Question

1. A physician is called to the intensive care unit at the local hospital to care for Joe West, a patient in coronary crisis. The physician spends an hour at the patient's bedside, stabilizing him.

CPT code    __________

2. The physician is preparing to leave the hospital after seeing Joe West but is called back into the intensive care unit to see and stabilize another patient, Ted Keel. The service to the patient takes 1 1/2 hours

CPT code      ____________________

3. An established patient, Harriet Turner, comes to the office for a follow up visit. She has been prescribed medication for her recent onset of depression, but since her last visit, when the dosage was increased, she has felt that the medication is making her sleepy and lethargic. Considering the other factors such as other medical problems and drug interactions, the physician spends 25 minutes with the patient performing a detailed history and physical examination. After reviewing the details as well as the recent laboratory work, the physician concludes that a different medication should be prescribed. The physician’s decision-making has moderate complexity, given the possible medical complications that could arise.

CPT code    __________

Answer 1

Current Procedural Terminology (CPT) is a medical coding system which is utilised to denote therapeutic and diagnostic procedures and services given by doctors, medical insurance companies and accrediting institutions.

Question No	CPT code	Rationale
1	99291	99291 and 99292 are Critical Care Codes. Time based guidelines are given to report critical care since it needs to be coded based on time the provider spend with a patient. Time duration Critical care code 30 minutes to 74 minutes (Excluding first 30 minutes which are to be coded separetely) 99291 x 1 75 minutes to 104 minutes 99291 x 1 and 99292 x 1 In the first situation, the physician spends 60 minutes with the patient for stabilization. So the code 99291 is given. In the second situation, the physician provides service to the patient for 1 1/2 hours. Hence the codes are 99291 and 99292 as per above guidelines.
2	99291 , 99292
3	99214	As per CPT coding, 99214 is used to represent an office or other outpatient visit for the evaluation and management of an established patient. It needs at least two of below mentioned three essential components: · a detailed history · a detailed examination · medical decision making of moderate complexity The given scenario satisfies all three components and hence the code 99214 is assigned.