question

Modifier -22

answer

Increased Procedural Services

question

Modifier -23

answer

Unusual Anesthesia Modifier

question

Modifier -24

answer

Unrelated E/M Services by the Same Physician During a Postoperative Period

question

Modifier -25

answer

Significant Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service

question

Modifier -26

answer

Professional Component

question

Modifier -32

answer

Mandated Services

question

Modifier -47

answer

Anesthesia by Surgeon

question

Modifier -50

answer

Bilateral Procedure

question

Modifier -51

answer

Multiple Procedures

question

Modifier -52

answer

Reduced Services

question

Modifier -53

answer

Discontinued Procedure

question

Modifier -54

answer

Surgical Care Only

question

Modifier -55

answer

Postoperative Management Only

question

Modifier -56

answer

Preoperative Management Only

question

Modifier -57

answer

Decision for Surgery

question

Modifier -58

answer

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

question

Modifier -59

answer

Distinct Procedural Service

question

Modifier -62

answer

Two Surgeons

question

Modifier -63

answer

Procedure Performed on Infants Less than 4 kg

question

Modifier -66

answer

Surgical Team

question

Modifier -76

answer

Repeat Procedure or Service by Same Physician

question

Modifier -77

answer

Repeat Procedure by Another Physician

question

Modifier -78

answer

Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the postoperative Period

question

Modifier -79

answer

Unrelated Procedure or Service by the Same Physician During the Postoperative Period

question

Modifier -80

answer

Assistant Surgeon

question

Modifier -81

answer

Minimum Assistant Surgeon

question

Modifier -82

answer

Assistant Surgeon (When Qualified Resident Surgeon Not Available)

question

Modifier -90

answer

Reference (Outside) Laboratory

question

Modifier -91

answer

Repeat Clinical Diagnostic Laboratory Test

question

Modifier -92

answer

Alternative Laboratory Platform Testing

question

Modifier -99

answer

Multiple Modifiers

question

Surgical Team

answer

When more than two physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion of the surgery to complete, they are term what?

question

Modifier -22

answer

This modifier indicates an increased service and is overused and results in an increase in payment of 20% to 30%. As such, the assignment of this modifier comes under particularly close scrutiny by third-party payers. What is this modifier?

question

Modifier -54

answer

Payment for the intraoperative or surgery portion of the surgical procedure is being requested.

question

Modifier -59

answer

Only to other than E/M codes

question

What is the weight in pounds of a 4-kilogram infant?

answer

8.8 lbs.

question

Modifier -55

answer

(Postoperative Management Only) should be assigned when a provider other than the surgeon is responsible for postoperative management.

question

NCCI

answer

National Correct Coding Initiative

question

National Correct Coding Initiative (NCCI)

answer

Implemented by the American Medical Association

question

Modifier -52

answer

A service that has been partially reduced at the physician's discretion is reflected by the modifier

question

Modifiers -23, -52, and -73

answer

When the provider performs a procedure or service for which there is no CPT code, the coder should assign

question

National Correct Coding Initiative (NCCI)

answer

Automated edits that identify pairs of services that normally should not be billed by the same physician for the same patient on the same day are part of the

question

What is a functional modifier

answer

It is a pricing modifier, which means that the third-party payer considers it when determining reimbursement

question

Modifier -62

answer

When two primary surgeons are required during an operative, each performing distinct parts of a reportable procedure, modifier ___________ should be assigned.

question

Modifier -76

answer

When a procedure was repeated because of special circumstances involving the original service and the same physician performed the repeat procedure, modifier ____ should be recorded.

question

Modifier -32

answer

Workers' Compensation referred a patient to a physician for a mandatory examination to determine the legitimacy of a claim (insurance certification). What modifier would be added to the code for the examination service?

question

Modifier -47

answer

Dr. Ramus administers regional anesthesia by intravenous injection (also known as Bier's local anesthesia) for a surgical procedure on the patient's lower arm. Dr. Ramus then performs the surgical procedure. What modifier would be added to the surgical code.

question

Modifier -25

answer

A patient came to the office twice in one day to see the same physician for unrelated problems. What modifier would be added to the code for the second office visit?

