AAPC – CPB – CHAPTER 5 PRACTICAL APPLICATION – FULL QUESTIONS AND
ANSWERS – QUESTIONS 1 TO 10
QUESTION# 1
A patient comes into the office for follow up of neck pain. The provider
documents a medically appropriate history and exam. The medical decision
making was of low complexity. What E/M code is reported for this visit?
A. 99202
B. 99203
C. 99212
D. Correct: 99213
Feedback: The patient is seen in the office and is being seen for follow-up of
neck pain making it an established patient. For an established patient, the
criteria of the E/M visit is based on the E/M Guidelines. The provider
documented a medically appropriate history and exam. The medical decision
making was of low complexity making this a 99213.
QUESTION# 2
A patient sees his primary care doctor for calluses on his feet. The provider
uses a scalpel to pare down six calluses (benign hyperkeratotic lesions) on
his feet. How is this reported?
A. 11055 x 6
B. 11057 x 6
C. Correct: 11057
D. 11055, 11056, 11057 x 4
Feedback: Look in the CPT Index for Paring/Skin Lesion/Benign Hyperkeratotic
11055-11057. In the Integumentary Section, the codes are determined based
on the number of lesions removed. 11057 reports more than four lesions.
This code is only reported once anytime more than 4 lesions are removed by
paring or cutting.
QUESTION# 3
, A 5 year-old fell on broken glass and required suturing of a laceration. Due to
the age and combative behavior of the patient, the provider utilized
moderate sedation while repairing the laceration. The provider gave the child
50 mg of Ketamine IM. A nurse monitored the patient during the procedure
which took 30 minutes. What CPT® code is reported for moderate sedation?
A. 99152
B. Correct: 99152, 99153
C. 99156
D. 99156, 99157
Feedback: Moderate sedation is often used for pediatric patients in situations
not normally requiring sedation. In this case, the provider administered
sedation with a nurse assisting in monitoring the patient. In the CPT® Index
look for Sedation/Moderate/with Independent Observation and you are
directed to code range 99151-99153. Code selection is based on age of the
patient and the length of time. Code 99152 describes an encounter using
moderate sedation, and the physician or other qualified healthcare
professional rendering the diagnostic or therapeutic service also manages
the sedation. This code is specific for the age of the patient and up to 15
minutes of time. Add-on 99153 is for each additional 15 minutes of
intraservice time.
QUESTION# 4
A child with suspected sleep apnea was given an apnea monitoring device to
use over the next month. The device was capable of recording and storing
data relative to heart and respiratory rate and pattern. The pediatric
pulmonologist reviewed the data and reported to the child’s primary
pediatrician. What CPT® code(s) is/are reported for the monitor attachment,
download of data, provider review, interpretation and report?
A. Correct: 94774
B. 95800
C. 95806
D. 94775, 94776, 94777
Feedback: In the CPT® Index look for Monitoring/Pediatric Apnea and you are
directed to code range 94774-94777. Code selection is based on the
components of the test performed. In this case, code 94774 describes the
data storage capability, including the provider or other qualified health care
ANSWERS – QUESTIONS 1 TO 10
QUESTION# 1
A patient comes into the office for follow up of neck pain. The provider
documents a medically appropriate history and exam. The medical decision
making was of low complexity. What E/M code is reported for this visit?
A. 99202
B. 99203
C. 99212
D. Correct: 99213
Feedback: The patient is seen in the office and is being seen for follow-up of
neck pain making it an established patient. For an established patient, the
criteria of the E/M visit is based on the E/M Guidelines. The provider
documented a medically appropriate history and exam. The medical decision
making was of low complexity making this a 99213.
QUESTION# 2
A patient sees his primary care doctor for calluses on his feet. The provider
uses a scalpel to pare down six calluses (benign hyperkeratotic lesions) on
his feet. How is this reported?
A. 11055 x 6
B. 11057 x 6
C. Correct: 11057
D. 11055, 11056, 11057 x 4
Feedback: Look in the CPT Index for Paring/Skin Lesion/Benign Hyperkeratotic
11055-11057. In the Integumentary Section, the codes are determined based
on the number of lesions removed. 11057 reports more than four lesions.
This code is only reported once anytime more than 4 lesions are removed by
paring or cutting.
QUESTION# 3
, A 5 year-old fell on broken glass and required suturing of a laceration. Due to
the age and combative behavior of the patient, the provider utilized
moderate sedation while repairing the laceration. The provider gave the child
50 mg of Ketamine IM. A nurse monitored the patient during the procedure
which took 30 minutes. What CPT® code is reported for moderate sedation?
A. 99152
B. Correct: 99152, 99153
C. 99156
D. 99156, 99157
Feedback: Moderate sedation is often used for pediatric patients in situations
not normally requiring sedation. In this case, the provider administered
sedation with a nurse assisting in monitoring the patient. In the CPT® Index
look for Sedation/Moderate/with Independent Observation and you are
directed to code range 99151-99153. Code selection is based on age of the
patient and the length of time. Code 99152 describes an encounter using
moderate sedation, and the physician or other qualified healthcare
professional rendering the diagnostic or therapeutic service also manages
the sedation. This code is specific for the age of the patient and up to 15
minutes of time. Add-on 99153 is for each additional 15 minutes of
intraservice time.
QUESTION# 4
A child with suspected sleep apnea was given an apnea monitoring device to
use over the next month. The device was capable of recording and storing
data relative to heart and respiratory rate and pattern. The pediatric
pulmonologist reviewed the data and reported to the child’s primary
pediatrician. What CPT® code(s) is/are reported for the monitor attachment,
download of data, provider review, interpretation and report?
A. Correct: 94774
B. 95800
C. 95806
D. 94775, 94776, 94777
Feedback: In the CPT® Index look for Monitoring/Pediatric Apnea and you are
directed to code range 94774-94777. Code selection is based on the
components of the test performed. In this case, code 94774 describes the
data storage capability, including the provider or other qualified health care
