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AAPC CERTIFIED PROFESSIONAL CODER CHAPTER 6
2025-2026|QUESTIONS AND ANSWERS|A+ GRADED
Codes exempt from the modifier 51 are identified with what symbol? universal forbidden symbol + What does CCM mean? Correct Coding Modifier What does the CCM indicator of 0 mean? A CCM is not allowed and will not bypass the edits. What officical publication of AMA offers accurate information and guidance for CPT code use? CPT Assistant What code set is used voluntarily by physicians to report performance measurement?
CPT Category II codes What do CPT Category II codes formatted? 4 numeric digits followed by the letter F. How often are CPT Category II codes updated? throughout the year What makes up the Quality Data Codes (QDC) for the Physician Quality Reporting Initiative established by CMS? CPT Category II codes and the HCPCS G codes AMA What assosciation maintains and publishes CPT coding guidelines, codes, and descriptions? Category I, II, III
Which CPT code set is used voluntarily by physicians to report quality patient performance measurements? New and Emerging CPT Category III codes are reported to indicate which type of service or procedure? Appendix C Which CPT Appendix lists clinical examples for E/M coding? add on code CPT code used to report a supplemental or additional procedure appended to a primary procedure (stand alone) code. It is recognized by the +. CMS (Centers for Medicare and Medicaid Services Agency within the US department of Health and Human Services that administers the Medicare program and works in partnership with the
state governments to administer Medicaid and State Childrens Health Insurance programs. CPT (Current Procedural Terminology) A code set copy righted and maintained by the American Medical Association. Diagnosis Pointer Field A field on the medical claim form (CMS 1500) that relates to the line item to the diagnosis on the base claim. Global Package The period and services provided for a surgery inclusive of preoperative visits, intraoperative services, post-surgical pain management by the surgeon, and several miscellaneous services as defined by the health plan regardless of setting. Global Surgery Status Indicator
surgeries that have a global surgical period that includes the preoperative service day of surgery, surgery, and any related follow up visits with/by the physician 0-10 days after the surgery. NCCI (National Correct Coding Initiative Used by professional coder to determine codes considered by CMS to be bundled codes for procedures and services deemed necessary to accomplish a major procedure. This is to promote correct coding methodologies and to control improper assignment of codes that results in appropriate reimbursement. RBRVS (Resource Based Relative Value Scale) Physician payment schedule established by Medicare. RVU (Relative Value Units) CMS reimburses physicians for Medicare services using a national payment schedule based upon the resources used in furnishing physician services. These are configured using work based on specialties, practice expense and physician liability insurance.
Common Procedure the words before the semi-colon in the code descriptor for the service or procedure in the CPT book. Add On codes What codes found in the CPT codebook are exempt from the multiple procedure concept (modifier 51)? bullet symbol what symbol to the left of a code indicates new procedures and services added to the CPT codebook? triangle symbol what symbol is located to the left of a code and indicates that the description of the code has been revised? Opposing horizontal triangles what symbol indicates new and revised text other that the procedure descriptors?
What are subheadings that list alternate coding suggestions in parenthesis? CPT index What is the alphabetized list with main terms organized by condition, procedure, anatomic site, synonyms, eponyms, and abbreviations? Separate Procedure A service or procedure that is performed alone or is considered unrelated to another procedure/service provided during the same patient encounter. IOM Internet Only Manuals PTP (Procedure to Procedure) Used by professional coders to determine codes considered by CMS to be bundled codes for procedures and services deemed necessary to accomplish a major procedure.
Column 1/Column What are edits for code pairs that should not be billed together because one service inherently includes the other, unless an appropriate modifier is used and allowed? Mutually exclusive edits What are edits for code pair that for clinical reasons are unlikely to be performed on the same patient on the same day? CCM indictor 0 What indicator means a CCM is not allowed and will not bypass the edits? CCM indicator 1 What indicator means a CCM is allowed and will bypass the edits? CCM indicator 0
Remittance Advice What does RA stand for? N What is the code on the RA for "this procedure code is not payable. It is for reporting/informational purposes only".? AMA What association maintains and publishes CPT coding guidelines, codes, and descriptions? Condition, synonyms, abbreviations What are three methods used to list main terms in the CPT codebook alphabetic index? Appendix c Which CPT Appendix lists clinical examples for E/M coding?
Surgery What medical branch utilizes various operative techniques by manual and instrumental means to diagnosis and/or treat injury, deformity, and disease? 99291- What critical care codes are not considered part of the global package and are reimbursed separately? Endoscopic procedures For what procedures except those requiring an incision, is there no postoperative period? G codes Which set of HCPCS Level II codes are temporary HCPCS Level II codes assigned by CMS and reviewed by AMA for inclusion in the CPT®?
