| Course | HCR 201 Medical Billing and Coding (HCR/201) |
|---|---|
| Week | 3 |
| Paper type | Procedure coding exercise |
| Length | about 937 words, 3 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | BS in Health Administration |
| Updated | September 2026 |
Free sample paper for HCR 201 Week 3
Choosing 99214 Over 99213, and When Modifier 25 Belongs: CPT Procedure Coding for Five Family Medicine Visits, With the Reasoning Behind Each Level
[Student Name]
University of Phoenix
HCR/201: Medical Billing and Coding
Week 3 Assignment
[Instructor Name]
[Date]
The patients and visit notes are composites written for a model coding exercise; code rules come from the CPT code set and the federal guidance listed.
How CPT Is Organized
CPT, maintained by the American Medical Association (2025), has six main sections: evaluation and management, anesthesia, surgery, radiology, pathology and laboratory and medicine. Codes are five digits, and modifiers of two characters add information such as a separately identifiable service. Each procedure code on a claim must be linked to a diagnosis code that explains why it was done.
How Office Visit Levels Work
Office visits are coded 99202 to 99205 for new patients and 99211 to 99215 for established patients. The level is chosen either by medical decision making or by the total time the practitioner spent on the date of the visit. Decision making is judged on three things: the problems the physician took on at the visit and their seriousness, what data the physician ordered, reviewed or obtained and how risky the chosen management is. A visit reaches a level when any two of those three reach it.
Visit One: Chronic Disease Follow-Up
Documentation: established 64-year-old patient with type 2 diabetes and hypertension, both stable. Physician reviewed home glucose log, adjusted metformin dose and continued the blood pressure medicine.
Codes: 99214, linked to the diabetes and hypertension diagnoses.
Reasoning: Two stable chronic illnesses make the problems moderate. Prescription drug management makes the risk moderate. With two elements at moderate, decision making is moderate even though data were limited, which supports 99214 rather than 99213. Changing a dose is what moved this visit from 99213 to 99214; a refill without any decision would not have.
Visit Two: New Patient With Strep Throat
Documentation: 9-year-old new to the practice with sore throat and fever, history given by her mother. Rapid strep test positive. Antibiotic prescribed.
Codes: 99203 and 87880.
Reasoning: An acute uncomplicated illness makes the problems low. Ordering and reviewing the test and obtaining history from a parent as an independent historian support at least limited data. Prescribing an antibiotic is prescription drug management, a moderate risk. Two elements meet low, so decision making is low and the new patient visit is 99203. The rapid antigen test for group A streptococcus is coded 87880; for Medicare patients a waived test also needs modifier QW.
Visit Three: Knee Injection
Documentation: established patient with known right knee osteoarthritis returns for a scheduled steroid injection. Brief check of the knee, injection performed.
Code: 20610.
Reasoning: 20610 reports injection of a major joint without ultrasound guidance. The brief assessment before a planned injection is part of the procedure, so no office visit is coded. If the patient had also raised a new problem, such as uncontrolled blood pressure, and the physician evaluated and managed it, an office visit with modifier 25 could be added. The drug itself is reported with a supply code, covered next week.
Visit Four: Preventive Visit With a Problem
Documentation: established 52-year-old for annual preventive examination. During the visit, he reports three weeks of heartburn; the physician evaluates it and starts a medication.
Codes: 99396 and 99213-25.
Reasoning: 99396 reports the preventive visit for an established patient aged 40 to 64. The heartburn required separate evaluation and a new prescription, a significant, separately identifiable problem, reported as an office visit with modifier 25. The level is based only on the problem work, not the preventive portion.
Visit Five: A Long Visit Coded by Time
Documentation: established 78-year-old whose heart failure and chronic kidney disease are now joined by two recent falls. Physician documented 44 minutes of total time on the date, including reviewing hospital records, examining, counseling the patient and daughter and coordinating home health.
Codes: 99215, 93000 and 36415.
Reasoning: When time is used, 99215 requires at least 40 minutes of total practitioner time on the date. The complete electrocardiogram with interpretation and report is 93000, and the blood draw is 36415. For Medicare patients with ongoing longitudinal care, federal guidance also allows an add-on code for visit complexity (Centers for Medicare & Medicaid Services, 2026).
Linking Codes to Diagnoses
Every CPT code on a claim points to at least one diagnosis code, and the pairing must make clinical sense. In the first visit, the office visit points to both diabetes and hypertension. In the second, the strep test points to the sore throat diagnosis confirmed as streptococcal pharyngitis. In the knee injection, 20610 points to osteoarthritis of the right knee. A mismatched link, such as an electrocardiogram pointed only to a knee diagnosis, will be denied as not medically necessary even if both codes are correct on their own.
Checking Before Release
Before releasing claims, the specialist runs them through the practice's claim scrubber, which applies national correct coding edits that flag pairs of codes not normally billed together on the same day. An edit on 20610 with an office visit, for example, prompts her to confirm that documentation supports modifier 25 before the claim goes out.
