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CPT Final Exam Questions with
100% Correct Answers| Verified |
Latest Update 202 5
CPT and HCPCS codes are used in what type of healthcare setting? ✔✔Hospital outpatient, physician offices CPT is ✔✔current procedural terminology HCPCS is ✔✔healthcare common procedure coding system Who publishes CPT (Level I HCPCS)? How often is it updated? When is it updated? ✔✔AMA publishes cpt, it is updated annually, on Jan. 1 of each year CPT Category 1 codes consist of: ✔✔Anesthesia, Evaluation and management, surgery, radiology, pathology and laboratory, medicine What are Category 2 CPT codes for? What does the Category 2 code consist of? ✔✔Performance Measures
consist of 4 numbers followed by a capital F, such as 1000F What are Category 3 CPT codes for? What does the Category 3 code consist of? ✔✔New & Emerging Technology consist of 4 numbers followed by a capital T, such as 2000T What are modifiers Why are they used? ✔✔Supplementary Codes to provide additional information to a code What is a HCPCS level II code used to report? What does the HCPCS level II code consist of? ✔✔Are used for supplies, DME, injectable substances, dental and chiropractic as well as orthotics Structure: J1885 - capital letter followed by 4 numbers What are HCPCS level II codes also called? ✔✔National codes
- (bullet) ✔✔new code ; (semi-colon) ✔✔main entry applies to & is part of all indented entries that follow Δ (triangle) ✔✔revision code . ˃˂ (Facing triangles) ✔✔beginning and ending of new or revised text
- (plus symbol) ✔✔add on code ʘ (circled bullet) ✔✔moderate sedation Ø (Null symbol) ✔✔exemptions to modifier 51 (Pending symbol) ✔✔product pending FDA approval
✔✔Out of numerical sequence code
○ ✔✔Recycled/reinstated code modifier - 51 ✔✔multiple procedures - used by Physicians ONLY What about modifier - 66? ✔✔Surgery Team - Physicians use ONLY modifier - 59 ✔✔distinct procedural service. Used by BOTH Physician and Hospital What all does the CPT definition of a surgical package include? ✔✔1. Decision to perform procedure; E/M encounter
- Surgical procedure
- Anesthesia
- Immediate postoperative care, including dictation of operative notes and talking to family and other physicians
- Orders
- valuation of the patient in the post-anesthesia recovery area
- To identify an initial service performed without any restorative treatment or stabilization of the fracture, injury, or dislocation and/or to afford pain relief to the patient
- To identify an initial cast or strapping when the same physician does not perform, or is not expected to perform any other treatment or procedure
- To identify an initial cast or strapping when another physician provided or will provide restorative treatment Diagnostic endoscopy with a surgical endoscopy? ✔✔1 code surgery endoscopy includes the diagnostic component What is the difference between selective and non-selective catheter placement ✔✔Selective catheter placement is moved beyond the vessel punctured or beyond the aorta Non-selective means the catheter is not advanced beyond the access site Gastrointestinal Coding:
A biopsy of a lesion is followed by an excision of the remaining lesion during the same operative episode, Can both be coded. ✔✔NO only the excision can be coded. When one lesion is biopsied and different lesion is excised, assign code for the biopsy and code for the excision. This rule is applicable unless the excision code narrative includes the phrase with or without biopsy. In this case only excision is assigned ✔✔It would be appropriate to append the biopsy code with modifier 59. In GI coding, if a biopsy code uses the terminology "with biopsy, single or multiple," would you use the code multiple times if 4 biopsies were taken? ✔✔Only 1 code , regardless of the number of times In Radiology, what is the difference between the Professional component and the technical component? ✔✔*professional component includes supervising the procedure, reading and interpreting the results, and documenting the interpretation in a report
then you code what test that was done and not the panel if not all of the test was done in that panel What is used to select the correct surgical pathology code? ✔✔specimen When referencing Evaluation and Management codes, what factors are considered when determining the level of Medical Decision Making? ✔✔Key Components to E/M Level of Service;
- History
- Examination
- Medical Decision Making Complexity CONTRIBUTORY FACTORS E/M Level of Service;
- Counseling
- Coordination of Care
- Nature of Presenting Problem
- Time In Evaluation and Management, what elements make up the history? ✔✔• Chief complaint
- History of present illness
- Review of systems
- Past, family, and/or social history What are the 3 key components in selection of an E/M code? ✔✔• History
- Examination
- Medical decision making When can time be used as a factor in selection of an E/M code? ✔✔When more than 50% of time is spend with patient or family Must have length of visit, how much time with counseling and coordination in care When assigning an E/M level, what is a "new" versus "established" patient? ✔✔New = individual who has not received professional services from the physician or any other physician of the same specialty in the same practice group within the past 3 years. Established = patient who has received professional services from the physician or any other physician of the same specialty in the same practice group within the past 3 years.
