150-Question Flashcard Prep Pack

A 4.2cm laceration of the forearm required closure of the subcutaneous tissue layer AND the skin. What type of repair is this and what code range applies?

• A.Simple repair (12001-12021) — single layer only
• B.Wound exploration — subcutaneous involvement is separate
• C.Complex repair (13100-13160) — reconstructive elements required
• D.Intermediate repair (12031-12057) — layered closure

EXPLANATION

Intermediate repair. Subcutaneous layer closure PLUS skin closure = layered = intermediate. Simple = single layer only. Complex requires reconstructive elements. CPT 12031-12057.

Tap card to flip back ↑

Patient has 2.0cm simple scalp repair AND 3.5cm simple neck repair. How is this coded?

• A.12002 — add lengths: scalp and neck are the same anatomical group, 2.0 + 3.5 = 5.5cm
• B.12002 only — use the largest wound
• C.12001 + 12002 — code each wound separately
• D.12011 + 12013 — face and neck are different groups

EXPLANATION

Add lengths: scalp and neck are in the SAME anatomical group (Group 1). Same type (both simple) = add together. 2.0 + 3.5 = 5.5cm = 12002.

Tap card to flip back ↑

Patient has a 2.5cm simple cheek repair AND a 3.0cm intermediate cheek repair. How are these coded?

• A.Add lengths and code intermediate only (12052)
• B.12052 only — intermediate includes simple by definition
• C.12052 + 12011 — code each type separately, most complex first, -51 on secondary
• D.12052 + 12011 with -51 on 12052

EXPLANATION

Different repair types = code each separately regardless of same location. Most complex first (intermediate 12052). Simple cheek 2.5cm = 12011 with modifier -51.

Tap card to flip back ↑

A 1.2cm benign lesion of the back is removed with a 1.6cm excision (including margins). What code applies?

• A.11401 — benign, trunk, 0.6-1.0cm (lesion size only)
• B.11305 — shave removal
• C.11600 — malignant lesion series
• D.11402 — excision benign lesion, trunk, 1.1-2.0cm (excision size with margins)

EXPLANATION

Excision of benign lesion, trunk. The diameter billed = lesion PLUS margins (1.6cm). 11402 = benign, trunk/extremities, 1.1-2.0cm. Malignant uses 11600 series.

Tap card to flip back ↑

Autograft is applied to a 30 sq cm wound on the thigh. The donor site is the patient's own lateral thigh. How many codes are reported?

• A.One code for the recipient site only
• B.Two codes — recipient site autograft + donor site repair if separately performed
• C.One code for the donor site only
• D.Three codes — autograft, donor site, and wound prep

EXPLANATION

Autograft requires separate coding of the recipient site; donor site repair may be a separate code if closure is performed. Procurement is typically included. CPT 15100 series.

Tap card to flip back ↑

A physician debrides a Stage 4 pressure ulcer down to and including muscle. What is the debridement depth classification?

• A.Skin, partial thickness (11042 series)
• B.Muscle and/or fascia (11043)
• C.Subcutaneous tissue (11042)
• D.Bone (11044)

EXPLANATION

CPT debridement codes are selected by the DEEPEST tissue removed. Debridement to muscle/fascia = 11043. Bone involvement would be 11044.

Tap card to flip back ↑

A malignant lesion excision on the face measures 0.8cm with 0.4cm margins on each side. What is the total excised diameter to code?

• A.0.8cm
• B.1.6cm
• C.1.2cm
• D.2.0cm

EXPLANATION

Malignant excision diameter = lesion size + margins on EACH side. 0.8 + 0.4 + 0.4 = 1.6cm.

Tap card to flip back ↑

Two malignant lesions are excised from the same arm: 1.0cm and 1.5cm (excised diameters). How are these reported?

