AAPC Certified Professional Coder (CPC) — Question 121

A 55-year-old patient was recently diagnosed with an enlarged goiter. It has been two years since her last visit to the endocrinologist. A new doctor in the exact same specialty group will be examining her. The physician performs a medically appropriate history and exam. The provider reviewed the TSH results and ultrasound. The provider orders a fine needle aspiration biopsy which is a minor procedure.
What E/M code is reported?

Answer options

• A. 99202
• B. 99214
• C. 99205
• D. 99213

Correct answer: B

Explanation

The correct E/M code is 99214, which indicates a moderate complexity office visit for an established patient. This code is appropriate given the patient's history, the new physician's comprehensive review of her previous records, and the decision to perform a minor procedure. The other options either represent lower complexity visits or are not suitable for the level of service provided in this scenario.