question

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?

answer

Surgical Team

question

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?

answer

Modifier -22

question

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

answer

Modifier -54

question

Only to other than E/M codes

answer

Modifier -59 goes with which type of codes?

question

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

answer

Modifier -55

question

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

answer

Modifiers -23, -52, and -73

question

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

answer

National Correct Coding Initiative (NCCI)

question

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

answer

What is a functional modifier

question

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?

answer

Modifier -32

question

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.

answer

Modifier -47

question

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?

answer

Modifier -25

question

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

answer

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

question

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.

answer

Modifier -54, -55, and -56

question

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

answer

Appendix A

question

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

answer

Preoperative Services

question

Highest to lowest

answer

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

question

Modifier -53

answer

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.

question

Modifier -23

answer

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.

question

Modifier -78

answer

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?

question

Modifier -22

answer

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.

question

Modifier -22

answer

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.

question

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

answer

The modifier -RT and LT are:

question

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

answer

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

question

By two different physicians, on separated claims

answer

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

question

Technical Component

answer

Modifier -TC means:

question

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

answer

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

question

Unusual anesthesia

answer

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

question

Evaluation and Management codes.

answer

Modifier -24 should always be used with:

question

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

answer

Modifier -25

question

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

answer

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

question

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

answer

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

question

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

answer

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

question

Modifiers -24, -32, and -57

answer

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

question

70%, 20%, 10%

answer

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

question

Intraoperative: 70%

answer

Percentage amounts for modifier -54

question

Postoperative: 20%

answer

Percentage amounts for modifier -55

question

Preoperative: 10%

answer

Percentage amounts for modifier -56

question

Unbundling

answer

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

question

Postoperative Services

answer

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

question

Modifier -50

answer

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

question

Modifier -32

answer

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.

question

Modifier -47

answer

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

question

Modifier -32

answer

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

question

Modifier -78

answer

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.

question

Modifier -76

answer

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.

question

Modifier -50

answer

The patient underwent a bilateral tympanoplasty.

question

Modifier -99

answer

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

question

Modifier -22

answer

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?

question

Modifier -55

answer

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?

question

Modifier -80

answer

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?

question

Modifier -FA

answer

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?

question

Modifier -E1

answer

What Level II modifier indicates the upper left eyelid?

question

Modifier -79

answer

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

question

Unrelated E/M service by the same physician or other qualified healthcare professional during a postoperative period

answer

-24

question

Decision for Surgery

answer

-57

question

Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period

answer

-58

question

Repeat procedure or service by same physician or other qualified healthcare professional

answer

-76

question

Repeat procedure by another physician or other qualified healthcare professional

answer

-77

question

Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period

answer

-78

question

Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period

answer

-79

question

Surgical care only

answer

-54

question

Postoperative management only

answer

-55

question

Preoperative management only

answer

-56

question

Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service

answer

-25

question

distinct procedural service

answer

-59

question

Multiple OUTPAITIENT hospital E/M encounters on the same date

answer

-27

question

Two surgeons

answer

-62

question

Surgical Team

answer

-66

question

Assistant surgeon

answer

-80

question

Minimum assistant surgeon

answer

-81

question

Assistant surgeon (when a qualified resident is not available) Teaching

answer

-82

question

Unusual anesthesia (not normally needed)

answer

-23

question

Anesthesia by surgeon

answer

-47

question

Reference (outside) laboratory

answer

-90

question

Repeat clinical diagnostic laboratory test

answer

-91

question

Alternative Laboratory Platform Testing

answer

-92

question

Increased procedural services (Extra Work)

answer

-22

question

Mandated services (Court or Insurance ordered)

answer

-32

question

Preventive services

answer

-33

question

Bilateral procedure

answer

-50

question

Multiple procedures

answer

-51

question

Reduced service (Lesser level)

answer

-52

question

Discontinued procedure (Stopped)

answer

-53

question

Procedure preformed on infants less than 4 kg

answer

-63

question

Discontinued outpatient hospital/ASC procedure prior to anesthesia

answer

-73

question

Discontinued outpatient hospital/ASC procedure after anesthesia

answer

-74

question

Multiple modifers

answer

-99

question

Orally administered Nutrition not by feeding tube.

answer

BO

question

Lower Left eyelid.

answer

E2

question

Left Hand, second digit.

answer

F1

question

Waiver of liability statement issued as required by Payer Policy, Individual Case.

answer

GA

question

Waiver of liability statement issued as required by Payer Policy, Routine Notice.

answer

GU

question

Left Side

answer

LT

question

New equipment

answer

NU

question

Service furnished by a locum tenens physician.

answer

Q6

question

Technical Component

answer

TC

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