ER/ED Professional & Facility Coding Interview questions

1.       What is the CPT code for ED visit with Comprehensive History, Comprehensive Exam and MDM of High Complexity?

Ans: 99285

2.       EKG 12 lead Performed in ER and Interpreted by ERMD report Correct CPT Codes for PRO&FAC?

Ans: For Facility 93005 & For Professional 93010

3.       What is the CPT code for ED visit with Detailed History, Comprehensive Exam and Moderate Complexity MDM?

Ans: 99284

4.       As per 95 guidelines how many Physical Exam organ systems we need for 99285?

Ans: As per 95 guidelines we need Physical Exam with 8 or more organ systems for 99285

5.       What are the guidelines for coding Complex I&D?

Ans: For coding Complex I&D we need at least one of the following statements in Procedure note
  • Packing with gauze
  • Multiple I&D procedures
  • Blunt dissection to Breakup Loculations
 6.       Patient presents to the ED with 2.5cm hand laceration with foreign body and In ER consult MD performed Laceration Repair, Report Correct CPT codes for PRO&FAC?

Ans: For Professional no need to Bill procedures performed by Consults and For Facility 12041

7.       Laceration Repair Coding Guidelines?

8.       What are the key components in selecting E/M level of service?

Ans: History, Physical Exam and MDM are key components

9.       What are the elements of HPI?

Ans: Location, Quality, Severity, Duration, Timing, Context, Modifying Factors and Associated signs and symptoms

10.   What is the basic difference between 95 and 97 guidelines?

Ans: 95 guidelines are based on body systems 97 systems based on bullet points.

11.   “Patient is staying with family” this statement comes under which history?

Ans: Social History

12.   In A ED visit Physician not documented any Critical Care time but Patient diagnosed with Acute Respiratory Failure and Intubation Performed by EDMD and patient admitted to Observation. Report Correct CPT codes for PRO&FAC?
  • For Professional: 99285-25, 31500
  • For Facility: 99291-25, 31500
As per ACEP guidelines when condition qualifies Critical Care we can bill Critical Care service for Facility without documentation of Physician Critical Care time and If RN documented Critical Care also we can bill Critical Care Service in Facility side but not in Professional.(Note Facility coding is based on Client guidelines so this will vary with various clients)

13.   A level 5 Caveat Patient Presents to the ED for Medical Clearance. EDMD evaluated then sent to Psych Hospital for admission. Lorazepam IV at 14:00, Hydration from 14:00 to 16:00 given in ED. Problem Focused History, Comprehensive Exam and High Complexity MDM documented in EMR and Clinical impression is Depression with suicidal ideation. Report Correct CPT & ICD code for PRO&FAC?
  • For Professional: 99285, F32.9, R45.851
  • For Facility: 99285-25, 96374, 96361*2, F32.9, R45.851
 14.   Can you bill Bladder Irrigation and Foley catheter insertion Procedures in same visit?

Ans: No, we need to bill only Bladder Irrigation CPT 51700 because Foley insertion (51702) is inclusive procedure in Bladder Irrigation (51700)

15.   What is the CPT code for removal of nail and nail matrix?

Ans: 11750

16.   A Patient presents with 1.5cm hand laceration and 2.5cm forehead laceration and Provider performed simple repair on hand and intermediate repair on forehead, Report correct CPT codes?

Ans: 12051, 12001-51

17.   How many Review of systems required for 99285?

Ans: 10 or more Review of Systems

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