Practice Quiz

Medical Coding

Category - Evaluation and Management

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A patient admitted in the afternoon for 24-hour observation, after complaining about chest pain in his PCP’s office, has worsened during the evening. He now has increasing chest pain, requiring medication for relief; his EKG has changed from his PCP’s office; and he is being prepped for a cardiac catheterization because his labs are returning indicating an acute MI. What is the appropriate code for a patient who is unstable after initial observation?
  1. 99220
  2. 99224
  3. 99225
  4. 99226
Explanation
Answer: D - 99226 is the correct code for subsequent observation care of a patient requiring more than 35 minutes of care requiring high complexity medical decision making with detailed interval history and detailed examination since initial observation care was given.
Code 99220 is incorrect because this code is for the initial observation care of a high complexity medical decision making encounter. Code 99224 is incorrect because, while it is the code for a subsequent observation encounter, this is for a patient that is straightforward or of low complexity. Code 99225 is incorrect because this code is for a patient of moderate complexity typically only requiring 25 minutes of care at the bedside or on the patient’s unit.
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