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No Question Weightage Questions Associate Score Status

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1 MCQ 1 32-year-old patient tested positive for COVID-19 a month Z09, 0 Wrong
ago and now arrives for follow-up exam. Provider orders Z86.19
a COVID-19 test and the results are negative. Assign all
applicable ICD-10 diagnosis codes.
2 MCQ 1 Patient is non-Medicare. Primary care physician (PCP) 99242, 1 Correct
has been monitoring and treating a 78-year-old I11.0, I50.9
established patient for known congestive heart failure
(CHF) and a known hypertension over a period of
time. Based upon recent findings, the PCP requests a
cardiology consultation. The intent is to obtain an
opinion and advice relevant to the status of the patient's
coronary heart disease, current treatment, revised
therapy, new therapy, recommended monitoring, and any
other clinical needs. The consulting cardiologist
evaluates the patient and gave recommendations for
management to the PCP. A report of the consultant’s
findings was sent to the referring provider. A total of 30
minutes were spent face-to-face with the patient during
this encounter and over half of that time was spent on
counseling and coordination of care. Assign the E&M
code and all applicable ICD-10 diagnosis codes.
3 MCQ 1 Chief complaint -cough.  HPI- New patient seen in the 99203-25, 1 Correct
office today is a 6-year-old child no prior medical 90460,
conditions who presents with parents for evaluation of J06.9, Z23
a cough. Symptoms were consistent with cough for 3
days associated with fever, diarrhea, and irritability.
Family is describing a barking like cough which is worse
today. The patient has taken Tamiflu, and has vomited as
many as 3 times today; non-bloody. Last emesis
episodes at 18:00.  MDM: A total of 35 minutes were
spent face-to-face with the patient during this encounter
and over half of that time was spent on counseling and
coordination of care. We discussed differential
diagnoses of flu vs URI. Will obtain Chest x ray and flu lab
test. Chest x-ray shows negative results. Influenza A and
B test is negative. Patient given Fluenz Tetra vaccine
intranasally. Parents were counseled on the side effects,
management of the side effects, and the need for follow
up visit. Mother verbalized understanding of the
same. Final impression: Acute upper respiratory infection
(URI). Assign the E&M code, vaccine administration code,
and applicable ICD-10 diagnosis codes.
4 MCQ 1 A 64-year-old non-Medicare patient with stage IIIC 99024, 0 Wrong
ovarian cancer underwent total oophorectomy and now T81.41A
has postoperative pain and redness near incision 14 days
out from surgery. The patient lives two hours away. She
presents for a telemedicine visit with visual technology.
No drainage or dehiscence is seen. Bactrim is ordered
for surgical incision infection. Precautions upon when to
go to the ER or seek medical attention are given. During
this visit the provider and patient did the
following: Reviewed signs and symptoms of
infection.Discussed wound care and starting oral
antibiotics.Bactrim Rx sent to pharmacy for patient to
start today. Impression: Post-op surgical wound
infection, superficial Time spent face to face today via
audio-visual telemedicine was 20 minutes and an
additional 10 minutes was used to document the
No Question Weightage Questions Associate Score Status
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encounter. A statement including the patient’s consent
was included in the encounter. Total minutes for the
encounter was added to the note. Assign appropriate
visit code and applicable ICD-10 diagnosis codes. 
