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CPT Self – Practice Questions with 100%
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CPT codes tell the insurance carrier what brought the patient to the physician's office. ✔✔false Text, symbols, and the history of CPT are found in the introduction of the book. ✔✔true The CPt code book is updated annually every July 1 ✔✔false The Surgery section of codes begins with code 1001 and goes through code 69999 ✔✔false ▲ Is the symbol for a revised code ✔✔true The CPT coding system was first published in 1966 by ____________. ✔✔The American Medical Association A complete and detailed description of all modifiers used in CPT is found in __________. ✔✔Appendix A
The CPT book contains _______ main sections. ✔✔ 6 The ___________ separates the common portion of the code description from additional portions of the code. ✔✔semicolon The _________ is organized by main terms. ✔✔index Appendix A ✔✔Detailed description of each of the modifiers used with CPT codes Appendix B ✔✔Additions, deletions, and revised CPT codes for the new year Appendix C ✔✔Clinical examples for codes found in the Evaluation and Management section of CPT Appendix D ✔✔Summary of CPT add-on codes Appendix E ✔✔The codes listed here are exempt from use of a - 51 modifier
- when d provider is employed by the healthcare facility
- by a hospital outpatient department. CPT sections (6 total) ✔✔1. evaluation and management (E/M)
- anesthesia
- surgery
- radiology
- pathology
- Medicine Level I ✔✔codes that are divided into Category I, Category II, and Category III codes Category I ✔✔codes that form the 6 main sections of CPT Category II ✔✔codes that are not mandatory and are considered tracking codes Category III ✔✔codes that are used for collection of statistical data
Current Procedural Terminology (CPT) ✔✔five-digit codes that are part of the language used by physicians and insurance companies to convey what service was provided to the patient during an encounter National Codes ✔✔commonly referred to as Level II codes, published annually by Medicare and used to bill for services and procedures that are not included in the Level I codes guidelines ✔✔define items that are necessary to appropriately interpret and report the procedures and services contained in that section Level II ✔✔codes that are used to bill for services and procedures that are not found in the main body of CPT codes. National Codes local codes ✔✔also called Level III codes, used by specific Medicare carriers and fiscal intermediaries to replace unlisted procedure codes bull's eye symbol ✔✔indicates a procedure that includes moderate (conscious) sedation.
Flash symbol ✔✔codes for products that are pending FDA approval Organization of sections ✔✔Section (Surgery) - Subsection (Musculoskeletal)
- Subcategory (Head) - Heading (Incision) - Procedure Cpt manual is also arranged ✔✔from head to toe and from the trunk outward For proper code selection, the coder should reference the index and then the main section of the CPT Coding book. ✔✔true Centers for medicare and medicaid services (CMS) formerly the Health Care Financing Administration (HCFA) incorporated CPT codes into ______________ to provide a uniform system of reporting services, procedures, and supplies. ✔✔Healthcare Common Procedural Coding System (HCPCS) In which year were CPT codes incorporated as Level I codes into the Heathcare Procedural Coding System (HCPCS) ✔✔ 1983 What is a stand alone code ✔✔have full description
what is indented codes ✔✔include portion of the stand alone code description that precedes the semicolon What type of code ends with 99 ✔✔Unlisted procedurer Codes and descriptions are updated annually by CMS on ✔✔January 1st unlisted procedure or service ✔✔a service may be provided that is not specifically listed in the CPT manual. add-on codes ✔✔are codes that are listed as secondary to a main procedure and are used in conjunction with the main code. Add-on codes are NOT to be reported alone Modifiers ✔✔are two-digit codes that are appended to CPT code to enhance or further describe a services provided Special Report ✔✔may be required by some third party payers when an unusual, variable, or new service is provided.includes description of nature, extent and need for the procedure
Level I CPT modifier ✔✔Two digit numeric codes Level II (HCPCS/National) modifiers ✔✔Two digit alphanumeric modifiers. What is in Appendix A ✔✔A complete listing of level I modifiers The CMS-1500 for physician services form contains. ✔✔modifier fields When billing physician services ✔✔Place modifiers in item 24d of the CM- 1500 form, following the CPT code. When reporting modifiers for medicare claims ✔✔When you enter only one modefier,enter it in the first modifier field. When more than one modifier is submitted, ✔✔the modifiers must be ranked according to whether the modifier will affect the fee for the service.
