AAPC CHAPTER 19 - EVALUATION AND
MANAGEMENT - REVIEW EXAM 2026
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 Nursing Facility Services state, "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 not been 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
overing for another provider, the patient's encounter will be classified as it would have been 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 test for 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 patient and sent a letter to the PCP with findings o
f the first visit and stress test. This would be coded as a new patient since the cardiologist accepted the p
atient and is taking over the care of a specific problem.
WhatzICD-10-CMzcodeziszreportedzforznauseazandzvomiting?z-zcorrectzanswer-CorrectzAnswer:
b.zR11.2
ResponsezFeedback:
Rationale:zLookzinzthezICD-10-
CMzAlphabeticzIndexzforzNausea/withzvomitingzreferringzyouztozR11.2.zVerifyzcodezselectionzinzthezTabula
rzList.
Azpatientziszdiagnosedzaszhavingzbothzacutezandzchronicztonsillitis.zHowziszthiszreportedzinzICD-10-
CM?z-
correctzanswer-CorrectzAnswer:
d.zThezacuteztonsillitisziszreportedzfirst;zthezchronicztonsillitisziszreportedzsecond.
ResponsezFeedback:
,z
Rationale:zCodingzacutezandzchroniczconditionszinzICD-10-
CMzfollowszthezcodingzguidelineszI.B.8.zIfzthezsamezconditionziszdescribedzaszbothzacutez(subacute)zandzc
h
ronic,zandzseparatezsubentrieszexistzinzthezAlphabeticzIndexzatzthezsamezindentationzlevel,zcodezbothzand
sequencezthezacutezorz(subacute)zcodezfirst.
Az10-year-
oldzgirlziszscheduledzforzherzyearlyzphysicalzwithzherzpediatrician.zAtztheztimezofzthezvisit,zthezpatientzcom
p
lainszofzwateryzeyes,zscratchyzthroatzandzstuffyznosezforzthezpastztwozdays.zThezproviderzperformszthezph
y
sical.zHezalsozperformszazhistoryzandzexamzandztreatszthezpatientzforzazURIzwithzlowzmedicalzdecisionzma
a.
ki z99393,z99213-25
ng.zWhatzCPT®zcodingziszreportedzforzthiszvisit?z-zcorrectzanswer-CorrectzAnswer:
ResponsezFeedback:
Rationale:zThezphysicalzexamzcodeziszselectedzfromzthezPreventivezMedicinezServiceszandzselectedzbased
onzwhetherzthezpatientzisznewzorzestablishedzandzbyzage.zThezpediatricianzalsozevaluateszandztreatszthez
U
RI.zThezadditionalzworkzforzthezURIzallowszusztozreportzanzestablishedzpatientzofficezvisit.zModifierz25zisza
p
pendedztozthezofficezvisitztozshowzitziszazsignificantzandzseparatelyzidentifiablezservicezfromzthezpreventiv
e
visit.
Dr.zJoneszdocumentszMrs.zSmith'szconditionzhaszimprovedzduringzhiszthirdzvisitztozherzhospitalzroom.zUpo
nzenteringzthezroom,zhezfindszherzsittingzupzinzbed,zwatchingztelevisionzandzeatingzbreakfast.zDr.zJoneszpe
r
formszazproblemzfocusedzexamzandzlowzmedicalzdecisionzmaking.zWhatzCPT®zcodeziszreported?z-
correctzanswer-CorrectzAnswer:
c.z99231
ResponsezFeedback:
Rationale:zThisziszazsubsequentzhospitalzcarezvisit.zSubsequentzhospitalzcarezcodeszarez99231-
99233.zCodeszinzthiszsectionzrequirez2zofz3zkeyzcomponentszbezmet.zAzproblemzfocusedzexamzandzlowzm
e zdecisionzmakingzsupportszaz99231.
dical
Azsoccerzplayerzhitszhiszheadzduringzanzindoorzgamezandziszadmittedztozobservationztozwatchzforzheadztr
a
uma.