• A.Two separate codes, one for each lesion, modifier -59 or -51 on the second
• B.One combined code using the total 2.5cm
• C.The larger lesion only
• D.Add lengths like a wound repair

EXPLANATION

Unlike wound repairs, lesion excisions are NEVER added together — each lesion excised is coded separately based on its own excised diameter.

Tap card to flip back ↑

A patient undergoes Mohs micrographic surgery on the nose. Which specialty distinction is essential for correct code selection?

• A.The size of the lesion only
• B.The location of the lesion only
• C.The physician acts as both surgeon and pathologist examining the tissue during the procedure
• D.Whether general anesthesia was used

EXPLANATION

Mohs surgery codes (17311-17315) require the same physician to act as both surgeon and pathologist, examining 100% of the tissue margins in real time — a distinguishing feature from standard excision.

Tap card to flip back ↑

A burn wound requiring debridement is reported by which key measurement?

• A.Depth of burn only
• B.Number of debridement passes
• C.Patient's total body surface area burned overall
• D.Total body surface area (%) debrided

EXPLANATION

Burn debridement codes are selected based on the percentage of total body surface area (TBSA) debrided, not the overall TBSA burned or number of passes.

Tap card to flip back ↑

Destruction of 15 skin tags is performed in one session. How is this coded?

• A.A single code for the first lesion + an add-on code for the remainder (e.g., first up to 15, add-on beyond that)
• B.One code per tag destroyed (x15 units)
• C.One flat code regardless of number destroyed
• D.Coded the same as an excision

EXPLANATION

Skin tag removal codes (11200-11201) are structured with a base code covering up to a set number of lesions and an add-on code for each additional group — not one code per single tag.

Tap card to flip back ↑

A physician performs a full-thickness skin graft to close a 25 sq cm defect on the hand after tumor excision. Is the recipient site preparation separately billable?

• A.Never — always included in the graft code
• B.Only for split-thickness grafts, not full-thickness
• C.Only if performed by a different physician
• D.Yes, if significant additional work (debridement or complex wound bed prep) was performed and documented separately from routine graft prep

EXPLANATION

Site preparation may be separately reported when significant additional work beyond the routine prep included in the graft code is documented — otherwise it is bundled into the graft code.

Tap card to flip back ↑

A tissue-cultured epidermal autograft (CEA) is applied. How does this differ from a standard split-thickness autograft in coding terms?

• A.No difference — same code series
• B.CEA is coded only as an unlisted procedure
• C.CEA codes are separate from standard autograft/allograft code series and are size-based
• D.CEA is never separately reportable

EXPLANATION

Cultured epidermal autografts have their own distinct CPT code series (15150-15157), separate from standard split/full-thickness autograft and allograft codes, and are also selected by size.

Tap card to flip back ↑

A patient with a distal radius fracture (skin intact) undergoes manual reduction without surgical incision and a cast is applied. What type of treatment is this?

• A.Open treatment — reduction was performed
• B.Percutaneous skeletal fixation
• C.Closed treatment with manipulation — no surgical incision, reduction performed
• D.Open fracture treatment — requires open code

EXPLANATION

Closed treatment with manipulation. No surgical incision = closed. Reduction was performed = with manipulation. Skin intact confirms closed treatment. CPT 25600.

Tap card to flip back ↑

A patient presents with a compound (open skin) tibia fracture. The surgeon opens the fracture site surgically, visualizes the bone ends, and applies internal fixation. What type of treatment is coded?

• A.Open treatment — the surgeon surgically opened and visualized the fracture site
• B.Closed treatment — the fracture was already open (compound)
• C.Percutaneous fixation — internal fixation was used
• D.Open fracture treatment code — compound fractures always use open codes

EXPLANATION

Open TREATMENT because the surgeon SURGICALLY OPENED the fracture site. The fracture being 'open' (compound) tells you nothing about treatment type. Code the treatment method. CPT 27758.

Tap card to flip back ↑

A physician injects a corticosteroid into the right knee joint under ultrasound guidance. How many CPT codes are reported?

