 90969 X 25
D. 90957

Answer 9

C. 90969 X 25

Rationale: Code 90969 describes ESRD related services for dialysis less than a full month of service per day, for patients 12-19 years of age. This was not a full month of ESRD related services and 90969 is reported per day with 25 units, 1 unit for each day. See the example in CPT® under End Stage Renal Disease Services. In the CPT® Index, look for End Stage Renal Disease Services/Less than a full month.

Question 10

A patient with renal failure needs to begin dialysis treatments. He and his daughter both complete training for managing dialysis at home. What code is reported for this service?
A. 90993
B. 90966
C. 90989
D. 90997

Answer 10

C. 90989

Rationale: Code 90989 describes a completed course of dialysis training for the patient and a helper. In the CPT® Index, look for Dialysis/Patient Training/Completed Course.

Question 11

A patient visits her physician complaining of severe left lower leg pain and numbness. The left lower leg is pale compared to the right lower leg. There is no known injury. The physician evaluates for a possible blood clot before considering treatment. The physician orders a stat duplex scan of the arteries of the left leg. The scan indicates no evidence of a clot. What is the appropriate CPT® code for reporting this service?
A. 93970
B. 93930
C. 93971
D. 93926

Answer 11

D. 93926

Rationale: Code 93926 describes duplex scan, limited or unilateral study, of the lower extremity arteries, including digits. Pain and discoloration were present in the lower left leg, the only extremity scanned. In the CPT® Index, look for Duplex Scan/Arterial Studies/Lower Extremity.

Question 12

A dialysis patient undergoes a duplex scan of his hemodialysis access site to determine the pattern and blood flow in his arteries and veins. What is the appropriate CPT® code for reporting this service?
A. 93978
B. 93970
C. 93971
D. 93990

Answer 12

D. 93990

Rationale: Code 93990 describes a scan of hemodialysis access and includes arterial inflow, body of access, and venous outflow. In the CPT® Index, look for Hemodialysis/Duplex Scan of Access.

Question 13

A patient with chronic gastrointestinal disturbances undergoes complete ultrasonic scanning of the intestinal vascular structure to determine if blood flow is adequate. What is the appropriate CPT® code for reporting this service?
A. 93976
B. 93975
C. 93931
D. 93981

Answer 13

B. 93975

Rationale: Code 93975 describes a complete scan of arterial inflow and venous outflow of the abdominal, pelvic, scrotal contents, and/or retroperitoneal organs. In the CPT® Index, look for Duplex Scan/Arterial Studies/Visceral.

Question 14

A patient with chronic skin rashes on the hands visits an allergist for evaluation and receives 12 percutaneous scratch tests with various household products. What is the correct code for the scratch test?
A. 95004 X 12
B. 95004
C. 95144
D. 95044 X 12

Answer 14

A. 95004 X 12

Rationale: Code 95004 describes scratch tests with allergenic extracts, immediate type of reaction. The code includes interpretation and report. Report the code with the correct number of units for the number of tests. In the CPT® Index, look for Allergy Tests/Skin Tests/Allergen Extract.

Question 15

A patient who suffers from nasal congestion, rhinitis, and facial swelling after being stung by honeybees undergoes allergen immunotherapy. The physician provides a single dose and injection of bee venom. What is the correct code for the service?
A. 95120
B. 95144
C. 95130
D. 95145

Answer 15

C. 95130

Rationale: Code 95130 describes provision of allergenic extract and injection of a single stinging insect venom. In the CPT® Index, look for Allergen Immunotherapy/Allergenic Extracts/Injection and Provision/Insect Venom.

Question 16

A patient exhibits severe allergic reaction to peanuts. An allergist prepares four vials of single-dose antigen to begin desensitization treatment to peanut products for the patient. What is the correct code for the service?
A. 95145 X 4
B. 95144 X 4
C. 95120 X 4
D. 95170 X 4

Answer 16

B. 95144 X 4

Rationale: Code 95144 describes preparation and provision of antigen for immunotherapy in single dose vials. Report 4 vials. In the CPT® Index, look for Allergen Immunotherapy/Antigens/Preparation and Provision.

Question 17

A genetic counselor met with a couple and their child who has Duchenne’s muscular dystrophy. The couple is considering another child but wants to know the potential risk of their future children being born with the same disorder. The session lasts 1.5 hours. How is this service reported?
A. 96040
B. 96040 X 4
C. 96040 X 2
D. 96040 X 3

Answer 17

D. 96040 X 3

Rationale: Code 96040 describes genetic counseling by a qualified counselor for each 30 minutes of face-to-face time. Report three units for the session lasting 1.5 hours. Report E/M codes if counseling is provided by a physician. In the CPT® Index, look for Medical Genetics.

Question 18

A patient needs a renal transplant. The patient has been on dialysis and is awaiting a suitable donor. A clinical psychologist meets with the patient to assess the patient’s ability to comply with the requirements and drug regimen if a donor match is found. The session lasts 2 hours. How is this service reported?
A. 96156
B. 96156 X 8
C. 96158, 96159 X 6
D. 96167, 91618 X 6

Answer 18

A. 96156

Rationale: Code 96156 describes the health behavior assessment or re-assessment. The encounter lasted two hours, but the code is not a time-based code and should only be billed with a quantity of 1. In the CPT® Index, look for Health Behavior/Assessment.

Question 19

A 4-year-old has not reached the expected developmental milestones for her age group. She was referred by her pediatrician for extensive developmental testing. The psychologist spends an hour administrating multiple function studies, using standardized instruments and reported the results to the child’s pediatrician. What is the code for the psychologist’s service?
A. 96116
B. 96125
C. 96112
D. 96121

Answer 19

C. 96112

Rationale: Code 96112 describes testing for developmental assessment, including interpretation and report. In the CPT® Index, look for Developmental Testing. Because the physician spent one hour, 96112 is reported.

