Medical Coding questions with correct
solutions provided 2025/2026 model
Procedure codes (CPT-4) ✅✅codes used to describe the particular procedure
performed by a healthcare professional
Diagnosis (ICD-10-CM) ✅✅codes used to describe and illness, injury or condition a
patient may have
Health Care Procedure Coding System (HCPCS) ✅✅codes used to supplement CPT
codes
90281-99602 ✅✅Medicine, Physical Medicine and Other
99201-99499 ✅✅Evaluation and Management
00100-01999 ✅✅Anesthesiology
10021-69990 ✅✅Surgery
70010-79999 ✅✅Radiology, Nuclear Medicine, Diagnostic Ultrasound
80048-89356 ✅✅Laboratory, Pathology
-21 ✅✅Prolonged Evaluation and Management Services: When the service is
prolonged or greater than that usually required for the highest level of evaluation and
management service within a category. A report may be appropriate
-22 ✅✅Unusual Services: If the service provided is greater than what is usually
required for the procedure. A report may be appropriate
-23 ✅✅Unusual Anesthesia: If a procedure which usually requires no anesthesia or
local anesthesia because of unusual circumstances must be done under general
anesthesia
-25 ✅✅Significant, separately identifiable E&M service by the same physician on the
day of a procedure: The provider may need to indicate that on the day a procedure or
service identified by a CPT code was performed, the patient's condition required a
significant separately identifiable E/M service above and beyond the usual preoperative
and postoperative care associated with the procedure that was performed
, -24 ✅✅Unrelated Evaluation and Management Service by the same physician during
a postoperative period. The provider may need to indicate that an E&M service was
performed during a postoperative period for a reason unrelated to the original procedure
-26 ✅✅Professional Component
-57 ✅✅Decision for surgery
-56 ✅✅Preoperative Management Only
-55 ✅✅Postoperative Management Only
-54 ✅✅Surgical Care only
-53 ✅✅Discontinued procedure
-52 ✅✅Reduced Procedure(s)
-51 ✅✅Multiple procedures
-50 ✅✅Bilateral Procedure: bilateral procedure performed at the same operative
session.
-47 ✅✅Anesthesia by surgeon: This does not include local anesthesia
-32 ✅✅Mandated Services: Services related to mandated consultation and or related
services (peer review, or 3rd party payer)
-27 ✅✅Multiple outpatient hospital E&M encounters on the same date
-58 ✅✅Staged or related procedure or service by the same physician during the
postoperative period
-59 ✅✅Distinct Procedural service
-62 ✅✅Two Surgeons
-66 ✅✅Surgical Team
-63 ✅✅Procedure performed on infants less than 4kg
-73 ✅✅Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure
prior to the administration of anesthesia
solutions provided 2025/2026 model
Procedure codes (CPT-4) ✅✅codes used to describe the particular procedure
performed by a healthcare professional
Diagnosis (ICD-10-CM) ✅✅codes used to describe and illness, injury or condition a
patient may have
Health Care Procedure Coding System (HCPCS) ✅✅codes used to supplement CPT
codes
90281-99602 ✅✅Medicine, Physical Medicine and Other
99201-99499 ✅✅Evaluation and Management
00100-01999 ✅✅Anesthesiology
10021-69990 ✅✅Surgery
70010-79999 ✅✅Radiology, Nuclear Medicine, Diagnostic Ultrasound
80048-89356 ✅✅Laboratory, Pathology
-21 ✅✅Prolonged Evaluation and Management Services: When the service is
prolonged or greater than that usually required for the highest level of evaluation and
management service within a category. A report may be appropriate
-22 ✅✅Unusual Services: If the service provided is greater than what is usually
required for the procedure. A report may be appropriate
-23 ✅✅Unusual Anesthesia: If a procedure which usually requires no anesthesia or
local anesthesia because of unusual circumstances must be done under general
anesthesia
-25 ✅✅Significant, separately identifiable E&M service by the same physician on the
day of a procedure: The provider may need to indicate that on the day a procedure or
service identified by a CPT code was performed, the patient's condition required a
significant separately identifiable E/M service above and beyond the usual preoperative
and postoperative care associated with the procedure that was performed
, -24 ✅✅Unrelated Evaluation and Management Service by the same physician during
a postoperative period. The provider may need to indicate that an E&M service was
performed during a postoperative period for a reason unrelated to the original procedure
-26 ✅✅Professional Component
-57 ✅✅Decision for surgery
-56 ✅✅Preoperative Management Only
-55 ✅✅Postoperative Management Only
-54 ✅✅Surgical Care only
-53 ✅✅Discontinued procedure
-52 ✅✅Reduced Procedure(s)
-51 ✅✅Multiple procedures
-50 ✅✅Bilateral Procedure: bilateral procedure performed at the same operative
session.
-47 ✅✅Anesthesia by surgeon: This does not include local anesthesia
-32 ✅✅Mandated Services: Services related to mandated consultation and or related
services (peer review, or 3rd party payer)
-27 ✅✅Multiple outpatient hospital E&M encounters on the same date
-58 ✅✅Staged or related procedure or service by the same physician during the
postoperative period
-59 ✅✅Distinct Procedural service
-62 ✅✅Two Surgeons
-66 ✅✅Surgical Team
-63 ✅✅Procedure performed on infants less than 4kg
-73 ✅✅Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure
prior to the administration of anesthesia