• A.One code — joint injection only (20610)
• B.Two codes — joint injection (20610) + ultrasound guidance (76942)
• C.One code — ultrasound guidance only
• D.Three codes — injection + guidance + drug administration

EXPLANATION

Joint injection (20610) + ultrasound guidance (76942). 20610 does NOT include imaging — it is separately reportable. Modifier -RT for right knee.

Tap card to flip back ↑

A greenstick fracture of a pediatric forearm is treated with closed reduction and casting. 'Greenstick' describes:

• A.An incomplete fracture where the bone bends and partially breaks — common in children
• B.A fracture treatment method
• C.A type of open fracture
• D.A fracture requiring open treatment

EXPLANATION

Greenstick describes the fracture PATTERN (incomplete break, bone bends) — most common in pediatric patients whose bones are more flexible. It does not by itself dictate treatment type.

Tap card to flip back ↑

A patient undergoes total knee arthroplasty. Six weeks later, the same surgeon performs an unrelated procedure on the same knee. What modifier indicates this is unrelated to the original surgery during the global period?

• A.Modifier -58 (staged procedure)
• B.Modifier -79 (unrelated procedure by same physician during postop period)
• C.Modifier -78 (return to OR for related procedure)
• D.Modifier -76 (repeat procedure)

EXPLANATION

Modifier -79 = unrelated procedure/service by the same physician during the postoperative period. -58 = planned staged procedure. -78 = unplanned return to OR for a RELATED procedure/complication.

Tap card to flip back ↑

A patient has a closed treatment of a nasal fracture with stabilization performed without anesthesia. Which factor is key to code selection?

• A.Whether a splint was applied
• B.The mechanism of injury
• C.The patient's age
• D.Whether the treatment required general anesthesia and if manipulation was performed

EXPLANATION

Closed nasal fracture treatment codes differentiate based on whether manipulation was performed and whether the patient required anesthesia — these are key selection criteria.

Tap card to flip back ↑

During a total hip arthroplasty, the surgeon also harvests a bone graft from the same incision for use in the procedure. Is the bone graft harvest separately billable?

• A.Always billed separately with an add-on code
• B.Only if requested by the patient in advance
• C.Typically bundled/included unless obtained from a separate distant site requiring additional incision
• D.Bone grafts are never used in hip arthroplasty

EXPLANATION

Local bone graft obtained through the same operative incision is generally included in the primary procedure. A separate, distant-site bone graft harvest (e.g., iliac crest through a separate incision) may be separately reportable.

Tap card to flip back ↑

A patient undergoes diagnostic arthroscopy of the shoulder, and based on findings, the surgeon proceeds to an open rotator cuff repair through a separate incision in the same session. How is this coded?

• A.Diagnostic arthroscopy + open repair, both reported separately since the diagnostic scope changed the surgical approach/decision
• B.Diagnostic arthroscopy only
• C.Open repair only — arthroscopy is always bundled
• D.Neither — this must be billed as an unlisted procedure

EXPLANATION

When a diagnostic arthroscopy leads to a separate OPEN procedure (not a therapeutic arthroscopic extension of the same procedure), both may be reported since the diagnostic scope directly informed a distinct open surgical decision.

Tap card to flip back ↑

Application of an external fixation device as the primary means of fracture treatment (not an add-on to another fracture code) is reported using:

• A.An add-on code only, appended to a fracture treatment code
• B.A HCPCS Level II code only
• C.A stand-alone primary CPT code for external fixation application
• D.The same code as a cast application

EXPLANATION

When external fixation is the primary treatment method (not supplemental to an ORIF or other fracture code), it is reported with its own primary CPT code, not just as an add-on.

