E & M Flashcards
New patient = Low severity, 10 minutes, Problem focused HPI (1), 0 ROS,
0 of 3 PMFSH, Problem focused exam (1-5 elements in 1 system), Straightforward decision making
99201
New patient = Low to moderate severity, 20 minutes, Expanded problem focused HPI (1), 1 ROS,
0 of 3 PMFSH, Expanded problem focused exam (6 elements in 1 system), Straightforward decision making
99202
New patient = Moderate severity, 30 minutes, Detailed focused HPI (4), 2 ROS,
1 of 3 PMFSH, Detailed exam (2 elements in 6 systems or 12 elements in 2 systems), Low complexity decision making
99203
New patient = Moderate to high severity, 45 minutes, Comprehensive focused HPI (4), 10 ROS,
3 of 3 PMFSH, Comprehensive exam (all elements in 9 systems or 2 elements in all systems), Moderate complexity decision making
99204
Established patient = Low severity, 5 minutes, 0 HPI, 0 ROS,
0 of 3 PMFSH, 0 exam, Straightforward decision making
99211
Established patient = Low to moderate severity, 10 minutes, HPI (1), 0 ROS,
0 of 3 PMFSH, Problem focused exam (1-5 elements in 1 system), Straightforward decision making
99212
Established patient = Moderate severity, 15 minutes, HPI (1), 1 ROS,
0 of 3 PMFSH, Problem focused exam (6 elements in 1 system), Low complexity decision making
99213
Established patient = Moderate to high severity, 25 minutes, HPI (4), 2 ROS,
1 of 3 PMFSH, Problem focused exam (2 elements in 6 systems or 12 elements in 2 systems), Moderate complexity decision making
99214
Unusual Procedure = When service is greater than usual for that procedure. Add statement to op report. Will always be denied so will have to appeal.
Modifier -22
Unrelated E/M During Postop Period = Use separate E/M during global period.
Modifier -24
- Separate E/M Service on Same Day of Surgical Procedure = Use when seeing patient with separate diagnosis and performing minor procedure. *
Ex: bunion eval + ingrown toenail
Modifier -25
Use when coding E/M for major procedure (90 day global
- NP E/M with procedure
- EST PT E/M with procedure for a new diagnosis
- Unrelated E/M and procedure
Professional Component Only = Use when billing for physician component of service such as Xrays
Modifier -26
Mandated Services = Used when carrier requires consultation and/or second opinion.
Modifier -32
- Bilateral Procedure = Used for identical procedure on both limbs. Bill 150% of fee.
Modifier -50
Can also use -51 modifier.
Discontinued Procedure = Used when stopped procedure after anesthesia induction.
Modifier -53
Surgical Care Only = Use when performing only surgical procedure and different doctor performing pre- and post-op services.
Modifier -54
- Postoperative Management Only = Used when performing only postop care when another surgeon has performed the procedure.
Modifier -55
Preop Management Only = Used when performing preop care when another surgeon performs surgery.
Modifier -56
Decision For Surgery = Add to E/M code when deciding to perform a surgical procedure (90 day).
Modifier -57
- Staged or Related Surgical Procedure = Use when indicating that performing procedure within global period was PRE-PLANNED
Modifier -58
Separate Encounter = Add to CPT if performing procedure on same day.
-XE
Separate Structure = Add to CPT if performing procedure on different anatomical structure or location.
-XS
Separate Practitioner = Add to CPT if performing procedure by different provider.
-XP
Unusual Nonverlapping Service = The use of a service that is distinct because it does not overlap usual components of the main service.
-XU
Two Surgeons = Use when 2 surgeons as primary performing distinct parts of one procedure. Both surgeons must use same procedure code.
Modifier -62
Repeated Procedure By Same Physician = Use when physician needed to repeat original procedure. Attach reason to perform 2nd procedure with billing.
Modifier -76
Repeated Procedure By Another Physician = Same as -76 but with 2nd physician
Modifier -77
- Unplanned Return to OR = Use if returning to the OR in postoperative period for a previously unplanned procedure.
Modifier -78
- Unrelated Procedure By Same Physician During Post-Op Period = Use when performing an unrelated surgical procedure during the postop period of another surgical procedure.
Modifier -79
Assistant Surgeon = This includes MD, DO, and DPM provider types and is an assistant surgeon providing full assist to the primary surgeon.
Modifier -80
Modifier -81 = minimal assistance to primary surgeon
Assistant When Resident Not Available = This includes MD, DO, and DPM provider types.
Modifier -82
Outside Laboratory = Use on lab procedures performed by a party other than the treating or reporting physician.
Modifier -90
Multiple Modifiers = Use when coding multiple modifiers.
Modifier -99
Resident involvement = Service performed in part by resident under supervision of physician.
Modifier -GC
Inpatient consultation low level
99221
99222
Inpatient consultation mid level/
Inpatient consultation high level
99223/
99224
Subsequent care hospital
99231
99232
99233
Telehealth consultion
G0406-G0408