question

Modifier -51 - There are three significant times when multiple procedures are reported:

answer

1. Same Operation, Different Site 2. Multiple Operation(s), same Operative Session 3. Procedure Performed Multiple Times

question

Modifier -54, -55, and -56

answer

When reporting his or her own individual services, each physician would use the same procedure code for the surgery, letting the modifier indicate to the third-party payer the part of the surgical package that each personally performed.

question

Appendix A

answer

What appendix in the CPT manual contains a complete list of all modifiers?

question

Preoperative Services

answer

What is the term that describes the services provided to a patient by the physician before surgery?

question

When listing multiple CPT modifiers, you would list them from:

answer

Highest to lowest

question

Which of the following statements is true about modifier?

answer

may be used to describe those times when the physician elects to terminate a procedure due to the well-being of the patient

question

Dr. Wells began surgery on an 86-year-old female with severe hypertension. The patient was satisfactorily anesthetized and the site opened to view. Shortly thereafter, the patient's blood pressure dropped significantly, and the physician was unable to stabilize the patient. The procedure was discontinued.

answer

Modifier -53

question

The patient is a 10-month-old boy who fell while trying to walk. He cut the bottom of his lip open. Sutures are necessary, but due to the patient's age and excessive movement, general anesthesia is needed.

answer

Modifier -23

question

A patient has a hernia repair and 2 days later must be returned to the operating room for a dehiscence of the incision. When coding the secondary hernia repair, which modifier would you add onto the surgical codes?

answer

Modifier -78

question

A surgeon performed a repair of an enterocele using an abdominal approach and reported the service with 57270. Then patient was morbidly obese with a BMI of 42, and due to this circumstance, the procedure took a significant amount of additional time to perform.

answer

Modifier -22

question

During a radical right descended orchiectomy for an extensive malignant tumor (54435), the patient began to hemorrhage. After considerable time and effort, the hemorrhage was controlled.

answer

Modifier -22

question

The modifier -RT and LT are:

answer

Right and Left, Never used with Modifier -50, and HCPCS modifiers

question

Which group of modifier, are most likely NOT to be recognized by insurance carriers?

answer

Modifiers -63, -53, -54, -55, and -56

question

Modifiers -54 and -55 most likely would be used.

answer

By two different physicians, on separated claims

question

Modifier -TC means:

answer

Technical Component

question

Adding modifier ______________, Unusual Services modifier, indicates "additional effort or time":

answer

Modifier -22; May still not be compensated at a higher rate, even with a report, if the carrier doesn't agree.

question

The modifier -23, ____________ would not be appropriate for the use of a accupuncture

answer

Unusual anesthesia

question

Modifier -24 should always be used with:

answer

Evaluation and Management codes.

question

Modifier -25

answer

Used for the initial evaluation of a problem for which a procedure is performed.

question

If general anesthesia is applied, modifier -23 should be used when your CPT manual notes under the CPT code:

answer

Procedure "usually performed without anesthesia or under local anesthesia."

question

Some CPT codes are "Technical Service only". This means:

answer

Only the "facility", most often a hospital, would bill for services (use of the equipment.)

question

The use of a magnifying surgical loupe qualifies the use of modifier -20, microsurgery:

answer

Modifier -20 has been deleted from CPT and can no longer be used.

question

Which of the following modifiers are considered informational only (will not impact reimbursement)?

answer

Modifiers -24, -32, and -57

question

What the percentage amounts allocated for Modifier -54, -55, and -56, respectively?

answer

70%, 20%, 10%

question

What the percentage amounts for modifier -54?

answer

Intraoperative: 70%

question

What the percentage amounts for modifier -55?

answer

Postoperative: 20%

question

What the percentage amounts for modifier -56?

answer

Preoperative: 10%

question

What is the word that means assigning multiple codes when one code would do?

answer

Unbundling

question

What is another term for the time after the surgery that the physician provides services to the patient?

answer

Postoperative Services

question

A patient is admitted and has bilateral arthroscopy of the knees due to Baker's cysts.

answer

Modifier -50

question

A radiological examination of the gastrointestinal tract was ordered by a third-party payer for a confirmation of Crohn's disease (regional enteritis) of the large bowel.

answer

Modifier -32

question

Anesthesia provided by the ENT physician during a tympanoplasty for repair of a tympanic membrane perforation.

