E & M

Question 1

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

Answer 1

99201

Question 2

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

Answer 2

99202

Question 3

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

Answer 3

99203

Question 4

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

Answer 4

99204

Question 5

Established patient = Low severity, 5 minutes, 0 HPI, 0 ROS,

0 of 3 PMFSH, 0 exam, Straightforward decision making

Answer 5

99211

Question 6

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

Answer 6

99212

Question 7

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

Answer 7

99213

Question 8

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

Answer 8

99214

Question 9

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.

Answer 9

Modifier -22

Question 10

Unrelated E/M During Postop Period = Use separate E/M during global period.

Answer 10

Modifier -24

Question 11

• 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

Answer 11

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

Question 12

Professional Component Only = Use when billing for physician component of service such as Xrays

Answer 12

Modifier -26

Question 13

Mandated Services = Used when carrier requires consultation and/or second opinion.

Answer 13

Modifier -32

Question 14

• Bilateral Procedure = Used for identical procedure on both limbs. Bill 150% of fee.

Answer 14

Modifier -50

Can also use -51 modifier.

Question 15

Discontinued Procedure = Used when stopped procedure after anesthesia induction.

Answer 15

Modifier -53

Question 16

Surgical Care Only = Use when performing only surgical procedure and different doctor performing pre- and post-op services.

Answer 16

Modifier -54

Question 17

• Postoperative Management Only = Used when performing only postop care when another surgeon has performed the procedure.

Answer 17

Modifier -55

Question 18

Preop Management Only = Used when performing preop care when another surgeon performs surgery.

Answer 18

Modifier -56

Question 19

Decision For Surgery = Add to E/M code when deciding to perform a surgical procedure (90 day).

Answer 19

Modifier -57

Question 20

• Staged or Related Surgical Procedure = Use when indicating that performing procedure within global period was PRE-PLANNED

Answer 20

Modifier -58

Question 21

Separate Encounter = Add to CPT if performing procedure on same day.

Answer 21

-XE

Question 22

Separate Structure = Add to CPT if performing procedure on different anatomical structure or location.

Answer 22

-XS

Question 23

Separate Practitioner = Add to CPT if performing procedure by different provider.

Answer 23

-XP

Question 24

Unusual Nonverlapping Service = The use of a service that is distinct because it does not overlap usual components of the main service.

Answer 24

-XU

Question 25

Two Surgeons = Use when 2 surgeons as primary performing distinct parts of one procedure. Both surgeons must use same procedure code.

Answer 25

Modifier -62

Question 26

Repeated Procedure By Same Physician = Use when physician needed to repeat original procedure. Attach reason to perform 2nd procedure with billing.

Answer 26

Modifier -76

Question 27

Repeated Procedure By Another Physician = Same as -76 but with 2nd physician

Answer 27

Modifier -77

Question 28

• Unplanned Return to OR = Use if returning to the OR in postoperative period for a previously unplanned procedure.

Answer 28

Modifier -78

Question 29

• Unrelated Procedure By Same Physician During Post-Op Period = Use when performing an unrelated surgical procedure during the postop period of another surgical procedure.

Answer 29

Modifier -79

Question 30

Assistant Surgeon = This includes MD, DO, and DPM provider types and is an assistant surgeon providing full assist to the primary surgeon.

Answer 30

Modifier -80

Modifier -81 = minimal assistance to primary surgeon

Question 31

Assistant When Resident Not Available = This includes MD, DO, and DPM provider types.

Answer 31

Modifier -82

Question 32

Outside Laboratory = Use on lab procedures performed by a party other than the treating or reporting physician.

Answer 32

Modifier -90

Question 33

Multiple Modifiers = Use when coding multiple modifiers.

Answer 33

Modifier -99

Question 34

Resident involvement = Service performed in part by resident under supervision of physician.

Answer 34

Modifier -GC

Question 35

Inpatient consultation low level

Answer 35

99221

99222

Question 36

Inpatient consultation mid level/

Inpatient consultation high level

Answer 36

99223/

99224

Question 37

Subsequent care hospital

Answer 37

99231
99232
99233

Question 38

Telehealth consultion

Answer 38

G0406-G0408