99 SERIES QUESTION -2022

Evaluation and management

1. How does the CPT Professional Edition define a new patient?

a. A new patient is one who has not received any professional services from the physician or
anotherphysician of the same specialty who belongs to the same group practice, within the past
two years.
b. A new patient is one who has not received any professional services from the physician or
anotherphysician of the same specialty who belongs to the same group practice, within the past
three years.
c. A new patient is one who has received professional services from the physician or another
physician ofthe same specialty within the last two years for the same problem.
d. A new patient is one who has received hospital services but has never been seen in the clinic
by thereporting physician.

2. James, a 35-year-old new patient, received 45 minutes of counseling and risk factor reduction
intervention services from Dr. Kelly. Dr. Kelly talked to James about how to avoid sports
injuries. Currently, James does not have any symptoms or injuries and wants to maintain this
status would youreport this.This was the only service rendered. How service?
a. 99213
b. 99203
c. 99385
d. 99403

3. Andrea, a 52-year-old patient, had a hysterectomy on Monday morning. That afternoon, after
returning to her hospital room, she suffered a cardiac arrest. A cardiologist responded to the call
and delivered one hour and 35 minutes of critical care. During this time the cardiologist ordered a
single view chest x-ray and provided ventilation management. How should you report the
cardiologist’s services?
a. 99291, 99292
b. 99291, 99292, 71010, 94002
c. 71010, 94002, 99231
d. 99291, 99292, 99292-52

4. Brandon was seen in Dr. Shaw’s office after falling off his bunk bed. Brandon’s mother reported
that Brandon and his sister were jumping on the beds when she heard a “thud.” Brandon
complained of knee pain and had trouble walking. Dr. Shaw ordered a knee x-ray that was done at
the imaging center across the street. The x-ray showed no fracture or dislocations. Dr. Shaw had
seen Brandon for his school physical six months ago. Today, Dr. Shaw documented a detailed
examination and decision-making of moderate complexity. He also instructed Brandon’s mother
that if Brandon had any additional pain or trouble walking he should see an orthopedic specialist.
How should Dr. Shaw report her services from today’s visit?
a. 99204
b. 99394, 99214
c. 99214
d. 99203

5. Dr. Mayer admitted Sally to observation status Monday afternoon related to minor changes to an
EKG and a dizzy spell. His dictated note for initial observation status included a comprehensive
history, comprehensive examination, and moderate decision-making. He started her on new
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medications and wanted to continue to observe her until he was sure her condition was stable. On
Tuesday, Dr. Mayer saw Sally, who was still receiving observation services as an outpatient, and
dictated a chart note related to her changes since his last visit. The note consisted of an expanded
Problem- focused interval history, expanded problem-focused examination, and straightforward
decision-making. How should Dr. Mayer report Tuesday’s visit?
a. 99220-25, 99232 b.99220, 99226-25 c.99232 d.99225

6.Why are the following codes not reported with continuing intensive care services (99478–
99480):36510, 36000, 43752, 51100, 94660, or 94375?
a. These codes are deleted from the 2008 edition.
b. These codes are included with continuing intensive care services.
c. These codes are only add-on codes and should be reported with a modifier -51
d. These codes are Category III Codes and should never be reported with Category I codes.

7. Dr. Peters is Tim’s family physician. During today’s visit with Dr. Peters, Tim complained of
Fatigue, lightheadedness, and intermediate chest pains. Dr. Peters called Dr. Counsel, a cardiologist,
and asked for a work-in visit for Tim. Dr. Counsel saw Tim in the office later that afternoon,
performed
a comprehensive examination, and obtained an extended history of the present illness with complete
past family, social, and personal history. Dr. Counsel’s decision-making was based on review of
extensive records and test results provided by the patient, the high risk of complications, and the
extensive management options. Dr. Counsel sent a written report back to Dr. Peters outlining the visit
and plans for insertion of a pacemaker in the next few days. How would Dr. Counsel report today’s
visit?
a.99214 b.99245 c.99244 d.99205

