The words that follow a code number in the CPT manual are called:
procedure/service descriptor
A code that has all of the words that describe the code that follows is what type of code?
stand alone
Procedures that are experimental, newly approved, or seldom used are reported with what type of code?
unlisted/category III
Who requires a special report with the use of unlisted codes?
third-party payers
Which of the following represents three of the six elements that a special report must contain?
Nature, extent, need
Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is available?
hypen
Which punctuation mark between codes in the index of the CPT manual indicates two codes are available?
comma
In which CPT appendix would additions, deletions, and revisions be found?
Appendix B
In which CPT appendix would all modifiers be found?
Appendix A
CPT stands for:
Current Procedural Terminology
Which term reflects the technologic advances made in medicine that are incorporated into the CPT manual?
revisions
Where is specific coding information about each section located?
guidelines
This act mandated the adoption of national uniform standards for electronic transmission of financial and administrative health information.
HIPAA
What year was CPT first developed and published?
1966
Who publishes CPT?
AMA
Health care providers are ____ based on the codes submitted on a claim form for procedures and services rendered.
reimbursed
Category I CPT codes have ____ digits.
5
The universal health insurance form for submission of outpatient services is the:
CMS-1500
Which of the following is NOT a reason for the CPT coding system?
increased reimbursment
What is the function of an add-on code?
identifies a code that is never used alone
How many main sections are in the CPT manual?
6
A modifer:
provides additional information to the third-party payer
Modifiers may affect
the way payment is made by a third-party payer
Modifiers are used to indicate what type of information?
all of the above
Modifier -57, decision for surgery, is used on what type of service?
E/M
Modifier -79, unrelated procedure or service by the same physician during the postoperative period, is used on what type of service?
surgery
Modifier -51, Multiple Procedure, is used on what type of services?
surgery
Modifier -80, Assistant Surgeon, is used when:
a second surgeon provides assistance to the primary surgeon
Modifier -32 is used to indicate a service is mandated. Which of the following is an example of when a service is "mandated?
An insurance company requires a second opinion prior to surgery
Modifier -25, significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service, is used to report an E/M service that was:
provided on the same day as a minor procedure performed by the same physician
Modifier -59, distinct procedure service, is used to indicate that:
services that are usually bundled into one payment were provided as separate services
Modifier -58, staged or related procedure or service by the same physician during the postoperative period, is used to indicate:
that a subsequent surgery was planned at the time of the first surgery
Modifier -52, reduced services, is used to indicate:
a service was reduced without changing the definition of the code
The modifier "-AA" is an example of what type of modifier?
HCPCS
Multiple modifiers are indicated with which modifier?
-99
The modifier that indicates only the professional component of the service was provided is:
-26
The modifier that indicates multiple procedures is:
-51
Mrs. Roberts falls at work. She claims that she is alright, but her employer's workers' compensation policy requires that she see a physician to confirm she was not injured when she fell. The physician files a claim to the workers' compensation carrier. W
-32
Mr. Coslett has multiple surgeries performed during the same operative session.
Which modifier would you use? ____________________
-51
When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon would report modifier ____________________ with his/her procedure code.
-62
Mr. Jones is admitted to the hospital by the orthopedic surgeon for severe hip pain. The ortho surgeon provides an initial hospital visit during which it is determined that Mr. Jones has a fractured hip that will require surgical intervention. Mr. Jones i
-57
Mrs. Smith presented to her physician's office for an office visit for an upper respiratory infection. The physician examines the patient and prescribes antibiotics. The physician notices the patient has a suspicious looking mole. The physician examined t
-25
What modifier would you use if you were coding only for the professional component of a diagnostic procedure? ____________________
-26
Modifier ______ is used to indicate that services of an outside laboratory were used.
-90