Tap card to flip back ↑

A patient undergoes carpal tunnel release. The approach used (open vs. endoscopic) affects code selection because:

• A.It does not affect code selection at all — one code covers both
• B.Open release always requires a modifier
• C.Endoscopic release is never a covered service
• D.Open and endoscopic carpal tunnel release have distinct, separate CPT codes

EXPLANATION

CPT distinguishes open carpal tunnel release from endoscopic carpal tunnel release with separate, distinct codes — approach directly determines code selection.

Tap card to flip back ↑

A patient has a displaced fracture requiring closed reduction under anesthesia in the OR (not the office), with fluoroscopic confirmation, but no incision made. How is the treatment classified?

• A.Open treatment, because it was done in the OR
• B.Percutaneous fixation, because fluoroscopy was used
• C.Closed treatment with manipulation — anesthesia location doesn't change treatment type; no incision was made
• D.Cannot be coded without an incision

EXPLANATION

Treatment type is defined by whether the fracture site was surgically opened, not by the setting (OR vs. office) or whether anesthesia/fluoroscopy was used. No incision = closed treatment.

Tap card to flip back ↑

During one colonoscopy session, the physician removes 3 polyps by snare technique and 1 by cold forceps. How are these coded?

• A.One code (45385) — primary technique only
• B.Four codes — one per polyp removed
• C.Two codes — one per technique used (snare + cold forceps)
• D.45385 x3 + 45384 — units for each polyp

EXPLANATION

Code one code per technique used, regardless of quantity per technique. Snare (45385) + cold forceps (45384 with -59). Never code by polyp quantity.

Tap card to flip back ↑

A surgeon performs a colonoscopy for screening. A polyp is found and removed by hot biopsy. The surgeon also performed a diagnostic colonoscopy at the beginning to visualize the colon. How many colonoscopy codes are reported?

• A.Two — diagnostic colonoscopy + therapeutic polypectomy
• B.One — therapeutic polypectomy only (45384) — diagnostic is bundled
• C.Two — screening code + polypectomy
• D.Three — screening, diagnostic, and therapeutic

EXPLANATION

The diagnostic colonoscopy is ALWAYS bundled into the therapeutic colonoscopy when the same scope is used. Code only the therapeutic procedure (45384).

Tap card to flip back ↑

During an EGD, the physician performs both a biopsy of a gastric lesion and control of bleeding from a separate site. How is this typically coded?

• A.Only the biopsy code — bleeding control is always bundled
• B.Neither is billable without a separate visit
• C.Only the bleeding control code
• D.Both procedures may be separately reported if performed at different, distinct sites/lesions, per CPT/NCCI guidance

EXPLANATION

When distinct procedures (biopsy vs. hemostasis) are performed at different sites/lesions during the same endoscopic session, both may be separately reportable per CPT guidance and modifier rules (e.g., -59), unlike same-lesion bundling.

Tap card to flip back ↑

An open cholecystectomy with exploration of the common bile duct is performed. This differs in coding from a simple open cholecystectomy because:

• A.CPT has a distinct, more comprehensive code for cholecystectomy WITH common bile duct exploration
• B.There is no code distinction — same code used
• C.It is always billed as two separate procedures with modifier -51
• D.Common bile duct exploration is never separately described in CPT

EXPLANATION

CPT provides a distinct, higher-level code specifically for cholecystectomy with exploration of the common bile duct, reflecting the additional work — it is not billed as two stacked procedures.

Tap card to flip back ↑

A hemorrhoidectomy involving both internal and external hemorrhoids in a single column is coded using:

• A.Two separate codes — one for internal, one for external
• B.The external hemorrhoidectomy code only
• C.The internal hemorrhoidectomy code only
• D.A single combined code that describes both internal and external hemorrhoidectomy when performed together

EXPLANATION

CPT includes combination codes describing simultaneous internal AND external hemorrhoidectomy — this reflects the actual combined procedure rather than stacking two separate codes.

Tap card to flip back ↑

A screening colonoscopy converts to a diagnostic/therapeutic colonoscopy when a polyp is found and removed. For a Medicare patient, which modifier indicates the screening intent despite the conversion?

