Chapter 5 Procedural Coding: CPT and HCPCS (SmartBook)
Which appendix includes a Clinical Examples and Case Studies in the CPT? A H F C
C
Identify all the correct statemetns related to the evaluation and management codes. E/M codes are rarely used E/M codes are listed first in CPT E/M codes determine a patient's diagnosis and the medications necessary to treat the condition E/M codes cover the complex process a physician uses to gather and analyze information about a patient's illness E/M codes are often called the cognitive codes
E/M codes are listed first in CPT E/M codes cover the complex process a physician uses to gather and analyze information about a patient's illness E/M codes are often called the cognitive codes
Select all that apply. Identify the correct statements related to the main text as used in selecting the CPT code. The section, subsection, and code number range on a page are shown at the top of the page. There are two sections of the main text that apply to the coding guidelines. Each of the six subsections of the main text lists procedure codes and descriptors under subsection headings. The subsection headings group procedures or services.
Each of the six subsections of the main text lists procedure codes and descriptors under subsection headings. The section, subsection, and code number range on a page are shown at the top of the page. The subsection headings group procedures or services.
The lightning bolt symbol is used when approval is pending from what agency? CMS CDC AMA FDA
FDA
Select all that apply. Which of the following statements are correct in regard to CPT symbols? Facing triangles enclose new or revises text other than the code's descriptor. A triangle indicates that the code's descriptor has changed. A bullet indicated a new procedure. A bullet indicates an existing procedure that was performed twice.
Facing triangles enclose new or revised text other than the code's descriptor. A triangle indicates that the code's descriptor has changed. A bullet indicates a new procedure.
Where are codes for items that are used in medical practices but are not listen in CPT (such as supplies and equipment) found? Common Procedure Coding Practices Healthcare Common Procedure Coding System Procedure Coding Clinical Procedure Coding
Healthcare Common Procedure Coding System (HCPCS)
Which of the following statements are related to certification and how that determines the relationship between tests performed and reported? (Select all that apply). In- office labs are guided by federal safety regulations from OSHA Some medical practices have laboratory equipment and perform their own testing CLIA- waived tests are not allowed to be performed in an office The tests that can be performed are regulated by CLIA In- office labs are regulated.
In- office labs are guided by federal safety regulations from OSHA Some medical practices have laboratory equipment and perform their own testing The tests that can be performed are regulated by CLIA
Identify three status level codes for the patient's physical status when coding anesthesia services. P4- Patient with severe systemic disease that is a constant threat to life P6- Moribund patient who is expected to survive the operation P1- Normal healthy patient P5- Moribund patient who is not expected to survive without the operation
P4- Patient with severe systemic disease that is a constant threat to life P1- Normally healthy patient P5- Moribund patient who is not expected to survive without the operation
Medicare insurance specialists should be aware that some private payers require anesthesia services to be reported by procedure codes from the ___________ section rather than from the Anesthesia section. Medicine Surgery Anesthesia Medicare
Surgery
What is the purpose of locating the index after reviewing the physician's statements in the patient's medical records? The index provides a description for the code. The index provides a pointer to the correct code range. The index provides the correct code. The index provides the correct pages.
The index provides a pointer to the correct code range.
Which of the following apply to grouping labs together? (Select all that apply). When a panel code is reported, al the listed tests must have been performed. When a panel code is reported, none of the listed tests should be completed. Related tests are grouped under laboratory panels for reporting convenience. Related tests are never grouped.
When a panel code is reported, all the listed tests must have been performed. Related tests are grouped under laboratory panels for reporting convenience.
Which of the following is the symbol for an FDA approval pending code? a diamond a lightning bolt a facing triangle a square
a lightning bolt
What is the correct definition of add- on codes? add- on codes reference experimental codes add- on codes describe a primary procedure add- on codes describe secondary procedures commonly carried out in addition to primary procedures add- on codes are optional codes that can be used to describe the patients' diagnoses
add- on codes describe secondary procedures commonly carried out in addition to primary procedures
How are modifiers shown in CPT? adding a five- digit code to the CPT code adding a space and the two- digit code to the CPT code adding a space and a five- digit code to the CPT code adding a dash between the modifier and the CPT code
adding a space and the two- digit code to the CPT code
Anesthesia services for Medicare patients and most other patients are reported using codes from the _______ section. anesthesia outpatient surgery medicare
anesthesia
The Anesthesia section's subsections are organized by _________. diagnosis body sites procedures terms
body sites
Which of the following apply to how bundled payment combinations are determined? individual codes for services included in a bundled code can be billed separately and in addition to the bundled code. only one bundled code per day can be billed bundled payment combinations are based on payers' judgement of the correct value for the physician's work bundled payments are determined by how many times the patient has seen the provider
bundled payment combinations are based on payers' judgement of the correct value for the physician's work
Which of the following statements apply to how payers bundle codes for payment? (Select all that apply). bundled payments are single payments to multiple providers involved in one episode of care with accountability shared among providers. bundled payments are also known as multiple payments bundled payments are multiple payments to single providers bundled codes are not ethical and should not be used for surgical procedures. bundled payments are also known as episode payments.
