CPMA COMPREHENSIVE QUESTIONS AND
COMPLETE SOLUTIONS TEST PAPER
●● A 60-year-old woman is seeking help to quit smoking. She makes an
appointment to see Dr. Lung for an initial visit. The patient has a
constant cough due to smoking and some shortness of breath. No night
sweats, weight loss, night fever, CP, headache or dizziness. She has tried
patches and nicotine gum which has not helped. Patient has been
smoking for 40 years and smokes 2 packs per day. She has a family
history of emphysema. A limited three system exam was performed. Dr
Lung discussed in detail the pros and cons of medications used to quit
smoking. Total time of 30 minutes was spent on this visit today.
Prescriptions for Chantix and Tetracycline were given. The patient to
follow up in 1 month. A chest X-ray and cardiac work up was ordered.
Select the appropriate CPT code(s) for this visit.
99203
b.
99214, 99354
c.
99202
d.
99203, 99354
Answer: 99203. Patient is coming to the provider's office for help to quit
smoking. The patient is new. The provider documents that 20 minutes of
the 30-minute visit was spent counseling the patient. E/M Guidelines
,identify when time is considered the key or controlling factor to qualify
for an E/M service. Time E/M guidelines indicate that time alone can be
used to select codes 99202-99215. The correct code is 99203 based on
the total time of the visit which is 30 minutes.
●● Mary is referred to a general surgeon for treatment of a left breast
mass. The surgeon reviews the visit records from Mary's primary care
provider and the results of a previous ultrasound. He orders a left breast
MRI and schedules a follow-up appointment with Mary to go over
treatment options. He calls the primary care provider to discuss his visit
with Mary and possible options. Based on this information, what is the
level for Amount and/or Complexity of Data to be Reviewed and
Analyzed?
a.
Minimal
b.
Extensive
c.
Moderate
d.
Limited
Answer: For an extensive level, any combination of 3 of the following
must be met from Category 1: 1) Review of prior external notes; 2)
Review results of a unique test; 3) order a unique test; 4) Assessment
requiring an independent historian(s). Three of the four requirements
,were met: review of prior notes from PCP; review of ultrasound;
ordering of MRI.
●● Which of the following scenarios qualifies for a consultation code?
Answer: A patient followed by her primary care physician for diabetes is
referred to an endocrinologist in the same group practice to review the
patient's current regimen and offer suggestions for ongoing treatment.
Her diabetes has been difficult to keep under control. Consultations
require a request from a provider or other appropriate source, a
recommendation for care or a decision to accept responsibility for
ongoing care, and a written report from the consulting provider back to
the requesting provider/appropriate source. In the first scenario, the
provider is being asked to take over the care. This would be a transfer of
care for the Coumadin management. The second scenario would be
billed as an ED E/M by the ED provider and an admission by the
orthopedic. The third scenario qualifies for a consultation. Second
opinions are coded as office visits in the fourth scenario.
●● A 15-year-old boy is scheduled for his yearly physical with his
pediatrician. At the time of the visit, the patient complains of lower
abdominal pressure and burning when urinating for the past two days.
The provider performs the physical. He also performs a history and
exam, does a U/A, and treats the patient for a UTI with low medical
decision making. What CPT® coding is reported for this visit?
a.
99394
b.
, 99213
c.
99213, 99394-25
d.
99213-25, 99394
Answer: 99213-25, 99394. 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 UTI. The additional work for the UTI allows us to report an
established patient office visit. Modifier 25 is appended to the office
visit to show it is a significant and separately identifiable service from
the preventive visit.
●● 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?
a. 99392
b. 99382
c. 99391
d. 99381
Answer: 99382 This is a new patient to the pediatric clinic. Look in the
CPT® Index for Preventive Medicine/New Patient and you are directed
to code range 99381-99387. The code selection is based on age. Code
99382 is for ages 1-4 making it the correct code choice.
COMPLETE SOLUTIONS TEST PAPER
●● A 60-year-old woman is seeking help to quit smoking. She makes an
appointment to see Dr. Lung for an initial visit. The patient has a
constant cough due to smoking and some shortness of breath. No night
sweats, weight loss, night fever, CP, headache or dizziness. She has tried
patches and nicotine gum which has not helped. Patient has been
smoking for 40 years and smokes 2 packs per day. She has a family
history of emphysema. A limited three system exam was performed. Dr
Lung discussed in detail the pros and cons of medications used to quit
smoking. Total time of 30 minutes was spent on this visit today.
Prescriptions for Chantix and Tetracycline were given. The patient to
follow up in 1 month. A chest X-ray and cardiac work up was ordered.
Select the appropriate CPT code(s) for this visit.
99203
b.
99214, 99354
c.
99202
d.
99203, 99354
Answer: 99203. Patient is coming to the provider's office for help to quit
smoking. The patient is new. The provider documents that 20 minutes of
the 30-minute visit was spent counseling the patient. E/M Guidelines
,identify when time is considered the key or controlling factor to qualify
for an E/M service. Time E/M guidelines indicate that time alone can be
used to select codes 99202-99215. The correct code is 99203 based on
the total time of the visit which is 30 minutes.
●● Mary is referred to a general surgeon for treatment of a left breast
mass. The surgeon reviews the visit records from Mary's primary care
provider and the results of a previous ultrasound. He orders a left breast
MRI and schedules a follow-up appointment with Mary to go over
treatment options. He calls the primary care provider to discuss his visit
with Mary and possible options. Based on this information, what is the
level for Amount and/or Complexity of Data to be Reviewed and
Analyzed?
a.
Minimal
b.
Extensive
c.
Moderate
d.
Limited
Answer: For an extensive level, any combination of 3 of the following
must be met from Category 1: 1) Review of prior external notes; 2)
Review results of a unique test; 3) order a unique test; 4) Assessment
requiring an independent historian(s). Three of the four requirements
,were met: review of prior notes from PCP; review of ultrasound;
ordering of MRI.
●● Which of the following scenarios qualifies for a consultation code?
Answer: A patient followed by her primary care physician for diabetes is
referred to an endocrinologist in the same group practice to review the
patient's current regimen and offer suggestions for ongoing treatment.
Her diabetes has been difficult to keep under control. Consultations
require a request from a provider or other appropriate source, a
recommendation for care or a decision to accept responsibility for
ongoing care, and a written report from the consulting provider back to
the requesting provider/appropriate source. In the first scenario, the
provider is being asked to take over the care. This would be a transfer of
care for the Coumadin management. The second scenario would be
billed as an ED E/M by the ED provider and an admission by the
orthopedic. The third scenario qualifies for a consultation. Second
opinions are coded as office visits in the fourth scenario.
●● A 15-year-old boy is scheduled for his yearly physical with his
pediatrician. At the time of the visit, the patient complains of lower
abdominal pressure and burning when urinating for the past two days.
The provider performs the physical. He also performs a history and
exam, does a U/A, and treats the patient for a UTI with low medical
decision making. What CPT® coding is reported for this visit?
a.
99394
b.
, 99213
c.
99213, 99394-25
d.
99213-25, 99394
Answer: 99213-25, 99394. 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 UTI. The additional work for the UTI allows us to report an
established patient office visit. Modifier 25 is appended to the office
visit to show it is a significant and separately identifiable service from
the preventive visit.
●● 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?
a. 99392
b. 99382
c. 99391
d. 99381
Answer: 99382 This is a new patient to the pediatric clinic. Look in the
CPT® Index for Preventive Medicine/New Patient and you are directed
to code range 99381-99387. The code selection is based on age. Code
99382 is for ages 1-4 making it the correct code choice.
