E/M (20%)

Cardiologist Office Visit - New Patient CC: CHEST ACHES-tightness History: Patient has chest pain. Describes it as being tight. Shortness of breath and fatigue. Occasional pain in both arms. Started with these symptoms a month ago. Has been under a lot of pressure from work. Family History: Sister with Wolf-Parkinson-White syndrome. Review of Systems Constitutional: Positive for fatigue Respiratory: Positive for dyspnea Cardiovascular: Negative for edema, orthopnea, PND; positive for chest pain, dyspnea, palpitations PHYSICAL EXAM Vital Signs: BP 120/86 sitting, left arm General/Constitutional: No apparent distress. Well-nourished and well developed. Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions. Neck/Thyroid: Supple, without adenopathy or enlarged thyroid. Respiratory: Normal to inspection. Lungs clear to auscultation. Cardiovascular: Regular rhythm. No murmurs gallops or rubs. Assessment/Plan Chest pain consistent with anxiety. Will need to order further tests to confirm. EKG ordered. CBC ordered. Chest CT scan ordered. Prescription given of isosorbide dinitrate (tablets) to relieve the chest pain. What is the E/M visit and ICD-10-CM codes to report? A. 99203, R07.9 B. 99203, F41.9 C. 99204, F41.9 D. 99204, R07.9

D (99204, R07.9) 1. Using the AMA CPT® Guidelines for Instructions for selecting a level of office or other outpatient services table 2 in your CPT® code codebook:· Moderate for number and complexity of problem addressed at the encounter - 1 undiagnosed new problem with uncertain prognosis (patient has chest pain, but doctor is not sure if it is due to anxiety and needs to order further tests to find out).· Moderate for amount /or complexity of data to be reviewed and analyzed - ordering of 3 unique tests (EKG, CBC lab, and CT chest scan).· Moderate risk of complication and/or morbidity or mortality of patient management - prescription drug management. - o qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is low reporting 99204. - The ICD-10-CM code to report is for the chest pain. Look in the ICD-10-CM Alphabetic Index for Pain/chest. The anxiety is not a confirmed definitive diagnosis and not reported. Refer to ICD-10-CM Coding Guideline I.IV.H.

CC: Follow up on Atrial Fibrillation History: A 62-year-old is here today to follow-up on her atrial fibrillation. She is a patient of my partner Dr. J, but he is out of the office today. She had no new problems. No chest pressure, fluttering or shortness of breath. Physical Exam Constitutional: BP 125/85 T 98.6F PR 72 Chest: Clear Cardiac: Normal sinus rhythm Assessment: F/U on atrial fibrillation Plan: Continue with meds prescribed by Dr. J. Follow-up in the next 3 months. What E/M code is reported for this service? A. 99201 B. 99202 C. 99212 D. 99213

D (99213) (1. According to CPT® Evaluation and Management (E/M) Service Guidelines subsection New and Established Patient indicates: An established patient is one who has received professional face-to-face services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. This eliminates multiple choices A and B. - Using the AMA CPT® Guidelines for Instructions for selecting a level of office or other outpatient services table 2 in your CPT® code codebook: · Low for number and complexity of problem addressed at the encounter - 1 stable chronic illness· None for amount /or complexity of data to be reviewed and analyzed.· Moderate risk of complication and/or morbidity or mortality of patient management - Prescription drug management. (Provider decides to have the patient continue with the prescription drug) - To qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is low reporting 99213)

A 55-year-old established patient is coming in for a pre-op visit; he is getting a liver transplant due to cirrhosis. The physician performs an appropriate history and examination. A moderate medical decision making is performed. Patient agrees with his physician's recommendations and the transplantation will take place as scheduled. The patient expresses a number of concerns and questions for the prospective liver transplant. Physician documents in spending a total time of 60 minutes with the patient that includes answering questions and addressing his concerns regarding the surgery and discussing possible outcomes. What CPT® codes should be reported? A. 99215, 99356 B. 99214, 99356 C. 99214, 99417 D. 99215, 99417

D (99215, 99417) (1. The overall time spent with patient is 60 minutes; time will be used to report the E/M codes. Prolong services codes will also be reported. There is one specific prolong code that is only reported with the office visit codes, 99417. There is a parenthetical instructional note given under code 99417 that this add-on code is only reported on codes 99205 and 99215. There is a parenthetical note for codes 99356 and 99358 that indicates which codes are reported with them and code 99215 is not listed.)