8. Dr. Mike asked Dr. Susan to conduct a follow-up consultation with Lou, a 15-year-old patient who
had a tympanotomy three days ago. Dr. Susan consulted for Lou the day after surgery for a fever and
mild seizures. The patient was stable until today when Lou’s fever returned and he suffered another
mild seizure. Dr. Susan dictated a detailed history and physical examination and high decision-making
related to her findings. How would Dr. Susan report her services for today’s visit?
a.99253 b.99234 c.99233 d.99252

9.Which code range would describe services for a critically ill patient who is 23 days old as a out
patient?a. 99291–99292
b. 99293–99294
c. 99295–99296
d. None of the above

10.Mr. Johnson, a 38-year-old established patient is being seen for management of his
hypertension, diabetes, and weight control. On his last visit, he was told he had a diabetic foot ulcer
and needed to be hospitalized for this condition. He decided to get a second opinion and went to
see Dr. Myers. This was the first time Dr. Myers had seen Mr. Johnson. Dr. Myers documented a
comprehensive history, comprehensive examination, and decision-making of high complexity. He
concurred with hospitalization for the foot ulcer and sent a report back to Mr. Johnson’s primary
care doctor. How would you report Dr.Myers visit?

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a. 99245
b. 99205
c. 99215
d. 99255

11.How does the CPT Professional Edition define an emergency department?

a. An organized hospital-based facility for the provision of unscheduled episodic services to patients
whopresent for immediate medical attention. The facility must be available 24 hours a day.
b. An organized hospital-based facility for the provision of scheduled episodic services to patients
whopresent for immediate medical attention. The facility must be available 24 hours a day.
c. An organized hospital-based facility for the care and treatment of chronically ill patients who
presentfor services. The facility must be available on weekends and holidays.
d. An organized outpatient-based facility for the care and treatment of unscheduled patient who
presentfor immediate medical attention. The facility must be available 24 hours a day.

12.Lucus, a three-year-old new patient is seen for a well-child examination. The doctor
documents an age appropriate history, examination, anticipatory guidelines, risk factor
reduction intervention, and indicates Lucus’ immunizations are up to date. How would you
report this service?
a. 99392
b. 99213-25, 99385
c. 99203
d. 99382
13.80-year-old patient is returning to the gynecologist’s 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, 996.65 D. 99212,V53.99

14.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

15.20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for
cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management
and a complete echocardiogram in the NICU and provided a report for the echocardiography
which did indicate congenital heart disease. Select the correct code(s) for the physician service.

A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303

C. 99460-25, 31500, 94002, 93303 D. 99291-25, 93303
16.A 40 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
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screening procedures and treatment if it turns out to be cervical cancer. What code(s) should be used
forthis visit?
A. 99215
B. 99213, 99354
C. 99213
D. 99213, 99403

17.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

18.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

19.Patient is here to follow up on her atrial fibrillation. Her primary care physician is not in the
office. She will be seen by the partner physician that is also in the same practice. No new
problems. Blood pressure is 110/64. Pulse is regular at 72. Temp is 98.6F Chest is clear. Cardiac
normal sinus rhythm. Medical making decision is straightforward. Diagnosis: Atrial fibrillation,
currently stable. What CPT® code is reported for this service?
A. 99201
B. 99202
C. 99212
D. 99213

20.Documentation of a new patient in a doctor’s office setting supports the History in four elements
for an extended history of present illness (HPI), three elements for an extended review of systems
(ROS) and three elements for a complete Past, Family, Social History (PFSH) . There is an extended
examination of six body areas and organ systems. The medical making decision making is of high
complexity. Which E/M service supports this documentation?
A. 99205
B. 99204
C. 99203
D. 99202

