Lesson 1 CPT Basics

Question 1

HCPCS

Answer 1

Healthcare Common Procedure Coding System

Question 2

Who maintains CPT codes (HCPCS Level 1)?

Answer 2

AMA

Question 3

Who maintains HCPCS codes (HCPCS Level 2)?

Answer 3

CMS

Question 4

When was CPT widely used?

Answer 4

1983

Question 5

Main purposes for CPT codes?

Answer 5

Reimbursing, trending services, future planning, benchmarking, measuring patient outcomes/quality of care

Question 6

What must a procedure/service meet to be included in CPT?

Answer 6

Commonly performed, consistent with mainstream medical practice, approved by AMA CPT editorial panel

Question 7

Code range for E/M

Answer 7

99201-99499

Question 8

Code range for Anesthesia

Answer 8

00100-01999, 99100-99499

Question 9

Code range for Surgery

Answer 9

10021-69990, *largest section Cat I

Question 10

Code range for Radiology

Answer 10

70010-79999

Question 11

Code range for Path/Lab

Answer 11

80047-89398

Question 12

Code range for Medicine

Answer 12

90281-99607

Question 13

Cat II Codes

Answer 13

F Codes
Prenatal care, tracking chronic conditions, etc.
Not required for correct coding
Payment for performance (P4P) codes

Question 14

Cat III Codes

Answer 14

T Codes
FDA approved new/emerging tech, services, procedures
If not Cat I by 5 years, code is deleted

Question 15

Phrase “separate procedure”

Answer 15

code can be listed as separate procedure only if:
it was performed alone
for a specific purpose
independent of any other related service provided

Question 16

Appendix A

Answer 16

Modifiers

Question 17

Appendix D

Answer 17

Summary of Add On codes

Question 18

Bullet (red)

Answer 18

New code added that year (one year only)

Question 19

Triangle (blue)

Answer 19

Revised code descriptor (one year only)

Question 20

Facing Triangles (green)

Answer 20

New and revised text in the guidelines and instructions (one year only)

Question 21

Plus Symbol

Answer 21

Add on code (appendix D)

Question 22

Hollow Circle

Answer 22

Reinstated or recycled Cat III code

Question 23

Modifier 51 Exempt

Answer 23

CPT codes that cannot be assigned modifier 51

Question 24

Circled Bullet

Answer 24

Conscious sedation is included in service/procedure

Question 25

Lightning Bolt

Answer 25

vaccine pending FDA approval

Question 26

Pound Sign #

Answer 26

Resequenced code

Question 27

Physician Claim Form

Answer 27

CMS-1500

Question 28

Hospital Claim Form

Answer 28

CMS 1450