CPC Evaluation and Management (E/M) 3

Question 1

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

Accepted Answer

99281–99285

Answer

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

Question 2

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?

Accepted Answer

99223

Answer

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

Question 3

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

Accepted Answer

At least 2 of 3 key components

Answer

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

Question 4

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?

Accepted Answer

Modifier 24

Answer

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

Question 5

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?

Accepted Answer

Modifier 57

Answer

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).

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CPC Evaluation and Management (E/M) 3