bundled payments are single payments to multiple providers involved in one episode of care with accountability shared among providers bundled payments are also known as episode payments
Which of the following is the symbol for an add- on code? < * ; +
+
How many categories of CPT codes are there? 3 4 1 2
3
Modifier _______ defines bilateral services.
50
How many sections are listed in the main text? 3 4 2 6
6
Which of the following apply to step 5 of the six steps of assigning CPT codes? check section guidelines and any notes directly under the code, within the code descriptor, or after the code descriptor do not eliminate items that are billed separately because they are covered under another broader code the codes to be reported for each day's services are ranked in order of highest to lowest reimbursement review the possible codes in the CPT section that the index entries point to
check the section guidelines and any notes directly under the code, within the code descriptor, or after the code descriptor the codes to be reported for each day's services are ranked in order of highest to lowest reimbursement review the possible codes in the CPT section that the index entries point to
Which of the following is an E/M subsection for the place of service. consultation laboratory surgery radiology
consultation
Which of the following is an E/M subsection for the place of service. laboratory consultation radiology surgery
consultation
____________ requested band reports must be written documents that are placd in the medical record
consultation
Which of the following apply ot the reporting of consultation requests? consultation requests and reports must be written documents that are placed in the medical records consultation requests are not formal or written but are informal discussions with the physician the consultation reports should be reviewed and initialed by the primary physician with documentation of follow- up plans the consultation reports are kept with the consulting physician and are not reviewed or signed by the primary physician
consultation requests and reports must be written documents that are placed in the medical records the consultation reports should be reviewed and initialed by the primary physician with documentation of follow- up plans
The subsections in the Medicine section have notes containing which of the following? (Select all that apply). definitions body areas usage guidelines medications
definitions medications
What is step 6 in the process of assigning CPT codes? determine the need for modifiers identify the main term for each procedure locate the main terms in the CPT index verify the code in the CPT main text
determine the need for modifiers
Which of the following are among the six steps for assigning CPT codes? determine the need for modifiers submit codes to the payer verify the code in the CPT main text locate the main terms in the CPT index
determine the need for modifiers verify the code in the CPT main text locate the main terms in the CPT index
Which of the following apply to step 1 of the six steps of assigning CPT codes? identify the main term for each procedure verify codes in the CPT main index determine the place of service decide which procedures were performed review the documentation
determine the place of service decide which procedures were performed review the documentation
Which of the following is an example of a type of radiologic procedure? chest x-ray electrocardiogram echocardiography diagnostic ultrasound
diagnostic ultrasound
Which of the following is NOT an exception to the usual subsection structure? maternity care subsection laparoscopy/ hysteroscopy subsection digestive system subsection
digestive system subsection
When unlisted codes are reported, a special report must be attached that defines which of the following? extent of the procedure nature of the procedure history of patient need for the procedure
extent of the procedure nature of the procedure need for the procedure
The period of time that is covered for follow- up care is referred to as the ______________. recovery time after care time global period surgical time
global period
In the Surgery section, the grouping of related work under a single procedure code is called which of the following? (Select all that apply.) global surgery rule surgical package comprehensive package combined package
global surgery rule surgical package
What is step 3 in the process of assigning CPT codes? determine the need for modifiers identify the main term for each procedure review medical documentation verify the code in the CPT main text
identify the main term for each procedure
Which of the following apply to step 4 of the six steps of assigning CPT codes? if the main term cannot be located in the index, find the closest term if the main term cannot be located in the index, the insurance specialist reviews the main term with the physician for clarification when a code range is listed, read the code descriptors for all codes within the range indicated in the index locate the procedures in the index at the back of the CPT
if the main term cannot be located in the index, the insurance specialist reviews the main term with the physician for clarification when a code range is listed, read the code descriptors for all codes within the range indicated in the index locate the procedures in the index at the back of the CPT
The use of a modifier means that the procedure __________. has a secondary diagnosis that needs to be used is routine and considered normal changes the definition of the procedure is different from the description without changing the definition
is different from the description without changing the definition
Which of the following apply to postoperative critical care and pain management requested by the surgeon? it is bundled in the procedure charges it is not included in the procedure charges it is represented by modifier 50 it can be billed in addition to the main anesthesia code
