AAPC CPC Chapter 19 – Evaluation and Management (E/M)
Services Exam Questions & 100% Verified Answers | CPC
Certification Review | 2026–2027
,Emergency Department Services Fred is fishing at the local area lake while on vacation. He gets lightheaded and
dizzy and goes to the local hospital Emergency Department. He's evaluated by the
ED provider. This is the first time he has been to this hospital. What subsection is
used to report the ED visit?
32 What modifier is used to report an evaluation and management service mandated
by a court order?
Established patient office visit A patient is seen by Dr. B who is covering on call services for Dr. A. The patient is
an established patient with Dr. A. but she has not been seen by Dr. B. before. Which
E/M subcategory is appropriate to report the services provided by Dr. B?
Location, quality and duration Which elements of HPI are met in this statement? Patient complains of headache
and blurry vision for the past 3 days.
Quality If the pain is sharp, stabbing or dull, what is the component of the History of Present
Illness (HPI)?
99475 A 3 year-old critically ill child is admitted to the PICU from the ER with respiratory
failure due to an exacerbation of asthma not manageable in the ER. The provider
starts continuous bronchodilator therapy and pharmacologic support along with
cardiovascular monitoring and possible mechanical ventilation support. The provider
documents a comprehensive history and exam and orders are written after
treatment is initiated. What is the CPT ® code for this encounter?
99382 After moving across country, Ms. Robbins took her 2 year-old daughter to a new
pediatric clinic for an annual physical. The provider completed an age / gender
appropriate history, exam, and provided anticipatory guidance. He ordered no
additional tests or immunizations. What CPT® code is reported?
99367 A patient is in the hospital after a wedge resection of the left lung due to cancer. He
has not been able to keep the lung inflated without a ventilator. A 45-minute team
conference between the general surgeon who performed the surgery, a
pulmonologist, an oncologist and a neurologist is held to discuss the best treatment
for the patient. The patient and/or patient's family is not present. What CPT® code
is reported?
I20.1 What ICD-10-CM code is reported for angina pectoris with a documented spasm?
99393, 99213-25 A 10 year-old girl is scheduled for her yearly physical with her pediatrician. At the
time of the visit, the patient complains of watery eyes, scratchy throat and stuffy
nose for the past two days. The provider performs the physical. He also performs an
expanded problem history and exam and treats the patient for a URI. What CPT®
code(s) is/are reported for this visit?
99242 A 32 year-old patient sees Dr. Smith for a consult at the request of his PCP, Dr.
Long, for an ongoing problem with allergies. The patient has failed Claritin and
Alavert and feels his symptoms continue to worsen. Dr. Smith performs an
expanded problem focused history and exam and discusses options with the patient
on allergy management. The MDM is straightforward. The patient agrees he would
like to be tested to possibly gain better control of his allergies. Dr. Smith sends a
report to Dr. Long thanking him for the referral and includes the date the patient is
scheduled for allergy testing. Dr. Smith also includes his findings from the
encounter. What E/M code is reported?
,99213, 99354 Mr. Flintstone is seen by his oncologist just two days after undergoing extensive
testing for a sudden onset of petechiae, night sweats, swollen glands and
weakness. After a brief review of history, Dr. B. Marrow re-examines Mr. Flintstone.
The exam is documented as expanded problem focused and the medical decision
making of moderate complexity. The oncologist spends an additional 45 minutes
discussing Mr. Flintstone's new diagnosis of Hodgkin's lymphoma, treatment options
and prognosis.
What is/are the appropriate procedure code(s) for this visit?
The acute tonsillitis is reported first; the chronic tonsillitis is A patient is diagnosed as having both acute and chronic tonsillitis. How is this
reported second. reported in ICD-10-CM?