• A.Modifier -PT (screening colonoscopy converted to diagnostic/therapeutic)
• B.Modifier -53
• C.Modifier -73
• D.Modifier -52

EXPLANATION

Modifier -PT is appended (Medicare) when a screening colonoscopy becomes diagnostic/therapeutic due to a finding — this preserves the patient's screening benefit/cost-sharing status.

Tap card to flip back ↑

A laparoscopic Nissen fundoplication is performed for GERD. If converted to an open procedure mid-surgery, how is this reported?

• A.Both laparoscopic and open codes, modifier -52 on the laparoscopic
• B.Only the laparoscopic code with a conversion modifier
• C.Only the open fundoplication code — the laparoscopic attempt is not separately billed
• D.Unlisted procedure code only

EXPLANATION

Consistent with the general rule for converted laparoscopic-to-open procedures: only the OPEN procedure code is reported; the laparoscopic attempt is not separately billable.

Tap card to flip back ↑

An esophagogastroduodenoscopy (EGD) with dilation of a stricture using a balloon is reported using:

• A.A specific EGD-with-dilation code (distinct from the diagnostic-only code) — therapeutic includes the diagnostic component
• B.The base diagnostic EGD code only
• C.Two codes: diagnostic EGD + dilation, always with -51
• D.An unlisted procedure code

EXPLANATION

CPT provides a distinct code for EGD with balloon dilation, which includes the diagnostic component of the exam — the base diagnostic EGD code is not separately billed alongside it.

Tap card to flip back ↑

A laparoscopic appendectomy is performed on a patient with a ruptured, gangrenous appendix. Does the complexity of the appendix (ruptured/gangrenous) change the CPT code from a routine laparoscopic appendectomy?

• A.Yes — there is a separate code/add-on for the more complex presentation
• B.No — CPT has one laparoscopic appendectomy code regardless of severity
• C.It changes the code only if converted to open
• D.It is coded using an unlisted procedure code

EXPLANATION

CPT does not differentiate the laparoscopic appendectomy code itself by ruptured/gangrenous status the way OPEN appendectomy codes distinguish 'for ruptured appendix' vs. routine — one laparoscopic code generally applies. (Note: severity may support modifier -22 for increased complexity.)

Tap card to flip back ↑

A patient undergoes percutaneous liver biopsy under ultrasound guidance. How many codes are typically reported?

• A.Two — biopsy plus separate ultrasound guidance always
• B.One — the biopsy code includes imaging guidance by CPT descriptor design in current codes
• C.Only the imaging guidance code
• D.Neither is separately billable

EXPLANATION

Current percutaneous liver biopsy CPT codes are typically imaging-guidance-inclusive by descriptor (guidance is bundled) — always check the specific code descriptor, as bundling imaging depends on how the code is written.

Tap card to flip back ↑

A physician sees an established patient with 2 stable chronic conditions and reviews external records from a specialist. Risk is determined to be low (OTC drug management). What is the MDM level?

• A.Low — 2 stable chronic conditions + limited data + OTC risk = Low MDM = 99213
• B.Straightforward
• C.Moderate
• D.High

EXPLANATION

Low MDM: 2 stable chronic conditions = Low complexity problems. Reviewing external records = Limited data (Low). OTC drug management = Low risk. Two elements at Low = Low MDM = 99213.

Tap card to flip back ↑

A patient saw a family medicine physician in a group practice 2 years ago. She now sees a different family medicine physician in the same group practice. What patient status applies?

• A.New patient — different physician
• B.Established patient — only if exact same physician
• C.New patient — more than 1 year has passed
• D.Established patient — same specialty, same group practice, within 3 years

EXPLANATION

Established patient. Same SPECIALTY (family medicine) + same GROUP PRACTICE within 3 years = established. The fact that it is a different physician does not change the status.

