CPC Ch6- Introduction to CPT, Surgery Guidelines, HCPCS, and Modifiers

Question 1

What is the full description for CPT® code 43622?
A. With formation of intestinal pouch, any type
B. Gastrectomy, total; with Roux-en-Y reconstruction and formation of intestinal pouch, any type
C. Gastrectomy, total; with esophagoenterostomy with formation of intestinal pouch, any type
D. Gastrectomy, total; with formation of intestinal pouch, any type

Answer 1

D. Gastrectomy, total; with formation of intestinal pouch, any type

Rationale: The full descriptor of 43622 includes the common portion before the semi-colon of code 43620, followed by the description next to 43620 (with formation of intestinal pouch, any type).

Question 2

Which one of the CPT® codes listed below would modifier 50 be appended to for a bilateral procedure?
A. 22510
B. 36251
C. 36252
D. 37650

Answer 2

D. 37650

Rationale: CPT® code 37650 has a parenthetic instruction below it stating to report 37650 with modifier 50 when performed bilaterally. CPT® code 22510 states it is for a unilateral or bilateral procedure so modifier 50 is not appropriate. CPT® code 36251 is for a unilateral procedure and CPT® code 36252 is for the same procedure performed bilaterally. Because there is a code option for unilateral and an-other code option for bilateral, modifier 50 is not appropriate for either code.

Question 3

Which statement is TRUE regarding modifier 51 in the CPT® code book?
A. Modifier 51 can be replaced by using the RT and LT modifiers.
B. Add-on codes should always have modifier 51 appended to them.
C. Codes exempt from modifier 51 are identified with the universal forbidden symbol.
D. A list of modifier 51 exempt codes can be found in Appendix A of the CPT® code book.

Answer 3

C. Codes exempt from modifier 51 are identified with the universal forbidden symbol.

Rationale: Codes exempt from modifier 51 are identified with the universal forbidden symbol. Add-on codes are also exempt from modifier 51. A list of modifier 51-exempt codes can be found in Appendix E of the CPT® code book.

Question 4

The National Correct Coding Initiative (NCCI) files contain a Correct Coding Modifier (CCM) indicator. What does the CCM indicator 0 mean?
A. A CCM is not allowed and will not bypass the edits.
B. A CCM is allowed and will bypass the edits.
C. The use of modifiers is not specified.
D. Only modifier 59 will bypass the edits.

Answer 4

A. A CCM is not allowed and will not bypass the edits.

Rationale: A CCM modifier of 0 indicates a CCM is not allowed and will not bypass the edits.

Question 5

According to the parenthetical instructions for CPT® code 33690, how should right and left pulmonary artery banding in a single ventricle be reported?
A. 33690-50
B. 33620
C. 33690-63
D. 33620-50

Answer 5

B. 33620

Rationale: The parenthetical instructions under CPT® code 33690 include:

(For right and left pulmonary artery banding in a single ventricle [eg, hybrid approach stage 1], use 33620) and (Do not report modifier 63 in conjunction with 33690).

Question 6

What association maintains and publishes CPT® coding guidelines, codes, and descriptions?
A. AMA
B. CPT
C. CMS
D. HCPCS

Answer 6

A. AMA

Rationale: The CPT® code set (HCPCS Level I) is copyrighted and maintained by American Medical Association (AMA).

Question 7

What are the three categories of CPT® codes?
A. CPT®, HCPCS, HCPCS Level II
B. Categories I, II, and III
C. CPT®, Modifiers, Index
D. CPT®, Modifiers, HCPCS Level II

Answer 7

B. Categories I, II, and III

Rationale: The main body of the CPT® code book is comprised of the Category I CPT® codes (00100–99607), Category II CPT® codes (0001F–9007F), Category III CPT® codes (0042T–0783T).

Question 8

What are three methods used to list main terms in the CPT® code book alphabetic index?
A. Condition, brand names, procedure
B. Condition, synonyms, abbreviations
C. Anatomic site, surgical specialty, eponyms
D. Eponyms, procedure, instruments

Answer 8

B. Condition, synonyms, abbreviations

Rationale: The CPT® code book’s index is alphabetized with main terms organized by condition; procedure; anatomic site; synonyms, eponyms, and abbreviations. This is listed in the first page of the CPT® Index, under the heading for Main Terms.