it is not included in the procedure charges it can be billed in addition to the main anesthesia code
Identify the step 4 in the process of assigning CPT codes? determine the need for modifiers locate the main terms in the CPT index identify the main terms abstract the medical procedures
locate the main terms in the CPT index
Which of the following procedures often use contrast materials? electromagnetic radiation magnetic resonance imaging (MRI) heart bypass hysterectomy
magnetic resonance imaging (MRI)
Which of the following apply to step 3 of the six steps of assigning CPT Codes? main terms may be based on organ or body part review visit documentation identify the main term for each procedure main terms may be based on procedure or service modified main terms may be used
main terms may be based on organ or body part identify the main term for each procedure main terms may be based on procedure or service
Which of the following apply to step 2 of the six steps to assigning CPT codes? medical procedures must be taken from a list provided by the physician. the main term must be located in the CPT index medical procedures must be taken from the visit documentation
medical procedures must be taken from the visit documentation
Which of the following send their suggestions for revisions to the CPT code to the AMA each year? Medical specialty societies State medical associations Insurance companies physicians
medical specialty societies state medical associations physicians
A(n) _______ is a number appended to a code to report particular facts. add- on addendum modifier root form
modifier
What are used to indicate special circumstances involved with surgical procedures? add- ons modifiers secondary codes special codes
modifiers
What of the following apply to the place and type of service in E/M codes? most codes in the E/M section are organized by the place of service, such as the office, the hospital, or a patient's home a few codes in the E/M section are grouped by type of service the place of services is not relevant with E/M codes all of the codes in the E/M section are grouped by type of service
most codes in the E/M section are organized by the place of service, such as the office, the hospital, or a patient's home a few codes in the E/M section are grouped by type of service
Which of the following statements apply to radiology code reporting? most radiology services are performed and billed by radiologists in a private office. most radiology services are performed and billed by radiologists working in hospital or clinic settings the radiologist serves as a consultant only the radiologist performs only the technical component
most radiology services are performed and billed by radiologists working in hospital or clinic settings
Which of the following apply to reporting unlisted codes for pathology and laboratory services? (Select all that apply). New developments are frequent in pathology and laboratory services. there are codes for twelve unlisted code areas there are codes for one hundred unlisted code areas any unlisted code must be submitted with a special report
new developments are frequent in pathology and laboratory services there are codes for twelve unlisted code areas any unlisted code must be submitted with a special report
Which of the following apply to radiology procedures? there are codes for nearly one hundred unlisted code areas. new procedures are uncommon in the area of radiology services new procedures are common in the area of radiology services not special report is required for radiology services
new procedures are common in the area of radiology services
Which subsections of the Radiology section are structured by type of procedure, followed by body sites, and then procedures? (Select all that apply). nuclear medicine fluoroscopic nuclear ultrasound diagnostic radiology diagnostic ultrasound
nuclear medicine diagnostic radiology diagnostic ultrasound
Radiology codes are selected based on which of the following? (Select all that apply). number of views body part type of views age of patient
number of views body part type of views
Some medicine codes are ancillary services that are used to support diagnosis and treatment for which of the following? (Select all that apply). marriage therapy occupational therapy rehabilitation nutrition therapy
occupational therapy rehabilitation nutrition therapy
According to E/M coding, who is considered a "new patient"? one who has only had recent treatment from the provider for issues and has not a physical one who has not received and professional services from the provider within one year one who has received professional services from the provider within three years one who has not received any professional services from the providers within three years
one who has not received any professional services from the provider within three years
Identify all the elements of a complete procedure for reporting pathology and laboratory codes. ordering the test performing the test retesting the sample for accuracy taking and handling the sample
ordering the test performing the actual test taking and handling the sample
A Complete Blood Count is an example of which of the following? procedure name of test panel of tests abbreviation of a test
panel of tests
Which of the following is a consideration when abstracting documentation to select services to be reported? date of procedure number of procedures modifiers payer's policies
payer's policies
Because the patient's health has a large effect on the level of difficulty of anesthesia services, anesthesia codes are assigned a __________. patient assessment patient report physical status modifier patient rating
physical status modifier
When using a modifier for a two- part procedure the professional component (PC) indicates the procedures performed by a _________.