Tap card to flip back ↑

A patient presents for a scheduled trigger point injection. During the visit, the physician identifies and treats a new complaint of hypertension. How is the E/M coded?

• A.E/M coded with modifier -25 — significant separately identifiable E/M same day as minor procedure
• B.E/M coded with modifier -57
• C.E/M not separately billable — included in the injection
• D.E/M coded without a modifier

EXPLANATION

Modifier -25. The E/M for the new hypertension complaint is significant and separately identifiable from the trigger point injection (a minor procedure). -25 appended to the E/M code.

Tap card to flip back ↑

A patient is evaluated in the office. The physician decides the patient needs a total hip replacement tomorrow (major surgery, 90-day global). What modifier applies to today's E/M?

• A.Modifier -25
• B.No modifier required
• C.Modifier -57 — decision for major surgery on day of or day before procedure
• D.Modifier -24

EXPLANATION

Modifier -57. The E/M resulted in the decision to perform a MAJOR surgery (90-day global). -57 is used when the E/M on the day of or day before major surgery led to the surgical decision.

Tap card to flip back ↑

A physician documents total time of 35 minutes for an established patient office visit on the date of service. What code is reported?

• A.99213 (20-29 minutes)
• B.99212 (10-19 minutes)
• C.99215 (40-54 minutes)
• D.99214 (30-39 minutes) — 35 minutes falls in this range

EXPLANATION

99214. Established patient, time-based: 99213 = 20-29 min, 99214 = 30-39 min, 99215 = 40-54 min. 35 minutes = 99214.

Tap card to flip back ↑

Under the 2021 (current) E/M guidelines, 'data reviewed and analyzed' as an MDM element includes which of the following as one category?

• A.Physical exam findings
• B.Review of prior external notes from each unique source
• C.Patient's chief complaint
• D.Time spent counseling only

EXPLANATION

Data complexity is assessed across categories including review of notes/tests from each unique source, ordering/reviewing tests, and independent historian — NOT exam findings or chief complaint, which are separate from MDM data scoring.

Tap card to flip back ↑

A physician spends 10 minutes face-to-face and an additional 15 minutes later that same day reviewing labs and coordinating care for an established patient, with no separate service billed for the additional time. Under time-based E/M coding, what time is counted?

• A.Only the 10 minutes face-to-face
• B.The TOTAL time (face-to-face + non-face-to-face) personally spent by the physician on the date of the encounter = 25 minutes
• C.Only the 15 minutes of non-face-to-face work
• D.Time-based coding cannot include non-face-to-face time

EXPLANATION

Since 2021, total time on the date of the encounter includes both face-to-face AND non-face-to-face time personally spent by the physician (e.g., chart review, care coordination) performed that same day.

Tap card to flip back ↑

A new patient visit involves straightforward MDM but the physician spends 70 minutes with the patient due to extensive counseling. Which is the correct approach?

• A.Code based on MDM only, ignoring time since MDM is straightforward
• B.Use prolonged service codes only, no base E/M code
• C.Time can never override a straightforward MDM level
• D.Code based on whichever is higher — MDM level OR total time — so the higher time-based level would apply

EXPLANATION

Since 2021, code level for office/outpatient E/M is based on MDM OR total time, whichever supports the HIGHER level — even if MDM alone would be lower.

Tap card to flip back ↑

Prolonged service add-on codes for office/outpatient E/M (99417 or similar) are reported when:

• A.Any additional time beyond the typical time is documented, regardless of amount
• B.The visit involves a new problem only
• C.Total time exceeds the maximum time of the highest-level base code (e.g., 99205/99215) by the required threshold increment
• D.Only for Medicare patients

EXPLANATION

Prolonged service add-on codes apply only once time EXCEEDS the maximum time threshold of the highest-level base code (99205 for new, 99215 for established) by the required increment — not for any minor extra time.

Tap card to flip back ↑

A physician sees a hospital inpatient and the level of service is based on MDM only (not time) under current guidelines. Which best reflects the current (2023+) inpatient/observation E/M framework?

