Question

question 22

a new patient visits the internal medicine clinic today for diabetes, hypertension, arthritis, and a history of cardiac disease. the provider performs a medically appropriate history and exam. blood pressure is high. all other conditions are stable. labs ordered are hba1c and complete blood count (cbc). the dosage for the blood pressure medication is reviewed and changed. the patient will follow up in three months. what cpt code is reported?

99203
99213
99204
99214

Explanation:

Determine patient status and setting

• Setting: Office or other outpatient clinic
• Patient status: New patient
• Code range: 99202–99205 (99203 and 99204 are the relevant options)

Analyze Medical Decision Making (MDM)

• Number and Complexity of Problems Addressed: 1 stable chronic illness (diabetes), 1 stable chronic illness (arthritis), 1 stable chronic illness (history of cardiac disease), and 1 chronic illness with exacerbation/progression or not well controlled (hypertension, as blood pressure is noted as high and medication is changed). This represents a high complexity of problems addressed (multiple chronic illnesses, at least one of which is not well controlled), pointing to Moderate or High MDM.
• Amount and/or Complexity of Data to be Reviewed and Analyzed: Labs ordered are HbA1c and CBC (2 unique tests). This meets the category 1 requirement for Moderate MDM (ordering/reviewing 2 unique tests).
• Risk of Complications and/or Morbidity or Mortality of Patient Management: Prescription drug management (dosage for the blood pressure medication is reviewed and changed). This constitutes Moderate Risk.
• Overall MDM Level: Moderate (requires meeting 2 out of 3 elements; both problems addressed, data, and risk support Moderate MDM).

Select the correct CPT code

• For a new patient outpatient visit, Moderate MDM corresponds to CPT code 99204.

Answer:

• 99203
• 99213
• 99204 (Correct answer)
• 99214