Question

question 18

mr. flintstone is seen by his oncologist just two days after undergoing extensive testing for a sudden onset of petechiae, night glands and weakness. after a brief review of history, dr. b. marrow re-examines mr. flintstone. the exam is documented, and making is of moderate complexity and takes 11 minutes. the oncologist spends an additional 45 minutes discussing mr. flints hodgkins lymphoma, treatment options and prognosis.
what cpt® coding is reported?

99215,99354
99215, 99417
99253
99204, 99354

Explanation:

Determine the primary Evaluation and Management (E/M) code

The patient is an established patient seen in the office by his oncologist. The medical decision making (MDM) is of moderate complexity. For an established office patient (CPT range 99211–99215), moderate complexity MDM maps to CPT code 99214. However, we must evaluate if coding by time is more appropriate. The total time spent is:

$$ 11 \text{ minutes (exam/evaluation)} + 45 \text{ minutes (discussion)} = 56 \text{ minutes} $$

For an established office visit (99215), the threshold time is 40 minutes (based on CPT 2021/2023 guidelines where 99215 requires 40–54 minutes). Since 56 minutes exceeds the 40-minute threshold of 99215, we select 99215 as the base E/M code.

Determine the prolonged services code

The total time spent is 56 minutes. The base code 99215 covers up to 54 minutes.
The remaining prolonged time is:

$$ 56 \text{ minutes} - 54 \text{ minutes} = 2 \text{ minutes} $$

Under CPT guidelines, prolonged office services are reported with code 99417 (for each 15 minutes beyond the companion E/M code threshold). Since the time exceeds the 99215 maximum range (54 minutes) by at least 1 minute, 1 unit of 99417 is reported. Thus, the correct code combination is 99215 and 99417.

Answer:

• 99215, 99354
• 99215, 99417 (Correct answer)
• 99253
• 99204, 99354