21.Two-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER
physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The
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ER physician documents a total time of 30 minutes on this critical infant in which the physician
already subtracted the time for the other billable services. Select the E/M service and procedures to
report for the ER physician?
A. 99291-25, 36555, 31500
B. 99291, 36556, 31500, 82803
C. 99285-25, 36556, 31500, 82803
D. 99475, 36556

22.2-year-old is coming in with his mom to see the pediatrician for fever, sore throat, and pulling of
the ears. The physician performs a brief history along with a problem pertinent review of systems.
A limited exam was performed on the ears, nose and throat and respiratory systems. A strep
culture was taken and came back positive. A diagnosis was also made of the infant having acute
otitis media with effusion. The medical decision making was of moderate complexity with the
giving of a prescription. What CPT® and ICD-9-CM codes should be reported?
A. 99212, 462, 382.9
B. 99213, 034.0, 381.4
C. 99212, 034.0, 381.00
D. 99213, 034.0, 381.00

23.42-year-old woman is being discharged today, 2/5/XX. She was admitted to the hospital 2/2/XX
for acute diverticulitis. Refer to dictated notes for a detailed description of the history, exam, and
assessment and treatment protocol. Patient was also seen in consultation by Dr Z. She was placed
on intravenous antibiotics and has made slow steady progress. Today has no abdominal pain. Labs
are normal and CT of the abdomen and pelvis showed changes consistent with diverticulitis in the
left side of colon. She was given follow up instructions of her medications, what diet to have and to
follow up with PCP in 10 to 14 days or return if pain resumes. Total time spent with patient 40
minutes. What CPT®code(s) should be reported?
A. 99233, 99239 B. 99217
C. 99252, 99238 D. 99239

24.63-year-old man is coming in for a second opinion for his sleep apnea. He has had it for the past
five months. Sleep is disrupted by frequent awakenings and getting worse due to anxiety and
snoring. He feels tired all the time, has some joint stiffness and night sweats; all other systems
were negative. He is going through a divorce which is causing him anxiety and had a hernia repair
two month ago. Doctor performs a comprehensive exam and orders labs and a sleep study test.
Prescription was given to help with the anxiety. What CPT® code should be reported?
A. 99203 B. 99204
C. 99244 D. 99214

25.A 55-year-old established patient is coming in for a pre-op visit; he is getting a liver transplant
due to cirrhosis. The physician performs an expanded problem focused history, detailed
examination, and moderate MDM. Patient agrees with his physician’s recommendations and the
transplantation will take place as scheduled. After the evaluation, the patient expresses a number
of concerns and questions for the prospective liver transplant. Physician spends an additional 30
minutes, excluding the time spent in doing the E/M service, in counseling and answering questions
regarding the surgery and discussing possible outcomes. What CPT® codes should be reported?
A. 99213, 99354 B. 99214, 99358
C. 99213, 99358 D. 99214, 99354

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26.Physician performs a medical review and documentation on an 83-year-old patient still

hospitalized for confusion for the last two days. She is alert and oriented x 3 today. Reviewing her
labs from yesterday, her BNP was elevated suspecting her confusion is due to congestive heart
failure. An
echocardiogram is ordered and treatment will be for congestive heart failure. Patient is not safe to
return home. What CPT® code should be reported?
A. 99231 B. 99221
C. 99218 D. 99232

27.A plastic surgeon is called to the ED at the request of the emergency department physician to
evaluate a patient that arrived with multiple facial fractures after being in an automobile accident
for heropinion on the need for reconstructive surgery. The plastic surgeon arrives at the ED, obtains
a history of present illness including an extended history of present illness; a system review,
including constitutional, musculoskeletal, integumentary, neurologic, and EENMT; and the patient’s
social history and past medical history. The plastic surgeon then performs a physical exam including
respiratory, cardiovascular, and an extended examination of the skin and bony structures of the
patient’s face. The plastic surgeon performs moderate medical decision making, including deciding
the patient needs major surgery to repair the injuries. The plastic surgeon schedules the patient for
surgery the next day and documents herfull note with findings in the ED chart.
A. 99284-57 B. 99244
C. 99243-57 D. 99221

