Evaluation and Management Coding Flashcards

Which modifier is appended to an E/M code to indicate the service is unrelated to a postoperative period?

Answer: -24

Modifier -24 is used when an unrelated E/M service is provided by the same physician during a postoperative period.

What distinguishes a consultation from a new patient visit in E/M coding?

Answer: Consultations require a request from another provider and a written report back

A consultation requires a written or verbal request from another provider and mandates that the consultant render a written opinion or report back to the requesting provider.

Under the 2021 E/M guidelines, which level of MDM corresponds to a straightforward problem with minimal data and minimal risk?

Answer: Straightforward

Straightforward MDM applies when there is a minimal number of problems, minimal or no data reviewed, and minimal risk of complications.

An established patient is seen in the office, and the physician makes an independent interpretation of an EKG during the visit. How is this reflected in MDM?

Answer: Counted as data reviewed under the 'amount and/or complexity of data' element

Independent interpretation of tests (such as an EKG) by the treating physician is counted as data reviewed under the MDM data element.

Which scenario best supports reporting modifier -57 with an E/M code?

Answer: E/M the same day as decision for major surgery

Modifier -57 indicates that the E/M service resulted in the initial decision to perform a major surgical procedure (90-day global period).

For office E/M codes, which of the following is NOT a recognized category of problems under the 2021 MDM guidelines?

Answer: Chronic illness with only marginal follow-up

'Chronic illness with only marginal follow-up' is not one of the defined MDM problem categories; recognized categories include stable chronic illness, acute illness/injury, and new undiagnosed problems.