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Help with e/m codes on test c of the aapc practice exam

  1. #1
    Smile Help with e/m codes on test c of the aapc practice exam
    Medical Coding Books

    This is my first time here and I have a question about an answer that I got recently on the practice exam C on an E/M code. I coded it one way and they coded it another and I totally do not understand the reasoning behind the one they choose to use.

    Below is the scenario with the choices to choose from:

    Documentation of a new patient in a doctor's office setting supports the History in four elements for an extended history of present illness (HPI), three elements for an extended review of systems (ROS) and three elements for a complete Past, Family, Social History (PFSH). There is an extended examination of six body areas and organ systems. The medical making decision making is of high complexity. Which E/M service supports this documentation?

    A. 99205
    B. 99204
    C. 99203
    D. 99202
    Can you please tell me which one it is? It says it is C 99203 but I think it should be 99205 and if not that then the 99204 but certainly not the 99203. I read the reasoning they gave but I do not understand it. I am going to be taking the CPC exam in Austin on the 5th of November and I want to do a good job. On this exam I got all of them right except for two of them.

    Thank you for your help in this matter.


  2. #2
    Richmond Association of Coders
    Default Jaci
    Hi , the 99205 would require both a comprehensive hx and exam. The question states only 3 ROS, comprehensive hx requires 10. The exam is stated as extended which infers a detailed exam. Both the hx and exam are detailed, therefore the answer is 99203.

    Jaci Johnson, CPC,cpma, cemc,CPC-h, CPC-I

  3. #3
    Columbia, MO
    When it is new patient then all three of the key components must be met or exceeded.
    so fo hx you have extended HPI, extended ROS and comprehensive PFSH - so hx requires all three of these components to be met or exceeded at any given level, which makes this detailed.
    exam is not real clear but it looks as though they are using the 95 guidelines for a detailed exam and decision making is comprehensive. In the code book under the new patient the only visit level that has both detail history and detailed exam with decision making at or below comprehensive is the 99203.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Thank you for the clarification on this code. Is there any easy way to determine these E/M Codes if the physician does not specify exactly or like comprehensive etc?

  5. #5
    Milwaukee WI
    Default You have to learn to audit
    Quote Originally Posted by View Post
    Thank you for the clarification on this code. Is there any easy way to determine these E/M Codes if the physician does not specify exactly or like comprehensive etc?
    Texaskat ...

    First - Do not worry about this for the CPC exam !!!
    On the exam, you'll be given the guidance as per this practice question.

    However, in the real world, the coder must learn to audit the note to determine the level of history, exam and MDM. Physicians will NEVER tell you what levels of the key elements they performed.

    To learn more about E/M coding I highly recommend
    Also, regularly reading the E/M and auditing threads on this forum will also be informative.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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