1) How is "a self-limited or minor problem" defined?
A) A problem that runs a definite and prescribed course,
is transient in nature, and is not likely to permanently
alter health status.
2) How is "a stable, chronic illness" defined?
A) A problem with an expected duration of at least a
year or until the death of the patient. For the purpose of
defining chronicity, conditions are treated as chronic
whether or not stage or severity changes (eg,
uncontrolled diabetes and controlled diabetes are a
single chronic condition).
3) How is "an acute, uncomplicated illness or injury"
defined?
A recent or new short-term problem with low risk of
morbidity for which treatment is considered. There is
little to no risk of mortality with treatment, and full
recovery without functional impairment is expected.
A problem that is normally self limited or minor, but is
not resolving consistent with a definite and prescribed
course is an acute uncomplicated illness.
4) Who qualifies as an independent historian?
A) An individual (e.g., parent, guardian, surrogate,
spouse, witness) who provides a history in addition to a
history provided by the patient who is unable to provide
a complete or reliable history (e.g., due to
developmental stage, dementia, or psychosis) or
because a confirmatory history is judged to be
necessary.
5) Does a letter to the referring source count for
discussion of management or test interpretation with
external physician/QHP or appropriate source?
A)No. To qualify, discussion requires two-way
communication.
6) How is "appropriate source for the purpose of the
discussion of management" defined?
An appropriate source includes professionals who are
not health care professionals, but may be involved in
the management of the patient (e.g., lawyer, parole
officer, case manager, teacher). It does not include
discussion with family or informal caregivers.
7) What are "social determinants of health?"
A) Economic and social conditions that influence the
health of people and communities. Examples may
include food or housing insecurity.
8) How will approach 99203/99213 according to new
2025 update?
A) To code 99203 the MDM should be Low, The
number of presenting problems should be 2 or more
self- limited problems or 1 stable chronic illness or 1
acute uncomplicated injury should be documented,
from Data Review out of 2 categories one category
should be documented, The risk should be low.
9)How will you approach 99204/99214 according to
new 2025 update?
Ans: To code 99204 the MDM should be moderate. The
number of presenting problems should be 1 or more
chronic illness with exacerbation or Side effects of
treatment or 2 or more stable chronic illness, 1 acute
complicated injury should be documented, from Data
review out 3 categories at least 1 category should be
documented, the risk should be moderate.
10)What are the updates of CPT 2025 in E&M ?
ANS:The CPT 2025 updates, effective January 1, 2025,
include
270 new codes,
38 revisions, and
112 deletions
One of the most significant changes is the introduction
of 17 new telemedicine codes, categorized by real-time
audio video and audio-only encounters. The service
must be performed by a physician or qualified health
care professional (QHP). Codes selected are based on
whether the patient is new or established and whether
medical decision-making (MDM) or time is used to select
the level for the service
11)How will you code consultations?
Ans: To code consultations 3R are required. Referring
Physician, rendering physician, Report. Medicare
doesn’t covers consultation. In case medicare
consultations we will code it as new patient or
established patient visits. The code for the consultations
are 99242 to 99245.
12)How will you code critical care?
Ans: To code critical care the patient should be critically
injured, critical interventions should be done, critical
care time should be documented. We have 2 codes for
critical care 99291, 99292.
If the time is given 30 -74 minutes we will code 99291.
For each additional 30 minutes above 74 minutes we
need to code 99292 additionally.
13)What are the inclusive/ bundled procedures of
critical care?
Ans: Chest Xray, pulse oximetry, ventilator
management, vein puncture, Blood gases, Gastric
intubation.
14)What are the exclusive procedures of critical care?
Ans: Central line placement, Cardioversion, ET
intubation, Tubethoracostomy, lumbar puncture, CPR.
15)30 minutes of critical care in that 20 minutes was
spent on tube placement. How will code this scenario?
Ans: In this case we don’t code critical care but will code
new/ established patient according to the
documentation because the time spent for procedure in
critical care should be excluded from total critical care
time.
16)How will you code preventive medicine/ annual
visits?