Admitzdate/time:z01/21/20XXz8:12zPM
DetailedzHistory,zDetailedzExam,zLowzMDM
Dischargezdate/time:z01/22/20XXz8:15zAM
MANAGEMENT - REVIEW EXAM 2026
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 Nursing Facility Services state, "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 not been 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
overing for another provider, the patient's encounter will be classified as it would have been 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 test for 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 patient and sent a letter to the PCP with findings o
f the first visit and stress test. This would be coded as a new patient since the cardiologist accepted the p
atient and is taking over the care of a specific problem.
WhatzICD-10-CMzcodeziszreportedzforznauseazandzvomiting?z-zcorrectzanswer-CorrectzAnswer:
b.zR11.2
ResponsezFeedback:
Rationale:zLookzinzthezICD-10-
CMzAlphabeticzIndexzforzNausea/withzvomitingzreferringzyouztozR11.2.zVerifyzcodezselectionzinzthezTabula
rzList.
Azpatientziszdiagnosedzaszhavingzbothzacutezandzchronicztonsillitis.zHowziszthiszreportedzinzICD-10-
CM?z-
correctzanswer-CorrectzAnswer:
d.zThezacuteztonsillitisziszreportedzfirst;zthezchronicztonsillitisziszreportedzsecond.
ResponsezFeedback:
,z
Rationale:zCodingzacutezandzchroniczconditionszinzICD-10-
CMzfollowszthezcodingzguidelineszI.B.8.zIfzthezsamezconditionziszdescribedzaszbothzacutez(subacute)zandzc
h
ronic,zandzseparatezsubentrieszexistzinzthezAlphabeticzIndexzatzthezsamezindentationzlevel,zcodezbothzand
sequencezthezacutezorz(subacute)zcodezfirst.
Az10-year-
oldzgirlziszscheduledzforzherzyearlyzphysicalzwithzherzpediatrician.zAtztheztimezofzthezvisit,zthezpatientzcom
p
lainszofzwateryzeyes,zscratchyzthroatzandzstuffyznosezforzthezpastztwozdays.zThezproviderzperformszthezph
y
sical.zHezalsozperformszazhistoryzandzexamzandztreatszthezpatientzforzazURIzwithzlowzmedicalzdecisionzma
a.
ki z99393,z99213-25
ng.zWhatzCPT®zcodingziszreportedzforzthiszvisit?z-zcorrectzanswer-CorrectzAnswer:
ResponsezFeedback:
Rationale:zThezphysicalzexamzcodeziszselectedzfromzthezPreventivezMedicinezServiceszandzselectedzbased
onzwhetherzthezpatientzisznewzorzestablishedzandzbyzage.zThezpediatricianzalsozevaluateszandztreatszthez
U
RI.zThezadditionalzworkzforzthezURIzallowszusztozreportzanzestablishedzpatientzofficezvisit.zModifierz25zisza
p
pendedztozthezofficezvisitztozshowzitziszazsignificantzandzseparatelyzidentifiablezservicezfromzthezpreventiv
e
visit.
Dr.zJoneszdocumentszMrs.zSmith'szconditionzhaszimprovedzduringzhiszthirdzvisitztozherzhospitalzroom.zUpo
nzenteringzthezroom,zhezfindszherzsittingzupzinzbed,zwatchingztelevisionzandzeatingzbreakfast.zDr.zJoneszpe
r
formszazproblemzfocusedzexamzandzlowzmedicalzdecisionzmaking.zWhatzCPT®zcodeziszreported?z-
correctzanswer-CorrectzAnswer:
c.z99231
ResponsezFeedback:
Rationale:zThisziszazsubsequentzhospitalzcarezvisit.zSubsequentzhospitalzcarezcodeszarez99231-
99233.zCodeszinzthiszsectionzrequirez2zofz3zkeyzcomponentszbezmet.zAzproblemzfocusedzexamzandzlowzm
e zdecisionzmakingzsupportszaz99231.
dical
Azsoccerzplayerzhitszhiszheadzduringzanzindoorzgamezandziszadmittedztozobservationztozwatchzforzheadztr
a
uma.
Admitzdate/time:z01/21/20XXz8:12zPM
DetailedzHistory,zDetailedzExam,zLowzMDM
Dischargezdate/time:z01/22/20XXz8:15zAM