What modifiers must be listed with anesthesia codes to distinguish between various levels of complexity of the anesthesia service provided? ✔✔P codes P1-P What is the purpose of the Medicare Outpatient Code Editor? ✔✔weed out incomplete and incorrect claims
- Simplify the Medicare outpatient pymnt system
- Decrease the Medicare beneficiaries share of the pymnt
- Encourage efficiency in providing hosp outp services What does upcoding mean? Give an example ✔✔Practice of purposely assigning a code to receive additional or increased payment
- Coding to a higher degree of work than was actually done, as in wound repair should have just been simple but then code for intermediate instead What does unbundling mean? Give an example ✔✔Practice of using multiple codes when the services should be represented with a single code
- As in a hysterectomy code 58150, instead they code the resection of the different body parts separately
When determining Anesthesia charges, what is the amount of time that is considered 1 time unit? ✔✔15 minutes Guidelines ✔✔Found at beginning of each CPT section. Read prior to coding from section. Contains info you need to know to code correctly in the section and is not repeated elsewhere in the section. Unlisted procedure code ✔✔Assigned only after thorough research fails to reveal more specific code. Special report describing procedure must accompany the claim. Surgical package ✔✔Includes operation itself, local anesthesia, "typical post-operative follow-up care," one E/M encounter prior to procedure, and immediate follow-up care. Surgery section ✔✔Largest CPT section. 19 subsections. Two most complex are the Integumentary & Cardiovascular subsections. Subsection Notes ✔✔Applies to entire subsection when listed at the beginning of that subsection.
What is a minor surgery global period? ✔✔Usually 10 days. Medicare has a 0 or 10 day global period. Who decides what is included in a surgical package (bundle)? ✔✔Third party payers What do Medicare's "Correct Coding Initiative" edits specify? ✔✔What is in a surgical package (bundle). Are all surgical packages the same? ✔✔No, they vary by payer. Are minor surgical procedures bundled in a surgical package? ✔✔No, preoperative and postoperative services are reported separately. Is general anesthesia bundled in a surgical package? ✔✔No, it is billed separately by the anesthesiologist. When a minor surgery is performed in the doctor's office such as a needle biopsy, what do you code for? ✔✔Procedure (biopsy); Supplies(surgical tray)
What is billed separately in a minor procedure during an office visit and why? ✔✔A surgical tray (needles, suture materials, wipes, drugs) is billable as a separate line item because it contains items that are not typically required for an office visit. 99070 CPT, Medicine section ✔✔Code for a surgical tray. (note: Medicare bundles into procedure) A4550 HCPCS ✔✔Code for surgical tray. (note: not separately reported to Medicare) What set of codes are used for inpatient services and procedures? ✔✔Inpatient coders address hospital (facility) payments with use of the ICD codes. What set of codes are used for outpatient services and procedures? ✔✔Outpatient coders use CPT codes to address payments for physicians (professional). What are the three parts of a surgery bundled into a surgical package? ✔✔preoperative, intraoperative, postoperative services
Debridement codes r based on depth, body surface, condition and some codes 4 location ✔✔Eczema Debridement of 10% of body surface or less, u code, use add-on code each additional 10%. Debridement based on depth of tissue removed & surface area of the wound ✔✔1 wound, report the depth of the deepest level of tissue removed. When it's multiple wounds, sum the surface area off the wound at the same depth. Do not combine sums of different depths. all lesion excisions include a Simple Closure ✔✔the Simple Closure should not be coded. They are included in with the E/M vistit. Avulsion ✔✔a tearing away of tissue from a body part. Bleeding may be heavy. It is possible that the torn tissue may be surgically reattached. if physician uses adhesive strips to close the wound ✔✔use 99201-99499. The more simple procedure would b billed an eval code rather than a procedure code. Do Not ill for would repair if adhesive strips r the only method utilized to close the woud.
simple repair ✔✔woud superficial, involving primarily epidermis or dermis, or subcu without significant involment of deeper structures & requires simple one layer closure intermediate repair includes addition requirements of simple repair ✔✔layered closure of one or more of the deeper layers of subcu. Also intermediate repair physician performed a single- layered closure that requred extensive debridement. Complex Repair, includes wounds requiring more than layered closure ✔✔complex repair code is most complicated surgical repair that a physican will perform on the integumentary system Add up the lengths of wounds from the same classification, simple, intermediate or complex, ✔✔if the anatomic sites r grouped together in the CPT manual. this allows to bill for multiple wound repairs using one CPT code. Dr. performed a Simple Repair of a 2.5 cm abrasion on the neck & a simple repair of a 3.4 cm laceration on the back, then the length of these Wounds may be added up and billed as 1 simple repair.. ✔✔12002 pertains to the scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet). Therefore, the neck and trunk (back is part of the trunk) r grouped together. The CPT now directs you to add up the lengths of the simple repairs and code these two