28. At the request of the mother’s obstetrician, the physician was called to attend the birth of an
infant being delivered at 29 weeks gestation. During delivery, the neonate was pale and bradycardic.
Suctioning and bag ventilation on this 1000 gram neonate was performed with 100 percent oxygen.
Brachycardia worsened; endotracheal intubation was performed and insertion of an umbilical line
for fluid resuscitation. Later this critically ill neonate was moved from the delivery room and
admitted to the NICU with severe respiratory distress and continued hypotension. What are the
appropriate procedure codes?
A. 99465, 99468 B. 99465, 99464, 99468-25, 31500, 36510-51
C. 99468, 99464 D. 99465, 99468-25, 31500-59, 36510-59

29.38-year-old female initial visit, just moved from out of state, has neck and back pain for the last
year and is getting worse. Pain is exacerbated when she drives, bends, or changes positions, and
moderately alleviated with ibuprofen. Positive for aches and weakness in her muscles and tingling
and numbness of the arms and hands, as well as headaches. All other systems are reviewed and are
negative. She has had a partial hysterectomy and is divorced. Her mother has a history of breast
cancer. The physician performs an exam on the following systems: constitutional, eyes, ENT,
respiratory, cardiovascular, gastrointestinal, musculoskeletal, and neurologic. X-rays of the cervical
and lumbar spine were taken. Will be sending her to get a MRI and to start physical therapy.
Prescription was given for muscle relaxer. Select the appropriate CPT® code for this visit?
A. 99203 B. 99204
C. 99214 D. 99244

30.A four-year-old patient presents with pain in the left forearm following a fall from a chair. The
injuryoccurred one hour ago. Her mom applied ice to the injury but it does not appear to help. The
ED physician performs a four system ROS. The patient lives at home with both parents and
attends pre-K classes. The patient has no known drug allergies. The ED physician performs an
extended six system exam. An X-ray is ordered, which shows a fracture of the distal end of the
radius as read by the radiologist. The ED physician performs moderate conscious sedation with

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ketamine for 30 minutes. The fracture is reduced and cast applied by an orthopedic surgeon
following consultation with the ED physician. The child was monitored with pulse oxymetry,
cardiac monitor and frequent physician evaluation. The patient was discharged with a sling and
requested to follow up with the orthopedic
surgeon. Code the services performed by the ED physician.
A. 99284, 99143 B. 99284-25, 99148
C. 99283-25, 99143 D. 99283

31.Dr. X performs a follow-up consultation on certain tests that were not available in a nursing
facility for a 75- year-old-male that was having chest pain. Today the patient is feeling better after
a GI cocktail with Maalox and Xylocaine. The EKG showed an arrhythmia and the chest X-ray came
back normal. Dr. X performs a problem focused history. He listens to the patient’s heart and lungs.
Dr. X makes the recommendation of repeat cardiac enzymes and EKG and to have a GI evaluation.
The PCP accepts the recommendations and implements the plan of care. What CPT® code should
be reported for Dr. X?
A. 99241 B. 99232
C. 99308 D. 99251

32.Physician was called to the floor to evaluate a 94-year-old that had sudden weakness,
hypotension, and diaphoresis. Physician found the patient in mild distress and dyspenic. Her BP
101/60, pulse 85. Her heart was positive for a systolic murmur. EKG came back with ST elevation
V2-V6. Labs were still pending. She was admitted to CCU for Acute Antero-lateral MI and
hypotension. Physician spent total critical care time of 48 minutes. Select the appropriate CPT®
code for this visit:
A. 99253 B. 99233
C. 99291 D. 99236

33. Dr. Clinton completed two hours of critical care services for a 33-year-old patient. During this
time, Dr. Clinton completed temporary transcutaneous pacing, measured cardiac output, and com-
pleted gastric intubation for the patient. How should Dr. Clinton report her services?
a.99291, 99292 x 2 b.99291, 99292 x 2, 92953, 93561, 43752
c.99221, 99292 d.99291 x 2

