CPMA Medical Auditor Practice Questions - AAPC Certified Professional Medical Auditor Exam

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Case 005 (Modifier 25 Audit Logic): During a payer overpayment response drill, the team is aligning audit evidence with policy timelines. A provider frequently reports modifier 25 with procedures. What evidence supports compliant use?

Any same-day E/M and procedure pairing regardless of note content. Documentation showing a significant, separately identifiable E/M service beyond procedure-related work. Automatic modifier use for all established-patient visits. A prior payer approval on unrelated claims.

Correct Answer:

Documentation showing a significant, separately identifiable E/M service beyond procedure-related work.

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