Why Levels Draw Scrutiny
The Office of Inspector General (2012) found that from 2001 to 2010 physicians increasingly billed higher-level visit codes across all types of visits and identified about 1,700 who consistently billed the highest levels while treating similar patients to their peers. Coders must choose levels from documentation, not habit or revenue targets.
Conclusion
The five visits show the core CPT skills: applying the two-of-three rule or total time to choose visit levels, distinguishing new from established patients, coding procedures and tests, using modifier 25 only for separately identifiable work and linking every service to a diagnosis. Each code must be supported by what the physician documented.
References
American Medical Association. (2025). CPT 2026 professional edition. American Medical Association.
Centers for Medicare & Medicaid Services. (2026). Evaluation and management services (MLN006764). U.S. Department of Health and Human Services. https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf
Office of Inspector General. (2012). Coding trends of Medicare evaluation and management services (OEI-04-10-00180). U.S. Department of Health and Human Services. https://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
What the HCR 201 Week 3 instructions ask
HCR 201 Week 3 usually introduces procedure coding with CPT. Students may be asked to describe the organization of the CPT manual, the evaluation and management section and its rules for selecting office visit levels, procedure codes in other sections, modifiers and the link between procedure and diagnosis codes. Many sections attach practice visits, and students must name each CPT code and defend it. Some ask about coding compliance and the risk of upcoding. Strong answers follow the current office visit rules based on medical decision making or total time, distinguish new from established patients, use modifiers only when documentation supports them and link every service to a supporting diagnosis.
How this HCR 201 Week 3 example is built
The exercise starts with how CPT is organized and how office visit levels work today: medical decision making judged on problems, data and risk, with two of three elements needed, or total time spent on the date of the visit. Five visits follow, each with a documentation excerpt, the codes, the reasoning and the diagnosis link. The diabetes and hypertension follow-up reaches moderate decision making. The new patient with strep throat is low decision making plus a rapid test. The knee injection shows when an office visit may be added with modifier 25. The preventive visit shows a problem addressed alongside it. The last visit is coded by time.
HCR 201 Week 3 grading rubric: where the points go
The CPT week is generally graded on correct code selection and clear reasoning. Instructors check new versus established patient status, correct application of medical decision making or time for office visits, accurate procedure codes and appropriate use of modifiers. Linking each procedure to a diagnosis that supports medical necessity earns credit, as does noting payer-specific rules where relevant. Explaining why a level was chosen, element by element, matters more than the code alone. Citations to the CPT manual and federal guidance should appear in APA format. Answers that choose visit levels by feel, or that append modifier 25 to every visit with a procedure, generally lose points.
HCR 201 Week 3 help: mistakes to avoid
The error seen most in HCR 201 Week 3 is picking an office visit level without walking through the elements. For medical decision making, rate the problems, the data and the risk, and apply the two-of-three rule. Or use total time on the date of service when it is documented. Another mistake is confusing new and established patients: a patient seen by a physician of the same specialty in the same group within three years is established. Students also add modifier 25 whenever a procedure is done; it requires a significant, separately identifiable visit. Link each code to a diagnosis. Check whether a test is waived and whether a payer needs a modifier for it. Finally, never code a level higher than the documentation supports.
Related HCR 201 sample papers
Other HCR 201 week samples
- HCR 201 Week 1: Coding Careers and Certification
- HCR 201 Week 2: Diagnostic Coding With ICD-10-CM
- HCR 201 Week 4: Procedure Coding With HCPCS
- HCR 201 Week 5: Codes in the Billing Cycle
More BS in Health Administration sample papers
- HCIS 352 Week 3: Information System Maintenance
- HCIS 420 Week 3: Risk Identification and Planning
- HCS 120 Week 3: Who's in Health Administration
- HCS 131 Week 3: Collaboration Through Conflict
HCR 201 Week 3 questions, answered
What does HCR/201 Week 3 usually ask for?
Many sections introduce CPT procedure coding, asking students to explain how the manual is organized, how office visit levels and procedure codes are chosen and how modifiers work, often with coding scenarios.
Where can I find a free HCR 201 Week 3 sample paper?
The five-visit CPT exercise can be read on this page without charge, and notes in the margin explain each level. Send your own scenarios and we will code a first worksheet free.
How is an office visit level chosen under current rules?
By the level of medical decision making, judged on problems addressed, data reviewed and risk of management, meeting two of three elements, or by the total time the practitioner spent on the date of the visit.
When is modifier 25 used?
When a significant, separately identifiable evaluation and management service is performed on the same day as a procedure or other service, beyond the usual care that goes with the procedure.
What is the difference between a new and an established patient?
A new patient has not received professional services from the physician or another physician of the same specialty in the same group within the past three years; otherwise the patient is established.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
Request this one custom, free · All HCR 201 week samples · All courses