physician
Codes in the Pathology and Laboratory section cover services provided by which of the following? nurse practitioners physicians or by technicians under the supervision of physicians physicians only technicians only
physicians or by technicians under the supervision of physicians
What are most codes in the E/M section organized by? date of service place of service diagnosis type of service
place of service
Which of the following anesthesia- related codes are not included in the Anesthesia section and can be billed separately? local anesthesia postoperative critical care general anesthesia requested by the physician pain management requested by the physician
postoperative critical care pain management requested by the physician
Which of the following anesthesia- related codes are not included in the Anesthesia section and can be billed separately? (Select all that apply.) postoperative critical care general anesthesia- requested by the physician pain management requested by the physician local anesthesia-
postoperative critical care pain management requested by the physician
Procedures and services for laboratory codes are listed in the index under which of the following types of main terms? (Select all that apply). procedure name of test abbreviation abnormal reporting results
procedure name of test abbreviation
Under each subsection in Anesthesia, the codes are arranged by ___________. terms body part being worked on codes procedures
procedures
Using two or more modifiers with one code will _____________. provide the best description possible not provide enough information about the procedure reduce the chances for claim payment be considered fraud
provide the best description possible
Select all that apply. The body- site subsections are followed by which other two subsections? radiological procedures other or unlisted procedures vascular procedures systemic procedures
radiological procedures other or unlisted procedures
The codes in the Radiology section are used to report which of the following? radiological services performed by a technician outpatient services radiological services performed by or supervised by a physician hospital services performed
radiological services performed by or supervised by a physician
What is step 1 in the process of assigning CPT codes? review complete medical documentation abstract the medical procedures from the visit documentation identify the main term for each procedure verify the code in the CPT main text
review complete medical documentation
An intended code uses a ______ to separate the common descriptor from the unique descriptor.
semicolon
Some procedural code descriptors in the Surgery section are followed by the words __________. isolated combined additional seperate
separate
Select the symbol used to indicate the code is approved for Telemedicine. star bullet triangle circle
star
What is the largest code section within the CPT? surgery E/M Medicine Anesthesia
surgery
Separate procedure means that the procedure is usually done as an integral part of a(n) __________. hospital visit operation procedure surgical package
surgical package
The services for a _________ code are rendered real- time through interactive audio and/or video telecommunications system.
telemedicine
Which of the following apply to anesthesia coding? the anesthesiologist records level of difficulty and not time during a procedure the anesthesiologist records the amount of time spent with the patient during the procedure and adds this to the base value the American Society of Anesthesiologists assigns a base unit value to each code difficulties, such as a patient with severe systemic disease, add to the value of the anesthesiologist's services
the anesthesiologist records the amount of time spent with teh patient during the procedure and adds this to the base value The American Society of Anesthesiologists assigns a base unit value to each code Difficulties, such as severe systemic disease, add to the value of the anesthesiologist's services
Which of the following apply to step 6 of the six steps of assigning CPT codes? the modifier should always be used the circumstances involved with the procedure or service may require the use of modifiers the patient's diagnosis does not affect whether a modifier is required the patient's diagnosis may affect whether a modifier is required
the circumstances involved with the procedure or service may require the use of modifiers the patient's diagnosis may affect whether a modifier is required
Select all that apply: Which of the following statements apply to surgery codes? The codes in the surgery section are used for the many hundreds of surgical procedures performed by physicians. The surgery code section is the largest procedure code section in CPT The surgery code section is the smallest section in CPT The codes range from 10021 to 69990
the codes in the surgery section are used for the many hundred of surgical procedures performed by physicians the surgery code section is the largest procedure code section in CPT the codes range from 10021 to 69990
Which of the following statement applies to the common descriptor? the common descript and the unique descriptors all begin with lowercase letters. the unique descriptors are not indented after the common descriptor the common descriptor begins with a capital letter, but the unique descriptors after the semicolon do not. the common descriptor and the unique descriptors after the semicolon all begin with a capital letter
the common descriptor begins with a capital letter, but the unique descriptors after the semicolon do not.