A 50-year-old patient is coming to see her primary care physician for hypertension. The patient also discusses with her physician that the OBGYN office had just told her that her Pap smear came back with an abnormal reading and is worried because her aunt had passed away with cervical cancer. The physician documents she spent 55 minutes face-to-face counseling on the awareness, other screening procedures and treatment if it turns out to be cervical cancer. What E/M code(s) is (are) reported for this visit? A. 99215, 99417 B. 99213, 99358 C. 99214, 99354 D. 99213

A (99215, 99417) (1. The overall time spent with patient is 55 minutes. Prolong services codes can be reported. There is one specific prolong code that is only reported with the office visit codes, add-on code 99417. There is a parenthetical instructional note given under 99417 that this add-on code is only reported on codes 99205 and 99215. There is also a parenthetical note for codes 99356 and 99358 that indicates which codes are reported with them and code 99215 is not listed.)

A 64-year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 99283-25, 12014, 12034-59, 12002-59, 11042-51 B. 99283-25, 12053, 12034-59, 12002-59 C. 99283-25, 12014, 12034-59, 11042-51 D. 99283-25, 12053, 12034-59

A (99215, 99417) (1. The overall time spent with patient is 55 minutes. Prolong services codes can be reported. There is one specific prolong code that is only reported with the office visit codes, add-on code 99417. There is a parenthetical instructional note given under 99417 that this add-on code is only reported on codes 99205 and 99215. There is also a parenthetical note for codes 99356 and 99358 that indicates which codes are reported with them and code 99215 is not listed.)

A 2-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedures to report for the ER physician? A. 99291-25, 36555, 31500 B. 99291-25, 36556, 31500, 82803 C. 99285-25, 36556, 31500, 82803 D. 99475-25, 36556

A (99291-25, 36555, 31500) (1. According to the CPT® subsection guidelines for Inpatient Neonatal and Pediatric Critical Care: To report critical care services provided in the outpatient setting (example, emergency department or office) for neonates and pediatric patients of any age, see the Critical Care codes 99291, 99292. This would eliminate multiple choice D. There is documentation in which the ER physician spent a total of 30 minutes on a critical patient, eliminating multiple choice C. Blood gas (82803) is a lab procedure that is not separately reported when billing for critical care. A list of services included in reporting critical care is found in the subsection guidelines under Critical Care Services. Modifier 25 is appended to 99291 to identify the evaluation and management service as a separately identifiable service in which billable procedures were performed on the same date of service.)

A 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct codes for the physician service. A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303-26 C. 99460-25, 31500, 94002, 93303-26 D. 99291-25, 93303-26

A (99468-25, 93303-26) (1. According to CPT® subsection guidelines under Inpatient Neonatal and Pediatric Critical Care: If the same physician provides critical care services for a neonatal or pediatric patient in both the outpatient and inpatient setting on the same day, report only the appropriate Neonatal or Pediatric Critical Care codes 99468-99476 for all critical care services provided on that day. This eliminates multiple choice answers C and D. The baby is 20 days-old and you cannot bill intubation (31500) and ventilation management with the neonatal and pediatric critical care codes, eliminating multiple choice B.)

