CPT Flashcards
What is the purpose of Category II CPT Codes?
They are designed to minimize administrative burdens because they facilitate data collection about quality of care.
If a Category III code is available that fully represents a case, can it be used instead of an unlisted Category I code?
Yes
When a procedure that is reported with an add-on code is performed bilaterally, is the the add-on code is reported twice?
Yes
What three components are used to configure relative value units?
Malpractice insurance costs, physician work, practice expense
Which CPT® code set is used voluntarily by physicians to report quality patient performance measurements?
Category II codes
What is the global surgery status indicator for the following:
Endoscopies or minor procedures with preoperative and postoperative relative values on the day of the procedure only are reimbursable. E/M services on the same day of the procedure are generally not payable (for example, CPT® 43255, 53020, 67346)
000
What is the global surgery status indicator for the following:
Minor procedures with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are reimbursable services. E/M services on the day of the procedure and during the 10-day postoperative period are not reimbursable (for example, CPT® 17261, 40800, 64612).
010
What is the global surgery status indicator for the following:
Major procedures with one-day preoperative period and 90-days postoperative period are considered to be a component of global package of the major procedure. E/M services on the day prior to the procedure, the day of the procedure, and during the 90-day postoperative period are not reimbursable (for example, CPT® 21048, 32664, 49591).
090
What is the global surgery status indicator for the following:
Maternity codes; the usual global period concept does not apply (for example, CPT® 59400, 59612).
MMM
What is the global surgery status indicator for the following:
The global concept does not apply to this code (for example, E/M services, anesthesia, laboratory, and radiology procedures) (for example, CPT® 10021, 36593, 38220, 44720).
XXX
What is the global surgery status indicator for the following:
These are unlisted codes, subject to individual pricing (for example, CPT® 19499, 20999, 44979).
YYY
What is the global surgery status indicator for the following:
These represent add-on codes. They are related to another service and are always included in the global period of the primary service (for example, CPT® 27358, 44955, 67335).
ZZZ
Which modifiers are appended to E/M codes to report payable services within the global package?
24, 25, 27
What is the CMS global period status indicator for endoscopies?
Status Indicator 000—Endoscopies or minor procedures
HCPCS Level II Organization Codes, what is the code category for:
Transportation codes, medical and surgical supplies, and administrative, miscellaneous and investigational services, equipment, and supplies
A codes
HCPCS Level II Organization Codes, what is the code category for:
Enteral and parenteral therapy
B codes
HCPCS Level II Organization Codes, what is the code category for:
C codes
HCPCS Level II Organization Codes, what is the code category for:
Durable medical equipment
E codes
HCPCS Level II Organization Codes, what is the code category for:
Procedures/professional services (temporary)
G codes
HCPCS Level II Organization Codes, what is the code category for:
Temporary national codes for governmental entities other than Medicare
H codes
HCPCS Level II Organization Codes, what is the code category for:
Drugs administered other than oral method and injectable chemotherapy drugs
J codes
HCPCS Level II Organization Codes, what is the code category for:
Assigned to DME MAC
K codes
HCPCS Level II Organization Codes, what is the code category for:
Orthotic procedures and services and prosthetic procedures
L codes
HCPCS Level II Organization Codes, what is the code category for:
Medical services
M codes
HCPCS Level II Organization Codes, what is the code category for:
Pathology and laboratory services
P codes
HCPCS Level II Organization Codes, what is the code category for:
Procedures, services, and supplies on a temporary basis
Q codes
HCPCS Level II Organization Codes, what is the code category for:
Diagnostic radiology services
R codes
HCPCS Level II Organization Codes, what is the code category for:
Temporary national codes (non-Medicare)
S codes
HCPCS Level II Organization Codes, what is the code category for:
National codes established for state Medicaid agencies
T codes
HCPCS Level II Organization Codes, what is the code category for:
Vision services and hearing, which also includes speech-language pathology services
V codes
In terms of common routes of administration, what does the abbreviation IA stand for?