Which of the following are true of bundled services? all components of the episode must always occur on the same day all components of the episode must always take place at the same location the episode may not take place over a period of time the episode may take place in multiple settings
the episode may take place in multiple settings
Which of the following are true of the two parts of radiology procedures? (Select all that apply). the second part of the radiology procedure is the follow- up the first part of a radiology procedure is the history taken the second part of a radiology procedure is the professional component the first part of a radiology procedure is the technical component
the second part of a radiology procedure is the professional component the first part of a radiology procedure is the technical component
Which of the following apply to coding contrast materials in radiological procedures? (Select all that apply.) the term with contrast means administered orally the term with contrast means only contrast materials are given in the patient's veins or arteries the term without contrast means contrast materials are administered orally or rectally the term without contrast means administered in the veins or arteries or arteries or
the term with contrast means only contrast materials are given in the patient's veins or arteries the term without contrast means contrast materials are administered orally or rectally
Which of the following is true when coding an office visit? there are five codes to choose from for an office visit with a new patient the E/M codes cover services that are similar in nature the physician may select any level code in the range there are 2 codes to choose from for an office visit with a new patient
there are five codes to choose from for an office visit with a new patient
Identify the two places resequenced codes are listed in CPT. they are listed in their original numeric position they are listed at the back of the CPT the code and its descriptor appear in a group of codes to which it is related the code is listed in a supplemental pamphlet.
they are listed in their original numeric position the code and its descriptor appear in a group of codes to which it is related
Anesthesia codes are reimbursed according to __________. type of anesthesia recovery time level of difficulty time
time
What is the purpose of the codes in the Evaluation and Management section? to cover physicians' services that are performed to determine the best course for patient care to cover geriatric care to determine if the patient is eligible for assisted living to cover pediatric care to determine if the patient is meeting wellness initiatives to cover managed care to determine if referrals are needed
to cover physicians' services that are performed to determine the best course for patient care
Why are certain pathology and laboratory tests customarily ordered together? to detect particular diseases or malfunctioning organs to reduce the cost of tests for convenience of administering the tests to get more results
to detect particular diseases or malfunctioning organs
Which of the following is used to determine the CPT code? treatment procedure appointment date service
treatment procedure service
A _________ symbol indicated that the code's descriptor has changed.
triangle
Resequenced codes are listed how many times in CPT? once multiple twice never
twice
What is step 5 in the process of assigning CPT codes? locate the main terms in the CPT index review complete medical documentation abstract the medical procedures verify the code in the CPT main text
verify the code in the CPT main text
Identify one of the two levels the CLIA certification program awards. The Occupational Safety and Health Level 1 Mild complexity testing Waived tests and provider- performed microscopy procedures mandatory tests
waived tests and provider- performed microscopy procedures
Anesthesia services for Medicare patients and most other patients are reported using codes from the _________ section. Medicare Anesthesia Outpatient Surgery
Anesthesia
Which of the following are appendixes in CPT? Appendix B- Summary of Additions, Deletions, and Revisions Appendix D- Summary of CPT Add- on Codes Appendix C- Vascular Families Appendix A- Modifiers
Appendix B- Summary of Additions, Deletions, and Revisions Appendix D- Summary of CPT Add- On Codes Appendix A- Modifiers
Identify the correct statements related to CPT. CPT is a proprietary code set and is not available free to the public. CPT code is available only in digital format. CPT code is available only in print from the AMA. CPT is non- proprietary and is available free to the public.
CPT is a proprietary code set and is not available free to the public.
Identify all the correct statements related to CPT modifiers. CPT modifiers are five- digit numbers that may be attached to most five- digit codes CPT modifiers are two- digit numbers that may be attached to most five- digit codes Modifiers are used to communicate routine circumstances involving a procedure that has been performed. Modifiers are used to communicate special circumstances involved with procedures that have been performed.
CPT modifiers are two- digit numbers that may be attached to most five- digit codes Modifiers are used to communicate special circumstances involved with procedures that have been performed.
_________ is the first part of the HCPCS codes.
CPT/ CPT codes
Which of the following are categories of CPT codes? Category I codes Category V codes Category III codes Category IV codes Category II codes
Category I codes Category II codes Category III codes
Which of the following apply to E/M codes not listed in the Medicine section? (Select all that apply). all services in the Medicien section are considered E/M services The 51 modifier should be used Codes not listed in the E/M section cannot use the 51 modifier for multiple procedures Some are considered Evaluation and Management services though they are not listed in the E/M section.
Codes not listed in the E/M section cannot use the 51 modifier for multiple procedures Some are considered Evaluation and Management services though they are not listed in the E/M section
