Evaluation and Management (E/M) Flashcards

Which code range is used for Emergency Department E/M services regardless of patient status (new vs. established)?

Answer: 99281–99285

ED E/M codes 99281–99285 apply to all ED patients; the new/established distinction does not apply in the ED setting.

A hospitalist admits a patient and provides an initial hospital care service requiring comprehensive history, comprehensive exam, and high-complexity MDM. Which code is reported?

Answer: 99223

99223 is used for initial hospital care requiring all three key components at the comprehensive/high-complexity level.

Subsequent hospital care codes (99231–99233) require how many of the three key components to meet the documented level?

Answer: At least 2 of 3 key components

Like established office visits, subsequent hospital care requires at least 2 of the 3 key components to meet or exceed the reported level.

Which modifier is appended to an E/M code when a physician other than the surgeon provides a medically necessary E/M service during the global surgical period?

Answer: Modifier 24

Modifier 24 indicates an unrelated E/M service by the same physician during a postoperative period.

A physician decides to perform a major surgery during an E/M visit. Which modifier is appended to the E/M code to indicate the visit resulted in the decision for surgery?

Answer: Modifier 57

Modifier 57 is appended to the E/M service when the visit results in the decision to perform a major surgery (90-day global period).

Prolonged service code 99417 may be reported with which office E/M codes under 2021 guidelines?

Answer: Only with 99205 or 99215 when total time exceeds the threshold

99417 is reported for each additional 15 minutes beyond the maximum time threshold for 99205 (74 min) or 99215 (54 min).

Which type of E/M visit is used when a physician is asked by the attending to evaluate a patient and provide a written report of findings and recommendations?

Answer: Inpatient consultation — but Medicare no longer recognizes consult codes

Medicare eliminated consultation codes in 2010; consultations for Medicare patients are reported using the appropriate new or established patient or inpatient E/M codes.