E/M OP Interview Important Q&A In 2025

E/M OP Interview Important Q&A In 2025

1.What are the denials

Denial codes serve as the key to unraveling the mystery behind these claim rejections, providing vital information about the reasons behind the denials.

2.What is medi care insurance?

Medicare is a federal health insurance program in the United States that provides coverage for people who are 65 or older, or under 65 and meet certain criteria:

• Receiving Social Security Disability Insurance (SSDI) for a specific amount of time
• Having End-Stage Renal Disease (ESRD), which is permanent kidney failure that requires dialysis or a transplant
• Having ALS, also known as Lou Gehrig’s disease

3.Difference between new patient establishment ?

New patient

A patient is considered new if they have not received professional services from the same physician or group practice within the past three years.

Established patient

A patient is considered established if they have received professional services from the same physician or group practice within the past three years.

4.NDC toggle

National Drug Codes (NDC)  The code is present on all nonprescription (OTC) and prescription medication packages and inserts in the US.

4.Medical necessity

Medical necessity is a legal doctrine that determines if a healthcare service or treatment is reasonable, necessary, and appropriate for a patient’s condition. It’s based on evidence-based clinical standards of care, medical standards, and the patient’s individual needs

5.Arthrocenthesis

Arthrocentesis (also called joint aspiration) is a procedure where a doctor uses a needle to take fluid out of a joint

6. I &D

Incision and drainage (I&D) is a surgical procedure that involves cutting into the skin to drain pus or fluid from an infected area.

What is modifier in medical coding?

A medical coding modifier is a two-character alphanumeric code that adds more information about a medical procedure, service, or supply without changing the code’s meaning. Modifiers are used to:

Provide more detail about the procedure or service

Indicate that a service was performed differently than described by the code

Provide details not included in the code, such as the anatomic location of the procedure

7.Difference between Exacerbation and severe Exacerbation.

Exacerbation

A general term for a worsening of respiratory symptoms that requires additional therapy. Exacerbations can be mild, moderate, or severe:

• Mild: Treated with short-acting bronchodilators
• Moderate: Treated with short-acting bronchodilators, antibiotics, and/or oral corticosteroids
• Severe: Requires hospitalization or an emergency room visit

Severe exacerbation

• An exacerbation that requires hospitalization or leads to respiratory failure. Severe exacerbations are associated with increased mortality.

How to identify Exacerbation as a coder and example.

The first definition of COPD exacerbation dates to the 1980s and was a symptom-based definition focused exclusively on three cardinal symptoms, i.e. the “increase or onset of shortness of breath, sputum production and/or sputum purulence”

COPD exacerbation with emphysema” is assigned code J43. 9

The condition Exacerbation leads to what?

Exacerbations can lead to serious complications, including:

• Reduced lung function: Exacerbations can cause a temporary or permanent reduction in lung function.
• Hospitalization: Exacerbations can lead to hospitalization, and account for a high proportion of the costs of COPD.
• Decline in quality of life: Exacerbations can lead to a decline in quality of life.
• Death: In rare cases, exacerbations can lead to death.

Exacerbations are a key feature of chronic obstructive pulmonary disease (COPD). They are usually caused by infections, such as those caused by bacteria or upper respiratory tract viruses.

What is MI?

MI can refer to myocardial infarction, which is the medical term for a heart attack, or mile.

What are the treatment options for MI?

• Medications: Aspirin, nitrates, beta blockers, calcium channel blockers, ACE inhibitors, statins, and other blood thinners
• Procedures: Balloon angioplasty, atherectomy, bypass surgery, or clot-dissolving drugs
• Pain relief: Opiates like morphine or meperidine
• Anti-emetics: Cyclizine or metoclopramide to prevent nausea and vomiting
• Anxiolytics: Diazepam to help with anxiety

What is the ICD guidelines for neoplasms?

Neoplasm : A new growth of abnormal tissue that is often uncontrolled and progressive These are commonly called as tumors or cancers,
Technically neoplasm is a nothing but abnormal division of cells from the tissue and formed as tumor
Mainly neoplasms have two behaviors
a) Benign
b) Malignant
a) Benign : The benign tumors are not cause any harm to us
b) Malignant : The malignant tumors highly dangerous and causes to death and these are spread from one place to another

What is the meaning of metastatic?

