Question

question 23

a 10-year-old girl is scheduled for her yearly physical with her pediatrician. at the time of the visit, the patient complains of watery eyes, sore throat and stuffy nose for the past two days. the provider performs the physical. he also performs a history and exam and treats the patient for uri with low medical decision making. what cpt® coding is reported for this visit?

99393, 99213-25
99213
99393-25, 99213
99393

Explanation:

Identify the preventive medicine code

The patient is a 10-year-old established patient receiving a yearly physical (preventive medicine exam). The CPT code range for established patient preventive medicine services is 99391–99397. For a child aged 5 through 11 years, the correct code is 99393.

Identify the evaluation and management code

During the preventive visit, the patient presents with an acute illness (watery eyes, sore throat, stuffy nose) diagnosed as an upper respiratory infection (URI) requiring a separate history, exam, and low medical decision making. This meets the criteria for an office visit code for an established patient, which is 99213.

Apply the appropriate modifier

To report both services on the same day, modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) must be appended to the office visit code (99213) to show it was distinct from the preventive exam. Therefore, the correct coding is 99393 and 99213-25.

Answer:

• (A) 99393, 99213-25 (Correct answer)
• (B) 99213
• (C) 99393-25, 99213
• (D) 99393