Modifiers that affect prices are referred to as ✔✔pricing modifiers Pricing modifiers will either ✔✔increase or decrease the fee for the service the remaining modifiers are referred to as ✔✔statistical modifiers or informational modifiers statistical modifiers or informational modifiers are used for.. ✔✔Informational purposes and have an impact on the processing or payment of the code billed but do NOT affect the fee. When reporting more than one statistical or informational modifier with no other pricing modifiers, you can report the statistical or informational modifier in any order with the exception of the ✔✔QT QW and SF modifiers (These modifiers are valid for use only in the first modifier field. Modifier 52 is an acceptable modifier for ✔✔Ambulatory Surgery Center Hospital Outpatient use. Hospital outpatient services are reported on the: ✔✔UB-04 form.
When a surgeon completes only the surgical care, modifier _________should be appended to the CPT procedure code. ✔✔ 54 To report the services of the assistant surgeon, add modifier ✔✔ 80 Modifier 90 ✔✔is used on outside laboratory procedure codes to indicate that the procedure was performed by a party other that the treating or reporting physician Two surgeons ✔✔ 62 Unusual anesthesia ✔✔ 23 Increased procedural services ✔✔ 22 Reduced services ✔✔ 52 Postoperative management only ✔✔ 55
Explain when modifier 26 is used ✔✔To report the professional component of a code Explain when modifier 47 is used ✔✔only by physicians or surgeons when regional or general anesthesia is provided by the same physician or surgeon who is completing a procedure or service. When a bilateral procedure is performed in the same operative session and the CPT code describes a unilateral procedure, which modifier should be appended to the CPT code ✔✔ 50 Which modifier is used to indicate that a different provider performed the preoperative procedure management of a patient ✔✔ 56 Differentiate between modifiers 76 and 77 ✔✔Modifier 76 is used to indicate that it was necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. Modifier 77 is used when a physician or other qualified health care professional needs to indicate that a basic procedure or
Assistant surgeon--Modifier 80 ✔✔used to indicate that one surgeon was in the operating room to assist the primary surgeon Assistant surgeon (when a qualified resident surgeon is not available in a teaching facility)-- Modifier 82 ✔✔used when there is the unavailability of a qualified resident surgeon Bilateral procedure--Modifier 50 ✔✔bilateral procedures performed in the same operative session CPT modifier ✔✔two-digit code that is appended to the CPT code to indicate that a service or procedure has been altered for some reason, but main definition of the code has not changed Decision for surgery--Modifier 57 ✔✔append to an evaluation and management service code when, during the service, the initial decision was made to perform surgery Discontinued outpatient hospital/ASC procedure after administration of anesthesia--Modifier 74 ✔✔used when, due to extenuating circumstances or those that threaten the well-being of the patient, the physician terminates a surgical or diagnostic procedure after the administration of anesthesia or after the procedure was started
Discontinued outpatient procedure prior to anesthesia administration--Modifier 73 ✔✔used for outpatient ambulatory surgery centers and used when, due to extenuating circumstances or situation that threatens the well-being of the patient, the physician decides to cancel the surgery or diagnostic procedure subsequent to the patient's surgical preparation Discontinued procedure--Modifier 53 ✔✔physician may terminate a surgical or diagnostic procedure because of extenuating circumstances that threaten the well-being of the patient Mandated services--Modifier 32 ✔✔used if services are performed because the service is required or mandated by a peer review organization, insurance company, governmental, legislative, or regulatory agency Minimum assistant surgeon--Modifier 81 ✔✔used if the circumstances required a second surgeon for a short period of time, but not throughout the whole procedure Modifier 22 ✔✔increased procedural service; service provided greater than that usually required for listed procedure
Modifier 50 ✔✔bilateral procedure Modifier 51 ✔✔multiple procedures; additional procedure(s) or service(s) would be reported with this modifier; not used by facilities Modifier 52 ✔✔reduced services; procedure is partially reduced or eliminated at the physician's discretion Modifier 53 ✔✔discontinued procedure; termination of a surgical or diagnostic procedure because of extenuating circumstances that threaten the well-being of the patient Modifier 54 ✔✔surgical care only Modifier 55 ✔✔postoperative management only Modifier 56 ✔✔preoperative management only Modifier 57 ✔✔decision for surgery
Modifier 58 ✔✔staged or related procedure or service by the same physician during the postoperative period Modifier 59 ✔✔distinct procedural service Modifier 62 ✔✔two surgeons; two primary surgeons work together to perform distinct parts of a single reportable procedure Modifier 63 ✔✔procedure performed on infants less than 4 kg Modifier 66 ✔✔surgical team; several physicians of different specialties, other highly skilled and specially trained personnel, and various types of complex equipment used during the operative procedure Modifier 73 ✔✔discontinued outpatient hospital/ASC procedure prior to the administration of anesthesia