Question 20

A child displayed emotional outbursts, inability to interact appropriately with peers and his teacher, and was not effective in grasping lessons deemed suitable for his age. The school counselor requested psychological testing to determine if the child had been placed in classes appropriate to his abilities. Testing was administered by a clinical psychologist, who spent 10 hours face-to-face with the patient and 3 hours preparing the report of the results. How is the clinical psychologist’s service reported?
A. 96113
B. 96112
C. 96130 X 13
D. 96130, 96131 X12

Answer 20

D. 96130, 96131 X 12

Rationale: Code 96130 describes multiple testing, face-to-face time with the patient, and time interpreting and preparing the report, first hour of time. 96131 Is to be reported with the 96130 for each additional hour. Number of units reported is 12. The time must be documented in the psychologist’s record. In the CPT® Index, look for Neuropsychological Testing/Evaluation Services.

Question 21

A patient presents with vomiting and diarrhea lasting three days. The physician determines the patient is dehydrated and orders infusion of hydration fluids to run for two hours. How is the hydration service reported?
A. 96360, 96361
B. 96361 X 2
C. 96360, 96361 X 2
D. 96360 X 2

Answer 21

A. 96360, 96361

Rationale: Codes 96360 and 96361 describe hydration infusion for two hours. Code 96360 is the first hour and 96361 is the second hour. The add-on code +96361 cannot be reported independently, but only in addition to 96360. The fluids infused are separately reported, using the appropriate code from HCPCS Level II. In the CPT® Index, look for Infusion/Hydration.

Question 22

A patient has an implanted intravenous pump for prescribed drug delivery at preset intervals. The patient is seen by the physician, who provides maintenance and refills the pump with the medication. What is the code for this service?
A. 96523
B. 96522
C. 96521
D. 95990

Answer 22

B. 96522

Rationale: Code 96522 describes refill and maintenance of an intra-arterial or intravenous implanted pump for drug delivery. The drug is separately reported with HCPCS Level II codes. In the CPT® Index, look for Infusion Pump/Maintenance or Drug Delivery Implant/Maintenance and Refill/Intravenous.

Question 23

A cancer patient will receive chemotherapy by intrathecal delivery. A spinal puncture is necessary to accommodate the catheter. What code is reported for this service?
A. 96523
B. 96413
C. 96420
D. 96450

Answer 23

D. 96450

Rationale: Code 96450 describes intrathecal delivery of chemotherapy agents. The code includes the spinal puncture. The drugs are separately coded using HCPCS Level II codes. Spinal catheter placement is included in the technique. In the CPT® Index, look for Spine Chemotherapy/Administration.

Question 24

A patient sustained a severe ankle sprain playing basketball. The ankle is stiff and without complete range of motion. The physician refers the patient for physical therapy. Prior to treatment, the therapist evaluates the patient. The therapist documents a brief history and exam of the ankle and determines the sprain is uncomplicated with no other injury to the ankle. The therapist recommends an additional 5 sessions for strength and endurance and no basketball for two weeks. The clinical decision-making is of low complexity. The patient has a one-hour therapy session on the same day. How are these services reported?
A. 97161-GP, 97110-GP x 4
B. 97164-GP, 97112-GP x 4
C. 97110-GP x 4
D. 97530-GP

Answer 24

A. 97161-GP, 97110-GP x 4

Rationale: The therapist evaluates the patient and problem at the first visit and determines a treatment. Code 97161 is reported for an uncomplicated injury with low clinical decision making. In the CPT® Index, look for Physical Medicine/Therapy/Occupational Therapy/Evaluation/Physical Therapy. Code 97110 describes exercises performed to develop strength and range of motion, per 15 minutes. For one hour, report four units. In the CPT® Index, look for Physical Medicine/Therapy/Occupational Therapy/Procedures/Therapeutic Exercises.

Question 25

A patient underwent a knee arthroplasty (joint replacement) and now requires physical therapy to learn to walk with the artificial joint. The therapist evaluates the patient and documents a brief history and exam and initiates therapeutic exercises and gait training. The clinical decision-making is of low complexity. The exercises are for 45 minutes and the gait training is 15 minutes at this session. What codes are reported for the evaluation and therapeutic services?
A. 97161-GP, 97110-GP, 97116-GP
B. 97164-GP, 97116-GP
C. 97161-GP, 97110-GP X 3, 97116-GP
D. 97161-GP, 97116-GP

Answer 25

C. 97161-GP, 97110-GP X 3, 97116-GP

Rationale: The therapist evaluates the patient and problem at the first visit and determines a treatment plan. Gait training will be necessary and will likely increase in time at subsequent therapy sessions. Code 97161 is reported for an uncomplicated condition with low clinical decision making. In the CPT® Index, look for Physical Medicine/Therapy/Occupational Therapy/Evaluation/Physical Therapy. Code 97110 is for the exercises. In the CPT® Index, look for Physical Medicine/Therapy/Occupational Therapy/Procedures/Therapeutic Exercises. And, 97116 for the gait training. In the CPT® Index, look for Physical Medicine/Therapy/Occupational Therapy/Procedures/Gait Training. Report three units for the exercises to cover 45 minutes.

Question 26

A patient has a collapsed arch on her left foot. The physician prescribed a custom orthotic insert for the patient’s shoe to support the collapsed arch. The patient visits the physician to receive the orthotic and is instructed how to position it inside the shoe for maximum results. The patient walks around the treatment room and hallway to determine if there is a comfortable fit. The session lasts 15 minutes. What code is reported for the service?
A. 97760
B. 97761
C. 97763
D. 97116

Answer 26

A. 97760

Rationale: Code 97760 describes Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes. Report the orthotic device separately using HCPCS Level II codes. In the CPT® Index, look for Orthotics/Management and Training.