The spread of cancer cells from the place where they first formed to another part of the body. I

Why we are called parenteral control substances.

Parenteral – substance administered/given by a route other than the alimentary canal.

Number of problem addressed in high ?

What are meaning of drugtherapy ?

Drug therapy, also known as pharmacotherapy, is the use of medications to treat or prevent diseases, conditions, or abnormal symptoms:

Drug therapy can be used to treat a wide range of conditions, including cancer, HIV, diabetes, tuberculosis, mental health disorders, heart disease, arthritis, chronic pain, and addiction.

Minor procedure

A minor procedure is a surgical procedure that is minimally invasive and doesn’t pose a significant risk to the patient:

• Cataract surgery.
• Dental restorations.
• Circumcision.
• Breast biopsy.
• Arthroscopy.
• Laparoscopy.
• Burn excision and debridement procedures.

Critical care

Critical care is the direct delivery by a physician of medical care for a critically ill or critically injured patient.
A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in
the patient’s condition.
Critical care involves high complexity decision making to assess, manipulate, and support vital system functions to treat single or multiple vital organ system
failure and to prevent further life threatening deterioration of the patient’s condition.

Cerumen impaction procedure

Cerumen impaction, or earwax blockage, can be treated with a variety of methods, including:

Code 69209 is reported when irrigation and/or lavage is used to remove impacted cerumen. This method uses a continuous flow of liquid (eg, saline, water) to loosen impacted cerumen and flush it out with or without the use of a cerumen softening agent.

Pneumoccal vaccine code

The Current Procedural Terminology (CPT) codes for pneumococcal vaccines are:

• 90669: Pneumococcal conjugate vaccine, 7 valent, for intramuscular use
• 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
• 90671: Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use
• 90677: Pneumococcal Conjugate vaccine, 20 valent (PCV20)
• 90684: Pneumococcal Conjugate vaccine, 21 valent (PCV21)
• 90732: Pneumococcal polysaccharide vaccine, 23 valent (PPSV23)

I & M vaccine code

PSA test

A prostate-specific antigen (PSA) test is a blood test that measures the amount of PSA in your blood:

And what is the changes In 2024 sepsis guidelines

New guidelines for the first time place increased emphasis on improving care for sepsis patients after they are discharged from the intensive care unit. Recommendations for survivors of sepsis or septic shock include assessment and follow-up for physical, cognitive, and emotional problems after hospital discharge.

What is modifiers using of E/M

• Modifier 25
• Used when a physician performs a surgical procedure, lab, X-ray, or supply code on the same day as an E/M service. The physician must provide separate documentation of the E/M service and the non-E/M service.

• Modifier 24
• Used to indicate that an E/M service is unrelated to a previous procedure. This modifier is used when the E/M service is provided during the global period by the same physician or other qualified healthcare professional.

• Modifier 57
• Used when an E/M service is provided within three days before or on the same day as a procedure with a 90-day global period. This is common when urgent surgical treatment is required.

• Modifier 54
• Used when one physician performs a surgical procedure and another provider performs preoperative and/or postoperative management.

• Modifier 55
• Used when the surgeon transfers postoperative care to another provider. The receiving provider bills the surgical code with modifier 55.

• Modifier 56
• Used when a physician or other qualified healthcare professional performs preoperative care but does not provide intraoperative or postoperative services.

Hypertension guidelines

Hypertension :
The classification presumes a causal relationship between
a) hypertension with heart involvement and → I11 series
b) hypertension with kidney involvement and → I12 series
c) hypertension with heart and kidney involvement → I13 series
as the two conditions are linked by the term “with” in the Alphabetic Index. These conditions should be coded as related even in the absence of
provider documentation, unless the documentation clearly states the conditions are unrelated
For hypertension and conditions not specifically linked by relational terms such as “with,” “associated with” or “due to” in the classification,
provider documentation must link the conditions in order to code them as related.

