Ch 10: Chapter Review

Question 1

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?

Answer 1

Co-Surgeons

Question 2

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 2

-22 (Increased Procedural Services)

Question 3

When modifier _____ is assigned, payment for the intraoperative or surgery portion of the surgical procedure is being requested.

Answer 3

-54 (Surgical Care Only)

Question 4

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

Answer 4

8.8 lbs

Question 5

T/F: Modifier -57 can be added to Surgery section codes.

Answer 5

False

Question 6

In what sequence do you add multiple CPT modifiers to a code?

Answer 6

Highest to Lowest

Question 7

What modifier: Repeat procedure or service by same physician?

Answer 7

-76

Question 8

What modifier: Two surgeons

Answer 8

-62

Question 9

What modifier: Professional Component

Answer 9

-26

Question 10

What modifier: Multiple modifiers

Answer 10

-99

Question 11

What modifier: Distinct procedural service

Answer 11

-59

Question 12

What modifier: Mandated service

Answer 12

-32

Question 13

What modifier: Significant identifiable E/M service provided by the same individual on the same day as another service or procedure

Answer 13

-25

Question 14

What modifier: Repeat procedure by another individual

Answer 14

-77

Question 15

What modifier: Minimum assist surgeon

Answer 15

-81

Question 16

What modifier: Unrelated procedure or service by the same individual during the postoperative period

Answer 16

-24

Question 17

What modifier: Unusual anesthesia

Answer 17

-23

Question 18

What modifier: Unplanned return to the operating room for a related procedure during the postoperative period

Answer 18

-78

Question 19

What modifier: Surgical care only

Answer 19

-54

Question 20

What modifier: Reduced services

Answer 20

-52

Question 21

What modifier: Surgical team

Answer 21

-66

Question 22

What part of the CPT manual lists a full description for all modifiers?

Answer 22

Appendix A

Question 23

When a CPT code does not fully explain an unusual procedure, what should be added to the code?

Answer 23

Modifier

Question 24

What modifier is applied to a surgical procedure to indicate increased physician work was performed?

Answer 24

-22

Question 25

What modifier is applied to indicate a service for which general anesthesia was used when normally local anesthesia would be indicated?

Answer 25

-23

Question 26

What modifier is applied to indicate an E&M encounter was performed and not related to a current global period?

Answer 26

-24

Question 27

When a patient comes into the office twice in one day for different medical reasons, the -25 modifier should be applied to which visit?

Answer 27

Second E/M

Question 28

What modifier indicates the professional component of a diagnostic test?

Answer 28

-26

Question 29

Third-party payers require this modifier for a mandated service.

Answer 29

-32

Question 30

Modifier -33 indicates a covered preventive service. What organization grades preventive services?

Answer 30

US Preventive Services Task Force (USPSTF)

Question 31

Modifier -47, anesthesia by the surgeon, is never added to what CPT codes?

Answer 31

Anesthesia codes

Question 32

How many units of service may be billed when reporting -50 modifier to Medicare?

Answer 32

One unit

Question 33

When reporting -51 modifier to indicate multiple procedures performed, which procedure should be reported first on the claim?

Answer 33

Primary Procedure

Question 34

Some payers may decrease the payment on a procedure when this modifier is applied.

Answer 34

-52

Question 35

Modifier -53, discontinued procedure, is never reported with E/M codes or codes based on what?

Answer 35

Time

Question 36

Modifier -55 is used for services provided to the patient after what disposition?

Answer 36

Discharge from the hospital

Question 37

Medicare considers what service to be part of the surgery and bundled payment not allowing the -56 modifier?

Answer 37

Preoperative

Question 38

E/M services provided the day before or the day of a major surgery are included in what package?

Answer 38

Global Days

Question 39

A planned procedure intended to include the original procedure plus one or more subsequent procedures is indicated by what modifier?

Answer 39

-58

Question 40

Modifier -59 is applicable to all CPT codes except what type of codes?

Answer 40

- E/M codes | - Weekly radiation management

Question 41

When two physicians of different specialities work together as co-surgeons, modifier -62 is supported if the operative note clearly shows what type of services?

Answer 41

Distinct, separate service

Question 42

Modifier -63 indicates procedures provided to a neonate or infant up to what weight?

Answer 42

4 kg or 8.8 lbs

Question 43

A surgical team consists of how man physicians?

Answer 43

More than two

Question 44

To avoid duplicate procedure denials by the SAME provider, what modifier should be applied?

Answer 44

-76

Question 45

To avoid duplicate procedure denials by DIFFERENT providers, what modifier should be applied?

Answer 45

-77

Question 46

What is defined as a place of service specifically equipped and staged for the sole purpose of performing procedures?

Answer 46

Operating/designated procedure room

Question 47

Billing separately for services included in the surgical package is considered what?

Answer 47

Fradulent

Question 48

A physician assistant providing assist at surgery would use HCPCS modifier -AS. What modifier would a physician surgical assistant use?

Answer 48

-80

Question 49

When an assistant surgeon is present and provides minimum assist for the procedure, what modifier should be applied?

Answer 49

-81

Question 50

Hospitals that have affiliations with medical schools are considered what type of facility?

Answer 50

Teaching facility

Question 51

When providers use an outside laboratory, who is responsible for billing these Medicare services?

Answer 51

Outside laboratory

Question 52

Is it appropriate to bill for repeat lab tests with a -91 modifier when a subsequent test is performed to confirm results of the initial test?

Answer 52

No

Question 53

What modifier identifies a lab test is performed using a kit or transportable instrument that wholly or in part consists of a single-use, disposable analytical chamber?

Answer 53

-92

Question 54

How many modifier areas are available on a CMS-1500 insurance claim form for one-line item charge?

Answer 54

Four

Question 55

When the surgeon transfers postoperative care to another physician, report with what modifier?

Answer 55

-54