CPC Evaluation and Management Coding 5 — Questions and Answers
Question 1: A surgeon sees a patient in the office 10 days after an appendectomy. This visit is within the global period. How should this visit be coded?
- Report the appropriate E/M code with modifier -24
- Report the appropriate E/M code with modifier -79
- No separate code — the visit is included in the global surgical package (Correct answer)
- Report with modifier -25
Correct answer: No separate code — the visit is included in the global surgical package
Routine follow-up visits within the global surgical period are included in the surgical package and are not coded separately.
Question 2: Which E/M code is used when a physician provides transitional care management services with moderate medical complexity, with a face-to-face visit occurring within 14 days of discharge?
- 99495 (Correct answer)
- 99496
- 99487
- 99489
Correct answer: 99495
99495 covers transitional care management with moderate medical complexity when the required face-to-face visit occurs within 14 days of discharge.
Question 3: A physician documents a chief complaint, history of present illness (4 elements), review of 2 organ systems, and no past/family/social history. What level of history is documented?
- Problem focused
- Expanded problem focused (Correct answer)
- Detailed
- Comprehensive
Correct answer: Expanded problem focused
An expanded problem focused history includes brief HPI (1-3 elements) or extended, problem pertinent ROS (1-2 systems), and no PFSH — but extended HPI with 2-system ROS also meets expanded problem focused.
Question 4: Which of the following is NOT a recognized setting for E/M services coded with office visit codes (99202–99215)?
- Patient's home used as an office
- Urgent care center
- Physician's private office
- Hospital inpatient room (Correct answer)
Correct answer: Hospital inpatient room
Hospital inpatient services use inpatient hospital care codes (99221–99223 initial, 99231–99233 subsequent), not office visit codes.
Question 5: A physician provides care and coordination for a patient with two or more chronic conditions via chronic care management. The physician spends 25 minutes in a calendar month. Which code is reported?
- 99490 (Correct answer)
- 99491
- 99487
- 99489
Correct answer: 99490
99490 is reported for the first 20 minutes of clinical staff time for CCM services in a calendar month for patients with 2+ chronic conditions.
Question 6: When coding an inpatient admission on the same day as an outpatient E/M visit at the same facility, how should the services be reported?
- Report both the outpatient E/M and the initial hospital care code
- Report only the initial hospital care code (99221–99223), incorporating all services from that date (Correct answer)
- Report only the outpatient E/M code with modifier -57
- Report the outpatient E/M and add modifier -25 to the hospital code
Correct answer: Report only the initial hospital care code (99221–99223), incorporating all services from that date
When a patient is admitted the same day as an outpatient visit, all services are combined and only the initial inpatient code is reported.
Question 7: A physician performs a 60-minute online digital E/M visit (patient-initiated) through a secure portal for an established patient. Which code is most appropriate?
- 99421
- 99422
- 99423 (Correct answer)
- 99441
Correct answer: 99423
99423 covers online digital E/M services for established patients requiring 21 or more minutes of cumulative physician/QHP time.
CPC Evaluation and Management Coding 5
A surgeon sees a patient in the office 10 days after an appendectomy.
This visit is within the global period.
How should this visit be coded?