Apply Medicine Section Coding - Certified Professional Coder CPC

1. A physician provides osteopathic manipulative treatment (OMT) to 3-4 body regions. Which CPT® code covers OMT of 3-4 body regions?
   Answer: 98926 CPT® 98925 covers OMT, 1-2 body regions; 98926 covers 3-4 regions; 98927 covers 5-6 regions; 98928 covers 7-8 regions; 98929 covers 9-10 regions. The number of body regions treated determines the correct OMT code. Body regions include: head, cervical, thoracic, lumbar, sacral, pelvic, lower extremities, upper extremities, rib cage, and abdomen/viscera.
2. A physician provides moderate (conscious) sedation for a patient undergoing a procedure that is not performed by the same physician administering the sedation. Which CPT® code range covers moderate sedation by a provider other than the performing physician?
   Answer: 99155–99157 CPT® codes 99155–99157 cover moderate sedation services provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service. Codes 99151–99153 are used when the same physician performing the procedure also administers the sedation. The distinction between same-provider and different-provider sedation drives code selection.
3. A cardiologist performs right heart catheterization with measurement of intracardiac pressures, including right atrium, right ventricle, and pulmonary artery. Which CPT® code covers this service?
   Answer: 93451 CPT® 93451 covers right heart catheterization including intracardiac and great vessel pressure measurements, recording of intracardiac electrograms, and intracardiac injection(s) for selective opacification of great vessel structures. Code 93452 covers left heart catheterization; 93453 covers combined right and left heart catheterization; 93461 covers right heart catheterization with left heart catheterization via separate access site.
4. A cardiologist performs and interprets a resting 12-lead electrocardiogram (ECG) in a private office setting. Which CPT® code is reported for the global service?
   Answer: 93000 CPT® 93000 covers the global ECG service — including both the tracing (technical component) and the interpretation and report (professional component) — when performed in a private (non-facility) setting. Code 93005 covers tracing only (technical component); 93010 covers interpretation and report only (professional component). Code 93017 is for exercise stress testing tracing only.
5. A physician performs an electroencephalogram (EEG) during sleep, including spike and seizure analysis, for a patient with suspected epilepsy. The tracing is performed and interpreted by the same physician in the office. Which CPT® code range covers EEG procedures?
   Answer: 95700–95726 CPT® codes 95700–95726 cover the current electroencephalography (EEG) reporting system, which uses a component-based approach. Codes within this range are selected based on the combination of recording duration, whether spike and seizure analysis is included, and the physician interpretation component. Codes 95860–95872 cover electromyography (EMG) and related nerve studies. Codes 95907–95913 cover nerve conduction studies categorized by number of studies performed. Code range 95950–95967 represented an older long-term EEG monitoring structure from prior CPT® editions.
6. A patient sends a clinical question through a HIPAA-compliant online patient portal about a chronic condition being managed by their physician. The physician reviews the messages and provides 13 cumulative minutes of medical discussion time over a 5-day period. The service is not related to an E/M service within the prior 7 days and does not lead to a visit within the next 24 hours. Which CPT® code applies?
   Answer: 99422 — online digital E/M, 11–20 minutes CPT® 99421 covers online digital evaluation and management service for an established patient, 5–10 minutes of cumulative physician time; 99422 covers 11–20 minutes; 99423 covers 21 or more minutes cumulated over a 7-day period. These codes require an established patient relationship and must not originate from a related E/M service within the prior 7 days. Code 98970 covers similar online services by a qualified non-physician health care professional, not a physician. The prior telephone-only E/M codes 99441–99443 were deleted effective January 1, 2025.
7. A physician provides intravenous infusion of a therapeutic drug for 2 hours and 20 minutes. Which CPT® codes are reported for the infusion?