Question 27

An anorexic patient is experiencing signs of severe dietary deficiency and electrolyte imbalance. She will need medical nutrition therapy to treat these symptoms. The provider spends 30 minutes with the patient to discuss the seriousness of her eating disorder and the necessity of nutrition therapy. What code is reported for this initial assessment?
A. 97804
B. 97802
C. 97802 X 2
D. 97803 X 2

Answer 27

C. 97802 X 2

Rationale: Code 97802 describes the initial medical nutrition assessment interview per 15 minutes of face-to-face time. Report two units for the 30-minute session. In the CPT® Index, look for Nutrition Therapy/Initial Assessment.

Question 28

A patient with a long history of migraine headaches decides to try acupuncture to reduce the symptoms. The provider uses acupuncture with electrical stimulation during a 15-minute, face-to-face encounter with the patient. How are these services reported?
A. 97810
B. 97810, 97811
C. 97813
D. 97814

Answer 28

C. 97813

Rationale: Code 97813 describes a 15-minute encounter with one-on-one patient contact using acupuncture with electrical stimulation. In the CPT® Index, look for Acupuncture/with Electrical Stimulation.

Question 29

A patient with polyneuropathy in the feet undergoes osteopathic manipulation to improve tingling and numbness sensations. The provider manipulates both feet during the session. How are these services reported?
A. 98926
B. 98925
C. 98925, 98926
D. 98929

Answer 29

B. 98925

Rationale: Code 98925 describes manipulation of one to two body regions. Both feet were manipulated during the session. In the CPT® Index, look for Osteopathic Manipulation.

Question 30

A patient presents with a complaint of continuing left shoulder pain after falling from her patio onto a wooden step. No fracture was identified at the time of the fall. After assessing the patient, the chiropractor manipulates the shoulder region. How are these services reported?
A. 98943
B. 98940
C. 98943, 98940
D. 98942

Answer 30

A. 98943

Rationale: Code 98943 describes extraspinal manipulation, one or more regions. In the CPT® Index, look for Manipulation/Chiropractic.

Question 31

A patient continues to have low back pain after lifting a heavy bin while cleaning the basement. The chiropractor manipulates both the lumbar and sacral areas. What code is reported for the service?
A. 98941
B. 98943
C. 98940
D. 98942

Answer 31

C. 98940

Rationale: Code 98940 describes manipulation of one to two spinal regions. In the CPT® Index, look for Manipulation/Chiropractic.

Question 32

A patient receives manipulations in the cervical, thoracic, and lumbar spine by a chiropractor. How are these services reported?
A. 98941
B. 98940
C. 98943
D. 98940 X 2

Answer 32

A. 98941

Rationale: Three regions of the spine were manipulated. Code 98941 describes manipulation of three to four regions. In the CPT® Index, look for Manipulation/Chiropractic.

Question 33

A registered dietician provided diabetes management education to seven patients for 90 minutes. How are these services reported?
A. 99078
B. 98961
C. 98960 X 3
D. 98962 X 3

Answer 33

D. 98962 X 3

Rationale: A Registered Dietician is a nonphysician practitioner that is qualified to educate at-risk patients in diet management. Code 98962 describes five to eight patients. Report three units for 90 minutes. In the CPT® Index, look for Special Services/Group Education/Self-Management.

Question 34

A diabetic patient who has not been successful managing his diet meets personally with a registered dietician for one hour to develop a diet plan. How are these services reported?
A. 98961
B. 98960 X 2
C. 98961 X 2
D. 98962

Answer 34

B. 98960 X 2

Rationale: Code 98960 describes face-to-face education and training with one patient for 30 minutes. Report two units for one hour. In the CPT® Index, look for Special Services/Individual Education/Self-management.

Question 35

A patient calls her physician to discuss the refill of a current prescription. She speaks with the registered nurse who discusses the patient’s current status and advises that the prescription is to be called into her pharmacy. The call lasts 12 minutes. What code is reported for the service?
A. 98966
B. 98968
C. 99442
D. 98967

Answer 35

D. 98967

Rationale: Code 98967 describes a telephone discussion with a nonphysician qualified healthcare professional for 11-20 minutes. The discussion did not lead to an appointment within the next 24 hours or the soonest available appointment and was not related to an E/M service within the previous seven days. In the CPT® Index, look for Telephone/Evaluation and Management/Nonphysician.

Question 36

A patient in a rural setting with limited travel resources visits his physician for a physical examination. Lab work is done. The physician advises the patient that if the results are negative, he does not need to return to the office. The nurse emails the patient that the results were negative, and the patient does not need to return for six months unless new symptoms appear. One month later, the patient emails the office with a request to change his current medication to a less-expensive generic version. The nurse answers the email, advising one of his medications could be changed to a generic version and refills will be called to the pharmacy as needed. She also responds to several additional questions the patient has about his general health conditions. She spends a total of 25 minutes conferring with the provider, responding to the patient, and entering this information. What code is reported for the nurse’s service?
A. 98971
B. 98972
C. 98970
D. 99423

Answer 36

B. 98972

Rationale: Code 98972 describes an online evaluation and management service of 21 minutes or more provided by a nonphysician qualified healthcare professional. In the CPT® Index, look for Case Management Services/Online.

Question 37

A physician provides medical testimony in a suspicious death case. What code is reported for the service?
A. 99026
B. 99080
C. 99056
D. 99075

Answer 37

D. 99075

Rationale: Physicians may be called upon to give a medical opinion about cause of death in a court proceeding. Code 99075 is designated for medical testimony. In the CPT® Index, look for Medical Testimony.

