CHAPTER 19 CPC STUDY GUIDE
QUESTIONS AND VERIFIED ANSWERS
/GET IT 100% ACCURATE|ALREADY
GRADED A+
Emergency Department Services - Correct answer.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 - Correct answer.What modifier is used to report an evaluation and management service mandated
by a court order?
Established patient office visit - Correct answer.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 - Correct answer.Which elements of HPI are met in this statement?
Patient complains of headache and blurry vision for the past 3 days.
Quality - Correct answer.If the pain is sharp, stabbing or dull, what is the component of the History of
Present Illness (HPI)?
99475 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.What ICD-10-CM code is reported for angina pectoris with a documented spasm?
99393, 99213-25 - Correct answer.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 - Correct answer.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 - Correct answer.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 reported second. - Correct answer.A patient
is diagnosed as having both acute and chronic tonsillitis. How is this reported in ICD-10-CM?
99222 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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,
QUESTIONS AND VERIFIED ANSWERS
/GET IT 100% ACCURATE|ALREADY
GRADED A+
Emergency Department Services - Correct answer.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 - Correct answer.What modifier is used to report an evaluation and management service mandated
by a court order?
Established patient office visit - Correct answer.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 - Correct answer.Which elements of HPI are met in this statement?
Patient complains of headache and blurry vision for the past 3 days.
Quality - Correct answer.If the pain is sharp, stabbing or dull, what is the component of the History of
Present Illness (HPI)?
99475 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.What ICD-10-CM code is reported for angina pectoris with a documented spasm?
99393, 99213-25 - Correct answer.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 - Correct answer.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 - Correct answer.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 reported second. - Correct answer.A patient
is diagnosed as having both acute and chronic tonsillitis. How is this reported in ICD-10-CM?
99222 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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 - Correct answer.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,