A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to Dr. S, who his neighbor referred him, to see if Dr. S can provide another type of treatment. Dr. S documents a detailed history. He has had it for the past five months. Sleep is disrupted by frequent awakenings and getting worse due to anxiety and snoring. Current medication that he is on now is not helping him. Physician also performs a comprehensive exam and moderate MDM. Which E/M category is reported for this encounter? A. New Patient Office Visit (99202-99205) B. Established Patient Office Visit (99211-99215) C. Office Consultation (99241-99245) D. Observation Care (99218-99220)

A (New Patient Office Visit (99202-99205)) (1. The patient was not referred by another physician for a second opinion for his sleep apnea, so this is not a consultation visit. The patient decided to go on his own to get the opinion from another doctor. According to CPT® guidelines: If a "consultation" is requested by a patient and/or family and not requested by a physician (self-referral), an office visit code may be used to report this service The doctor is seeing the patient for the first time. The E/M category to report an E/M code from is the new patient office visit (99202-99205).)

Physician performs a medical review and documentation on an 83 year-old patient who has been in the hospital for the last two days with confusion. Problem focused exam where she is alert and oriented x 3 today. Low medical decision making by ordering an echocardiogram and to continue IV fluids. Patient is not safe to return home. What E/M code is reported for this visit? A. 99231 B. 99221 C. 99224 D. 99234

A. 99231 (1. The patient has been in the hospital for the last two days and is being seen by the physician reporting the visit as a subsequent hospital care. Documentation does not support the patient is in observation care or observation status. In the CPT® Index, look for Hospital Services/Inpatient Services/Subsequent Hospital Care. You are referred to 99231-99233. Two out of three key components need to be met or exceeded for subsequent hospital care codes. The physician documented a problem focused exam + medical decision making of low complexity= 99231)

An 80-year-old patient is returning to the gynecologist's office for pessary cleaning. Patient offers no complaints. The nurse removes and cleans the pessary, vagina is swabbed with betadine, and pessary replaced. For F/U in 4 months. What CPT® and ICD-10-CM codes are reported for this service? A. 99202, Z46.89 B. 99211, Z46.89 C. 99202, Z46.9 D. 99212, Z46.9

B (99211, Z46.89) (Scenario documents patient returning to the gynecologist guiding you to the codes for established patient office visit. This eliminates multiple choices A and C. For this scenario, the patient did not have any complaints that required the presence of a physician. There was no examination or medical making decision performed for the patient guiding you to code 99211. There must be an order for the patient to come in for the office visit. For the diagnosis code, the pessary was removed for cleaning reporting Z46.89 Encounter for fitting and adjustment of other specified devices. (Refer to ICD-10-CM guideline I.A.9)

CC: Osteoarthritis flare ups in both knees History: Patient is here today with continued pain in both knees due osteoarthritis. The left knee bothers her a more that her right knee. She has been having this issue for over a year. She is requesting a steroid injection. She uses one over-the-counter ibuprofen daily. No weakness or numbness. Exam: Weight is 167 Lbs. Blood pressure is 118/60 Pulse is 72 beats/min. There is some pain but not in distress. There is crepitus at the knees with some tenderness with flexion and extension of the knees which is mildly noted today. No effusion is clearly noted. No warmth of the knees noted. There are some flexion contractures of the fingers as noted before. Elbow flexion contracture noted on the left side. Assessment: As above with what appears to be continued progression of primary osteoarthritis of the knees. Prescription of Celebrex given. Note given for work today as well. What is the overall E/M for this office visit? A. 99215 B. 99214 C. 99213 D. 99212

B (99214) (1. Using the AMA CPT® Guidelines for Instructions for selecting a level of office or other outpatient services table 2 in your CPT® code codebook · Moderate for number and complexity of problem addressed at the encounter - 1 or more chronic illness with exacerbation, progression, or side effects of treatment (continue progression of primary osteoarthritis of the knees)· None for amount /or complexity of data to be reviewed and analyzed.· Moderate risk of complication and/or morbidity or mortality of patient management - Prescription drug management. - To qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is moderate reporting 99214.)