Question 38

A hospital must provide an on-call radiology technician trained in MRI services for emergent cases presenting to the emergency department from 6 p.m. until 7 a.m. The technician is required to return to the hospital within 40 minutes of notification. How are these services reported?
A. 99060
B. 99027 X 13
C. 99026 X 13
D. 99058

Answer 38

B. 99027 X 13

Rationale: Code 99027 describes mandated on-call service, out of the hospital, per hour. In the CPT® Index, look for Mandated Services/On Call Services.

Question 39

An independent laboratory charges a fee to transport medical specimens from physicians’ offices to the laboratory for testing. What code is reported for the service?
A. 99000
B. 99056
C. 99050
D. 99002

Answer 39

A. 99000

Rationale: Physicians often contract with an outside laboratory to handle specimens and provide reports. The laboratory will arrange for courier pick up and charge the physician a handling fee. In the CPT® Index, look for Handling/Specimen Transport.

Question 40

A physician agrees to meet a patient at the office on Sunday afternoon to assess a repeat problem. Special equipment in the physician office is needed to evaluate the condition. Normal office hours are Monday-Friday. What code is reported for the encounter?
A. 99058
B. 99056
C. 99060
D. 99050

Answer 40

D. 99050

Rationale: Code 99050 describes services provided on holidays and weekends that are outside of normal business hours. In the CPT® Index, look for After Hours Medical Services.

Question 41

A patient ingested a toxic substance and was administered ipecac in the Emergency Department to empty the stomach. What code is reported for the service?
A. 99195
B. 43755
C. 99199
D. 99175

Answer 41

D. 99175

Rationale: Code 99175 describes administration of ipecac to induce emesis for emptying the stomach. In the CPT® Index, look for Ipecac Administration/for Poisoning.

Question 42

A physician performs a magnified anogenital examination on a young child to determine if assault occurred. What code is reported for the service?
A. 99175
B. 99170
C. 99174
D. 99195

Answer 42

B. 99170

Rationale: Code 99170 describes a magnified anogenital examination on a child for suspected trauma. In the CPT® Index, look for Anogenital Region—See Perineum. Locate Perineum/Anogenital Examination/with Magnification and Image/Recording.

Question 43

A post-surgical patient is discharged from the hospital to home. The patient still has a urinary catheter needing attention for the next several days. The physician arranges for patient care through a home care agency. What code is reported for the non-physician healthcare professional’s service?
A. 99505
B. 99509
C. 99512
D. 99507

Answer 43

D. 99507

Rationale: Patients discharged from hospital care may still need some assistance with their medical condition. The physician typically arranges the care with a home care agency by sending a qualified person to the patient’s home to provide that assistance. Code 99507 describes home care for maintenance of catheters. In the CPT® Index, look for Home Services/Catheter Care.

Question 44

A patient was discharged recently from the hospital following a colon resection with colostomy. A nurse makes a home visit to assist with the patient’s colostomy. What code is reported for the nurse’s visit?
A. 99505
B. 99509
C. 99511
D. 99512

Answer 44

A. 99505

Rationale: Code 99505 describes a home care visit from a nonphysician practitioner to manage stomas and ostomies. In the CPT® Index, look for Home Services/Stoma Care.

Question 45

A nurse visits a patient in the home to manage infusion of a thrombolytic agent for two hours. How is the nurse’s service reported?
A. 99512
B. 99605
C. 99601, 99602
D. 99601

Answer 45

D. 99601

Rationale: Code 99601 describes home infusion of a specialty drug per visit, up to two hours. In the CPT® Index, look for Home Services/Home Infusion Procedures.

Question 46

An established patient on multiple prescriptions had concerns about possible drug interactions with a new prescription. She requested consultation from the local pharmacist before leaving the pharmacy. The pharmacist met with her for 23 minutes to discuss possible interactions with her current medications and assured her that it was not likely the new medication would cause significant side effects. How are the pharmacist’s services reported?
A. 99605
B. 99606
C. 99605, 99607
D. 99606, 99607

Answer 46

D. 99606, 99607

Rationale: Code 99606 describes the initial 15-minute consultation with a pharmacist for an established patient. Code 99607 describes an additional 15 minutes. Both are reported for the 23-minute encounter. In the CPT® Index, look for Medication Therapy Management/Pharmacist Provided.

Question 47

A child with suspected sleep apnea was given an apnea monitoring device to use over the next month. The device was capable of recording and storing data relative to heart and respiratory rate and pattern. The pediatric pulmonologist reviewed the data and reported to the child’s primary pediatrician. What is reported for the monitor attachment, download of data, provider review, interpretation and report?
A. 94774
B. 95806
C. 94775, 94776, 94777
D. 95800

Answer 47

A. 94774

Rationale: In the CPT® Index look for Monitoring/Pediatric Apnea. Code selection is based on the components of the test performed. In this case, code 94774 describes the data storage capability, including the provider or other qualified health care professional interpretation and report. The code is to be reported each 30-day period.

Question 48

A 5-year-old fell on broken glass and required suturing of a laceration. Due to the age and combative behavior of the patient, the provider utilized moderate sedation while repairing the laceration. The provider gave the child 50 mg of Ketamine IM. A nurse monitored the patient during the procedure which took 30 minutes. What is reported for the moderate sedation?
A. 99156
B. 99152, 99153
C. 99152
D. 99156, 99157

Answer 48

B. 99152, 99153

Rationale: Moderate sedation is often used for pediatric patients in situations not normally requiring sedation. In this case, the provider administered sedation with a nurse assisting in monitoring the patient. In the CPT® Index look for Sedation/Moderate/with Independent Observation. Code selection is based on age of the patient and the length of time. Code 99152 describes an encounter using moderate sedation, and the physician or other qualified health care professional rendering the diagnostic or therapeutic service also manages the sedation. This code is specific for the age of the patient and up to 15 minutes of time. Add-on code +99153 is for each additional 15 minutes of intraservice time.

