23 worked examples from the deterministic coding engine behind the AI Op Note Assistant: the scenario, the expected codes, the live tool output, and the rule that decided it. Every example on this page is passing, generated by running the shipped engine at build time, not hand written.
The load bearing rules behind the tools, each with its source, effective year, and the tests that guard it. When a page and this registry ever disagree, report it; the registry wins until corrected.
Medicare does not pay G2211 when the office visit is reported with modifier 25 for a same day minor procedure; the restriction attaches to the visit, not the procedure. Preventive service exceptions (such as the AWV day) apply per CMS.
CMS MPFS final rule policy, 2024 onwardengine pins; battery em_proc cases29877 is not reported with 29881 in the same knee; since 2020 the 29880/29881 descriptors include chondroplasty in any compartment. For Medicare, G0289 with 29880/29881 covers ONLY loose or foreign body removal from a different compartment, never chondroplasty (the NCCI manual controls over the older G0289 descriptor text).
CMS NCCI Policy Manual 2026, Chapter IV; CPT 2020 descriptor revisionop engine scenarios; battery op casesCPT 99417 starts from the minimum time of the top code (55 total minutes with 99215; 75 with 99205). Medicare G2212 starts from the maximum (69 with 99215; 89 with 99205). Never interchangeable.
AMA CPT E/M guidance; CMS G2212 policyengine timeLevel pinsRoutine postoperative care is 99024. A related complication managed without a return to the operating room is included (Medicare). A related return to the operating room is the procedure with modifier 78. Unrelated E/M takes modifier 24; unrelated procedures take modifier 79. The decision for major surgery takes modifier 57.
CMS Claims Processing Manual ch. 12engine global pins; battery postop casesWork beyond the procedure supports modifier 25 through documented legs: independent interpretation of an outside study (named), prescription management separate from the procedure (never the injected agent), comorbidity evaluation altering management, or referrals and orders placed that day. Each documented leg is evidence, and the whole encounter must meet the CMS standard of a significant, separately identifiable E/M beyond the work of deciding on and performing the procedure; the tool lists every documented leg so a reviewer can weigh them. When the two diagnosis and beyond work pathways both apply, code the higher; on a tie use two diagnoses.
AMA CPT modifier 25 guidance; site doctrine34 permutation pins; battery em_mod25 casesA problem whose entire management is codable counseling (nicotine dependence with 99406/99407; obesity with G0447) never carries the E/M level; its credit is the counseling code. Counting it twice is the audit pattern.
CPT counseling code definitions; MDM frameworkengine backstop pins; battery em_smoking cases99406 requires MORE than 3 minutes (up to 10); 99407 more than 10. Exactly 3 minutes does not code. Obesity counseling G0447 requires 15 or more; advance care planning 99497 requires 16 or more.
CPT descriptorsthreshold pins; battery counseling casesA test the clinician orders counts once, as an ordered test; it never also counts as an independent interpretation. Independent interpretation is reserved for a study performed or ordered elsewhere, personally read and documented, and not separately reported.
AMA MDM data column guidanceengine data pins; battery em_own_order_trapTwo or more stable chronic conditions addressed reach moderate (level 4 tier), as does one chronic condition with exacerbation or an undiagnosed new problem with uncertain prognosis. OTC only management is low risk; prescription drug management is moderate; intensive toxicity monitoring is high.
AMA MDM tablereferee sweep; core pinsThe engines behind these tools pass tens of thousands of automated checks on every build: thousands of generated office visit encounters cross validated against an separately implemented internal reference engine, plus operative scenarios spanning more than 200 procedures. Bundling logic follows the CMS NCCI Policy Manual 2026 and CPT guidance; commercial payer rules may vary. See also the public What changed log.
Partial medial meniscectomy plus patellofemoral chondroplasty, both compartments documented.
29881-RT29881-RT (6.85 wRVU)Per CMS NCCI 2026, 29877 is not reported with knee arthroscopy codes 29866 to 29889; since 2020, 29880 and 29881 include chondroplasty in the same or a separate compartment. Medicare G0289 applies only to loose or foreign body removal from a different compartment. Payer specific: some commercial plans differ.
ACL reconstruction, medial meniscectomy, chondroplasty.
29888-LT + 29881-LT/5129888-LT + 29881-LT/51 (20.79 wRVU)Published NCCI guidance bundles chondroplasty into ACL reconstruction regardless of compartment; the meniscectomy stays with modifier 51.
Meniscectomy with limited synovectomy of the same knee.