5 MCQ 1 CC: Well Woman Exam HPI: A 30 y/o established patient. 99213, 0 Wrong
Doing well. No concerns today.PMH:Medical Hx- HTN, Z00.00,
Hypothyroid.Surgical Hx-Thyroidectomy.Family Hx- I10, E03.9
Reviewed, No changes, Hashimoto’s in Mother.Social/
Personal Hx-Reviewed, No changes.Vitals:
BP-140/90.PE-General: Well nourished, well hydrated, no
acute distress.Respiratory: Clear to auscultation
bilaterally, No rales, rhonchi, or wheezes.Neck: Thyroid:
No enlargement Breast: No abnormal findings, no
masses, lumps found Nipple: no abnormal
findingsCardiovascular: S1, S2 audible no murmur rub, or
gallop, RRR.GI: soft, non-tender, no masses, normal
bowel sounds.GU: Uterus: No lesions on external
genitalia, no scarring of the urethra, no cervical discharge
found, adnexa normalMusculoskeletal: All Extremities
with normal alignment.Skin: No Rashes and other skin
abnormalities. Assessment: 1. Well Women Exam S/P
thyroidectomy2. Hypothyroidism 3. HTN  Plan:Well
Women Exam-Pt is coming for yearly exam. No new
concerns today, except BP is elevated when checking in
the office today. All other screenings and test are
scheduled.Order: CMB, CBC, TSH.Hypothyroidism -
Hypothyroidism S/P thyroidectomy. Continue
Levothyroxine 25 mg.Order: CMB, CBC, TSH.HTN - BP is
elevated in the office today. Discussed low salt diet and
medication control.Order: CMB, CBC,
TSH. Medications:Levothyroxine 25 mg.Changed
Lisinopril 5 mg to Amlodipine 10 mg for hypertension
uncontrolled. Assign E&M code(s) and applicable ICD-10
diagnosis codes.                                 
6 MCQ 1 A 2-month-old new patient presents for her routine well 99381-25, 1 Correct
baby exam. Mom had no complaints, however upon 90698,
exam, an innocent heart murmur was noticed. No heart 90670,
problems are noted in the family history. The 90744,
paediatrician informed the Mom about it and told her that 90681,
nothing needed to be done at this point, but would follow‐ 90460 x 4,
up at the baby’s next encounter. Vaccines are 90461 x 7,
administered: Pentacel by IM (DTaP‐Haemophilus Z00.121,
influenzae type b (Hib)‐inactivated poliovirus (IPV), R01.0, Z23
Hepatitis B by IM, pneumococcal conjugate by IM, and
Rotavirus orally) and the Mom is counselled on them all.
The diagnoses listed for this encounter are well baby
exam, vaccine encounter, and innocent heart
murmur. Assign the appropriate E&M code, vaccine
administration codes, and applicable ICD-10 diagnosis
codes. 
7 MCQ 1 CC:  Cough, weakness HPI: A 25yr old presents to the R05, 1 Correct
office with complaints of cough for 2 days with R53.1,
generalized weakness and patient states his neighbor Z20.822
tested COVID-19 positive and he was around him
recently. ROS: Resp: Cough, no sob         GI: no abdominal
painAllergies: No known medicine, food, or
environmental allergiesPMH: NILPhysical Exam:
 Vitals: Temperature, 98.6 F; heart rate 88; respiratory rate,
22; blood pressure 120/80General: She is well appearing
but anxious, Respiratory: No abnormal lung
sounds.Laboratory Studies: Rapid SARS Antigen test for
No Question Weightage Questions Associate Score Status
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COVID-19 completed. Negative.Chest X-ray:
Impression: Normal Assessment and
PlanCoughGeneralized WeaknessNegative for
COVID-19Treatment: OTC cough suppressants Assign all
applicable ICD-10 diagnosis codes for this encounter.
8 MCQ 1 CC: Nexplanon insertion Interval history: The patient is 11981, 1 Correct
here for insertion of Nexplanon for birth control. GYN Z30.46
History:Unprotected coitus. Abnormal vaginal bleeding:
none. Bone Density: Not applicable.  Breast complaints:
none. Breast Awareness: YES. Calcium intake: adequate.
History of gynecologic surgery: Denies Menopause: N/A.
Menstrual cycle: normal. Urinary problems: none. Vaginal
discharge: normal. Vasomotor symptoms: none. Sexual
partner: monogamous. Sexual orientation: monogamous,
opposite sex.  Physical abuse: no history of physical or
sexual abuse PHYSICAL EXAM: Vital Signs: Ht 63.39, Wt.