Question 49

A new patient with cystic fibrosis underwent evaluation of lung function, including percussion, vibration and cupping to the chest wall to facilitate his lung function. What is reported for this service?
A. 94667
B. 94662
C. 99202-25, 94668
D. 94664

Answer 49

A. 94667

Rationale: In the CPT® Index look for Pulmonology/Therapeutic/Manipulation of Chest Wall or Chest Wall/Manipulation. Code 94667 is the correct code because it includes the patient’s first time, and it includes the evaluation.

Question 50

A patient who has had two recent seizures underwent a 3-hour continuous EEG recording without video. The physician interpreted the study and documented a report in the patient’s medical record. What CPT® code is reported?
A. 95700
B. 95717
C. 95711
D. 95705

Answer 50

B. 95717

Rationale: In the CPT® Index look for EEG directing you to See Electroencephalography (EEG). Look for Electroencephalography (EEG)/Recording/Detection. The patient had a 3 hour continuous EEG without use of video which the physician interpreted, not an EEG technologist. The correct code to report is 95717.

Question 51

A 15-year-old underwent placement of a cochlear implant 1 year ago. It now needs to be reprogrammed. What CPT® code is reported for the reprogramming?
A. 92602
B. 92601
C. 92603
D. 92604

Answer 51

D. 92604

Rationale: Cochlear implants differ from hearing aids; they bypass the damaged part of the ear. The use of a cochlear implant involves relearning how to hear and react to sounds. In the CPT® Index look for Cochlear Device/Programming which directs you to codes 92602, 92604. The code selection is based on the age of the patient and whether it is the initial programming or subsequent reprogramming. Code 92604 describes subsequent reprogramming for a patient age 7 or older.

Question 52

A patient with atrial fibrillation had a dual lead pacemaker implanted 1 year ago. Today she returns to the provider’s office for evaluation of function of the device by analyzing and reviewing the parameters stored comparing it to current readings. It was determined minor adjustments and reprogramming were needed. What CPT® code is reported?
A. 93280
B. 93289
C. 93288
D. 93283

Answer 52

A. 93280

Rationale: In the CPT® Index look for Pacemaker and you are directed to See Cardiac Assist Devices. In the CPT® Index look for Cardiac Assist Devices/Pacemaker System/Device and Evaluation. The elements included in the service are described in the Programming device evaluation (in person) guidelines, listed under Cardiovascular Monitoring Services – Implantable and Wearable Cardiac Device Evaluations. You can find these guidelines in CPT® just before code 93280. Code 93280 is the correct code for a dual lead pacemaker, with adjustments, in person.

Question 53

A post-MI (myocardial infarction) patient has been receiving cardiac rehabilitation. At this session the provider evaluates the patient, determines he shows satisfactory progress and may increase his normal daily activities. Continuous EKG is not used at this session. What CPT® code is reported?
A. 99213
B. 93799
C. 93797
D. 93798

Answer 53

C. 93797

Rationale: In the CPT® Index look for Rehabilitation/Cardiac. Code 93797 describes the provider services for cardiac rehabilitation when continuous EKG monitoring is not utilized at the encounter.

Question 54

A patient with chronic respiratory failure is visited at home by a certified respiratory therapist to manage his home oxygen therapy. What CPT® and ICD-10-CM codes are reported?
A. 99510, 99507-59, J96.10
B. 99504, J95.821
C. 99503, J96.10
D. 99504, J98.4

Answer 54

C. 99503, J96.10

Rationale: In the CPT® Index look for Home Services/Respiratory Therapy and you are directed to 99503. In the ICD-10-CM Alphabetic Index, look for Failure, failed/respiration, respiratory/chronic referring you to J96.10. Verification in the Tabular List confirms code selection.

Question 55

A baby was born with a ventricular septal defect (VSD). The provider performed a right heart catheterization and transcatheter closure with implant by percutaneous approach. What CPT® and ICD-10-CM codes are reported?
A. 93593, 93581-59, Q21.0
B. 93593, 93581-59, Q21.9
C. 93593, Q20.4
D. 93581, Q21.0

Answer 55

D. 93581, Q21.0

Rationale: In the CPT® Index look for Septal Defect/Closure/Ventricular. Reading the descriptions code 93581 describes percutaneous transcatheter closure of a congenital ventricular septal defect using an implant. There is a parenthetical note under code 93581 stating that the right heart catheterization is included in this procedure and not to report code 93593 with code 93581.

VSD is a congenital condition (present at birth). In the ICD-10-CM Alphabetic Index look for Defect/ventricular septal referring you to Q21.0. Verification in the Tabular List confirms code selection.

Question 56

A 30-year-old male cut his right hand on a nail repairing the gutter on his house. Six days later it became infected. He went to the intermediate care center in his neighborhood, his first visit there. The wound was very red and warm with purulent material present. The wound was irrigated extensively with sterile water and covered with a clean sterile dressing. An injection of Bicillin CR, 1,200,000 units was given. The patient was instructed to return in three to four days. The provider diagnosed open wound of the hand with cellulitis. A medically appropriate history and examination with a straightforward MDM were performed. What are the codes?
A. 99202, J0558 x 4, S52.009A, W31.81XA
B. 99284, S41.009A, L03.113
C. 96372, S61.411A, L03.114, W45.0XXA, Y93.H9
D. 99202, 96372, J0558 x 12, S61.411A, L03.113, W45.0XXA, Y93.H9

Answer 56

D. 99202, 96372, J0558 x 12, S61.411A, L03.113, W45.0XXA, Y93.H9

Rationale: The patient is a new patient to the clinic. Code selection is made from 99202-99205 for the office visit. For a new patient, a medically appropriate history and/or examination and straightforward medical decision making is required. The clinic visit is reported as 99202.