   Answer: 96365, 96366 CPT® 96365 covers intravenous infusion of a therapeutic drug, initial up to 1 hour. Add-on code 96366 covers each additional hour of infusion beyond the first. For a 2 hour and 20-minute infusion: 96365 for the first hour, and 96366 x2 for hours 2 and 3 (the second hour is complete; the 20 minutes of the third hour counts as an additional increment). However, many guidelines require at least 30 minutes of an additional hour to report another unit. At 2 hours 20 minutes: 96365 + 96366 x1 (for the full second hour) + the 20 minutes is over 15 minutes so 96366 x1 more may apply per payer. Conservatively: 96365 and 96366 for a 2-hour infusion. For 2h20m: 96365 + 96366 x2 (hours 2 and the partial third). Per CPT® guidelines, each additional 30 minutes or more beyond the first hour warrants an additional 96366. At 2h20m, two full or partial additional hours = 96366 x2.
8. A patient receives two separate immunization injections at a single encounter — an influenza vaccine and a pneumococcal vaccine. Which CPT® codes are reported for the administration of these vaccines?
   Answer: 90471, 90472 CPT® 90471 covers immunization administration for the first injection. Add-on code 90472 is reported for each additional injection at the same encounter. For two separate injections, 90471 is reported for the first vaccine administration and 90472 for the second. The vaccine product codes (e.g., 90686 for influenza, 90732 for pneumococcal) are reported separately in addition to the administration codes.
9. A pulmonologist performs spirometry to measure forced vital capacity (FVC) and forced expiratory volume (FEV1) before and after bronchodilator administration. Which CPT® code covers spirometry with pre- and post-bronchodilator testing?
   Answer: 94060 CPT® 94060 covers spirometry, including graphic record, before and after bronchodilator. Code 94010 covers spirometry without bronchodilator testing. Code 94070 covers multiple spirometry tracings (methacholine challenge). Code 94150 covers vital capacity only. The pre- and post-bronchodilator component is the key differentiator between 94010 and 94060.
10. A patient receives dialysis training to perform continuous ambulatory peritoneal dialysis (CAPD) at home. The training is completed over 3 sessions. Which CPT® code covers peritoneal dialysis with training?
    Answer: 90989 CPT® 90989 covers dialysis training, patient, including helper if applicable, any mode of dialysis, completed course — this covers the complete training for self-dialysis at home regardless of dialysis modality. Code 90990 is for dialysis training, per session. Code 90945 covers hemodialysis, one evaluation; 90947 covers continuous ambulatory peritoneal dialysis (CAPD) outpatient, per day. Training codes are distinct from dialysis service codes and reflect the educational component of preparing the patient for home dialysis.
11. A physician administers an allergen immunotherapy injection(s) from a previously prepared antigen extract to a patient. The physician did not prepare the antigen — it was prepared by an allergist. Which CPT® code covers the injection service only?
    Answer: 95115 CPT® 95115 covers professional services for allergen immunotherapy, single injection. Code 95117 covers 2 or more injections. Codes 95115 and 95117 cover the injection service only — not the antigen preparation. Code 95120 covers single injection with antigen preparation; 95165 covers professional services for antigen preparation. When the physician provides only the injection (not the antigen), 95115 or 95117 is used.
12. A patient receives a 2-hour hydration infusion of normal saline for dehydration, along with an IV push of an antiemetic drug during the same encounter. Which CPT® codes are reported?
    Answer: 96360, 96361, 96374 CPT® 96360 covers IV hydration, initial 31 minutes to 1 hour. For a 2-hour hydration infusion, add-on code 96361 is reported for the additional hour beyond the first. The IV push of an antiemetic drug (96374) is reported separately as a concurrent service during the same encounter. The correct codes are 96360 + 96361 + 96374. Reporting 96360 alone without 96361 would capture only up to 1 hour of hydration. Code 96366 applies to additional hours of therapeutic infusion, not hydration.
13. A physician administers the PHQ-9 depression screening tool to a patient and documents the scored results. Which CPT® code is reported for this brief behavioral health screening?
    Answer: 96127 CPT® 96127 covers administration of a brief emotional/behavioral assessment instrument such as the PHQ-9, PHQ-2, or similar validated screening tool. When the primary service is administering and scoring a brief screening instrument, 96127 is the appropriate code — not a psychiatric diagnostic evaluation code. Code 90791 covers a comprehensive psychiatric diagnostic evaluation, which requires substantially more work and clinical judgment than administering a brief screening tool. Code 90832 covers standalone psychotherapy.
