CPC Assessment M1

Question 1

When a cystourethroscopy with biopsy is performed and a ureteral stent inserted, what code or code(s) are assigned?

1. Cystourethroscopy with biopsy only
2. Both the cystourethroscopy with biopsy and cystourethroscopy with ureteral stent
3. Depends on whether the ureteral stent is left in place
4. Both with modifier -22 appended to the ureteral stent code

Answer 1

3. Depends on whether the ureteral stent is left in place

Question 2

When colonoscopy with biopsy (CPT code 45380) is performed as well as colonoscopy with polypectomy removed by snare to a different site/polyp (CPT code 45385) during the same surgical session at another site, what code(s) are reported?

1. 45385, 45380-59
2. 45380
3. 45385, 45380-51
4. 45385

Answer 2

1. 45385, 45380-59

Question 3

When HBOT therapy is performed at a wound care facility for a total of 90 minutes, what code(s) would be assigned?

1. G0277 X 3 (or 3 units)
2. G0277, G0277, G0277
3. G0277
4. 99173

Answer 3

1. G0277 X 3 (or 3 units)

Question 4

When it is necessary for the surgeon to provide an additional service during the global, postoperative period that is related to the original procedure, what modifier is appended?

1. Modifier -58
2. Modifier -57
3. Modifier -51
4. Modifier -62

Answer 4

1. Modifier -58

Question 5

When coding sepsis, what diagnosis is assigned when the organism is not known?

1. A41.9
2. R65.20
3. A41
4. R65.21

Answer 5

1. A41.9

Question 6

What modifier code is assigned when two surgeons participate jointly in the performance of one surgical procedure?

1. Modifier -80
2. Modifier -63
3. Modifier -62
4. Modifier -81

Answer 6

3. Modifier -62

Question 7

When four (4) biopsies are removed during the course of a diagnostic colonoscopy, what code(s) would be assigned?

1. colonoscopy with biopsy only
2. diagnostic colonoscopy only
3. colonoscopy with biopsy and diagnostic colonoscopy
4. colonoscopy with biopsy X 4

Answer 7

1. colonoscopy with biopsy only

Question 8

When nonexcisional debridement is performed to an entire wound area, what code(s) are assigned?

1. 11042
2. 97597
3. 97602
4. 97598

Answer 8

3. 97602

Question 9

When a radiology service is performed with oral contrast, how should it be coded?

1. without contrast, followed by with contrast
2. code with modifier -51
3. with contrast only
4. without contrast

Answer 9

4. without contrast

Question 10

When multiple modifiers are applied to one CPT code, how do you determine the correct sequencing of the modifier codes?

1. highest number first
2. HCPCS modifiers first
3. the modifier that most affects reimbursement first
4. lowest number first

Answer 10

3. the modifier that most affects reimbursement first

Question 11

Patient presents to clinic, status post arthroscopy of left knee 7 days ago for follow-up. Problem-focused history and exam and straightforward MDM were performed. What code(s)/modifier(s) would be appropriate for this encounter?

1. 99212-24
2. 99024
3. no CPT code assigned
4. 99212

Answer 11

2. 99024

Question 12

When multiple lesions are excised during the same surgical session, how are they coded?

1. All lesions are assigned a separate CPT code, and, any with more than a simple closure are assigned additional code(s).
2. All lesions are combined if same type (benign/malignant).
3. All lesions from the same anatomical area are combined.
4. Each lesion is assigned a separate CPT code.

Answer 12

1. All lesions are assigned a separate CPT code, and, any with more than a simple closure are assigned additional code(s).

Question 13

When a diagnostic arthroscopy is performed followed by a surgical arthroscopic procedure, what service(s) are reportable?

1. surgical arthroscopy followed by dx arthroscopy with modifier -59
2. surgical arthroscopy procedure only
3. surgical arthroscopy followed by diagnostic arthroscopy
4. both procedures are reportable

Answer 13

2. surgical arthroscopy procedure only

Question 14

When anesthesia is performed by the surgeon rather than an anesthesia professional, what services and codes are assigned?