Question 9

What three components are used to configure relative value units?
A. Location of practice, location of medical school, ancillary personnel
B. Malpractice insurance claims, physician work, practice expense
C. Malpractice insurance costs, physician work, practice expense
D. All of the above

Answer 9

C. Malpractice insurance costs, physician work, practice expense

Rationale: RVUs are configured utilizing physician work, practice expense and malpractice insurance costs

Question 10

What are the Physician Fee Schedule’s definitions for facility and non-facility?
A. Facility includes privately owned physician practices and non-facility includes hospital owned physician practices
B. Non-facility includes privately owned physician practices
C. Facility includes skilled nursing facilities, nursing homes, and hospital settings
D. Both B and C

Answer 10

D. Both B and C

Rationale: Facility practice RVU expenses include services performed in emergency rooms, hospital settings (inpatient and outpatient), skilled nursing facilities, nursing homes, or ambulatory surgical centers (ASCs). The non-facility RVUs include services performed in non-hospital owned physician practices or privately owned practices.

Question 11

Which CPT® code set is used voluntarily by physicians to report quality patient performance measurements?
A. Category I codes
B. Category II codes
C. Category III codes
D. CPT® unlisted codes

Answer 11

B. Category II codes

Rationale: CPT® Category II codes are supplementary tracking codes and are reported voluntarily by eligible physicians.

Question 12

CPT® Category III codes are reported to indicate which type of service or procedure?
A. New and emerging
B. Experimental
C. Unlisted
D. New and extended

Answer 12

A. New and emerging

Rationale: Category III codes do not indicate the service or procedure is experimental, only that they are new and emerging and are being tracked for trending purposes. This information is found in the guidelines for the Category II Codes section.

Question 13

Which CPT® Appendix lists the summary of the resequenced CPT® codes?
A. Appendix B
B. Appendix N
C. Appendix D
D. Appendix P

Answer 13

B. Appendix N

Rationale: Appendix N provides a summary of CPT® codes not appearing in numeric sequence. This allows existing codes to be relocated to an appropriate location.

Question 14

What services are included in the surgical global package?
A. Preoperative visits, Intraoperative services, Initial consultation
B. Intraoperative services, Diagnostic tests, Experimental procedures
C. Bilateral procedures, Documentation, Diagnostic tests
D. Preoperative visits, Intraoperative services, Postsurgical pain management

Answer 14

D. Preoperative visits, Intraoperative services, Postsurgical pain management

Rationale: The Surgical Global Package includes: Preoperative Visits, Intraoperative Services, Complications Following Surgery, Postoperative Visits, Postsurgical Pain Management, and Miscellaneous Services.

Question 15

What is the postoperative period included in the surgical global package for major surgery?
A. 0-10 days
B. 60 days
C. 90 days
D. 120 days

Answer 15

C. 90 days

Rationale: The global period of major procedures is 90 days.

Question 16

When surgery is performed, what services are included and not billed separately?
A. Postoperative follow-up care
B. Topical anesthesia
C. Writing orders
D. All of the above

Answer 16

D. All of the above

Rationale: Services included in the surgical package include:

• Evaluation and Management (E/M) service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical).
• Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia
• Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified healthcare professionals
• Writing orders
• Evaluating the patient in the post-anesthesia recovery area
• Typical postoperative follow-up care

Question 17

Which modifiers are appended to E/M codes to report payable services within the global package?
A. 24, 26, 51
B. 24, 25, 47
C. 24, 25, 57
D. 24, 26, 57

Answer 17

C. 24, 25, 57

Rationale: Modifiers 24 Unrelated evaluation and management service by the same physician during a postoperative period, 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, and 57 Decision for surgery are used on evaluation and management CPT® codes only.

Question 18

What is the CMS global period status indicator for endoscopies?
A. 000
B. 010
C. 030
D. None of the above

Answer 18

A. 000

Rationale: Status Indicator 000—Endoscopies or minor procedures

Question 19

What are three types of codes printed in the HCPCS Level II code book?
A. Level II Codes, Modifiers, DME Codes
B. Level II Codes, G Codes, Miscellaneous
C. Miscellaneous Codes, Permanent National Codes, Temporary National Codes
D. Dental Codes, Permanent National Codes, Unlisted Codes

Answer 19

C. Miscellaneous Codes, Permanent National Codes, Temporary National Codes

Rationale: Three types of HCPCS codes printed in the HCPCS Level II code book consist of: Permanent National Codes, Miscellaneous Codes/not otherwise classified, Temporary National Codes. This can be verified by reviewing the HCPCS Coding Procedures in the front of the HCPCS Level II code book.