• A.Inpatient E/M still requires History + Exam + MDM under old 1995/1997 guidelines
• B.Observation and inpatient codes were eliminated entirely
• C.Inpatient E/M cannot be time-based under any circumstance
• D.Inpatient and observation E/M codes now also use MDM or time, aligned with the office/outpatient model

EXPLANATION

The MDM/time framework was extended beyond office/outpatient visits to most other E/M categories (inpatient, observation, nursing facility, etc.) in subsequent CPT updates, aligning the approach across E/M code families.

Tap card to flip back ↑

Which MDM risk element would most likely elevate a visit to 'High' complexity?

• A.Decision regarding hospitalization or escalation of care to a higher level of care
• B.Prescription drug management with routine monitoring
• C.Over-the-counter medication management
• D.Ordering a single routine lab test

EXPLANATION

Decision for hospitalization/escalation of care is a hallmark of HIGH risk in the MDM risk column. OTC management and routine monitoring are typically Low; single routine labs contribute to data complexity, not risk directly.

Tap card to flip back ↑

A physician provides a preventive medicine visit (99396) and during the same visit addresses a significant new complaint requiring separate management (e.g., new onset chest pain worked up separately). How is the additional service coded?

• A.Not separately billable — preventive visits are always all-inclusive
• B.Only the preventive code is billed, and the complaint is addressed at a future visit
• C.A separate problem-oriented E/M code with modifier -25 may be reported in addition to the preventive code
• D.The complaint requires modifier -59, not -25

EXPLANATION

When a significant, separately identifiable problem is addressed during a preventive visit, a problem-oriented E/M code with modifier -25 may be reported in addition to the preventive medicine code.

Tap card to flip back ↑

For a new patient, which MDM element combination would most likely support a 99204 (moderate MDM) level?

• A.One or more chronic illnesses with exacerbation, moderate amount/complexity of data, prescription drug management (moderate risk)
• B.Self-limited problem, minimal data, minimal risk
• C.Two or more self-limited problems only, no data reviewed
• D.Stable chronic illness only, no risk factors

EXPLANATION

Moderate MDM typically requires at least moderate complexity in TWO of the three MDM elements — e.g., a chronic illness with exacerbation (moderate problem), moderate data review, and prescription drug management (moderate risk).

Tap card to flip back ↑

A telehealth E/M visit is billed using standard office/outpatient codes (99202-99215) with the appropriate place-of-service and modifier. Which modifier commonly indicates a synchronous audio-video telemedicine service?

• A.Modifier -25
• B.Modifier -76
• C.Modifier -59
• D.Modifier -95

EXPLANATION

Modifier -95 indicates synchronous telemedicine service rendered via real-time audio and video communication, appended to the appropriate E/M or other eligible CPT code.

Tap card to flip back ↑

An online digital E/M service (e-visit) via a patient portal for an established patient, when the cumulative time over 7 days is 18 minutes, is reported using which code range logic?

• A.Standard office visit codes (99213)
• B.Telephone E/M codes only
• C.Digital E/M service codes (99421-99423), tiered by cumulative time over a 7-day period
• D.This scenario is never separately billable

EXPLANATION

Online digital E/M services for established patients use a distinct code set (99421-99423), tiered by cumulative time over a rolling 7-day period, separate from telephone-only codes.

Tap card to flip back ↑

A patient is seen for an emergency department visit. ED E/M codes (99281-99285) differ from office visit codes primarily because ED codes:

• A.Distinguish new vs. established patients
• B.Are based purely on time, never MDM
• C.Do not distinguish new vs. established patient status — all ED patients use the same code range
• D.Require a separate code for every diagnosis addressed

EXPLANATION

Emergency Department E/M codes do NOT differentiate between new and established patients — the same code range (99281-99285) applies to all ED patients, unlike office/outpatient codes.

Tap card to flip back ↑