Question

question 11

a 32-year-old patient sees dr. smith for a consult at the request of his pcp, dr. long, for an ongoing problem with allergies. the patient has failed claritin and alavert and feels his symptoms continue to worsen. dr. smith performs medically appropriate history and exam and discusses options with the patient on allergy management. the patient agrees he would like to be tested to possibly gain better control of his allergies. dr. smith sends a report to dr. long thanking him for the referral and includes the date the patient is scheduled for allergy testing. dr. smith also includes his findings from the encounter. what e/m code is reported?

99243
99203
99214
99242

Explanation:

Analyze the encounter type and requirements

The patient is referred by his PCP (Dr. Long) to Dr. Smith for a "consult" regarding ongoing allergies. Dr. Smith performs an evaluation, discusses management, and sends a written report of his findings and recommendations back to the referring physician (Dr. Long). This meets all CPT criteria for an office consultation service (codes 99242–99245).

Determine the medical decision making level

The patient has an ongoing chronic condition (allergies) that has failed multiple over-the-counter treatments (Claritin and Alavert) and is worsening, requiring further diagnostic testing (allergy testing). This represents a moderate level of complexity for the presenting problem. The medical decision making (MDM) is of moderate complexity, which corresponds to code 99244. However, looking at the available options: 99243, 99203, 99214, and 99242:

• 99203 and 99214 are office visit codes, but this encounter meets the formal consultation requirements (request, render, report).
• Between the consultation codes 99243 (low MDM) and 99242 (straightforward MDM), 99243 is the most appropriate and highest applicable consultation code among the choices.

Answer:

• (A) 99243 (Correct answer)
• (B) 99203
• (C) 99214
• (D) 99242