Intra-arterial administration—Administration of the drug is given into an artery
In terms of common routes of administration, what does the abbreviation IV stand for?
Intravenous administration—Administration of the drug is given into the vein
In terms of common routes of administration, what does the abbreviation IM stand for?
Intramuscular administration—Administration of the drug via an injection into a muscle
In terms of common routes of administration, what does the abbreviation IT stand for?
Intrathecal—Administration of the drug is given into the subdural space of the spinal cord
In terms of common routes of administration, what does the abbreviation SC stand for?
Subcutaneous administration—Administration of the drug via an injection just under the skin
In terms of common routes of administration, what does the abbreviation INH stand for?
Administration by inhaled solution—Administration of the drug by breathing it
In terms of common routes of administration, what does the abbreviation VAR stand for?
Various routes of administration—Administration of the drug by various routes commonly administered into, joints, cavities, tissues, or topical applications
In terms of common routes of administration, what does the abbreviation OTH stand for?
Other routes of administration—Other administration methods like suppositories or catheter injections
In terms of common routes of administration, what does the abbreviation ORAL stand for?
Administered orally—Administration of the drug via taking it by mouth
What does MAC stand for?
Medicare Adminstrative Contractor
What are three types of codes printed in the HCPCS Level II code book?
Miscellaneous Codes, Permanent National Codes, Temporary National Codes
Which set of HCPCS Level II codes are required for use under the Medicare Outpatient Prospective Payment System?
C codes
Which set of HCPCS Level II codes are used to report injected drugs?
J codes
Which CPT® modifier should you append to a procedure code for a bilateral procedure?
50
What three components are used to configure relative value units?
Malpractice insurance costs, physician work, practice expense
Uncertain Behavior which is a specific pathologic diagnosis requires a pathology report. True or False?
True
When coding multiple burns, what is sequenced first?
the code reflecting the highest degree of burn.
Bilateral Modifier
50
Modifier: increased procedural services
22
An _____ code means that there are codes for some diagnoses, but there is not one specific for the patient’s condition. In this case, the physician knows what the condition is, but there is no code for it.
other
uAn _____ code means that the condition is unknown at the time of coding.
unspecified
This abbreviation is used when the ICD-10-CM system does not provide a code specific for the patient’s condition. Selecting a code with the NEC classification means that the provider documented more specific information regarding the patient’s condition, but there is not a code in ICD-10-CM to report the condition accurately.
Not Elsewhere Classified (NEC)
This abbreviation is the equivalent of unspecified and is used only when you lack the information necessary to code to a more specific diagnosis.
Not Otherwise Specified (NOS)
The ____ skeleton consists of the bones of the skull, the chest, and the spine.
Axial
The ____ skeleton includes the remaining bones of the upper and lower limbs, shoulders, and pelvis.
appendicular
____ attach bones to other bones
ligaments
_____ attach muscles to bones.
tendons
_____ acts as a cushion between bones in a joint.
cartilage
A fracture of the wrist at the distal radius. Sometimes the ulnar styloid also is involved.
Colles’ Fracture
Similar to a Colles’ fracture, except the bones are displaced toward the palm.
Smith’s Fracture
A stress fracture of the fifth metatarsal of the foot.
Jones Fracture
An epiphyseal plate fracture; a common injury seen in children.
Salter-Harris Fracture
Fracture of the distal fibula with rupture of the distal tibiofibular ligaments and lateral displacement of the talus.
Dupuytren’s Fracture
Fracture of the proximal third of the ulna with associated dislocation of the radial head.
Monteggia’s Fracture
Which type of muscles help control movement of the body, maintain posture, and help produce heat?
