AAPC Certified Professional Coder CPC New Questions

1. E/M Code Category Selection:

The patient is a 19-year-old seen by his primary care physician for an annual preventive exam. His last exam was four years ago, and he has no complaints, indicating a preventive rather than problem-focused visit.

CPT® Code 99385 is for a new patient preventive visit for ages 18-39. Since the patient’s last visit was four years ago, this qualifies him as a new patient by CPT® standards (a patient is considered new if they have not received any professional services from the physician within the past three years).

2. Rationale for Excluding Other Options:

Code 99395 is for an established patient preventive visit for ages 18-39, which does not apply here since the patient is considered new after four years.

Code 99394 is for a preventive visit for an established patient aged 12-17, which does not match the patient’s age.

Code 99384 is for a new patient preventive visit for ages 12-17, which also does not apply given the patient’s age of 19.

3. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, 99385 is appropriate for a new patient in the 18-39 age range for a preventive visit, especially when they have not seen the provider in over three years.

Therefore, the correct answer is A. 99385.

00537 – Anesthesia for electrophysiologic procedures including ablation

Patient is otherwise healthy → P1

Why others are incorrect:

00532 – Pacemaker insertion

01922 – MRI

01026 – Lower extremity procedures

Fascia debridement → 11043 (first 20 sq cm)

Subcutaneous debridement → 11042

Multiple anatomical sites → Modifier -59

Add-on code 11045 for additional subcutaneous surface area

Complex (arm, 4 cm) → 13121

Intermediate legs total = 20.5 cm → 12036

Simple face closures coded separately:

12013 (cheek)

12011 (nose)

Modifiers allow separate anatomical reporting.

Correct answer: A