answer

Modifier -47

question

A patient is seen at the direction of Workers' Compensation for a complete physical examination for insurance certification.

answer

Modifier -32

question

The patient returns to the operating room for removal of deep pins during the postoperative period, due to complication (dislodged) after an open repair of a humerus fracture.

answer

Modifier -78

question

A patient has a surgical procedure on Turesday, and later that day the physician must take the patient back to the operating room to repeat (redo) a coronary bypass, due to complications of initial procedure.

answer

Modifier -76

question

The patient underwent a bilateral tympanoplasty.

answer

Modifier -50

question

If you must use two or more modifiers to describe a service, you would use which modifier to indicate this circumstance?

answer

Modifier -99

question

A surgeon performs a procedure on a neonate weighing 9kg; the procedure was extremely complicated. What modifier would you use to indicate this service, which has an increased level of complexity?

answer

Modifier -22

question

Dr. Storely performed cataract surgery on 10/31/2008 and Dr. Jones provided postoperative care following discharge. What modifier would you use to indicate the postoperative care following discharge?

answer

Modifier -55

question

Dr. Merideth serves as an assistant surgeon to Dr. Taylor. What modifiers; would you add to the procedure code to indicate Dr. Merideth's status during the procedure?

answer

Modifier -80

question

The third-party payer requires the use of HCPCS/National modifiers; the surgeon performed a surgical procedure on the patient's left thumb. What Level II modifier would indicate the left thumb?

answer

Modifier -FA

question

What Level II modifier indicates the upper left eyelid?

answer

Modifier -E1

question

Which modifier is requests payment for the full fee of the subsequent service because it was unassociated with the first procedure. A new global period should start when modifier _____ is submitted

answer

Modifier -79

question

The CPT manual was developed by the

answer

American Medical Association (AMA)

question

CPT stands for

answer

Current Procedural Terminology

question

Providers of health care are paid based on the codes submitted for _____________ or procedures provided to the patient.

answer

services

question

The first CPT was published in this year

answer

1966

question

In which year were CPT codes incorporated as Level I codes into the Healthcare Procedure Coding Sytem (HCPCS)?

answer

1983

question

The CPT manual often reflects the technologic advances made in medicine with these codes:

answer

Category 3 Codes

question

The CPT manual is ever changing and is updated annually to reflect technologic advances and editorial _______.

answer

Revisions

question

What type of codes end with 99?

answer

Unlisted Procedure

question

Coding information that pertains to an entire section is located in the ___________.

answer

Guidelines

question

These codes provide supplemental information and do not substitute for a Category 1 Code:

answer

Category 2 Codes

question

What is the name of the two-digit number or a digit and a number that is located after the CPT code number and provides more detail about the code?

answer

Modifier

question

When using an unlisted or Category 3 Code, third-party payers usually require the submission of what?

answer

Special Report

question

Appendix A

answer

lists all modifiers that are used to alter or modify codes.

question

Appendix B

answer

additions to, deletions from, and revisions of the CPT manual.

question

Appendix C

answer

clinical examples of many of the Evaluation and Management (E/M) codes.

question

Appendix D

answer

lists all add-on codes.

question

Appendix E

answer

complete list of Modifier -51 exempt codes.

question

Appendix F

answer

summary of CPT codes that are Modifier -63 exempt.

question

Modifier -51 indicates what?

answer

More than one procedure was performed.

question

Modifier -63 identifies what?

answer

Procedures that are performed on infants who weigh less than 4 kg or 8.8 pounds and represents a significant increase in the physician's works and complexity of service/procedure.

question

Appendix G

answer

Summary of Moderate Sedation Codes. (Procedure that requires conscious sedation.)

question

Appendix H

answer

Category 2 Codes.

question

Category 2 codes

answer

optional tracking codes that are used to identify performance measures of clinical components that may be typically included in evaluation and management services. (Removed)

question

Category 1 codes

answer

for the most part, define professional services.

question

Appendix I

answer

Genetic Testing Code Modifiers

question

Appendix J

answer

Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves.

question

Appendix K

answer

Product Pending FDA Approval

question

Appendix L

answer

Vascular Families

question

Appendix M

answer

Summary of crosswalked deleted CPT codes.