99222 The provider admitted an 18 month-old infant to the hospital from his office to rule
out sepsis. The infant is crying inconsolably. He has a large amount of gas in his
bowel, no hematochezia associated with it. A comprehensive history,
comprehensive exam and moderate decision making is documented. If cultures are
negative and the patient remains afebrile for 48 hours, the infant will be discharged
home. What CPT® code is reported for this visit?
99212 A 37 year-old female is seen in the clinic for follow-up of lower extremity swelling.
HPI: Patient is here today for follow-up of bilateral lower extremity swelling. The
swelling responded to hydrochlorothiazide.
DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have
moderate pulmonary hypertension.
Exam: Patient is in no acute distress.
ASSESSMENT:
1. Bilateral lower extremity swelling. This has resolved with diuretics; it may be
secondary to problem #2.
2. Pulmonary hypertension: Etiology is not clear at this time, will work up and
possibly refer to a pulmonologist.
PLAN: Will evaluate the pulmonary hypertension. Patient will be scheduled for a
sleep study.
99235 A 90 year-old female was admitted this morning from observation status for chest
pain to r/o angina. A cardiologist performs a comprehensive history and
comprehensive exam. Her chest pain has been relieved with the nitroglycerin drip
given before admission and she would like to go home. Doctor has written
prescriptions to add to her regimen. He had given her Isosorbide, and she is
tolerating it well. He will go ahead and send her home. We will follow up with her in
a week. Patient was admitted and discharged on the same date of service. What
CPT® code is reported?
99291-25, 31500, 36510, 94610 An infant is born six weeks premature in rural Arizona and the pediatrician in
attendance intubates the child and administers surfactant in the ET tube while
waiting in the ER for the air ambulance. During the 45-minute wait, he continues to
bag the critically ill patient on 100 percent oxygen while monitoring VS, ECG, pulse
oximetry and temperature. The infant is in a warming unit and an umbilical vein line
was placed for fluids and in case of emergent need for medications. How is this
coded?
99231 The physician was called to the hospital floor for the medical management of a 56
year-old patient admitted one day ago with aspiration pneumonia and COPD. No
chest pain at present, but still SOB and some swelling in his lower extremities.
Patient was tachypneic yesterday; lungs reveal course crackles in both bases, right
worse than left. The physician writes instructions to continue with intravenous
antibiotic treatment and respiratory support with ventilator management. He
reviewed chest X-ray and labs. Patient is improving and a pulmonary consultation
has been requested. What CPT® code is reported?
, 99213, S39.012A, W01.0XXA, Y92.030 An established 47 year-old patient presents to the provider's office after falling last
night in her apartment when she slipped in water on the kitchen floor. She is
complaining of low back pain and no tingling or numbness. Provider documents that
she has full range motion of the spine, with discomfort. Her gait is within normal
limits. Straight leg raising is negative. She requested no medication. It is
recommended to use heat, such as a hot water bottle. Provider's Assessment:
Lower Back Muscle Strain. What E/M and ICD-10-CM codes are reported for this
service?
92950, 99291-25, 36556, 31500 A 5 year-old is brought to the Emergency Department by ambulance, He had been
found floating in a pool for an unknown amount of time. EMS started CPR which
was continued by the ED provider along with endotracheal intubation and
placement of a CVC. The ER provider spent 1 hour with the critically ill patient. The
ED provider makes a notation the 1 hour does not include the time for the other
separate billable services. What CPT® codes are reported?
99213 An established patient presents to the clinic today for a follow-up of his pneumonia.
He was hospitalized for 6 days on IV antibiotics. He was placed back on Singulair
and has been doing well with his breathing since then. An expanded problem
focused exam was performed. Records were obtained from the hospital and the
provider reviewed the labs and X-rays. The patient was told to continue antibiotics
for another two weeks to 20 days, and the prescription Keteck was replaced with
Zithromax. Patient is to return to the clinic in two weeks for recheck of his breathing
and follow up X-ray. What CPT® code is reported?
