COC (Formerly CPC-H) Practice Questions - AAPC Certified Outpatient Coder Exam

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Case 005 (Modifier 25): During a payer denial appeal review, a coding lead is validating outpatient claim construction. An E/M visit and minor procedure are billed on the same date. When is modifier 25 appropriate on the E/M service?

Whenever any procedure occurs on the same day as an E/M encounter. When documentation supports a significant, separately identifiable E/M service beyond usual pre/post work. Only when the procedure is denied by the payer initially. Only when diagnosis codes differ across line items.

Correct Answer:

When documentation supports a significant, separately identifiable E/M service beyond usual pre/post work.

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