WHAT IS E/M ?
E/M is a process of evaluating the patient and giving appropriate management by the Physician.(code range:99201-99499)
# New and Established Patient
#Place of service
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Andrea, a 52-year-old patient, had a hysterectomy on Monday morning. That afternoon, after returning to her hospital room, she suffered a cardiac arrest. A cardiologist responded to the call and delivered one hour and 35 minutes of critical care. During this time the cardiologist ordered a single view chest x-ray and provided ventilation management. How should you report the cardiologist’s services?
99291, 99292, 71010, 94002
71010, 94002, 99231
99291, 99292, 99292-52
Question 1 Explanation:
RATIONAL:The guidelines for critical care have a list of services that are included with critical care when performed by the physician providing the critical care and these services should not be reported separately.
Brandon was seen in Dr. Shaw’s office after falling off his bunk bed. Brandon’s mother reported that Brandon and his sister were jumping on the beds when she heard a “thud.” Brandon complained of knee pain and had trouble walking. Dr. Shaw ordered a knee x-ray that was done at the imaging center across the street. The x-ray showed no fracture or dislocations. Dr. Shaw had seen Brandon for his school physical six months ago. Today, Dr. Shaw documented a detailed examination and decision-making of moderate complexity. He also instructed Brandon’s mother that if Brandon had any additional pain or trouble walking he should see an orthopedic specialist. How should Dr. Shaw report her services from today’s visit?
Question 2 Explanation:
This is an established patient visit and meets two of the three key components for a 99214 level visit
Adam, a 48-year-old patient, presented to Dr. Crampon’s office with complaints of fever, malaise, chills, chest pain, and a severe cough. Dr. Crampon took a history, did an exam, and ordered a chest x-ray. After reviewing the x-ray, Dr. Crampon admitted Adam to the hospital for treatment of pneumonia. After his regular office hours, Dr. Crampon visited Adam in the hospital where he dictated a comprehensive history, comprehensive examination, and decision-making of moderate complexity. How would you report Dr. Crampon’s services?
Question 3 Explanation:
The subcategory guidelines for Initial Hospital Care state, “When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., hospital, emergency department, observation status in a hospital, physician’s office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. Therefore, the services are reported with the initial hospital care code only. The office visit is a bundled service.
James, a 35-year-old new patient, received 45 minutes of counseling and risk factor reduction intervention services from Dr. Kelly. Dr. Kelly talked to James about how to avoid sports injuries. Currently, James does not have any symptoms or injuries and wants to maintain this status would you report this. This was the only service rendered. How service?
Question 4 Explanation:
Counseling and/or risk factor reduction intervention services are provided to patients with symptoms or established illness.
How does the CPT Professional Edition define a new patient?
A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past two years.
A new patient is one who has not 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 years.
A new patient is one who has received professional services from the physician or another physician of the same specialty within the last two years for the same problem.
A new patient is one who has received hospital services but has never been seen in the clinic by the reporting physician.
Question 5 Explanation:
A new patient is described as not receiving any professional serves in the past three years. You can find this answer in the Evaluation and Management Services Guidelines and on the Decision Tree for New vs. Established Patients (same guidelines) in the CPT Professional Edition.
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