Question

question 25

subjective: 6-year-old girl twisted her arm on the playground. she is seen in the ed complaining of pain in her wrist.
objective: vital signs: stable. wrist: significant tenderness laterally. x-ray is normal
assessment: wrist sprain
plan: over the counter anaprox. give twice daily with hot packs. recheck if no improvement.
what is the e/m code for this visit?

99283
99281
99284
99221

Explanation:

Identify the service setting and patient type

The documentation states the patient "is seen in the ED" (Emergency Department). Therefore, we must select an Emergency Department Services E/M code from the range 99281–99285.

Determine the level of Medical Decision Making (MDM)

• Number and Complexity of Problems Addressed: One acute, uncomplicated illness or injury (wrist sprain), which represents a low complexity level.
• Amount and/or Complexity of Data to be Reviewed and Analyzed: Minimal or none (ordering/reviewing a single simple X-ray).
• Risk of Complications and/or Morbidity or Mortality of Patient Management: Low risk (over-the-counter Anaprox and hot packs).
• MDM Level: Low complexity, which corresponds to CPT code 99283.

Map MDM level to the correct CPT code

• 99281: Straightforward MDM (often clinical staff focus)
• 99282: Straightforward MDM
• 99283: Low MDM
• 99284: Moderate MDM
• 99285: High MDM

Thus, the correct code is 99283.

Answer:

• (A) 99283 (Correct answer)
• (B) 99281
• (C) 99284
• (D) 99221