ICD & CPT Coding QUESTIONS WITH COMPLETE SOLUTIONS

What are the 3 key components to consider when determining the level of complexity (billing)? correct answer: 1. History 2. Examination 3. Medical Decision Making What code would be used for a *New Patient* when doing a "*Focused* history, *Focused* exam, *Straightforward* medical decision; Problem or condition: self-limited to minor; avg. time: 10 minutes"? correct answer: 99201 What code would be used for for a *New Patient* when doing a "*Expanded* history, *Expanded* exam, *Straightforward* medical decision; Problem or condition: low to moderate avg. time: 20 minutes"? correct answer: 99202 What code would be used for for a *New Patient* when doing a "*Detailed* history, *Detailed* exam, *Low* medical decision; Problem or condition: moderate; avg. time: 30 minutes"? correct answer: 99203 What code would be used for for a *New Patient* when doing a "*Comprehensive* history, *Comprehensive* exam, *Moderate* medical decision; Problem or condition: moderate to high; avg. time: 45 minutes"? correct answer: 99204 What code would be used for for a *New Patient* when doing a "*Comprehensive* history, *Comprehensive* exam, *High* medical decision; Problem or condition: moderate to high; avg. time: 60 minutes"? correct answer: 99205 Of the EM codes for new patients, which ones will we most likely be using during student clinic? correct answer: 99202, 99203, & 99204 What requirements does a patient need to qualify as a "established patient"? correct answer: They have received any professional services from the physician or another physician of the same specialty who belongs to the *same* group practice, within the *past three (3) years*. How many of the 3 key components must be documented for an established patient visit? correct answer: 2 (history/exam/medical decision) What are some examples of when to use ESTABLISHED E/M codes? correct answer: *Re-exams*: every 30 days or at end of current treatment plan *New financial class*:Change in carrier *Change doctor*:transfer of care from one doctor to another of same specialty in the same office *New conditions*: change in diagnosis requ