Striated (or skeletal)
Which type of muscle is involuntary muscle found in the internal organs such as in the bowels and blood vessels.
smooth
A fracture caused by disease such as an infection or a tumor leading to weakness of the bone.
pathological fracture
a fracture not indicated as displaced or non displaced is coded as _____
displaced
Injection of a substance includes the drug itself; the drug supply may not be billed separately. TRUE or FALSE
FALSE
When a code refers to a procedure that is performed “extra-articular,” what does that mean?
the procedure is performed on the outer portion of the joint
Which CPT codes are used for removal of implants/hardware ( they are reported more than once if the hardware (pins, screws, nails, rods) needs to be taken out from more than one fracture site involved)
20670 & 20680
What are the six columns of the neoplasm table?
Malignant Primary, Malignant Secondary, Ca In Situ, Benign, Uncertain Behavior, Unspecified Behavior
Lesion excisions, as with any open wound, often require a level of repair or closure. Simple repairs are included in the excision codes (CPT® 11400-11646), but intermediate and complex closures are separately billable when medically necessary. TRUE OR FALSE
TRUE
The lymphatic system includes four organs. What are they?
the spleen (discussed above), tonsils, thymus gland, and Peyer’s patches
When is a condition considered chronic?
if it has developed slowly over time, is persistent, and lasts over 3 weeks in duration.
Define Acute
a sudden and short-term infection
Lower respiratory infections that are not otherwise specified and are associated with documented COVID-19, are reported with:
U07.1 COVID-19 and J22 Unspecified acute lower respiratory infection.
What does status asthmaticus mean?
the patient fails to respond to therapy during an asthmatic episode; this is a life-threatening complication.
What does the suffix ostomy mean?
create an opening into the body
What does the suffix otomy mean?
cut into (incision)
What does the suffix ectomy mean?
surgical removal (excision)
What does the suffix centesis mean?
surgical puncture of a cavity or organ to remove fluid
__________ catheterization is placement of a catheter into the desired blood vessel. No manipulation is needed, and the catheter is not advanced into other branches of the vascular family, or the catheter is only negotiated into a vessel such as the thoracic or abdominal aorta.
Nonselective Cathaterization
_______ catheterization means the needle or catheter must be manipulated into other branches of the vascular family. This is usually performed under fluoroscopic guidance and involves more work and risk.
Selective
Sometimes providers will document CKD and ESRD for the same patient. In that case, what code(s) are reported?
report N18.6 End stage renal disease only.
Should Z3A codes be assigned for pregnancies with abortive outcomes?
No
When a patient has functional activity (thyrotoxicosis or disorders of thyrocalcitonin secretion) associated with a neoplasm, which should be reported first?
the neoplasm
When are the codes from G89 are reported as the primary code?
if the encounter is for pain control or pain management and may be used with codes identifying the site of pain.
a space covered by tough membranes between the bones of an infant’s cranium, which has yet to close
fontanel
In the Tabular List, 7th character 2 is reported to indicate the right eye or the left eye?
left eye
What is the code for an acoustic neuroma (benign)?
D33.3
Any foreign body that enters the orbit of the eye must pierce the conjunctiva to get there.
TRUE OR FALSE
TRUE
The ____ ear includes the tympanic membrane (eardrum), the auditory ossicles, and four openings.
middle
Modifier 51 is never applied to add-on codes.
TRUE OR FALSE
TRUE
Oblique Position
At an angle, neither frontal nor lateral
How does the Axial Plane divide the body
Superior (upper) and Inferior (lower)
How does the frontal(coronal) plane divide the body?
Anterior (Front) and Posterior (Back)
How does the Sagittal plane divide the body?
Right and Left portions
How does the transverse/axial plane divide the body?
Superior (upper) and inferior (lower)
How does the midsagittal plane divide the body?
Equal portions right and left
For encounters for routine laboratory/radiology testing in the absence of any signs, symptoms, or associated diagnosis, assign what code?
Z01.89 Encounter for other specified special examinations
Does Oral and rectal contrast administration alone qualify as a study “with contrast”?
No