Ans: Annual visits are preventive visits. To code
preventive medicine services we need to check patient’s
age and whether the patient is new patient or
established patient. The code set for new patient’s
preventive care is 99381 to 99387, The code set for the
established patient’s preventive care is 99391 to 99397.
For medicare patient we will code G0438 for initial visit,
G0439 for subsequent visits.
17)What is modifier 24?
Ans: Un-related E&M service during the post
operative period.
18)What is Modifier 25?
Ans: Significant procedure during the E& M ( Minor
surgery)
19)What is modifier 57?
Ans: Decision for major surgery during the E&M,
The surgery should be done with 48 hours of visit.
20)What is modifier 51?
Ans: Multiple procedure during the same session. For
example laceration repair of hand & epistaxis
procedure are performed in same session we append 51
modifier.
21)What is modifier 52?
Ans: Modifier 52 is reduced service . For example if
foreign body is removed partially we will append 52
modifier.
22)What is modifier 59?
Ans: Distinct procedure : If one procedure is inclusive in
another procedure we will append 59 to lowest
procedure by using NCCI edits.
23)What is modifier 76?
Ans: Repeated procedure by the same physician
24)What is 77 modifier?
Ans: Repeated procedure by the different physician
25)What is 95 Modifier?
Ans: Modifier 95 is a tele-health modifier. If any E&
M service is performed by using audio or video we will
consider it is tele-health service. We will append 95
Modifier.
26)What is GC modifier?
Ans: Teaching physician: in any fellowship doctors,
students involved in the services we wil append GC
modifier (medicare). The documentation like ,I reviewed
the record & I agreed with Doctor findings.
27)What is CS modifier?
Ans: If medicare patient is identified with Covid -19
positive we will append CS modifier to E&M.
28)What is a pathological fracture?
Ans:If the fracture is due to other diseases then it called
pathological fracture. Examples are fracture due to
osteoporosis or fracture due to neoplasm.
29)Patient is suffering from Anemia & malignancy. And
anemia is being treated today. How will ou code this
scenario?
Ans: Malignancy should be primary code, Anemia
should be secondary code.
30)Patient is suffering from Dehydration &
malignancy. And Dehydration is being treated today.
How will ou code this scenario?
Ans: Dehydration should be coded as Primary code,
malignancy should be secondary code.
31)What is myocardial infarction?
Ans: Myocardial infarction means death of heart tissue
due to blockage of blood vessel or lack of blood supply.
32)How will you code subsequent myocardial
infarction?
Ans: For example the patient admitted in hospital with
Acute myocardial infarction of anterior wall and within 4
weeks of time the patient inferior wall also effected,
then we will code AMI of anterior wall and subsequent
AMI of inferior wall.
33)What are the key components of E&M?
Ans; History, Physical examination, Medical Decision
Making
34)What are the elements of History?
Ans: History has 3 elements
HPI, ROS , PFSH
35)Explain about ROS
Ans: ROS is review of systems. We have 14 ROS . three
types of ROS are there
Problem pertinent- 1 ROS
Extended ROS: 2-9 ROS
Complete ROS: 10 or 10+ ROS should be documented
36)What is principle diagnosis?
Ans: The condition established after study to be chiefly
responsible for occasioning the admission of the patient
to the hospital for care.
37)What is Modifier?
Ans: To indicate that service or procedure that has been
performed and has been altered by some specific
circumstance but not changed in its definition or code.
38)What are the types of repairs?
a. Simple Repair: Involving primarily epidermis or
dermis, or subcutaneous tissue without significant
involvement of deeper structures and requires one layer
closure.
b. Intermediate Repair: Require one or more of the
deeper layers of the subcutaneous tissue and superficial
fascia and heavily contaminated for this requiring
extensive cleaning.
c. Complex Repair: For this require more than layered
closure Ex: scar revision, debridement.