In the CPT® Index look for Antibiotic Administration/Injection. Code selection is based on the route of administration. The administration of the antibiotic is reported with 96372. The Bicillin CR is found in the HCPCS Level II code book in the Table of Drugs and Biologicals. Look for Bicillin C- which directs you to code J0558. The code descriptor for J0558 is 100,000 units. Report 12 units to correctly charge for the 1,200,000 units delivered to the patient, J0558 x 12.

In the ICD-10-CM Alphabetic Index look for Wound, open/hand/laceration which states to see Laceration, hand. Look for Laceration/hand/right directing you to S61.411-. Tabular Lists indicates a 7th character is needed to complete the code. Report A for the initial encounter. Next, look in the Alphabetic Index for Cellulitis/hand which states to see Cellulitis, upper limb. Look for Cellulitis/upper limb referring you to L03.11-. Complete code in the Tabular List to indicate right hand, L03.113. Then look in the ICD-10-CM External Cause of Injuries Index for Contact (accidental)/nail referring you to W45.0-. The Tabular List indicates the code is complete with seven characters. The complete code requires placeholders be placed at the 5th and 6th characters and a 7th character A for initial encounter. The second external cause code is used to identify the activity. In the External Cause of Injuries Index look for Activity/maintenance/property referring you to Y93.H9. Verification in the Tabular List confirms code selection.

Question 57

A provider has ordered de-ironing by therapeutic phlebotomy to be performed weekly. The patient is diagnosed with hemochromatosis and therapeutic phlebotomy is used to avoid irreversible tissue damage. One unit of blood is removed weekly. What CPT® and ICD-10-CM codes are reported for each weekly visit treatment?
A. 36430, 99195, E83.119
B. 36415, E83.110
C. 99195, E83.119
D. 99195, E80.0

Answer 57

C. 99195, E83.119

Rationale: In the CPT® Index look for Phlebotomy/Therapeutic referring you to 99195. The codes are reported once per encounter.

In the ICD-10-CM Alphabetic Index look for Hemochromatosis and without further information you are directed to E83.119. Verification in the Tabular List confirms code selection.

Question 58

A patient who has psoriasis vulgaris on his back has not responded to topical applications. He is treated with laser therapy on a total area of 260 sq. cm. What CPT® and ICD-10-CM codes are reported?
A. 17108, L44.0
B. 96921, L40.0
C. 17108, L20.0
D. 96921, L20.0

Answer 58

B. 96921, L40.0

Rationale: In the CPT® Index look for Psoriasis/Treatment. Codes 96910-96913 are for photochemotherapy. Codes 96920-96922 are for laser treatment and code selection is based on the size of the area treated. 260 sq. cm is reported with 96921.

In the ICD-10-CM Alphabetic Index, look for Psoriasis/vulgaris referring you to L40.0. Verification in the Tabular List confirms code selection.

Question 59

A patient with chronic myeloid leukemia (CML), BCR/ABL-positive has an implanted access port for delivery of chemotherapy. The device needs to be irrigated before receiving treatment. What ICD-10-CM and CPT® codes are reported for the irrigation?
A. 96523, C92.10
B. 96522, C92.11
C. 96521, C95.10
D. 96522, C95.10

Answer 59

A. 96523, C92.10

Rationale: In the CPT® Index look for Irrigation/Venous Access Device. Report code 96523 for irrigation of an implanted venous access device.

In the ICD-10-CM Alphabetic Index look for Leukemia/chronic myeloid, BCR/ABL-positive and you are directed to C92.1-. In the Tabular List the 5th character of 0 is used to indicate there is no mention of having achieved remission.

Question 60

A patient has an open wound on his left lower leg caused by a cat bite. The animal tested negative for rabies, but the wound has failed to heal and became infected by Clostridium perfringens. The patient underwent hyperbaric oxygen therapy attended and supervised by the provider. What CPT® and ICD-10-CM codes are reported?
A. 97597, S81.001A, T63.891A
B. 97597, S81.852A, W55.01XA
C. 99183, S81.852A, B96.7, W55.01XA
D. 97605, S81.802A, B95.5, W55.03XA

Answer 60

C. 99183, S81.852A, B96.7, W55.01XA

Rationale: In the CPT® Index look for Hyperbaric Oxygen Pressurization referring you to code 99183. The wound is complicated due to the infection. In the ICD-10-CM Alphabetic Index look for Bite(s) (animal) (human)/leg (lower) and you are directed to S81.85-. Tabular List shows seven characters are needed to complete the code. The 6th character 2 indicates the left leg. 7th character A indicates initial encounter for receiving active treatment. The infectious agent is identified as Clostridium perfringens. Look for Infection/Clostridium/perfringens/as cause of disease classified elsewhere directing you to code B96.7. The external cause is the cat bite. Look in the ICD-10-CM External Cause of Injuries Index for Bite, bitten by/cat referring you to code W55.01-. Tabular List shows seven characters are needed to complete the code. A placeholder X is assigned to the 6th character and A is assigned for initial encounter for the 7th character.

Question 61

A patient diagnosed with amyotrophic lateral sclerosis has increasing muscle weakness in the upper extremities. The provider orders needle electromyography (EMG) to record electrical activity of the muscles. What CPT® and ICD-10-CM codes are reported?
A. 95860, G12.21
B. 95861, G12.21
C. 95869, G12.22
D. 95861, G12.22

Answer 61

B. 95861, G12.21

Rationale: In the CPT® Index look for Electromyography/Needle/Extremities. Code selection is based on the number of extremities studied. In this case, two extremities (upper) are studied making 95861 the correct code selection. Amyotrophic lateral sclerosis (ALS) is also known as Lou Gehrig’s disease.

In the ICD-10-CM Alphabetic Index, look for Amyotrophia, amyotrophy, amyotrophic/lateral sclerosis or Sclerosis/amyotrophic (lateral) referring you to code G12.21. Verification in the Tabular List confirms code selection.

