AAPC CHAPTER 19 - EVALUATION AND
MANAGEMENT - REVIEW EXAM 2025
WITH CORRECT ANSWERS
A provider admits Mrs. Smith to the hospital. She is there for five days. The provider sees her each day sh
e's in the hospital. What subcategory of E/M codes would be used for days two, three and four? -
correct answer-Correct Answer:
c. Subsequent Hospital Care
Response Feedback:
Rationale: Codes from the Subsequent Hospital Care subcategory would be used for days two, three and f
our. The code for the first day would be from the Initial Hospital Care subcategory. Day five could be repor
ted with either subsequent hospital care or hospital care discharge depending on the role of the provider.
What modifier is used to report an evaluation and management service mandated by a court order? -
correct answer-Correct Answer:
c. 32
Response Feedback:
Rationale: Modifier 32 is used for services related to mandated consultation and/or related services by a
third-party payer, governmental, legislative or regulatory requirements.
What category of codes should be used to report an evaluation and management service provided to a p
atient in a psychiatric residential treatment center? - correct answer-Correct Answer:
c. Nursing facility services
Response Feedback:
Rationale: The guidelines for NursingZFacility ServicesZstate, "These codes should also be used to report e
valuation and management services provided to a patient in a psychiatric residential treatment center."
A patient is seen by Dr. B who is covering on call services for Dr. A. The patient is an established patient wi
th Dr. A. but she has notZbeen seen by Dr. B. before. Which E/M subcategory is appropriate to report the s
ervices provided by Dr. B? - correct answer-Correct Answer:
,c. Established patient office visit
Response Feedback:
Rationale: According to the E/M Guideline for New and Established Patient, when a provider is on call or c
overingZfor another provider, the patient's encounter will be classified as it would haveZbeen by the provi
der who is not available. In this instance, Dr. B would report an established patient office visit.
A PCP transfers a patient to a cardiologist for management of the patient's congestive heart failure. The c
ardiologist examines the patient, discusses treatment options and schedules a stress testZfor this new pati
ent. A report is sent to the PCP detailing the findings of the office visit, results of the stress test and intent
to manage and treat the congestive heart failure. An E/M code would be selected from what subcategor
y for the cardiologist? - correct answer-Correct Answer:
a. New patient office visit
Response Feedback:
Rationale: The PCP transferred the patient to the cardiologist to manage/treat the congestive heart failur
e. The cardiologist accepted the transfer of care of the patientZand sent a letter to the PCP with findings o
f the first visit and stress test. This would be coded asZa new patient since the cardiologist accepted the p
atient and isZtaking over the care of a specific problem.
WhatZICD-10-CM code isZreported for nausea and vomiting? - correct answer-Correct Answer:
b. R11.2
Response Feedback:
Rationale: Look in the ICD-10-
CM AlphabeticZIndex for Nausea/with vomiting referring you to R11.2. Verify code selection in the Tabula
r List.
AZpatient is diagnosed as having both acute and chronic tonsillitis. How is this reported in ICD-10-CM? -
correct answer-Correct Answer:
d. The acute tonsillitis is reported first; the chronic tonsillitis is reported second.
Response Feedback:
, Rationale: Coding acute and chronic conditions in ICD-10-
CM followsZthe coding guidelines I.B.8. If the same condition is described as both acute (subacute) and ch
ronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and
sequence the acute or (subacute) code first.
A 10-year-
old girl is scheduled for her yearly physical with her pediatrician. At the time of the visit, the patient comp
lains of watery eyes, scratchy throat and stuffy nose for the past two days. The provider performs the phy
sical. He also performs a history and exam and treats the patient for a URI with low medical decision maki
ng. What CPT® coding isZreported for this visit? - correct answer-Correct Answer:
a. 99393, 99213-25
Response Feedback:
Rationale: The physical exam code is selected from the Preventive Medicine Services and selected based
on whether the patient is new or established and by age. The pediatrician also evaluates and treats the U
RI. The additional work for the URI allows us to report an established patient office visit. Modifier 25 is ap
pended to the office visit to show it is a significant and separately identifiable service from the preventive
visit.
Dr. Jones documents Mrs. Smith's condition has improved during his third visit toZher hospital room. Upo
n entering the room, he finds her sitting up in bed, watching television and eating breakfast. Dr. Jones per
forms a problem focused exam and low medical decision making. What CPT® code is reported? -
correct answer-Correct Answer:
c. 99231
Response Feedback:
Rationale: ThisZis a subsequent hospital care visit. Subsequent hospital care codes are 99231-
99233. Codes in this section require 2 of 3 key components be met. A problem focused exam and low me
dical decision making supports a 99231.
A soccer player hits his head during an indoor game and is admitted to observation to watch for head tra
uma.