39)What is 24, 57,62 and 73 modifier?
a. 24 – Unrelated Evaluation and Management Service
by the Same Physician during a Postoperative Period
57 – Decision for Surgery
62 - Two Surgeons
73 - Discontinued Outpatient Hospital/Ambulatory
Surgery Center (ASC) Procedure prior to the
Administration of Anesthesia
40)What is abbreviation of NCC coding and use?
a. NCCI- National Correct Coding Initiative.
Used for identifying bundling and unbundling of
services.
41)What is a medical necessity review?
Ans:A medical necessity review is an assessment of
whether a particular healthcare service or procedure is
appropriate and necessary for the patient's condition. It
ensures that the service is justified and not medically
unnecessary, preventing unnecessary costs and
improving healthcare efficiency.
42)What is transitional care management (TCM)?
Ans:Transitional care management is a medical billing
option that reimburses billing practitioners for treating
patients with a complex medical condition during their
30-day post-discharge period.
Key elements: Admission date, discharge date.
43)What is double dipping?
Ans: Some time we extrat Ros from HPI. But we should
not considered one symptom for both HPI&ROS. If we
pull that is called as double dipping.
44)What is up coding and Down coding?
Ans:
UPCODING:Involves billing for a more expensive service or
procedure than what was performed.
Down coding: Involves billing for a less expensive service
or procedure than what was actually provided.
45)What is OTC and Prescribed drugs with examples?
OTC medications are drugs that can be purchased over the
counter, meaning they don't require a prescription from a
doctor.
EX: Pain relievers: Acetaminophen (Tylenol),
Antacids: Cimetidine (Tagamet), omeprazole,
Laxatives: Bisacodyl (Dulcolax)
Prescription Medications: Prescription medications
require a written order (prescription) from a licensed
healthcare professional before they can be dispensed.
EX:Antibiotics: Penicillin, amoxicillin, cephalexin
Medications for diabetes: Insulin, metformin,
Psychiatric medications: Antidepressants, antipsychotics
Medications for chronic pain: Opioids.
46)What is Elective Major surgeries with examples?
Elective major surgery refers to a planned surgical
procedure, not performed due to an immediate medical
emergency, that involves significant risk and requires a
longer recovery period than minor surgeries. Examples
include organ transplants, open-heart surgery, and
some cancer surgeries
47)What is Nuclear&Parentral control medication?
Ans: The parenteral administration of drugs means to
inject them into the body via ID, SubQ, IM, or IV routes
in order to bypass the first pass metabolism in the liver..
EX: Amoxicillin, Beta-methasone, Calcium Chloride,
Cefadroxil,Chloramphenicol.
In medical coding, Nuclear Medication refers to the use
of radioactive substances, called radiopharmaceuticals
or radio-tracers, for diagnosis and treatment of various
diseases.
48)What is place of services codes, with examples?
Ans:In medical coding, Place of Service (POS) codes
are two-digit numeric codes that identify the location
where healthcare services were provided. These codes,
developed by the Centers for Medicare and Medicaid
Services (CMS).
There are two tele health-specific places of service
(POS):
POS 02 is used for tele- health services provided in a
location other than the patient’s home.
POS 10 is used for tele health services provided to a
patient located in their home.
49)what is global period?
Ans: Global period as that period of time during which a
physician may not bill for related office visits.
The global period may be 90, 10, or 0 days. According to
Medicare, a major surgery has a global period of 90
days, and a minor surgery has a global period of either
10 or 0 days.
50)what is the updates for ICD 2025?
Ans:New ICD-10-CM Codes for 2025
252 new codes.
36 code deletions.
13 code revisions.
51)What is definitive diagnosis?
A definitive diagnosis is the final and confirmed
diagnosis after investigations.
52)What is the difference between 1995 and 1997 E/M
guidelines?
Ans:The 1995 guidelines provide more general
documentation requirements for history and
examination, while the 1997 guidelines are more
specific and include detailed "bullet points"
53)What is FS Modifier?
Ans: This modifier is used when an E/M service is
provided jointly by a physician and a non-physician
practitioner (NPP) in a facility setting.
54)What are the modifiers used in E/M services?
Ans: 24, 25 and 57 modifiers.