34. Diana was seen in the ED with a complaint of severe stomach pain, nausea and vomiting, and a
headache. Dr. Michelle completed a detailed history and a detailed exam, and documented mod-erate
decision-making. Diana was discharged after three hours with a diagnosis of food poison-ing. She was
instructed to return if her symptoms returned. How should Dr. Michelle report this service?
a.99284, 99283 b.99284
c. 99221-25, 99284 d.99284, 99354, 99357 x 2

35. How should Dr. Kara report today’s service?

Discharge note: Dr. Kara dictated and completed service.
Mr. Davis, a 54-year-old male patient, is doing well following laparoscopic appendectomy com- pleted
at Calvin Hospital yesterday. He has been afebrile since the procedure, tolerating a surgical soft diet,
and ambulating with minimal assistance. He states he has “quality help” at home with his wife and
son. Given his current improved condition and eagerness to leave the hospital, he will be discharged
today. The nursing staff will provide discharge instructions and review these with the patient and
home health team (family). A follow-up office visit is set for 10 days. I have instructed the patient to
notify me immediately if he experiences a fever, pain, or oozing from the operative site.
a. 99232-25, 99239 b.99238

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c. 99315 d.99232-25, 99217

36. Which CPT® code would you use when billing for a patient who has three ongoing chronic
conditions and who received 20 minutes of care from a nurse practitioner in the month of January?
A. 99490 B. 99487 C. 99491 D. 99421

37. Baby Jones is 26 days old and requires continued intensive care services but is not considered
critically ill. Her present body weight is 1,400 grams. Dr. Rob initially admitted Baby Jones to her
service on Monday. Dr. Rob completed a visit with Baby Jones and her parents on Tuesday and
Wednesday. How would Dr. Rob report all three days of service?
a. 99468, 99469 x 2 b. 99477, 99478 x 2
c. 99460, 99462 x 2 d. 99291, 99292 x 2

38. Today Dr. Miller completed an annual assessment with Mary, an established patient. Mary has
been living in a nursing facility for the past three years. Today’s documentation included an
assessment of her overall condition, her continued need for 24-hour nursing assistance, and her
decline in mental acuity. Dr. Miller dictated a comprehensive history, comprehensive examination,
high decision-making, and notes related to discussions with her extended family. Additionally, he
completed the required resident assessment instrument and protocols and Minimum Data Set
paperwork. Which code(s) should Dr. Miller report for today’s visit?
a.99306 b.99215 c.99318 d.99310-25,
99318

39.Physician performs a medical review and documentation on an 83-year-old patient still

hospitalized for confusion for the last two days. She is alert and oriented x 3 today. Reviewing her labs
from yesterday, her BNP was elevated suspecting her confusion is due to congestive heart failure. An
echocardiogram is ordered and treatment will be for congestive heart failure. Patient is not safe to
return home. What CPT® code should be reported?
A. 99231 B. 99221
C. 99218 D. 99232

40.A plastic surgeon is called to the ED at the request of the emergency department physician to
evaluate a patient that arrived with multiple facial fractures after being in an automobile accident for
her opinion on the need for reconstructive surgery. The plastic surgeon arrives at the ED, obtains a
history of present illness including an extended history of present illness; a system review, including
constitutional, musculoskeletal, integumentary, neurologic, and EENMT; and the patient’s social
history and past medical history. The plastic surgeon then performs a physical exam including
respiratory, cardiovascular, and an extended examination of the skin and bony structures of the
patient’s face. The plastic surgeon performs moderate medical decision making, including deciding
the patient needs major surgery to repair the injuries. The plastic surgeon schedules the patient for
surgery the next day and documents her full note with findings in the ED chart.
A. 99284-57 B. 99244
C. 99243-57 D. 99221

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