Ch 13: True and False

Question 1

T/F: Today, most managed care and other insurance companies base their reimbursements on the values established by the CMS

Answer 1

True

Question 2

T/F: If the correct CPT code is not known, a narrative description of the procedure or service rendered can be used for third-party claims

Answer 2

False

Question 3

T/F: Modifiers are listed in Appendix A at the back of the CPT manual

Answer 3

True

Question 4

T/F: Missing or incorrect modifiers are a common reason for claim denial

Answer 4

True

Question 5

T/F: If a category 3 code is available and accurately describes the service provided, it should be used instead of an unlisted Category 1 code

Answer 5

True

Question 6

T/F: Modifier 99 can be used if the coder cannot find a five-digit CPT code that adequately describes the procedure performed

Answer 6

False

Question 7

T/F: There are two types of CPT codes: stand-alone and indented

Answer 7

True

Question 8

T/F: E/M codes are based on the complexity of the history, examination, or medical decision making performed during the visit

Answer 8

True

Question 9

T/F: A new patient is one who is new to the practice (regardless of service location) or one who has not received medical treatment by the healthcare provider or any other provider in that same office within the past 3 years

Answer 9

True

Question 10

T/F: Coding E/M services is based on the amount of time spent with the patient or his or her family

Answer 10

False

Question 11

T/F: Time is not considered a factor unless 75% of the encounter is spent in counseling

Answer 11

False

Question 12

T/F: Time is never a factor for emergency department visits

Answer 12

True

Question 13

T/F: All three key components (history, examination, and medical decision making) must be met or exceeded for new patients; only two must be met for established patients

Answer 13

True

Question 14

T/F: Hospital discharge services codes are used for reporting services provided on the final day of a multiple-day stay

Answer 14

True

Question 15

T/F: To qualify for the use of E/M codes 99281 through 99288, the facility must be available for immediate emergency care 24 hours a day for patients not on “observation status.”

Answer 15

True

Question 16

T/F: Critical care services can be provided only if the facility has an emergency department that operates 24 hours a day

Answer 16

False

Question 17

T/F: To use the critical care services codes properly, the physician must be constantly at the patient’s bedside

Answer 17

False

Question 18

T/F: Time is the controlling factor for assigning the appropriate critical care code

Answer 18

True

Question 19

T/F: Modifiers are never used in E/M coding

Answer 19

False

Question 20

T/F: HCPCS Level 2 (national) codes are five-digit alphanumeric codes consisting of one alphabetic character (a letter between A and V) followed by three digits

Answer 20

False

Question 21

T/F: If there are CPT and HCPCS Level 2 codes for the service provided, the CMS requires that the HCPCS Level 2 code be used

Answer 21

True

Question 22

T/F: As with CPT-4, HCPCS Level 2 code sets contain modifiers; however, modifiers in HCPCS Level 2 are either alphabetic or alphanumeric

Answer 22

True

Question 23

T/F: HIPAA requires that procedure coding be standardized

Answer 23

True

Question 24

T/F: With the implementation of HIPAA, the CMS has required medical offices to eliminate any unapproved local procedure or modifier codes (Level 3 codes)

Answer 24

True

Question 25

T/F: The AMA is in the process of developing CPT-5, which will totally change the procedural coding process

Answer 25

False