AMA CPT® Assistant - 2026 Issue 2 (February)
Questions and Answers
February 2026 page 40 Questions and Answers Evaluation and Management (E/M): Office or Other Outpatient Services Question: A 35-year-old, who is an established patient, was seen by the primary care physician for migraines that had recently worsened, despite the use of prescribed medication. After a medically appropriate history and physical examination, the physician decides to increase the dosage for zonisamide. What would be the appropriate E/M code to report? Answer: For this scenario, it would be appropriate to report code 99214 , Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically...
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Article Overview
This article presents a set of coding questions and answers drawn from multiple clinical and procedural areas, including office/outpatient evaluation and management, preventive services, anesthesia, and several surgery specialties. It is designed for coding professionals who need a broad update on how current guidance applies to common reportable services and procedural scenarios. The discussion centers on code selection, related modifiers, and whether certain services are separately reportable or considered included in broader services.
Why This Topic Matters
Coding staff, auditors, and clinicians rely on this kind of Q&A content to stay current on how common encounters and procedures should be represented in claims and documentation. It helps clarify where specialized guidance may affect reporting across multiple specialties and service types.
Article Sections
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Evaluation and Management (E/M): Office or Other Outpatient Services
Covers an established-patient office/outpatient scenario and general considerations for selecting an E/M service level. The discussion includes time-based selection and the broad elements considered in the service.
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E/M: Preventive Medicine Services
Addresses a preventive medicine visit for an established patient and the related reporting context. The section also references an appended modifier used in mandated-service situations.
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Anesthesia: Upper Abdomen
Discusses anesthesia reporting for upper-abdominal hernia repair scenarios and related anatomical considerations. The section compares separate procedural situations within the same general anesthesia family.
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Anesthesia: Obstetric
Reviews obstetric anesthesia reporting across labor analgesia and a subsequent urgent operative procedure. The section focuses on documentation structure and distinct phases of care.
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Surgery: Integumentary System
Covers multiple wound repair scenarios involving different body sites and repair types. The section also includes discussion of when a separate imaging-related service is not reportable in conjunction with a surgical procedure.
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Surgery: Digestive System
Addresses whether intraoperative margin-related reporting is appropriate in a non-oncologic repair scenario. The section contrasts general surgical practice with situations where margin assessment is typically relevant.
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Surgery: Urinary System
Discusses nephrostomy tube removal with imaging guidance and the related imaging service considerations. The section also touches on when a diagnostic ultrasound may be separately reportable.
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Surgery: Male Genital System
Covers transperineal prostate biopsy performed with MRI fusion guidance and targeted lesion sampling. The section addresses reporting for multiple targeted regions in the same encounter.
What You Will Learn
- How to identify the broad service type involved in common coding questions across multiple specialties
- How preventive medicine and evaluation and management scenarios are framed in a Q&A format
- How anesthesia reporting questions may differ by anatomical site and clinical circumstance
- How wound repair scenarios are organized by repair complexity and body site
- How procedural imaging and guidance issues can affect reporting in surgery-related contexts
- How targeted biopsy scenarios are presented when multiple lesions are involved
Who Should Read This
- Medical coders
- Coding auditors
- Physician practices
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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