question

Appendix N

answer

Resequenced CPT codes

question

Modifiers

answer

provide additional information to the third-party payer about services provided to the patient. At times a five digit code may not reflect completely the service or procedure provided.

question

CPT modifiers are listed in descending or ascending numeric order?

answer

Descending.

question

Definition of a chief complaint using the E/M Guidelines:

answer

Chief Complaint is a concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient's words.

question

According to the Surgery Guidelines, surgical destruction is a part of a surgical procedure and ____________ methods of destruction are not ordinarily listed separately.

answer

different

question

According to the Radiology Guidelines, who must sign a written report to have the report considered part of the radiologic procedure?

answer

the interpreting individual

question

Under whose supervision are the Pathology and Laboratory services provided?

answer

Physician

question

What is the code listed in the Medicine Guidelines that is to be used to identify materials supplied by the physician that are beyond those ordinarily included in the service provided?

answer

99070

question

Describe a stand-alone code.

answer

They have the full description.

question

Describe an intended code.

answer

They are listed under associated stand-alone codes.

question

Words following the semicolon in stand-alone codes can indicate the following three things:

answer

Alternative anatomical sites, alternative procedures, or a description of the extent of the service.

question

What is the two-digit modifier that indicates two primary surgeons?

answer

-62

question

If the CPT code is 43820 (gastrojejunostomy without vagotomy) and two primary surgeons performed the services, the service could be stated this way:

answer

43820-62

question

Bilateral inguinal herniorrhaphy:

answer

-50

question

A postoperative ureterotomy patient has to be returned to the operating room (unplanned) for a complication related to the initial procedure during the postoperative period:

answer

-78

question

A decision to perform surgery is made during an evaluation and management service on the day before or the day of surgery:

answer

-57

question

A surgical team is required:

answer

-66

question

Physician A actively assists physician B during a surgical procedure:

answer

-80

question

Symbols with definitions are located at the bottom of the page in the CPT manual; True or False?

answer

True

question

A category III code would be reported rather than a Category I __________ code.

answer

unlisted

question

Special reports must be submitted with claims for procedures that are unusual, new, seldom used, or use Category I ____________ codes or Category _______ codes.

answer

unlisted; III

question

The symbol used between two code numbers to indicate that a range is available is a _________?

answer

hyphen (-)

question

Using figure 13-31 (bottom of page) Identify, in this order, #13, #14, #15, #16

answer

Subsection, Section, Subheading, Category

question

The symbol that indicates a product is pending FDA approval is the __________________?

answer

Lightening bolt

question

A complete list of the codes disgnated with the symbol that indicates a product is pending FDA approval is listed in this appendix of the CPT manual ____________.

answer

Appendix K

question

The Genetic Testing Code Modifiers are listed in this appendix of the CPT manual. ____________.

answer

Appendix I

question

total

answer

Anesthesia services are based on ____________time the patient is under the anesthesiologist's care. Calculation of units of time is determined by the third-party payer.

question

begins preparing the patient to receive anesthesia, continues through the procedure, and ends when the patient is no longer under the personal care of the anesthesiologist.

answer

Anesthesia time begins when the anesthesilogist ___________________and continues ______________ the procedure, and ends when ______________________________________________

question

-47

answer

According to the Anesthesia Guidelines, what is the one modifier that is not used with anesthesia procedures? _______

question

physical status

answer

"P1" is an example of what type of modifier? ___________ _____________

question

moribund

answer

What word means "in a dying state"?

question

systemic

answer

What word means "affecting the body as a whole"?

question

6

answer

The letter "P" in combination with what number indicates a brain-dead patient?

question

qualifying

answer

What type of circumstance identifies a component of anesthesia service that affects the character of the service?

question

anatomic

answer

Anesthesia procedures are divided by what type of site?

question

complex, combined total (or total time)

answer

According to the Anesthesia Guidelines, the Separate or Multiple Procedures section, when multiple surgical procedures are performed during a single anesthetic administration, the anesthesia code representing the most ____________ procedure is reported and the time reported is the ________________ or _________________ for all procedures.

question

No

answer

Is it true that a physician who personally administers the anesthesia to the patient upon whom he or she is operating cannot bill the third-party payer? (if True, why; if False, why, AND is there any additional information you might want to add?)