99214, K37, R12 A 28 year-old female patient is returning to her provider's office with complaints of
RLQ pain and heartburn with a temperature of 100.2. The provider performs a
detailed history, detailed exam and determines the patient has mild appendicitis.
The provider prescribes antibiotics to treat the appendicitis in hopes of avoiding an
appendectomy. What are the correct CPT® and ICD-10-CM codes for this
encounter?
20610-50 An established patient presents to the office with a recurrence of bursitis in both
shoulders. Examination is limited only to the shoulders in which range of motion is
good and full, but he has tenderness in the subdeltoid bursa. Both shoulders were
injected in the deltoid bursa with 120mg Depo-Medrol. What CPT® code(s) is/are
reported for this visit?
99288, 99291, 92950 Mr. Trumph loses his yacht in a poker game and experiences a sudden onset of
chest pain which radiates down his left arm. The paramedics are called to the
casino he owns in Atlantic City to stabilize him and transport him to the hospital. Dr.
H. Art is in the ER to direct the activities of the paramedics. He spends 30 minutes
in two-way communication directing the care of Mr. Trumph. When EMS reached
the hospital Emergency Department, Mr. Trumph is in full arrest with torsades de
pointes (ventricular tachycardia). Dr. H. Art spends another hour stabilizing the
patient and performing CPR. Defibrillation is performed with 250 joules to a NSR.
What are the appropriate procedure codes for this encounter?
99232 Dr. Jones documents Mrs. Smith's condition has improved during his third visit to
her hospital room. Upon entering the room, he finds her sitting up in bed, watching
television and eating breakfast. Dr. Jones performs a problem focused exam and a
low medical decision making. What CPT® code should be reported?
E/M services are further categorized based on the setting Examples of settings include:
in which the service is provided. What are they?? Office or other outpatient setting
Inpatient Hospital
Emergency department (ED)
Nursing facility (NF)
Outpatient Hospital
Components used in History
selecting a level of E/M service. Exam
Medical Decision Making
Counseling
Coordination of Care
Nature of Presenting Problem
Time
Services Exam Questions & 100% Verified Answers | CPC
Certification Review | 2026–2027
,Emergency Department Services Fred is fishing at the local area lake while on vacation. He gets lightheaded and
dizzy and goes to the local hospital Emergency Department. He's evaluated by the
ED provider. This is the first time he has been to this hospital. What subsection is
used to report the ED visit?
32 What modifier is used to report an evaluation and management service mandated
by a court order?
Established patient office visit A patient is seen by Dr. B who is covering on call services for Dr. A. The patient is
an established patient with Dr. A. but she has not been seen by Dr. B. before. Which
E/M subcategory is appropriate to report the services provided by Dr. B?
Location, quality and duration Which elements of HPI are met in this statement? Patient complains of headache
and blurry vision for the past 3 days.
Quality If the pain is sharp, stabbing or dull, what is the component of the History of Present
Illness (HPI)?
99475 A 3 year-old critically ill child is admitted to the PICU from the ER with respiratory
failure due to an exacerbation of asthma not manageable in the ER. The provider
starts continuous bronchodilator therapy and pharmacologic support along with
cardiovascular monitoring and possible mechanical ventilation support. The provider
documents a comprehensive history and exam and orders are written after
treatment is initiated. What is the CPT ® code for this encounter?
99382 After moving across country, Ms. Robbins took her 2 year-old daughter to a new
pediatric clinic for an annual physical. The provider completed an age / gender
appropriate history, exam, and provided anticipatory guidance. He ordered no
additional tests or immunizations. What CPT® code is reported?
99367 A patient is in the hospital after a wedge resection of the left lung due to cancer. He
has not been able to keep the lung inflated without a ventilator. A 45-minute team
conference between the general surgeon who performed the surgery, a
pulmonologist, an oncologist and a neurologist is held to discuss the best treatment
for the patient. The patient and/or patient's family is not present. What CPT® code
is reported?
