hat HCPCS Level II code is used to report 80 mg of a Depo-Medrol used for osteoarthritis of
the knees? - ✔✔J1040
Rationale: Look in the HCPCS Level II Table of Drugs and Biologicals for Depo-Medrol referring
you to See Methylprednisolone acetate. Look in the Table of Drugs and Biologicals for
Methylprednisolone acetate 80 mg referring you to J1040. Next look in the listing for J1040 to
verify and you will see Depo-Medrol listed below the code descriptor.
A 7 year-old patient with asthma was experiencing acute exacerbation of his condition. The
parents rushed their son to the emergency department where the ED physician performed a
midlevel E/M service. In addition, an albuterol treatment was performed. When the patient was
stabilized, he was released in good condition to his parents. What modifier is appended to the
E/M service for the facility? - ✔✔25
Rationale: Modifier 25 is used to report an E/M service was performed on the same day of a
procedure, but is separately identifiable from the procedure. For example, a patient is treated
in the ED after a car accident and sustained multiple contusions, a stiff neck, and a laceration
requiring repair. The ED visit reported for the facility resources would have modifier 25
appended to indicate the ED visit was separately identifiable from the laceration repair (99285-
25, 12011). It may also be necessary to report an E/M service in addition to drug
administration. When this is the case, modifier 25 would be appended to the E/M service to
indicate that it is separately identifiable from the drug administration service.
According to Medicare, which modifier should always be appended to the emergency
department E/M code when a procedure/service is also provided? - ✔✔25
, Rationale: Modifier 25 is used to report an E/M service was performed on the same day of a
procedure, but is separately identifiable from the procedure. For example, a patient is treated
in the ED after a car accident and sustained multiple contusions, a stiff neck, and a laceration
requiring repair. The ED visit reported for the facility resources would have modifier 25
appended to indicate the ED visit was separately identifiable from the laceration repair (99285-
25, 12011). It may also be necessary to report an E/M service in addition to drug
administration. When this is the case, modifier 25 would be appended to the E/M service to
indicate that it is separately identifiable from the drug administration service.
odifier 51 is used for multiple procedures. Is this modifier used in the outpatient facility or ASC?
What appendix in the CPT ® codebook helps you determine this? - ✔✔No. Appendix A
Rationale: In the CPT ® codebook, Appendix A lists full descriptions of modifiers. There is a
section specifically for Hospital Outpatient and ASC services. Modifier 51 is not indicated for
Hospital Outpatient or ASC services.
When multiple E/M encounters are performed on the same day in the same revenue
center, what modifier and condition code must be used? - ✔✔27; G0
Rationale: Modifier 27 indicates multiple outpatient hospital E/M encounters are performed
on the same date of service. When both E/M encounters have the same revenue center code,
condition code G0 must be on the claim.
What is the reported HCPCS code for a diaphragm for contraceptive use? - ✔✔A4266
Rationale: Look in the HCPCS Level II Index for Contraceptives/Diaphragm referring you
to A4266. Verify this code.
What is the CPT® code for a laparoscopic appendectomy? - ✔✔44970
Rationale: Look in the CPT ® Index for Appendectomy/Laparoscopic referring you to 44970.
Always check the code in the numeric section.
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