218.0, BMI 38.14, BP 120/80 mm Hg, Pulse 88, RR 20,
Pain scale 0 1-10, Wt.-kg 98.88 kg, GENERAL
APPEARANCE: alert, in no acute distress, well developed,
well nourished.  EXTREMITIES: no clubbing, cyanosis, or
edema.  SKIN: no rashes, no suspicious lesions.  PSYCH:
alert, oriented, cognitive function intact, cooperative with
exam. AssessmentEncounter for initial prescription of
other contraceptives - Nexplanon implant treatmentLab:
Pregnancy test results NEGATIVE ProcedureGeneral:
TIME OUT: The patient's identity, procedure, and site were
verified prior to proceeding with the procedure as per
universal protocol recommendations. CONSENT: After
discussing risks and benefits of outlined procedure,
informed consent was reviewed and signed by the
patient. Risks may include infection, scaring,
hypopigmentation, bleeding, and other possible
complications related to today's specific procedure
where reviewed.  Nexplanon Insertion:        Nexplanon Lot
# T042662   Exp Date: 2023SEP27  MA Name  L.LOPEZ
 Procedure: Insertion site was identified at inner side of
non-dominant upper arm about 8-10 cm above the
medial epicondyle of the humerus and marked with a
sterile marker. Insertion site was cleaned with antiseptic
solution and prepped and draped in a sterile fashion. 5
mL of 1% Lidocaine was injected under the skin along the
insertion tract for local anesthesia. The Nexplanon
insertion device was removed from the box. The
Nexplanon device was located in the insertion device.
The skin was stretched around the insertion site with the
thumb and index finger. It was then punctured with the
tip of the needle at an angle of 30 degrees. The insertion
device was then lowered to a horizontal position while
tenting the skin with the tip of the needle. The needle
was then slid to its entire length under the skin. The
purple slider was then unlocked and the slider was fully
moved back until it stopped and the applicator was
removed. The implant was then palpated under the skin
to confirm proper placement, and a bandage was placed
over the insertion site and a pressure bandage was
applied to the arm.  Post Procedure counseling provided
regarding warning signs and problems such as pain,
paresthesia’s, bleeding, hematomas, scarring or
infection. Instructions were given to patient to remove
the bandage on the insertion site after 3-5 days and to
return to the clinic in one month.  Pain No./Bleeding No.
No Question Weightage Questions Associate Score Status
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 Family Planning/STI Education: Discussed-Birth Control
Methods. Discussed verbal and written education on
birth control options. Risks and benefits of each type of
birth control discussed and all questions answered. Birth
Control, Safer Sex, ECP Inquiry, and counseling about
contraceptive practices given. Patient also counseled
regarding the use of contraception and practicing safe
sex. Explained that the use of ECP is only for
emergencies and not as a routine birth control method.
Discussed-STD Education and Screening; discussed
verbal and written education on STD education and
screening. Education about HIV provided. Discussed
verbal and written education on HIV and screening. Safe
sex with condoms. Assign appropriate CPT and ICD-10
codes for this encounter. 
9 MCQ 1 Chief Complaint: 1. Chest pains/heart problems History 99204-25, 1 Correct
of Present IllnessHPI: 6-year-old male brought into office 93000,
as a new patient by his Dad for chest pain and R07.9,
headaches. Chest pain started about two weeks ago and R51.9,
occurs daily. It happens about 1-2 times/day but is not J30.9
associated with eating or activity. Patient reports feeling
that his heart is beating quickly. Patient has also
complained of intermittent headaches for the past few
days. No associated nausea, vomiting, vision changes,
sinus pressure, congestion, or sore throat. He has not
taken any medications for either symptoms. No family
history of cardiac disease. Current MedicationsNot-
Taking/PRN· Albuterol Inhaler (ProAir HFA) (10M)
90mcg/Inh Inhaler as directed inhaled· Medication List
reviewed and reconciled with the patient Past Medical
HistoryAsthma.Surgical HistoryDenies Past Surgical
History Family HistoryFather: alive, ADHD, bipolar
disorderMother: alivePaternal great grandfather died of
heart attack at 42 years of age.Social HistoryFirst grade
student; no learning disabilities knownVision impaired:
NoHearing impaired: NoTobacco Use: noExposed to 2nd
hand smoke:  NoTravelled in the last 6 months:
No.AllergiesN.K.D.A. Hospitalization/Major Diagnostic
ProcedureDenies Past HospitalizationReview of
SystemsGeneral/Constitutional:cough Denies. 