Question 20

How often can HCPCS Level II temporary codes be updated?
A. Once annually
B. Biannually
C. Quarterly
D. None of the above

Answer 20

C. Quarterly

Rationale: Temporary codes can be added, changed, or deleted on a quarterly basis and once established; temporary codes are usually implemented within 90 days.

Question 21

Which set of HCPCS Level II codes are required for use under the Medicare Outpatient Prospective Payment System?
A. A codes
B. C codes
C. G codes
D. T codes

Answer 21

C. C codes

Rationale: C codes are required for use under the Medicare Outpatient Prospective Payment System (OPPS). Hospitals report new technology procedures, drugs, biologicals, and radiopharmaceuticals that do not have other HCPCS codes assigned with C codes

Question 22

Which set of HCPCS Level II codes are considered temporary codes assigned by CMS and reviewed by AMA for inclusion in the CPT®?
A. A codes
B. C codes
C. G codes
D. T codes

Answer 22

C. G codes

Rationale: The G codes are temporary HCPCS Level II codes assigned by CMS. The G codes are reviewed by the AMA for possible inclusion in the CPT®. Until these codes are replaced by CPT® codes and appropriate descriptions, CMS uses the G codes to report specific services and procedures that do not otherwise have a Level I or Level II code.

Question 23

Which set of HCPCS Level II codes are used to report injected drugs?
A. A codes
B. C codes
C. H codes
D. J codes

Answer 23

D. J codes

Rationale: The J code category contains codes and descriptions specific to drugs and biologicals (J0120–J8999) as well as chemotherapy drugs (J9000–J9999). The list of drugs described in the J category can be injected by one of three means: subcutaneously, intramuscularly, or intravenously.

Question 24

Which CPT® modifier should you append to a procedure code for a bilateral procedure?
A. 22
B. 50
C. 51
D. 59

Answer 24

B. 50

Rationale: 50 Bilateral Procedure

Question 25

What types of modifiers are listed in Appendix A of the CPT® code book?
A. CPT®, Anesthesia Physical Status Modifiers, Surgical
B.CPT®, ASC, HCPCS, Anesthesia Physical Status Modifiers
C. HCPCS, CPT®, Surgical
D. CPT®, HCPCS, Category I

Answer 25

B. CPT®, ASC, HCPCS, Anesthesia Physical Status Modifiers

Rationale: Appendix A lists modifiers for CPT®, Anesthesia Physical Status Modifiers, ASC, and HCPCS Level II.

Question 26

Which HCPCS Level II modifier should you append for a new wheelchair purchase?
A. GM
B. HC
C. NR
D. NU

Answer 26

D. NU

Rationale: New Equipment. For example, append NU when a new walker, folding, wheeled, adjustable or fixed height is sold to a patient.

Question 27

What modifier do you append to a CPT® code if a commercial insurance company requires the patient to acquire a medical consultation from a second physician?
A. 22
B. 25
C. 32
D. 59

Answer 27

C. 32

Rationale: CPT® modifier 32—Mandated Services

Question 28

Which HCPCS level II codes are not reported for Medicare, but used by commercial health plan Blue Cross Blue Shield (BCBS) to report drugs, services, and supplies for which there are no national codes?
A. G codes
B. A codes
C. J codes
D. S codes

Answer 28

D. S codes

Rationale: S codes meet various business needs of commercial and Medicaid agency health plans. HCPCS S codes report drugs, services, and supplies for which national codes do not exist but are needed to implement policies, programs, or support claims processing. They are not payable by Medicare.

Question 29

A patient is seen in the physician’s office for a 2,400,000 U injection of Bicillin L-A. What code represents this drug and the units given?
A. J2540 X 4
B. J00561 X 24
C. J2510 X 4
D. J0558 X 24

Answer 29

B. J0561 X 24

Rationale: In the HCPCS Level II Table of Drugs, look up Bicillin L-A, which directs you to code J0561. One unit of J0561 represents 100,000 U, so 24 units are reported for 2,400,000 U.

Question 30

What is the CPT® code used to report a right heart cardiac catheterization for congenital anomalies with abnormal native connections?
A. 93594
B. 93451
C. 93453
D. 93593

Answer 30

A. 93594

Rationale: In the CPT® Index, look for Catheterization/Cardiac directs you to See Cardiac Catheterization. Cardiac Catheterization/Congenital Cardiac Defect(s)/Right Heart directs you to codes 93593, 93594. Code 93594 is correct for abnormal native connections.