I20.1 What ICD-10-CM code is reported for angina pectoris with a documented spasm?
99393, 99213-25 A 10 year-old girl is scheduled for her yearly physical with her pediatrician. At the
time of the visit, the patient complains of watery eyes, scratchy throat and stuffy
nose for the past two days. The provider performs the physical. He also performs an
expanded problem history and exam and treats the patient for a URI. What CPT®
code(s) is/are reported for this visit?
99242 A 32 year-old patient sees Dr. Smith for a consult at the request of his PCP, Dr.
Long, for an ongoing problem with allergies. The patient has failed Claritin and
Alavert and feels his symptoms continue to worsen. Dr. Smith performs an
expanded problem focused history and exam and discusses options with the patient
on allergy management. The MDM is straightforward. The patient agrees he would
like to be tested to possibly gain better control of his allergies. Dr. Smith sends a
report to Dr. Long thanking him for the referral and includes the date the patient is
scheduled for allergy testing. Dr. Smith also includes his findings from the
encounter. What E/M code is reported?
,99213, 99354 Mr. Flintstone is seen by his oncologist just two days after undergoing extensive
testing for a sudden onset of petechiae, night sweats, swollen glands and
weakness. After a brief review of history, Dr. B. Marrow re-examines Mr. Flintstone.
The exam is documented as expanded problem focused and the medical decision
making of moderate complexity. The oncologist spends an additional 45 minutes
discussing Mr. Flintstone's new diagnosis of Hodgkin's lymphoma, treatment options
and prognosis.
What is/are the appropriate procedure code(s) for this visit?
The acute tonsillitis is reported first; the chronic tonsillitis is A patient is diagnosed as having both acute and chronic tonsillitis. How is this
reported second. reported in ICD-10-CM?
99222 The provider admitted an 18 month-old infant to the hospital from his office to rule
out sepsis. The infant is crying inconsolably. He has a large amount of gas in his
bowel, no hematochezia associated with it. A comprehensive history,
comprehensive exam and moderate decision making is documented. If cultures are
negative and the patient remains afebrile for 48 hours, the infant will be discharged
home. What CPT® code is reported for this visit?
99212 A 37 year-old female is seen in the clinic for follow-up of lower extremity swelling.
HPI: Patient is here today for follow-up of bilateral lower extremity swelling. The
swelling responded to hydrochlorothiazide.
DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have
moderate pulmonary hypertension.
Exam: Patient is in no acute distress.
ASSESSMENT:
1. Bilateral lower extremity swelling. This has resolved with diuretics; it may be
secondary to problem #2.
2. Pulmonary hypertension: Etiology is not clear at this time, will work up and
possibly refer to a pulmonologist.
PLAN: Will evaluate the pulmonary hypertension. Patient will be scheduled for a
sleep study.
99235 A 90 year-old female was admitted this morning from observation status for chest
pain to r/o angina. A cardiologist performs a comprehensive history and
comprehensive exam. Her chest pain has been relieved with the nitroglycerin drip
given before admission and she would like to go home. Doctor has written
prescriptions to add to her regimen. He had given her Isosorbide, and she is
tolerating it well. He will go ahead and send her home. We will follow up with her in
a week. Patient was admitted and discharged on the same date of service. What
CPT® code is reported?
99291-25, 31500, 36510, 94610 An infant is born six weeks premature in rural Arizona and the pediatrician in
attendance intubates the child and administers surfactant in the ET tube while
waiting in the ER for the air ambulance. During the 45-minute wait, he continues to
bag the critically ill patient on 100 percent oxygen while monitoring VS, ECG, pulse
oximetry and temperature. The infant is in a warming unit and an umbilical vein line
was placed for fluids and in case of emergent need for medications. How is this
coded?
99231 The physician was called to the hospital floor for the medical management of a 56
year-old patient admitted one day ago with aspiration pneumonia and COPD. No
chest pain at present, but still SOB and some swelling in his lower extremities.
