Study Guide — CPC Study Hub

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E/M Codes (Evaluation & Management)

30–35% of exam · Highest priority

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New Patient Codes

99201Level 1 (minimal)

99202Level 2 (low)

99203Level 3 (low-mod)

99204Level 4 (moderate)

99205Level 5 (high)

Established Patient Codes

99211Nurse visit (no MD required)

99212Level 2 (minimal)

99213Level 3 (low) ← MOST COMMON

99214Level 4 (moderate)

99215Level 5 (high)

New vs. Established Patient Rule

A patient is new if they have NOT received face-to-face services from the physician or any physician of the SAME SPECIALTY in the SAME GROUP PRACTICE within the past 3 years.

Key Components (2 of 3 must be met or exceeded)

→ History (chief complaint, HPI, ROS, PFSH)
→ Physical Exam (body areas + organ systems)
→ Medical Decision Making (problems, data, risk)

Exam Tip: For preventive visits + problem-focused E/M on SAME DAY → add -25 to the office visit E/M code.

Watch out: Time-based billing only valid when counseling/coordination of care dominates (>50% of face-to-face time).

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Surgery Codes

25–30% of exam · Global packages + unbundling key

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0

Day global (minor procedures)

10

Day global (simple procedures)

90

Day global (major surgeries)

What's Included in the Global Package

Pre-op care (day before for major, same day for minor)
Intra-operative services
Post-op care during global period
✗ Unrelated conditions, complications requiring return to OR, implants/supplies

The global package does NOT include services for complications that require a return to the operating room (use -78) or unrelated procedures (-79).

Billing two codes that are bundled per NCCI without -59 = unbundling = FRAUD. Always check NCCI edits.

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Modifiers — Master List

Critical for surgery + E/M questions

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-25Significant, Separately Identifiable E/M

E/M same day as procedure. The E/M must be for a DIFFERENT problem or significantly greater than pre-/post-op care.

-51Multiple Procedures

Two or more procedures same day by same provider. Add to SECONDARY procedure. Do NOT use on add-on codes (marked with +).

-57Decision for Major Surgery

E/M on day of OR day before MAJOR surgery where the decision to operate was made. Appended to E/M code (not procedure).

-59Distinct Procedural Service

Overcomes NCCI bundling. Use ONLY when procedures are truly separate (different site, session, or indication). Most audited modifier.

-76Repeat Procedure — Same Physician

Same physician repeats the SAME procedure same day. Compare with -77 (DIFFERENT physician).

-77Repeat Procedure — Different Physician

Different physician performs same procedure same day (e.g., anesthesia coverage changes mid-procedure).

-78Return to OR for Complication (Related)

Unplanned return to OR during global period because of RELATED complication. Reduced payment applies.

-79Unrelated Procedure During Global Period

Totally unrelated surgery performed during another procedure's global period. New global period starts.

-50Bilateral Procedure

Same procedure on both sides same session. Alternative: bill twice with -LT and -RT (payer preference varies).

Know -25 vs -57. Know -76 vs -77. Know -78 vs -79. These four pairs are ALL over the CPC exam.

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Radiology

10–15% of exam · -26 / -TC most tested

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-26

Professional Component

Physician interprets only. Hospital owns equipment.

-TC

Technical Component

Facility bills equipment + staff. No interpretation.

Global

Global (No Modifier)

Physician owns equipment AND interprets. Both included.

Chest X-Ray Codes (Frequently Tested)

710451 view

710462 views ← MOST COMMON

710473 views

710484+ views

If code descriptor already says "bilateral" — do NOT add -50. Read every descriptor fully before coding.

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Medicine Codes

10–15% of exam · Immunizations + infusions common

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Immunization Administration

90460With counseling, age ≤8, first component

90461With counseling, each additional component

90471Without counseling, first injection

90472Without counseling, each additional

IV Infusion Codes

96360Hydration, IV infusion, initial 31-90 min

96365Therapeutic, initial up to 1 hour

96413Chemotherapy IV, initial up to 1 hour

96415Chemotherapy, each additional hour

Immunization codes: ALSO code the vaccine product separately (90707, 90714, etc.) in addition to the administration code.

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Pathology & Laboratory

5–10% of exam · Panel codes most tested

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Common Panel Codes

80047Basic Metabolic Panel (w/ ionized Ca)

80048Basic Metabolic Panel (total Ca)

80053Comprehensive Metabolic Panel (14 tests)

80061Lipid Panel (chol + HDL + LDL + triglycerides)

85025CBC with differential, automated

81002Urinalysis, without microscopy

81001Urinalysis, with microscopy, automated

Panel codes require ALL tests in the panel to be performed. If any test is skipped, bill the individual test codes instead — NOT the panel.

Reflex tests are billed only if performed. They must have documentation showing the initial result triggered the reflex test.

Common Errors That Kill Your Score

Learn these once. Never miss them again.

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1. Unbundling: Never bill codes separately if NCCI edits bundle them — unless truly distinct services with -59.

2. Wrong modifier pair: Confusing -25 with -57, or -76 with -77, or -78 with -79. Know these cold.

3. Panel coding: If all tests in a panel weren't performed, don't bill the panel code. Bill tests individually.

4. Bilateral already in code: Some codes say "bilateral" in the descriptor. Adding -50 double-bills. Read descriptors fully.

5. Wrong place of service: Office (11) vs. outpatient hospital (22) changes which codes are appropriate.

6. Missing modifier on same-day E/M: If a procedure and E/M are on same day, E/M needs -25 (or -57 for major surgery decision).

7. Add-on codes with -51: Never append -51 to add-on codes (+). They're always listed as additional and excluded from -51 rules.

Exam Day Strategy

150 questions · 5h 40min · Open book

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Time Management

→ 5h 40min ÷ 150 questions = 2 min 16 sec per question
→ Flag and skip hard questions. Come back after.
→ Leave 30 min at end for flagged questions.
→ Don't second-guess yourself. First instinct is usually right.

Open Book Strategy

→ Tab your CPT book (E/M, Surgery, Radiology, etc.)
→ Know the code RANGE first, then look up exact code
→ Don't look up every answer — too slow
→ Use the index strategically for unfamiliar procedures

Answer Strategy

→ Eliminate 2 wrong answers first
→ Read the FULL question before looking at options
→ Watch for qualifiers: "always," "never," "most commonly"
→ When in doubt, simplest code is often correct

Day Before Exam

→ Review modifier pairs only (the highest-yield study)
→ Sleep 8 hours. Seriously.
→ Bring snacks, water, tabs in code books
→ No new topics. Review what you know.

You've already taken 6 practice exams. That's more prep than most people do. Trust your knowledge and stay calm.