A patient came into the ER with wheezing and a rapid heart rate. The ER physician documents a comprehensive history, comprehensive exam and medical decision of moderate complexity. The patient has been given three nebulizer treatments. The ER physician has decided to place him in observation care for the acute asthma exacerbation. The ER physician will continue examining the patient and will order additional treatments until the wheezing subsides. Select the appropriate code(s) for this visit. A. 99284, 99219 B. 99219 C. 99284 D. 99235

B (99219) (1. According to CPT® subsection guidelines under Initial Observation Care: When "observation status" is initiated in the course of an encounter in another site of service (example, hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating "observation status" are considered part of the initial observation care when performed on the same date. Meaning you will not report an emergency service code since the patient was placed in observation care from the ER on the same date of service, eliminating multiple choice C. CPT® subsection guidelines add: Evaluation and management services on the same date provided in sites that are related to initiating "observation status" should not be reported separately. This eliminates multiple choice A. Patient was not admitted and discharged in observation status on the same date of service, eliminating multiple choice D.)

CC: Shortness of breath History: A 62-year-old female returns to a family practice having shortness of breath for the last week. It has been two years since her last visit to the practice. She also has nausea, diaphoresis, chest pressure. Past History: Celebrex® for her arthritis. Hysterectomy 1 year ago. Social History: Smoker-No Alcohol-No Allergies: Penicillin PHYSICAL EXAM Vital Signs: BP 195/95 sitting, left arm General/Constitutional: Mild distress. Some diaphoresis. Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions. Neck/Thyroid: Supple, without adenopathy or enlarged thyroid. Respiratory: Shallow breathing, no wheezing. Cardiovascular: Unequal pulses in both arms. Abnormal heart sounds heard. EKG ordered. Assessment/Plan Severe exacerbation of congestive heart failure Patient is sent to the hospital to be admitted. Will send hospital orders to start her on IV, order chest X-ray and CBC. A. 99202 B. 99215 C. 99204 D. 99214

B. 99215 (1. Using the AMA CPT® Guidelines for Instructions for selecting a level of office or other outpatient services table 2 in your CPT® code codebook:· High for number and complexity of problem addressed at the encounter - 1 acute or chronic illness or injury that poses a threat to life or bodily function· Moderate for amount /or complexity of data to be reviewed and analyzed - ordering of 3 unique tests (EKG, CBC, and X-ray).· High risk of complication and/or morbidity or mortality of patient management - Decision regarding hospitalization. To qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is low reporting 99215.)

A 6-month-old patient is administered general anesthesia to repair a cleft palate. What anesthesia code(s) is (are) reported for this procedure? A. 00170, 99100 B. 00172 C. 00172, 99100 D. 00176

C (00172, 99100)

Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision making of moderate complexity. Which E/M service is reported? A. 99285 B. 99284 C. 99221 D. 99222

C (99221) (1. According to CPT® guidelines: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (example, hospital emergency department, observation status in a hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date of service. Meaning for this scenario the patient's physician had come to the ER and also admitted the patient on the same date of service, eliminating multiple choices A and B. All three of the key components of an initial hospital care code must be met or exceeded. 99221 requires: detailed or comprehensive history, detailed or comprehensive examination, and straightforward or low complexity medical decision making. Because the lowest key component in the question is a detailed history, the highest level that can be reached is 99221. To report code 99222 you would need a comprehensive history.)

A patient was admitted yesterday to the hospital for possible gallstones. The following day the physician who admitted the patient performed a detailed history, a detailed exam and a medical decision making of low complexity. The physician tells her the test results have come back positive for gallstones and is recommending having a cholecystectomy. What code is reported for this evaluation and management service for the following day? A. 99253 B. 99221 C. 99233 D. 99234

C (99233) (1. The scenario indicates to select an evaluation and management service for the physician evaluating the patient on the following day of admission, eliminating multiple choice B; code 99221 is reported for when the patient is initially admitted to the hospital. The patient is not in observation status in which the patient was admitted and discharged on the same date of service, eliminating multiple choice answer D. There is no request documented in the scenario for another physician to recommend care for the condition, eliminating multiple choice A. Subsequent hospital care codes require meeting or exceeding two of three key components. Code 99233 is correct because a detailed and detailed exam are the two key components that meet.)