Patient was tachypneic yesterday; lungs reveal course crackles in both bases, right
worse than left. The physician writes instructions to continue with intravenous
antibiotic treatment and respiratory support with ventilator management. He
reviewed chest X-ray and labs. Patient is improving and a pulmonary consultation
has been requested. What CPT® code is reported?
, 99213, S39.012A, W01.0XXA, Y92.030 An established 47 year-old patient presents to the provider's office after falling last
night in her apartment when she slipped in water on the kitchen floor. She is
complaining of low back pain and no tingling or numbness. Provider documents that
she has full range motion of the spine, with discomfort. Her gait is within normal
limits. Straight leg raising is negative. She requested no medication. It is
recommended to use heat, such as a hot water bottle. Provider's Assessment:
Lower Back Muscle Strain. What E/M and ICD-10-CM codes are reported for this
service?
92950, 99291-25, 36556, 31500 A 5 year-old is brought to the Emergency Department by ambulance, He had been
found floating in a pool for an unknown amount of time. EMS started CPR which
was continued by the ED provider along with endotracheal intubation and
placement of a CVC. The ER provider spent 1 hour with the critically ill patient. The
ED provider makes a notation the 1 hour does not include the time for the other
separate billable services. What CPT® codes are reported?
99213 An established patient presents to the clinic today for a follow-up of his pneumonia.
He was hospitalized for 6 days on IV antibiotics. He was placed back on Singulair
and has been doing well with his breathing since then. An expanded problem
focused exam was performed. Records were obtained from the hospital and the
provider reviewed the labs and X-rays. The patient was told to continue antibiotics
for another two weeks to 20 days, and the prescription Keteck was replaced with
Zithromax. Patient is to return to the clinic in two weeks for recheck of his breathing
and follow up X-ray. What CPT® code is reported?
99214, K37, R12 A 28 year-old female patient is returning to her provider's office with complaints of
RLQ pain and heartburn with a temperature of 100.2. The provider performs a
detailed history, detailed exam and determines the patient has mild appendicitis.
The provider prescribes antibiotics to treat the appendicitis in hopes of avoiding an
appendectomy. What are the correct CPT® and ICD-10-CM codes for this
encounter?
20610-50 An established patient presents to the office with a recurrence of bursitis in both
shoulders. Examination is limited only to the shoulders in which range of motion is
good and full, but he has tenderness in the subdeltoid bursa. Both shoulders were
injected in the deltoid bursa with 120mg Depo-Medrol. What CPT® code(s) is/are
reported for this visit?
99288, 99291, 92950 Mr. Trumph loses his yacht in a poker game and experiences a sudden onset of
chest pain which radiates down his left arm. The paramedics are called to the
casino he owns in Atlantic City to stabilize him and transport him to the hospital. Dr.
H. Art is in the ER to direct the activities of the paramedics. He spends 30 minutes
in two-way communication directing the care of Mr. Trumph. When EMS reached
the hospital Emergency Department, Mr. Trumph is in full arrest with torsades de
pointes (ventricular tachycardia). Dr. H. Art spends another hour stabilizing the
patient and performing CPR. Defibrillation is performed with 250 joules to a NSR.
What are the appropriate procedure codes for this encounter?
99232 Dr. Jones documents Mrs. Smith's condition has improved during his third visit to
her hospital room. Upon entering the room, he finds her sitting up in bed, watching
television and eating breakfast. Dr. Jones performs a problem focused exam and a
low medical decision making. What CPT® code should be reported?
E/M services are further categorized based on the setting Examples of settings include:
in which the service is provided. What are they?? Office or other outpatient setting
Inpatient Hospital
Emergency department (ED)
Nursing facility (NF)
Outpatient Hospital
Components used in History
selecting a level of E/M service. Exam
Medical Decision Making
Counseling
Coordination of Care
Nature of Presenting Problem
Time