Explain moderate example in medical coding

Moderate Risk. One or more chronic illness with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem with uncertain prognosis (e.g., lump in breast) Acute illness with systemic symptoms (e.g., pyelonephritis, pneumonitis, colitis.

Patient presents with a breast lump. Biopsy and ultrasound planned. Patient with moderate exacerbation of Crohn’s disease. Patient with no risk factors assessed in ED, needs surgery for a hernia repair, scheduled within the next few weeks

I & M vaccine code

When appropriate, the add-on code 90461 is included for each additional antigen contained per vaccine. 90471 – 90474. Codes in this range correspond to:.

PSA test

A prostate-specific antigen (PSA) test is a blood test that measures the amount of PSA in your blood:

And what is the changes In 2024 sepsis guidelines

New guidelines for the first time place increased emphasis on improving care for sepsis patients after they are discharged from the intensive care unit. Recommendations for survivors of sepsis or septic shock include assessment and follow-up for physical, cognitive, and emotional problems after hospital discharge.

Independent historian

A person who provides a patient’s history An independent historian is someone who provides a history of a patient in addition to the patient’s own history. Examples of independent historians include: A parent, A guardian, A spouse, A surrogate, and A witness

Independent interpretation

Independent interpretation is when a medical provider personally reviews and documents their interpretation of a diagnostic test, such as an image, specimen, or tracing:

• Review
• The provider must examine the actual images, slides, or tracings themselves, not just rely on a report from another professional.

Each unique test

A unique test is a test that is defined by a CPT code set and is considered a single test, even if it has multiple laboratory values. For example, if a provider orders serial glucose testing over several hours or days and compares the results during an E/M service, this is considered one unique test.

Each unique source

“A unique test is defined by the CPT code set. When multiple results of the same unique test (eg, serial blood glucose values) are compared during an E/M service, count it as one unique test.

Social determinants

Overview. The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

AWV

What Is G0439? G0439 is the HCPCS code you should use for all subsequent annual wellness visits. Its long descriptor is “Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit,” while its short descriptor is “Annual wellness subseq.”

laceration

A laceration is a cut or wound in the skin that’s caused by tearing, stretching, or shearing forces. Lacerations are often irregular and jagged, and can be contaminated with bacteria and debris from the object that caused the cut.

incision and drainage explanation

Incision and drainage (I&D) is a medical procedure that involves making a small cut to release pus or fluid from a localized infection under the skin. It’s a common treatment for abscesses, cysts, and other infections.

Medicare guidlines G0402,G0438,G0439 definations

G0402, G0438, and G0439 are HCPCS codes used to bill Medicare for Annual Wellness Visits (AWVs) and Initial Preventative Physical Examinations (IPPEs):

• G0402
• The code for an Initial Preventative Physical Examination (IPPE). Claims for this code can’t be billed more than once in a lifetime or more than 12 months after the beneficiary’s first part B coverage.

• G0438
• The code for the initial Annual Wellness Visit (AWV), which includes a personalized prevention plan (PPPS). Claims for this code can’t be billed more than once in a lifetime.

• G0439
• The code for subsequent AWVs, which includes a PPPS. Claims for this code can’t be billed within 12 months of G0438 or G0439.

Arthrocentesis definition and cpt codes

Arthrocentesis is a procedure that involves injecting a needle into a joint or bursa to inject medication or aspirate fluid. The CPT codes for arthrocentesis are 20600–20615, and are categorized based on the type of joint or bursa and whether ultrasound guidance is used:

 What is BC modifier

Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code.

Mdm table risk

 What is the prolonged service code? when to use prolonged service code?

1.Service given by a provider, which involve time beyond what is usual for such service.

This can be added with 99205 or 99215 .

99417- for each additional 15 min

2.For medicare G2212 for each additional 15 min.

What is meant by acute illness with systemic symptom?

An illness that cause systemic symptoms (symptoms affecting one or more organ systems ) and has high risk of morbidity without medical intervention.

These systemic symptoms are not general like fever, bodyache or fatigue. It should be single system. Example- pneumonia.

Discussion of management explanation

• Mdm table brief explanation
• Table b
• 6) Explain Moderate level In Table A, B & C
• 8) em level calculate

ICD-10 CM Conventions

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