This morning a 48-year-old is placed in observation status from the emergency room with severe diarrhea and extreme thirst. The physician performs a comprehensive history, comprehensive examination and determines the patient is suffering from dehydration. The physician places the patient on IV saline 500 ml and conducts normal saline hydration for a couple hours. The medical making decision making is of moderate complexity. Patient is discharged home in the late evening on the same day and is told to return if symptoms occur again. The E/M service(s) for this encounter is: A. 99285 B. 99219, 99217 C. 99235 D. 99217

C. 99235 (1. The patient is designated as being in observation status, eliminating multiple choice A. According to the Initial Observation Care guidelines it states: For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236.)

A plastic surgeon is called to the ED at the request of the emergency department physician to evaluate a patient that arrived with multiple facial fractures that may need surgery. Patient was in an automobile accident and an opinion is needed for reconstructive surgery. The plastic surgeon arrives at the ED, obtains detailed history and performs a detailed exam. The plastic surgeon performs a moderate medical decision making, in deciding that the patient needs major surgery to repair the injuries. The plastic surgeon schedules the patient for surgery the next day and documents her full note with findings in the ED chart. The E/M service reported by the plastic surgeon is: A. 99284-57 B. 99243-32 C. 99243-57 D. 99284-32

C. 99243-57 (1. The E/M service is reported as a consultation because the request of the ED physician to have a plastic surgeon render an opinion on whether the patient needs surgery. A written report of the findings is documented in the ED chart. According to CPT® coding guidelines, the requirements for a consultation have been met. The consultation service is provided in the ED, which is an outpatient setting. The plastic surgeon performs a detailed history, a detailed exam, and a moderate MDM. For an outpatient consultation all three key components must be met or exceeded to report the correct level of service. 99243 is the appropriate code. During this encounter, the plastic surgeon made the decision to perform a major surgery, which is scheduled for the next day. Modifier 57 is appended to the E/M service. Modifier 32 is not appropriate to report because there is no documentation that the consultation was requested by a third party, such as an insurance company.)

Physician was called to the floor to evaluate a 94 year-old that had sudden weakness, hypotension, and diaphoresis. Physician found the patient in mild distress and dyspneic. Her BP 101/60, pulse 85. Labs were still pending. Arterial blood gas was drawn and interpreted by the physician. She was admitted to CCU for Acute Antero-lateral MI and hypotension. Physician spent total critical care time of 65 minutes. Select the appropriate CPT® coding for this visit: A. 99291, 99292 B. 99233, 82803-26 C. 99291 D. 99291, 82803-26

C. 99291 (1. According to CPT® Critical Care Services guidelines: "Critical care is the care of the unstable critically ill or unstable critically injured patient who requires constant physician attendance (the physician need not be constantly at bedside per se but is engaged in physician work directly related to the individual patient's care). The critical care codes may be reported wherever critical care services are provided. It is important to recognize that the critical care codes are reported based upon the type of care rendered not the location of where the care is rendered. The critical care codes are used to report the total duration of time spent by a physician providing constant attention to an unstable critically ill or unstable critically injured patient even if the time spent by the physician providing critical care services on that date is not continuous." For this encounter the physician was called to the floor to evaluate a critically ill patient. The physician documents 65 minutes of critical care time which is reported with 99291. Note the Critical Care guidelines has a list of services that are included in critical care and not reported separately. The blood gas (82803) service is included in the Critical Care and not reported separately.)

