Evaluation and Management Coding Flashcards

An outpatient visit where the physician's total time is 40 minutes for an established patient would be coded as:

Answer: 99214

Under 2021 guidelines, 40 minutes of total time for an established patient maps to 99214 (30–39 minutes = 99213; 40–54 minutes = 99214).

Which type of E/M service is reported when a physician provides care for a patient in an observation unit?

Answer: Hospital observation codes (99217–99220 or 99234–99236)

Hospital observation services are reported with CPT codes 99217–99220 for admission/discharge and 99234–99236 for same-day admit/discharge.

What is required to report a prolonged services code (99417) with an office E/M code?

Answer: Total time exceeds maximum time of the highest-level E/M code by at least 15 minutes

CPT 99417 is added for each additional 15 minutes beyond the time threshold of the highest-level office E/M code (99215 at 55 minutes baseline).

When a physician bills preventive medicine services and an E/M service on the same day, which modifier is required?

Answer: -25

Modifier -25 is appended to the E/M code to indicate a significant, separately identifiable problem-oriented service was provided on the same day as a preventive medicine visit.

In outpatient coding, what is the key distinction between a 99213 and a 99214 for an established patient using MDM?

Answer: 99213 = low MDM; 99214 = moderate MDM

Under 2021 guidelines, 99213 requires low-level MDM while 99214 requires moderate-level MDM for established outpatients.

Which is the correct code for an initial observation care admission by the admitting physician with high-complexity MDM?

Answer: 99220

CPT 99220 represents initial hospital observation care with high-complexity medical decision making by the admitting physician.