Admit date/time: 01/21/20XX 8:12 PM
Detailed History, Detailed Exam, Low MDM
Discharge date/time: 01/22/20XX 8:15 AM
MANAGEMENT - REVIEW EXAM 2025
WITH CORRECT ANSWERS
A provider admits Mrs. Smith to the hospital. She is there for five days. The provider sees her each day sh
e's in the hospital. What subcategory of E/M codes would be used for days two, three and four? -
correct answer-Correct Answer:
c. Subsequent Hospital Care
Response Feedback:
Rationale: Codes from the Subsequent Hospital Care subcategory would be used for days two, three and f
our. The code for the first day would be from the Initial Hospital Care subcategory. Day five could be repor
ted with either subsequent hospital care or hospital care discharge depending on the role of the provider.
What modifier is used to report an evaluation and management service mandated by a court order? -
correct answer-Correct Answer:
c. 32
Response Feedback:
Rationale: Modifier 32 is used for services related to mandated consultation and/or related services by a
third-party payer, governmental, legislative or regulatory requirements.
What category of codes should be used to report an evaluation and management service provided to a p
atient in a psychiatric residential treatment center? - correct answer-Correct Answer:
c. Nursing facility services
Response Feedback:
Rationale: The guidelines for NursingZFacility ServicesZstate, "These codes should also be used to report e
valuation and management services provided to a patient in a psychiatric residential treatment center."
A patient is seen by Dr. B who is covering on call services for Dr. A. The patient is an established patient wi
th Dr. A. but she has notZbeen seen by Dr. B. before. Which E/M subcategory is appropriate to report the s
ervices provided by Dr. B? - correct answer-Correct Answer:
,c. Established patient office visit
Response Feedback:
Rationale: According to the E/M Guideline for New and Established Patient, when a provider is on call or c
overingZfor another provider, the patient's encounter will be classified as it would haveZbeen by the provi
der who is not available. In this instance, Dr. B would report an established patient office visit.
A PCP transfers a patient to a cardiologist for management of the patient's congestive heart failure. The c
ardiologist examines the patient, discusses treatment options and schedules a stress testZfor this new pati
ent. A report is sent to the PCP detailing the findings of the office visit, results of the stress test and intent
to manage and treat the congestive heart failure. An E/M code would be selected from what subcategor
y for the cardiologist? - correct answer-Correct Answer:
a. New patient office visit
Response Feedback:
Rationale: The PCP transferred the patient to the cardiologist to manage/treat the congestive heart failur
e. The cardiologist accepted the transfer of care of the patientZand sent a letter to the PCP with findings o
f the first visit and stress test. This would be coded asZa new patient since the cardiologist accepted the p
atient and isZtaking over the care of a specific problem.
WhatZICD-10-CM code isZreported for nausea and vomiting? - correct answer-Correct Answer:
b. R11.2
Response Feedback:
Rationale: Look in the ICD-10-
CM AlphabeticZIndex for Nausea/with vomiting referring you to R11.2. Verify code selection in the Tabula
r List.
AZpatient is diagnosed as having both acute and chronic tonsillitis. How is this reported in ICD-10-CM? -
correct answer-Correct Answer:
d. The acute tonsillitis is reported first; the chronic tonsillitis is reported second.
Response Feedback:
, Rationale: Coding acute and chronic conditions in ICD-10-
CM followsZthe coding guidelines I.B.8. If the same condition is described as both acute (subacute) and ch
ronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and
sequence the acute or (subacute) code first.
A 10-year-
old girl is scheduled for her yearly physical with her pediatrician. At the time of the visit, the patient comp
lains of watery eyes, scratchy throat and stuffy nose for the past two days. The provider performs the phy
sical. He also performs a history and exam and treats the patient for a URI with low medical decision maki
ng. What CPT® coding isZreported for this visit? - correct answer-Correct Answer:
a. 99393, 99213-25
Response Feedback:
Rationale: The physical exam code is selected from the Preventive Medicine Services and selected based
on whether the patient is new or established and by age. The pediatrician also evaluates and treats the U
RI. The additional work for the URI allows us to report an established patient office visit. Modifier 25 is ap
pended to the office visit to show it is a significant and separately identifiable service from the preventive
visit.
Dr. Jones documents Mrs. Smith's condition has improved during his third visit toZher hospital room. Upo
n entering the room, he finds her sitting up in bed, watching television and eating breakfast. Dr. Jones per
forms a problem focused exam and low medical decision making. What CPT® code is reported? -
correct answer-Correct Answer:
c. 99231
Response Feedback:
Rationale: ThisZis a subsequent hospital care visit. Subsequent hospital care codes are 99231-
99233. Codes in this section require 2 of 3 key components be met. A problem focused exam and low me
dical decision making supports a 99231.
A soccer player hits his head during an indoor game and is admitted to observation to watch for head tra
uma.
Admit date/time: 01/21/20XX 8:12 PM
Detailed History, Detailed Exam, Low MDM
Discharge date/time: 01/22/20XX 8:15 AM