Question 62

A patient with bilateral sensory hearing loss is fitted with a digital, binaural, behind the ear hearing aid. What HCPCS Level II and ICD-10-CM codes are reported?
A. V5261, Z46.1, H90.3
B. V5140, H90.3, Z46.1
C. V5140, H90.6
D. V5261, Z01.110, H90.3

Answer 62

A. V5261, Z46.1, H90.3

Rationale: In the HCPCS Level II Index look for Hearing aid/Binaural/Digital/BTE referring you to V5261. The purpose of the visit is the fitting of the hearing aid. Look in the ICD-10-CM Alphabetic Index for Fitting (and adjustment) (of)/hearing aid directing you to Z46.1. The condition necessitating the hearing aid is bilateral sensory hearing loss. In the Alphabetic Index, look for Deafness/sensorineural/bilateral referring you to H90.3. Verification in the Tabular List confirms code selection.

Question 63

A therapist in a residential care facility works with a nonverbal autistic child, age 4. In this session the therapist uses drawing paper and washable markers. The therapist sat with the child and began to draw on a sheet of paper. She gave paper and markers to the child and encouraged the child to draw. The psychotherapy session lasted 30 minutes. What CPT® and ICD-10-CM codes are reported?
A. 90882, F84.0
B. 90832, 90785, F84.0
C. 90791, 90785, F84.9
D. 90785, F84.0

Answer 63

B. 90832, 90785, F84.0

Rationale: Psychotherapy session with was performed lasting 30 minutes. In the CPT® Index look for Psychotherapy/Individual Patient. Review the codes, code 90832 is the correct code to report. Art therapy is frequently used when working with children who are unable to verbalize well or not at all. It may give insight to thought processes through the expressions captured in the artwork. Art therapy is considered individual psychotherapy. In the CPT® Index look up Psychotherapy/Interactive Complexity you are directed to code range 90785. Code selection is based on time and whether a medical evaluation and management was performed. Code +90785 is an add-on code and for this case is reported with 90832 per instructions at the beginning of this section. Time is not a factor with +90785.

The child is currently autistic and does not communicate verbally. In the ICD-10-CM Alphabetic Index look for Autism, autistic (childhood) (infantile) which directs you to F84.0. Since an autism spectrum is not defined, the correct diagnosis code is F84.0. Verification in the Tabular List confirms code selection.

Question 64

What ICD-10-CM code(s) is/are reported for a diabetic foot ulcer on the right foot?
A. E11.621, L97.519
B. L89.619
C. L97.519
D. E11.8, L97.519

Answer 64

A. E11.621, L97.519

Rationale: ICD-10-CM guideline I.C.4.a.2. instructs you to use the default code E11- for type 2 diabetes when the type is not indicated. Look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/with/foot ulcer referring you to E11.621. In the Tabular List there is a note to use an additional code to identify the site of the ulcer (L97.4-, L97.5-). Look in the Alphabetic Index for Ulcer/lower limb/foot specified NEC/right referring you to L97.519. The severity of the ulcer is not documented in this scenario. Verification in the Tabular List confirms E11.621 is for type 2 diabetes mellitus with foot ulcer and L97.519 is for non-pressure chronic ulcer of other part of right foot with unspecified severity.

Question 65

A patient with sickle cell anemia with painful sickle crisis received normal saline IV 100 cc per hour to run over 5 hours for hydration in the provider’s office. She will be given Morphine & Phenergan, prn (as needed). What codes are reported?
A. 96360, 96361 x 3, J7030, D57.00
B. 96360, J7030, D57.819
C. 96360 x 5, J7050, D57.1
D. 96360, 96361 x 4, J7050 x 2, D57.00

Answer 65

D. 96360, 96361 x 4, J7050 x 2, D57.00

Rationale: In the CPT® Index look for Hydration/Intravenous and you are directed to codes 96360-96361. The hydration will run 5 hours at 100 cc per hour. Codes are time based. Code the hydration therapy as 96360 for the first hour, and 96361 x 4 for a total infusion time of 5 hours. In the HCPCS Level II code book, look for Saline Solution referring you to codes J7030-J7050. Code for the normal saline with J7050 x 2 units for 500 cc.

The type of sickle cell anemia is not identified, but the patient has painful sickle crisis. In the ICD-10-CM Alphabetic Index, look for Disease, diseased/sickle-cell/with crisis directing you to D57.00. Verification in the Tabular List confirms code selection.

Question 66

A 32-year-old ETOH dependent female is in a partial hospitalization program and has been seeing an addictive disease specialist (psychotherapist) in a chemical dependency program. Her employer is aware of her problem. She was referred to the group through their Employee Assistance Program. As long as she is in compliance they will support her efforts. Recently, she has arrived late at the meetings. The provider met with the patient and discussed the importance of her treatment, compliance with the program and avoidance of situations in which she may use alcohol. She denies contact with her previous associates and assures the provider she has had no alcohol intake since beginning the substance abuse treatment program. They will continue to reinforce her progress and successful sobriety. Time of the session was 45 minutes. What CPT® and ICD-10-CM codes are reported?
A. 90834, F10.20
B. 90834, F10.220
C. 90832, F10.220
D. 90832, F10.20

Answer 66

A. 90834, F10.20

Rationale: In the CPT® Index look for Psychotherapy/Individual Patient. Code selection is based on time. The duration of the counseling session was 45 minutes making 90834 the correct code. Evaluation and Management services were not performed.

The diagnosis is ETOH dependence. ETOH is alcohol. The patient is alcohol dependent, although there is no indication of the frequency of her intoxication. Look in the ICD-10-CM Alphabetic Index for Dependence/alcohol directing you to F10.20. Report code F10.20 for the condition as there is not mention of intoxication or complications. Verification in the Tabular List confirms code selection.