question

Relative Value Guide (RVG)

answer

What is the name of the guide that is published by the American Society of Anesthesiologists and provdides the weights of various anesthesia services?

question

body area

answer

Is the examination of the back an organ system or body area examination?

question

new, established, outpatient, inpatient

answer

The four types of patient status are?

question

initial, subsequent

answer

The first outpatient visit is called the ________visit, and the seond visit is called the _________visit.

question

status, place of service, type of service

answer

The first three factors a coder must consider when coding are patient ______, ________ __ ________, and _________ __ ________.

question

4

answer

How many types of histories are there?

question

expanded problem focused history

answer

Which history is more complex: The problem focused history or the expanded problem focused history?

question

problem focused, expanded problem focused, detailed, comprehensive

answer

The four types of examinations, in order of difficulty (from least difficult to most difficult) are as follows:

question

problem focused

answer

The examination that is limited to the affected body area is the ___________ ____________ .

question

very low birth weight

answer

What does VLBW stand for?

question

straightforward

answer

What medical decision making involves a situation in which the diagnosis and management options are minimal, data amount and complexity that must be reviewed are minimal/none, and there is a minimal risk to the patient of complications or death?

question

inpatient

answer

What term is used to describe a patient who hs been formally admitted to a hospital?

question

surgical team, 66

answer

When more than two physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion of the surgery to complete, they are termed what ____________ ___________, and the modifier is -_______.

question

No, because it states in the notes for modifier 22 that this modifier should not be appended to an E/M Service

answer

Can modifier -22 be assigned to 99291, 99292 codes ( which are E/M service codes)

question

-22

answer

This modifier indicates an increased service and is overused and results in an increase in payment of 20% to 30%. As such, the assignment of this modifier comes under particularly close scrutiny by third-party payers. What is this modifier?

question

intraoperative or surgery

answer

When modifier -54 is assigned, payment for the __________________ portion of the surgical procedure is being requested.

question

She is incorrect because modifier 32 is only assigned for mandated services, such as police and Workers Compensation and not for requests made by patient, family member, or another physician.

answer

Joan is a new coder at the local clinic. You have been assigned to review her coding before it is submitted to the third-party payer. You note that she assigned modifier -32 to E/M consultation code 99244. The medical record indicates that the request for the second opinion was made by the patient's spouse. Is Joan correct in modifier -32 assignment? Why or why not?

question

b

answer

Which of these statements is true about modifier -59? a. It is only appended to E/M codes b. It is only appended to other than E/M codes.

question

8.8 lbs.

answer

What is the weight in pounds of a 4-kilogram infant?

question

c

answer

Which of the following statemtns is NOT true about modifier -53? a. describes circumstances based on the patient's condition. b. may be used to describe those times when the physician elects to terminate a procedure due to the well-being of the patient. c. describes circumstances in which the patient cancelled the procedure. d. may be used to describe ASC reporting of previously scheduled procedure that is partially reduced as a result of extenuating circumstances.

question

False

answer

True or False: Modifier -57 can be added to Surgery section codes?

question

a

answer

When adding multiple CPT modifiers to a cdoe, you would list the modifiers from: a. highest to lowest b. lowest to highest c. makes no difference which is listed first.

question

-76

answer

Modifier used to repeat procedure or service by same physician?

question

-62

answer

Modifier for Two surgeons?

question

-26

answer

Modifier for Professional component?

question

-99

answer

Modifier for Multiple modifiers?

question

-59

answer

Modifier for Distinct Procedural Service?

question

-32

answer

Modifier for Mandated Service

question

-25

answer

Modifier for Significant identifiab le E/M service provided by the same physician on the same day as another service or procedure?

question

-81

answer

Modifierfor Minimum Assistant Surgeon?

question

-77

answer

Repeat procedure by another physician?

question

-79

answer

Unrelated procedure or service by the same physician during the postoperative period

question

-23

answer

Unusual anesthesia

question

-78

answer

Unplanned return to the operating room for a related procedure during the postopeative period.

question

-54

answer

Surgical care only.

question

-52

answer

Reduced service.

question

-66

answer

Surgical Team

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