2988129881 (6.85 wRVU)NCCI: 29875 is a separate procedure code and is never reported with another arthroscopic procedure of the same knee.
Cuff repair, biceps tenodesis, subacromial decompression, extensive debridement in a different area.
29827-RT + 29828-RT/51 + 29826-RT + 29823-59/RT/5129827-RT + 29828-RT/51 + 29826-RT + 29823-59/RT/51 (30.96 wRVU plus 1 to verify)29826 is an add-on to cuff, claviculectomy, tenodesis, labral, and SLAP work; 29823 survives only with a documented different area of the same shoulder.
SLAP repair plus subacromial decompression.
29807-LT + 29826-LT29807-LT + 29826-LT (17.23 wRVU)The decompression add-on attaches to SLAP repair and never takes modifier 51.
Note documents fixation of all three malleoli.
27822-RT27822-RT (value to verify)Exclusive family: the trimalleolar code replaces the bimalleolar code rather than stacking with it.
Cephalomedullary nail for an intertrochanteric fracture.
27245-LT27245-LT (17.73 wRVU)Single fracture fixation code, valued at 17.73 from the 2026 file.
Primary TKA.
27447-RT27447-RT (19.11 wRVU)Valued at 19.11, the 2026 figure; hip and knee primaries were equalized in the 2021 revaluation.
Acetabular and femoral component revision.
27134-LT27134-LT (29.52 wRVU)Both-component revision is a single code at 29.52, not two codes.
Displaced femoral neck fracture treated with hemiarthroplasty.
27236-LT27236-LT (14.76 wRVU)One code covers open reduction or prosthetic replacement of the femoral neck; the 2026 file values it at 14.76.
Colonoscopy with biopsy plus EGD with biopsy.
45380 + 43239-5145380 + 43239-51 (5.80 wRVU)Different endoscopic families in one session are each reportable; the lesser-valued scope takes modifier 51.
Endoscopic release, both wrists; open code also mentioned.
29848-5029848-50 (value to verify)The endoscopic code excludes the open code for the same release, and bilateral surgery takes modifier 50 with 150 percent credit.
ACDF at two interspaces with plate, cage, and structural allograft.
22551 + 22845 + 22552 + 22853 + 2093122551 + 22845 + 22552 + 22853 + 20931 (48.09 wRVU)Add-ons stack on the primary in value order and never take modifier 51; the set totals 48.09 wRVU.
Removal of a deep plate and screws from a healed fracture.
20680-LT20680-LT (5.81 wRVU)Deep implant removal is 20680 at 5.81; a superficial pin or wire is 20670 at 1.79. One code per fracture site regardless of the number of screws, and a staged removal planned at the index surgery takes modifier 58.
Cholecystectomy with intraoperative cholangiography.
4756347563 (11.18 wRVU)The cholangiogram upgrades the code rather than adding one; valued at 11.18 from the 2026 file; the plain chole is 10.21, so documenting the cholangiogram is worth about one wRVU.
Open ventral hernia repair with mesh placement.
4959149591 (value to verify)The 2023 CPT revision deleted 49560 to 49590 and mesh add-on 49568. The current family is 49591 to 49596 for initial repairs, sized by defect, with 49613 to 49618 for recurrent; mesh is included when performed.
One stable chronic problem on a continued prescription, nothing else.
9921399213Two of three columns set the level and the second highest here is low: one stable chronic problem is low complexity even with prescription management at moderate risk.
Hypertension and diabetes, both stable, both medications continued after review.
99214 + G221199214 + G2211Two or more stable chronic conditions reach moderate problem complexity; with prescription management this is a defensible level 4, and the stated return plan adds G2211.
Knee injection today plus diabetes managed separately.
99214-25 + 2061099214-25 + 20610A modifier 25 procedure day excludes G2211 on ordinary visits; the level rests only on the diabetes because assessing the injected joint is part of the injection. CMS preventive service exceptions such as the AWV are the carve out.
Patient returns solely for the planned injection.
2061020610The only documented problem is the one treated by the procedure, so no separate E/M was coded; distinct work on a different problem is what earns modifier 25.
Simple stable problem, but 33 documented minutes of counseling and education.
9921499214MDM alone supports only a low level, but 30 to 39 documented total minutes supports 99214 on time; one sentence with real minutes changes the level.
Suspected giant cell arteritis with transient vision loss; urgent workup; hospitalization considered.
9920599205High problem complexity plus high risk once hospitalization is considered and documented; without that sentence the same chart is an airtight 99204.