Abdominal pain Denies.  Nausea Denies. 
Vomiting Denies.  chest pain Admits.  Shortness of
Breath Denies.  Dizziness Denies.  Change in
appetite Denies.  Fatigue Denies.  Fever Denies. 
Headache Admits.Vital SignsHt 47, Wt 58.4, BMI 18.59,
BP 117/72 mm Hg,repeat:105/58, Pulse 87, Pain scale 0
1-10, Oxygen Sat Pre 98 %, Ht % 36.41 %, Wt % 82.17 %,
BMI % 93.38 %, Ht-cm 119.38 cm, Wt-kg 26.49 kg, Weight
Change 5 lbs. ExaminationGeneral
Examination:GENERAL APPEARANCE: alert, in no acute
distress, well developed, well
nourished.HEAD: normocephalic, atraumatic.EYES: pupils
equal, conjunctiva clear, no discharge.EARS: both
ears, tympanic membrane:, intact, clear, external auditory
canal clear.THROAT: clear, no erythema, no
exudate, uvula midline.NOSE: nares patent, turbinates
pale and swollen.NECK/THYROID: neck supple, full range
of motion.ORAL CAVITY: mucosa moist, no
lesions.LYMPH NODES: no cervical
adenopathy.LUNGS: clear to auscultation bilaterally, no
wheezes, no rales, no rhonchi.HEART: regular rate and
No Question Weightage Questions Associate Score Status
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rhythm, no murmurs, S1, S2 normal.CHEST: normal
shape and expansion, no subcostal or intercostal
retractions.ABDOMEN: soft, nontender, nondistended, no
guarding or rigidity, no hepatosplenomegaly.PERIPHERAL
PULSES: 2+ radial.NEUROLOGIC: nonfocal, alert and
oriented, normal strength, tone and reflexes , gait
normal.Assessment1. Chest pain, unspecified2.
Headache, unspecified Treatment Plan1. Chest pain,
unspecifiedRoutine, 12 lead EKG with Interp & Report
performed. Normal.IMAGING: X-RAY CHEST 2 VIEWS
ordered Notes: EKG reassuring with sinus arrhythmia,
likely normal variant. Will order chest x-ray to evaluate
further. RTC in 1-2 weeks after radiograph is completed.
Consider cardiology referral if chest pain persists.
Present to ER If chest pain is severe, does not go away
quickly, or if he has associated dizziness or
syncope.2. Headache, unspecifiedStart Ibuprofen
Suspension, 100 MG/5ML, 10 ml with food or milk as
needed for pain, Orally, Three times a day, 5 days, 150 ml,
Refills 0. Start Fluticasone Propionate Suspension, 50
MCG/ACT, 1 spray in each nostril once a day, 30 day(s), 1
Bottle, Refills 2 3. Allergic rhinitis. Will treat with nasal
steroid spray to see if there is improvement in
headaches. May give ibuprofen as needed for headache
pain. Encouraged healthy habits include increased water
intake, healthy well-balanced meals, regular exercise,
decreased screen time. RTC as needed if headaches
persist.Follow Up2 Weeks (Reason: Follow up chest
pain) Assign appropriate E&M code and all applicable
ICD-10 diagnosis codes.
10 MCQ 1 A 74-year-old established patient was seen in the office 99213, 0 Wrong
today for blurred vision which has continued to worsen; H25.11
right eye worse than left. He is unable to see well enough
to drive now. Visual acuity on exam is 20/60 O.D. and
20/40 O.S. with correction. After discussion,
recommendation was to undergo cataract surgery for an
age-related cataract of the right eye. The patient agreed
to this and was scheduled for this procedure in 2 weeks.
He was counselled on the risks and benefits of
undergoing cataract surgery. The post-operative care
was also explained. The patient verbalized
understanding of this information.   Assign the E&M code
and all applicable ICD-10 diagnosis codes.