14. A patient receives an intramuscular injection of a single non-chemotherapy therapeutic drug (e.g., antibiotic) in the physician's office. Which CPT® code covers this service?
    Answer: 96372 CPT® 96372 covers therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular. This code applies to IM injections of therapeutic drugs such as antibiotics, hormones, or vitamins. Code 96374 is for IV push; 96365 is for IV infusion; 96402 is for chemotherapy injection. The route of administration (IM vs. IV) determines the appropriate injection code.
15. During a clinical encounter, a physician provides 30 minutes of individual psychotherapy in addition to an E/M service. Which CPT® code covers the psychotherapy add-on service performed in conjunction with an E/M?
    Answer: 90833 CPT® 90833 is an add-on code for 30 minutes of individual psychotherapy performed in conjunction with an E/M service. It is reported in addition to the E/M code. Code 90832 is for standalone psychotherapy (30 minutes) without a concurrent E/M; 90834 is standalone psychotherapy for 45 minutes. The add-on psychotherapy codes (90833, 90836, 90838) must be used when psychotherapy is combined with an E/M at the same session.
16. A patient receives a chemotherapy infusion of 500 mg of drug A over 3 hours, followed by a sequential infusion of 250 mg of drug B over 1 hour during the same encounter. Which CPT® codes are reported?
    Answer: 96413, 96415 x2, 96417 CPT® 96413 covers chemotherapy infusion, initial, up to 1 hour. Add-on code 96415 covers each additional hour of the same drug infusion. Code 96417 covers sequential infusion of an additional drug. For a 3-hour infusion of drug A: 96413 (first hour) + 96415 x2 (hours 2 and 3). Then 96417 for the sequential infusion of drug B. The correct reporting is 96413, 96415 x2, 96417.
17. A physician performs a complete ophthalmologic examination of a new patient, including history, general medical observation, external and ophthalmic examination, and initiation of diagnostic and treatment program. Which CPT® code covers this service?
    Answer: 92004 CPT® 92004 covers ophthalmologic services, medical examination and evaluation with initiation of diagnostic and treatment program, new patient, comprehensive. Code 92002 is for a new patient intermediate examination; 92012 is for an established patient intermediate examination; 92014 is for an established patient comprehensive examination. The distinction between new vs. established and intermediate vs. comprehensive drives code selection in ophthalmology.
18. A physician performs a treadmill stress test with ECG monitoring and provides the interpretation and report, but the technical component (tracing and monitoring) is performed by a technician at a hospital outpatient facility. Which CPT® code does the physician report?
    Answer: 93018 CPT® 93015 covers the global cardiovascular stress test (physician performs and interprets); 93016 covers physician supervision only; 93017 covers tracing only (technical component); 93018 covers interpretation and report only (professional component). When the physician provides only the interpretation and report and the technical monitoring is performed at a separate facility, 93018 is the correct code. The physician appends modifier -26 if needed, but 93018 itself represents the professional component.
19. A patient receives an infusion of immune globulin intravenously (IVIG). In addition to the administration code, how is the drug itself reported?
    Answer: Using the appropriate HCPCS J code for the specific IVIG product administered When IVIG or other biologics are administered, the drug product is reported separately using the appropriate HCPCS Level II J code (e.g., J1459 for immune globulin, Privigen). The administration is reported with the infusion code (96365 series). Both the drug code (HCPCS J code) and the administration code must be submitted together for complete billing of infusion services.
20. A patient with end-stage renal disease (ESRD) receives outpatient hemodialysis. The physician provides the complete monthly ESRD-related evaluation and management services for this patient with 4 face-to-face visits during the month. Which CPT® code covers monthly ESRD services for a patient 20 years and older?
    Answer: 90960 CPT® 90960 covers ESRD-related services for patients 20 years and older with 4 or more face-to-face visits per month. Code 90961 covers 2–3 visits per month; 90962 covers 1 visit per month. Code 90963 covers home dialysis patients. The monthly ESRD codes are all-inclusive for the dialysis-related E/M services and are not reported per visit — they are reported once per month.

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