Practice Quiz

Medical Coding

Category - Evaluation and Management

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A 54-year-old woman is being set up for consultation with general surgery for follow up after a large lump was identified on mammography by the woman’s PCP. This office consultation will include a comprehensive history, a comprehensive examination, and moderate-complexity medical decision making because it will involve discussing options, additional tests, and surgery. The surgeon allowed for a 60-minute visit with this woman and her family. What is the appropriate code for consultation?
  1. 99242
  2. 99243
  3. 99244
  4. 99245
Explanation
Answer: C - 99244 is the correct code for an office consultation involving 60 minutes of care, a comprehensive history and physical examination and medical decision making of moderate complexity.
Code 99242 is incorrect because this code is for an office consultation that requires straight forward medical decision making and an expanded problem-focused history and examination. Code 99243 is incorrect because this code is for an office consultation involving a comprehensive history and examination as well as moderate-complexity medical decision making. Code 99245 is incorrect because this office consultation code is for a visit that is usually 80 minutes, requiring high-complexity medical decision making.
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