Question 31

What is the correct HCPCS Level II code for a removable metatarsal foot arch support that is pre-molded?
A. L3090
B. L3060
C. L3050
D. L3080

Answer 31

C. L3050

Rationale: In the HCPCS Level II Index, look for Support/arch. You are directed to see codes L3040-L3090. When you review the L codes, L3050 represents a removable, pre-molded, metatarsal foot arch support.

Question 32

What code represents a secondary rhinoplasty where a small amount of work is performed on the tip of the nose?
A. 30400
B. 30430
C. 30435
D. 30420

Answer 32

B. 30430

Rationale: In the CPT® Index, look for Rhinoplasty/Secondary, which directs you to codes 30430-30450. Look at the codes in the Respiratory numeric section. Code 30430 represents a small amount of work for a secondary rhinoplasty when performed on the tip of the nose.

Question 33

What is the correct CPT® code for the extensive excision of nasal polyps?
A. 30125
B. 30124
C. 30115
D. 30110

Answer 33

C. 30115

Rationale: In the CPT® Index, look for Excision/Polyp/Nose which directs you to 30110, 30115. You may also look in the CPT® Index for Excision/Nose/Polyp and get the same codes. Looking at the description for each code in the Respiratory numeric section, code 30115 is selected for extensive. If you look up Polyp/Nose/Excision/Extensive in the CPT® Index, code 30115 is listed.

Question 34

What is the correct CPT® code for a complete, four-view, chest X-ray with fluoroscopy?
A. 71046 X 2
B. 71045 X 4
C. 71048
D. 71047

Answer 34

C. 71048

Rationale: In the CPT® Index, look for X-ray/Chest referring you to code range 71045-71048. Code 71048 is the correct code to report the four views.

Question 35

What is the correct CPT® coding for a cystourethroscopy with brush biopsy of the renal pelvis?
A. 52005
B. 52005, 52007
C. 52007
D. 52000, 52007

Answer 35

C. 52007

Rationale: In the CPT® Index, look for Cystourethroscopy/Biopsy/Brush referring you to 52007.

Question 36

What chapter in the HCPCS Level II code book lists the code for Wheelchairs?
A. Transportation Services including Ambulance (A0021-A0999)
B. Orthotic Procedures and Services (L0112-L4631)
C. Prosthetic Procedures (L5000-L9900)
D. Durable Medical Equipment (E0100-E8002)

Answer 36

D. Durable Medical Equipment (E0100-E8002)

Rationale: A wheelchair is considered durable medical equipment. In the HCPCS index, look for the term Wheelchair. The majority of the codes listed are E codes.

Question 37

What is the full description for code 11001?
A. Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure)
B. Each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure)
C. Debridement of extensive eczematous or infected skin; up to 10% of body surface; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure).
D. Debridement of extensive eczematous or infected skin; up to 10% of body surface

Answer 37

A. Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure)

Rationale: Look at code 11001 in the Integumentary numeric section of the CPT® code book. The code description of an indented code includes the portion before the semicolon in the main code. In this example, the common portion of the code is shown in 11000 Debridement of extensive eczematous or infected skin; and the remaining portion of the code descriptor is in add-on code 11001 each additional 10% of the body surface, or part thereof.

Question 38

What is the correct CPT® code for level IV surgical pathology?
A. 88304
B. 88309
C. 88307
D. 88305

Answer 38

D. 88305

Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam/Level IV. The code you are directed to use is 88305.

Question 39

The Table of Drugs in the HCPCS Level II book indicates various medication routes of administration. What abbreviation represents the route where a drug is introduced into the subdural space of the spinal cord?
A. IM
B. INH
C. IT
D. SC

Answer 39

C. IT

Rationale: In the HCPCS Level II code book, there is an appendix that lists the abbreviations and acronyms and their meanings. IT stands for Intrathecal. IT is the route where a drug is introduced into the subdural space of the spinal cord.

Question 40

What publications does the AMA copyright and maintain?
A. CPT® code book, HCPCS Level II code book, ICD-10-CM code book
B. CPT® code book and HCPCS Level II code book
C. AHA Coding Clinic and CPT® Assistant
D. CPT® code book and CPT® Assistant

Answer 40

D. CPT® code book and CPT® Assistant

Rationale: CPT® code book (all three categories) and CPT® Assistant is published, copyrighted and maintained by AMA.

