The questions physicians actually ask, answered in one screen: the verdict, the rule, and the exact phrase your note is missing.
G2211 is blocked with modifier 25 on ordinary procedure visits: injections, biopsies, laceration repairs, wart destruction. CMS carved out exceptions for certain preventive services, including the annual wellness visit and vaccine administration, when its criteria are met. On ordinary procedure days the add-on drops; on visit-only days for a patient whose ongoing care you own, it belongs on every claim.
Evaluating the problem the procedure treats is part of the procedure: assessing the joint you inject, examining the laceration you repair, inspecting the lesion you biopsy. The visit is separately reportable with modifier 25 only when the note shows significant, separately identifiable work: another problem managed in its own right, or genuinely separate evaluation beyond the procedure decision. This is the single highest volume coding question in office practice.
Closed treatment without manipulation codes exist for exactly this, and they carry a 90 day global. The alternative is coding each visit as E/M instead; the better choice depends on expected follow up, and either is defensible when documented.
The AWV (G0438 first, G0439 after) and a problem oriented E/M can be reported the same day when the problem work is separately documented; the E/M takes modifier 25. By current CMS policy G2211 can still pay on the visit. If selecting the E/M by time, count only the minutes attributable to the problem visit, never the wellness work. This combination is among the most underused in primary care.
A preventive visit (99381 to 99397) plus a problem E/M with modifier 25 is legitimate when a real problem needed real evaluation beyond the preventive service: the new knee pain worked up, the blood pressure that forced a medication change. Two cautions: minor findings folded into the physical do not earn a second code, and the patient may see cost sharing on the problem visit that the preventive visit alone would not trigger, so many practices tell the patient at checkout.
A pre-participation sports physical is coded as the preventive medicine service it is, and many commercial plans do not cover it as a preventive benefit, which is why so many are cash visits. The coding question that matters: when the physical turns up a real problem you work up, exertional chest pain, an irregular rhythm, an unresolved concussion history, that evaluation is a problem oriented E/M with modifier 25 alongside the preventive code. The frequent error is giving that genuine workup away inside the physical.
G0447 pays for 15 documented minutes of intensive behavioral therapy for obesity (BMI 30 or above) alongside the visit, and Medicare covers it at a defined frequency. One structural rule the tools on this site enforce: when obesity is managed only through the counseling you are coding, the counseling code is its credit; the same problem cannot also carry the visit level.
Examining and closing the cut is the repair code. The visit is payable with modifier 25 when distinct evaluation happened: the head injury screened after the fall that caused the cut, the syncope workup behind the collapse, tetanus and neurovascular assessment beyond the wound itself when documented as real evaluation. And one repair rule that pays attention: lengths of repairs in the same classification and site group are summed into one code, never coded as two small repairs.
On top of 99215 or 99205 selected by time, prolonged services add in full 15 minute units, and the thresholds differ by payer: CPT 99417 begins at 55 total minutes with 99215 and 75 with 99205; Medicare G2212 begins at 69 and 89. Documented exact total minutes are the whole game; a range is not a time.
99497 pays for the first 16 to 45 minutes of face to face advance care planning, and when it is furnished on the same day as the AWV, Medicare waives the patient's cost sharing, which makes the wellness visit the natural home for it. Document the minutes and the voluntary nature of the discussion; forms do not have to be completed for the time to count.
An in office ECG with your documented interpretation and report is separately reportable alongside the E/M (93000 with your equipment, 93010 for interpretation and report alone). The trade every coder checks: a test you separately report cannot also count in the MDM data column, so the ECG pays as itself and the visit level stands on the rest of the encounter.
A consult needs a documented request from another clinician, your opinion rendered, and a report back. A transfer of care is not a consult. And for Medicare and many plans, new patient plus G2211 often outpaces the consult family anyway; run both before assuming.
Since the 2020 descriptor revision, 29880 and 29881 include chondroplasty in the same or a separate compartment, and CMS NCCI states 29877 is not reported with knee arthroscopy codes 29866 to 29889. Medicare's G0289 applies only to loose or foreign body removal from a different compartment, not chondroplasty. Payer specific: a few commercial plans differ; check before appealing.
Routine care of the operative site is the package: that is 99024, no wRVU. A visit for a genuinely unrelated problem is payable with modifier 24. Complications: under Medicare, a related complication managed without a return to the operating room is included in the global package; a related return to the operating room is reported as the procedure with modifier 78, not as a visit. Some commercial payers pay complication visits; verify the payer. The note must make the distinction obvious.
99406 pays for more than 3 and up to 10 documented minutes (exactly 3 does not qualify) and 99407 beyond that, on top of the E/M. The work is usually happening already; the minutes are what is missing.