Podcast
Questions and Answers
What subcategory of E/M codes would be used for days two, three, and four while a provider sees Mrs. Smith in the hospital?
What subcategory of E/M codes would be used for days two, three, and four while a provider sees Mrs. Smith in the hospital?
Subsequent Hospital Care
If the pain is sharp, stabbing, or dull, what is the component of the History of Present Illness (HPI)?
If the pain is sharp, stabbing, or dull, what is the component of the History of Present Illness (HPI)?
Quality
What modifier is used to report an Evaluation and Management service mandated by a court order?
What modifier is used to report an Evaluation and Management service mandated by a court order?
32
According to CPT® guidelines, what is the first step in selecting an evaluation and management code?
According to CPT® guidelines, what is the first step in selecting an evaluation and management code?
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What subsection is used to report the emergency department visit for Fred?
What subsection is used to report the emergency department visit for Fred?
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How is the digital rectal examination for prostate cancer screening and PSA reported?
How is the digital rectal examination for prostate cancer screening and PSA reported?
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What CPT® code is reported for the physical screening of a 75-year-old established patient?
What CPT® code is reported for the physical screening of a 75-year-old established patient?
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What ICD-10-CM code is reported for vertigo?
What ICD-10-CM code is reported for vertigo?
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What CPT® code is reported for the home care visit to the 63-year-old hemiplegic patient?
What CPT® code is reported for the home care visit to the 63-year-old hemiplegic patient?
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What E/M code is reported for the consult regarding the 32-year-old patient with allergies?
What E/M code is reported for the consult regarding the 32-year-old patient with allergies?
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What procedure codes are appropriate for Mr. Flintstone's follow-up visit after diagnosis?
What procedure codes are appropriate for Mr. Flintstone's follow-up visit after diagnosis?
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What ICD-10-CM code is reported for angina pectoris with a documented spasm?
What ICD-10-CM code is reported for angina pectoris with a documented spasm?
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What ICD-10-CM code is reported for nausea and vomiting?
What ICD-10-CM code is reported for nausea and vomiting?
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What CPT® code(s) is/are reported for the yearly physical of the 10-year-old girl?
What CPT® code(s) is/are reported for the yearly physical of the 10-year-old girl?
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What is the CPT® code for the encounter of the 3-year-old critically ill child admitted to the PICU?
What is the CPT® code for the encounter of the 3-year-old critically ill child admitted to the PICU?
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What CPT® and ICD-10-CM codes are reported for the visit regarding the right inguinal hernia?
What CPT® and ICD-10-CM codes are reported for the visit regarding the right inguinal hernia?
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What CPT® code is reported for the 12/20 visit following the motor vehicle accident?
What CPT® code is reported for the 12/20 visit following the motor vehicle accident?
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What CPT® code is reported for the visit of a 45-year-old established female patient with dizziness?
What CPT® code is reported for the visit of a 45-year-old established female patient with dizziness?
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What is the E/M code for the ED visit for the 6-year-old girl with a wrist sprain?
What is the E/M code for the ED visit for the 6-year-old girl with a wrist sprain?
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What CPT® code is reported for the visit of Dr. Y for the nursing facility patient?
What CPT® code is reported for the visit of Dr. Y for the nursing facility patient?
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What CPT® code(s) is/are reported for the initial visit of a 60-year-old woman seeking help to quit smoking?
What CPT® code(s) is/are reported for the initial visit of a 60-year-old woman seeking help to quit smoking?
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What E/M code(s) is/are reported for Dr. Inez's discharge and readmission of Mr. Blancos?
What E/M code(s) is/are reported for Dr. Inez's discharge and readmission of Mr. Blancos?
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What are the correct CPT® and ICD-10-CM codes for the encounter of the 28-year-old female with RLQ pain?
What are the correct CPT® and ICD-10-CM codes for the encounter of the 28-year-old female with RLQ pain?
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What CPT® code(s) is/are reported for the established patient with bursitis in both shoulders?
What CPT® code(s) is/are reported for the established patient with bursitis in both shoulders?
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What E/M code(s) is/are reported for the 4-month-old checkup?
What E/M code(s) is/are reported for the 4-month-old checkup?
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Study Notes
Evaluation and Management (E/M) Codes
- Subsequent Hospital Care is applicable when a provider sees a patient for multiple days during hospitalization.
- The Quality component of the History of Present Illness (HPI) details how pain is experienced (sharp, stabbing, dull).
- Modifier 32 is utilized for E/M services required by a court order.
- The initial step for selecting an E/M code involves determining the appropriate category and subcategory per CPT® guidelines.
- Emergency Department Services are used to report visits made by patients in acute situations, as in the case of uninitiated patients in the ED.
Specific CPT® Coding
- For prostate cancer screening, the appropriate code is G0102, used when a digital rectal examination and PSA are performed.
- For a patient with an established diagnosis seeking a comprehensive check-up, CPT® code 99397 applies.
- A home care visit to a hemiplegic patient generates a CPT® code of 99348 due to the expanded problem-focused examination.
- A consult for persistent allergies involves reporting E/M code 99242 after a detailed assessment and management discussion.
- For patients with Hodgkin's lymphoma, the combined appropriate codes are 99213 and 99354, reflecting the complexity of ongoing care and discussions.
- The ICD-10-CM code for vertigo is R42, while other common codes include R11.2 for nausea and vomiting, and I20.1 for angina pectoris with spasm.
Health Visit Scenarios
- An annual check for a 10-year-old girl with URI symptoms leads to CPT® codes 99393 and 99213-25.
- Critical scenarios in pediatrics, such as a 3-year-old with respiratory failure, are reported with code 99475.
- For new patients reporting a right inguinal hernia, the coded services are defined by CPT® 99203 and ICD-10-CM K40.90.
- Discharge visits for patients, such as an individual post-splenectomy, are captured under CPT® code 99238.
Follow-Up Care and Counseling
- Established patients reporting severe dizziness and related symptoms align with CPT® code 99214 after a detailed history and moderate MDM.
- E/M visit assessments for children include checkups coded as 99391.
- When patients return with recurrent conditions, like bursitis, specific injection codes such as 20610-50 can be used for the treatment rendered.
Medication Management and Recommendations
- Counseling and prescriptions provided for smoking cessation during an initial visit to Dr. Lung should be reported as 99203.
- Upon discharge, the care plan and complex decisions made during patient interactions justify codes such as 99239 for follow-ups and 99304 for subsequent admissions.
- Nystatin suspension and creams for conditions like thrush and diaper rash are important facets of the treatment plan that may accompany the E/M coding for pediatric visits.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge with this review exam based on AAPC Chapter 19. The flashcards cover essential topics related to evaluation and management (E/M) coding, including hospital care and the history of present illness. Get ready to enhance your understanding of coding practices and modifiers.