Question 41

Where is the starting point for selective catheter placement for the vascular families in Appendix L in the CPT® code book?
A. Aorta
B. Carotid artery
C. Brachial artery
D. Femoral artery

Answer 41

A. Aorta

Rationale: Look in Appendix L of the CPT® code book. The guideline for Appendix L states the assumption is made that the starting point of catheterization is the aorta.

Question 42

What codes are voluntarily reported to payers and provide evidence-based performance-measure data?
A. CPT® Category III codes
B. CPT® Category I codes
C. CPT® Category II codes
D. HCPCS Level II codes

Answer 42

C. CPT® Category II codes

Rationale: Per AMA, CPT® Category II codes are a set of supplemental tracking codes used for performance measurement.

Question 43

What agency maintains and distributes HCPCS Level II codes?
A. CMS
B. NIH
C. OIG
D. AMA

Answer 43

A. CMS

Rationale: CMS maintains and distributes HCPCS Level II codes.

Question 44

What is the correct code for a radical maxillary sinusotomy?
A. 31020
B. 31032
C. 31050
D. 31030

Answer 44

D. 31030

Rationale: In the CPT® Index, look for Sinusotomy/Maxillary, which directs you to codes 31020-31032. Look in the Respiratory numeric section and review the code descriptors. Code 31030 is reported. 31032 is not correct because there is no indication of removing antrochoanal polyps.

Question 45

HCPCS Level II includes code ranges that consist of what type of codes?
A. Category II codes, temporary national codes and miscellaneous codes
B. Category II codes, temporary national codes and miscellaneous codes
C. Permanent national codes, miscellaneous codes, and temporary national codes
D. Dental codes, morphology codes, miscellaneous codes and permanent national codes

Answer 45

C. Permanent national codes, miscellaneous codes, and temporary national codes

Rationale: HCPCS Level II codes consist of permanent national codes, miscellaneous codes, and temporary national codes.

Question 46

What is the correct code for the application of a short arm cast?
A. 29065
B. 29280
C. 29075
D. 29125

Answer 46

C. 29075

Rationale: In the CPT® Index, look for Cast/Type/Ambulatory/Short Arm. The code you are directed to use is 29075.

Question 47

When procedures are “mandated” by third party payers, what modifier would you use?
A. 52
B. 26
C. 76
D. 32

Answer 47

D. 32

Rationale: Modifier 32 reports “mandated services”.

Question 48

A patient is in the OR for an arthroscopy of the medial compartment of his left knee. A meniscectomy is performed. What is the correct code used to report for the anesthesia services?
A. 29870-LT
B. 01402
C. 29880-LT
D. 01400

Answer 48

D. 01400

Rationale: In the CPT® Index, look for Anesthesia/Knee where there are multiple codes to choose from. Turn to these codes in the Anesthesia section and review them. Code 01400 represents anesthesia for a surgical arthroscopic procedure performed on the knee joint, not otherwise specified.

Question 49

Which statement is TRUE regarding the instruction for use of the CPT® code book?
A. Use an unlisted code when modifying a procedure
B. Select the name of the procedure or service that most closely approximates the procedure or service performed.
C. Parenthetical instructions define each code listed in the code book.
D. Select the name of the procedure or service that accurately identifies the service performed.

Answer 49

D. Select the name of the procedure or service that accurately identifies the service performed.

Rationale: CPT® Instructions for the use of the CPT® code book indicates to “select the name of the procedure or service that accurately identifies the service performed.” Instructions for Use of the CPT code book is found in the front of the CPT® code book in the Introduction.

Question 50

What is the correct code for the administration of one vaccine given intramuscularly for a child under eight years of age when the physician counsels the parents?
A. 90460
B. 90473
C. 90461
D. 90471

Answer 50

A. 90460

Rationale: In the CPT® Index, look for Immunization Administration/18 Years of Age and Under. You are directed to codes 90460, 90461.

Question 51

What is the correct CPT® code for the wedge excision of a nail fold of an ingrown toenail?
A. 11765
B. 11750
C. 11760
D. 11720

Answer 51

A. 11765

Rationale: In the CPT® Index, look for Excision/Nail Fold referring you to 11765.

Question 52

The Global Surgical Package applies to services performed in what setting?
A. Hospitals
B. Ambulatory Surgical Centers
C. Physician’s offices
D. All of the above

Answer 52

D. All of the above

Rationale: The services included in the global surgical package may be furnished in any setting, including hospitals, ASCs, and physicians’ offices. Visits to a patient in an intensive or critical care unit are also included if made by the surgeon.