The patient is a 35-year-old male who presents to the emergency department (ED) after several hours of low back pain, nausea, and chills. The ED physician takes a detailed history and performs a comprehensive examination. A urinalysis lab and CT of the abdomen is ordered. The results of the CT show two small kidney stones. The ED physician discusses the results with the patient and tells him the stones are small and will pass on their own. Medical decision making (MDM) of moderate complexity is made with the patient being discharged, with a prescription of pain medication, and with a diagnosis of kidney stones. Select the E/M code and diagnosis codes. A. 99285, N20.0, M54.5, R11.2, R68.83 B. 99284, M54.5, R11.2, R68.83, N20.0 C. 99283, N20.0 D. 99284, N20.0

D (99284, N20.0) (1. All three key components for an emergency department code needs to be met or exceeded. 99284 requires a: detailed history, detailed examination, medical decision making of moderate complexity. Because the lowest key components in the question is a detailed history and moderate MDM the highest level that can be reached is 99284. The diagnosis is kidney stones. In the ICD-10-CM Alphabetic Index look for Stone(s)/kidney or Stone(s)/renal, directing you to code N20.0. Back pain, nausea, and chills are symptoms of kidney stones. ICD-10-CM guideline (section I.B.5) states: Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification. The low back pain, nausea, and chills are not reported.)

15-year-old male is seen by the pediatrician in his office for having excessive thirst and frequent urination. A urine dip is performed showing +3 sugar and with some ketones. Glucometer reading is done showing a blood sugar range of 500-600. Physician sends the patient with his father to the hospital for emergency admission and insulin drip. The pediatrician meets the patient at the hospital and performs a detailed history, comprehensive exam and a high complexity medical decision making. How should the pediatrician code the E/M service for this visit? A. 99214 B. 99221 C. 99223 D. 99285

D. 99285 (1. Patient was not seen in the Emergency Department, eliminating multiple choice answer D. According to CPT® subsection guidelines for Initial Hospital Care: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (eg, hospital emergency department, observation status in the hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same of admission. The means the evaluation that was performed in the physician's office will not be reported since the physician also admitted the patient to the hospital on the same date of service, eliminating multiple choice A.For the Initial Hospital Care codes (99221-99223) all three key components (History, Examination, and Medical Making Decision) must meet or exceed to qualify for a particular service Code 99221 requires a detailed or comprehensive history, detailed or comprehensive examination, and medical decision making that is straightforward or of low complexity. Because the lowest component is a detailed history, the highest level that can be reached is 99221. To report code 99223 you need a comprehensive history.)

At the request of the mother's obstetrician, a neonatologist is called to attend the birth of an infant being delivered at 29 weeks gestation. During delivery, the neonate was pale and bradycardic needing resuscitation. Neonatologist performs the suctioning and bag ventilation on this 1000 gram neonate was performed with 100 percent oxygen. Bradycardia worsened, requiring endotracheal intubation and insertion of an umbilical line for fluid resuscitation. Later this critically ill neonate was moved from the delivery room and admitted to the NICU with severe respiratory distress and continued hypotension. What are the appropriate procedure codes reported by the neonatologist? A. 99465, 99468 B. 99465, 99464, 99468-25, 31500-59, 36510-59 C. 99468, 99464 D. 99465, 99468-25, 31500-59, 36510-59

D. 99465, 99468-25, 31500-59, 36510-59 (1. Parenthetical instruction states that code 99464 cannot be reported with 99465. Because the baby needed resuscitation report 99465. The critically ill neonate is admitted to critical care. According to CPT® coding guidelines, 99468 can be reported with 99465. The guidelines also state "other procedures performed as a necessary part of the resuscitation are also reported separately when performed as part of the pre-admission delivery room care". In this scenario the intubation (31500) and the umbilical line (36510) were performed pre-admission to the NICU for resuscitation so they are both reported. Modifier 59 is appended to indicate that these procedures were performed before the baby was admitted to NICU. Failing to append modifier 59 on the procedure codes, will allow both services to be bundled with 99468. Modifier 25 is reported to indicate a separate and significant E/M service.)