Chapter 13

6. Evaluation and Management codes 99241 to 99255 are used for consultations provided is a service provided by a physician wh

7. Evaluation and Management codes 99281 to 99499 are used for emergency department, critical care, nursing facility, rest ho

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6. Evaluation and Management codes 99241 to 99255 are used for consultations provided is a service provided by a physician whose opinion about a case is requested by another in the physician’s office or in an outpatient or inpatient hospital facility. A consultation Procedural Terminology code book. physician. Read the brief statement and then locate the code number in the Current a. Office consultation for a 30-year-old woman complaining of a mild systolic click. This is an expanded problem-focused palpitations and chest pains. Her family physician described history & examination and straightforward decision making. b. Subsequent inpatient consultation for a 54-year-old woman, who is now stable, admitted 2 days ago for a bleeding ulcer. This case requires a detailed history & examination and low-complexity decision making. 99241-99245 99251 -99255 c. Office consultation for a 14-year-old boy with poor grades in school and suspected alcohol abuse. This is a comprehen- sive history & examination and medical decision making of 99244 moderate complexity. 99255 d. Subsequent inpatient consultation for a 50-year-old man who is diabetic and is suffering with fever, chills , gangrenous heel ulcer, rhonchi, and dyspnea (difficulty breathing), an unstable condition. The patient appears lethargic and tachypneic (rapid breathing). This case is a comprehensive history & examina- tion with highly complex medical decision making. e. Initial emergency department (ED) consultation for a senior who presents with thyrotoxicosis, exophthalmos, cardiac arrhythmia, and congestive heart failure. This case is a com- prehensive history & examination with highly complex medical decision making. f. Initial hospital consultation for a 30-year-old woman, post- abdominal surgery, who is exhibiting a fever. This case is an expanded problem-focused history examination and straightforward medical decision making. 7. Evaluation and Management codes 99281 to 99499 are used for emergency department, critical care, nursing facility, rest home, custodial care, home, prolonged, physician code number in the Current Procedural Terminology code book. 99281-94285 a. First hour of critical care of a senior who, after major surgery, suffers a cardiac arrest from a pulmonary embolus. 99291 b. A 40-year-old woman is admitted to the Obstetrical unit, and the primary care physician has requested the neona- tologist to stand by for possible cesarean section and neo- natal resuscitation. Code for a 1-hour standby. 99465 c. A child is seen in the ED with a fever, diarrhea, abdominal cramps, and vomiting. This case had an expanded problem- focused history & examination, and a moderately complex medical decision was made. d. A patient is seen for an annual visit at a nursing facility for detailed history & comprehensive examination and low-complexity medical decision making. e. An initial visit is made to a domiciliary care facility for a developmentally disabled individual with a mild rash on hands and face. This case had an expanded problem-focused history & examination and low-complexity medical decision making. f. A 50-year-old man with a history of asthma comes into the office with acute bronchospasm and moderate respiratory distress. Office treatment is initiated. The case requires intermittent physician face-to-face time with the patient for 2 hours and prolonged services. Assume the appropriate E/M code has been assigned for this case. 94324-99337
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