Question 67

A young child received a mumps, measles, rubella and varicella (MMRV) injection at a neighborhood clinic with provider counseling. What CPT® codes are reported?
A. 90707, 90716, 90471, 90472 x 3
B. 90707, 90716, 90460, 90461 x 3
C. 90710, 90460
D. 90710, 90460, 90461 x 3

Answer 67

D. 90710, 90460, 90461 x 3

Rationale: In the CPT® Index look for Vaccine and Toxoids/Measles, Mumps, Rubella and Varicella (MMRV) referring you to 90710. According to the CPT® guidelines for Vaccines and Toxoids, an administration code from 90460-90474 is also reported. In the CPT® Index look for Immunization Administration/Toxoid/with Counseling. Because counseling was included, a code from 90460-90461 is used for the administration. According to the guidelines, 90460 and 90461 are reported per component of the vaccine. Although it is one vaccination, there are four separate components, 90460 is reported for mumps and 90461 x 3 (measles, rubella, and varicella).

Question 68

A qualified genetics counselor is working with a child who has been diagnosed with fragile X syndrome. After extensive research about the condition, she meets with the parents to discuss the features of the disease and the child’s prognosis. The session lasted 45 minutes. What CPT® and ICD-10-CM codes are reported?
A. 96040, Q99.9
B. 96040 x 2, Q99.8
C. 96040, Q99.2
D. 96040 x 2, Q99.2

Answer 68

C. 96040, Q99.2

Rationale: In the CPT® Index look for Medical Genetics referring you to 96040. The genetics counseling session is reported as face-to-face time per 30 minutes. Report one unit for the first 30 minutes. Since the remaining time is 15 minutes, it is not reported separately per the Medical Genetics and Genetic Counseling Services guidelines. Fragile X syndrome is a congenital chromosomal anomaly that may include mental retardation.

In the ICD-10-CM Alphabetic Index look for Syndrome/fragile X. The condition is reported with code Q99.2. Verification in the Tabular List confirms code selection.

Question 69

A female patient reports repeated falls. She has no known head trauma or other injuries. She noticed some slight stiffness in her joints and weakness in her lower extremity muscles, with slight stiffness in her arm joints. The provider decided to test for possible multiple sclerosis (MS). She was sent to a clinic providing somatosensory studies. The testing included upper and lower limbs. What CPT® and ICD-10-CM codes are reported?
A. 95938, M62.81, M25.60, R29.6
B. 95926, G35
C. 95925, 95926, G35
D. 95926, M62.81, M25.60, R29.6

Answer 69

A. 95938, M62.81, M25.60, R29.6

Rationale: In the CPT® Index look for Somatosensory Testing. Studies are reported based on location. The list of codes range for upper limbs are 95925, 95938, 95939 and lower limbs are 95926, 95938, 95939. In this case the upper limbs and lower limbs were both performed guiding you to code 95938. MS has not been confirmed. Symptoms of weakness in her muscles and stiffness of the joints is reported. She also reports repeated falls. In the ICD-10-CM Alphabetic Index look for Weak, weakening, weakness/muscle leading to M62.81. Also, look for Stiffness, joint NEC leading to M25.60. Specific joints affected are not identified. Next, in the Alphabetic Index look for Falling, falls (repeated) R29.6. Verification in the Tabular List confirms code selection.

Question 70

A 5-year-old is brought in to see an allergist for generalized urticaria. The family just recently visited a family member that had a cat and dog. The mother wants to know if her son is allergic to cats and dogs. The child’s skin was scratched with two different allergens. The provider waited 15 minutes to check the results. There was a flare up reaction to the cat allergen, but there was no flare up to the dog allergen. The provider included the test interpretation and report in the record.
A. 95004 x 2
B. 95027 x 2
C. 95018 x 2
D. 95024 x 2

Answer 70

A. 95004 X 2

Rationale: In the CPT® Index look for Allergy Tests/Skin Tests/Allergen Extract. Code selection is based on the method of testing performed. Code 95004 describes the scratch test with allergenic extracts. The test is reported twice for the number of substances that were tested.

Question 71

A 64-year-old patient came to the emergency department complaining of chest pressure. The provider evaluated the patient. Appropriate initial management was continued by the ED provider who contacted the cardiologist on call in the hospital. Admission to the cardiac unit was ordered. No beds were available in the cardiac unit and the patient was held in the ED. The cardiologist left the ED after completing the evaluation of the patient and had interpreted the findings of an EKG that indicated signs of acute cardiac damage.

Several hours passed and the patient was still in the ED. During an 80-minute period, the patient experienced acute breathing difficulty, increased chest pain, arrhythmias, and cardiac arrest. The patient was managed by the ED provider during this 80-minute period. Included in the ED provider management were endotracheal intubation and CPR to restore the patient’s breathing and circulation for 20 minutes. CPR was unsuccessful, the patient was pronounced dead after a total of 44 minutes critical care time, exclusive of other separately billable services. What CPT® codes are reported by the ED provider?
A. 99285-25, 31500, 92950
B. 99291
C. 99291-25, 99292-25, 31500
D. 99291-25, 99285-25, 31500, 92950

Answer 71

D. 99291-25, 99285-25, 31500, 92950

Rationale: The patient never left the emergency department. The first part of the encounter did not meet critical care but does for the emergency department, and the second part did meet critical care. According to CPT® Emergency Department Services guidelines, both the ED E/M level and Critical Care is coded together. In the CPT® Index look for Critical Care Services. Use code 99291 for 44 minutes of critical care. The Critical Care Services guidelines list services that are included in Critical Care time. Additional services performed not included in the listing are reported separately. In the CPT® Index look for Emergency Department Services/Evaluation and Management Visit 99285. In the CPT® Index look for Insertion/Endotracheal Tube/Emergency Intubation referring you to 31500. In the CPT® Index look for CPR. Report cardiopulmonary resuscitation with code 92950.