1. Surgical code and anesthesia code
2. Anesthesia code as usual
3. Surgical code with modifier -47 appended
4. Surgical code and anesthesia code with modifier -47 appended

Answer 14

3. Surgical code with modifier -47 appended

Question 15

When an intravenous medication infusion is performed for 1 hour as well as an intravenous injection (IVP) during the same encounter, how are these services reported?

1. 96360
2. 96365, 96375
3. 96365, 96374
4. 96365 only

Answer 15

2. 96365, 96375

Question 16

Patient presents with nausea and vomiting and was determined to be suffering from dehydration. IV Normal Saline was administered from 9:00 AM to 9:45 AM for dehydration. Phenergan was administered IVP at 11:25 AM, following another IVP of Phenergan at 12:15 PM. Patient’s symptoms appeared improved and the patient was released. What services would be appropriate to code/bill?

1. 96374, 96375, 96361
2. 96361, 96375, 96376
3. 96360, 96375, 96376
4. 96360, 96365, 96409

Answer 16

3. 96360, 96375, 96376

Question 17

When debridement is performed but is documented as excision only through the subcutaneous tissue they are assigned as:

1. debridement codes with modifier -53.
2. debridement codes with modifier -52.
3. code from the Active wound care management in the Medicine section.
4. assigned debridement codes 11042 and/or 11045 only.

Answer 17

4. assigned debridement codes 11042 and/or 11045 only.

Question 18

Patient presents with extensive skin cancer of forehead. The site was prepared for skin graft repair with sharp debridement of eschar as well as remodeling of some of the granulation growth site. The STSG was harvested from the right thigh and carefully laid over the defect and trimmed to fit the defect properly. How should this be coded?

1. 15120, 15002
2. 15100
3. 15120
4. 15120, 15004

Answer 18

4. 15120, 15004

Question 19

When an appendectomy is performed incidentally during the time of another major procedure, what code (if any) is assigned?

1. major procedure with modifier -59 appended
2. none
3. 44955
4. major procedure with modifier -22 appended

Answer 19

2. none

Question 20

Patient presented for knee pain associated with an injury that occurred at work approximately 6 weeks ago. Expanded problem-focused history and exam and low MDM were documented and coded/billed to Medicare. Determine why these services were denied by Medicare.

1. Code 99214 was coded and is inappropriate for this encounter.
2. Modifier -25 should be appended to E/M
3. Visit coded to Medicare, visit should be billed to Workers’ Compensation as injury at work.
4. Consultation code should have been coded for service

Answer 20

3. Visit coded to Medicare, visit should be billed to Workers’ Compensation as injury at work.

Question 21

When an organ or disease-oriented panel is ordered and performed, however, one of the components is not included in the order, what service(s) should be assigned?

1. Code all services performed with the component not ordered listed with a “0” charge.
2. Cannot be coded.
3. Select another panel or do not code
4. Those services performed must be coded/billed individually.

Answer 21

4. Those services performed must be coded/billed individually.

Question 22

What guidelines are utilized in ICD-10-CM when determining the extent of body surface area?

1. Rule of Nines
2. Rules of Eight
3. Extent of Body Area
4. BSA Index

Answer 22

1. Rule of Nines

Question 23

When two acute conditions are equally responsible for an encounter, which condition should be coded as primary (first listed)?

1. Either one
2. Highest number
3. Condition that is the focus of treatment
4. One listed first by physician

Answer 23

3. Condition that is the focus of treatment

Question 24

When bilateral procedures are performed during the same surgical session, how should those services be reported?

1. two lines with modifier -50 appended on the 2nd lines CPT code with modifier -50 appended
2. one line with -RT, one line with -LT
3. one line with modifier -50 appended
4. one line without modifier, one line with modifier -51

Answer 24

3. one line with modifier -50 appended

Question 25

Patient presents to the ED where a diagnosis of closed fracture of the right distal radius was made by the ED physician. The orthopedic surgeon performs closed treatment of the fracture. The patient is referred to an orthopedist in his hometown for postoperative care. Assign the appropriate CPT code(s)/modifier(s) for the procedures performed by the surgeon in the ED. 1. 25600-54-RT 2. 25600-56-RT 3. 25600-RT 4. 25605-54-RT

Answer 25

1. 25600-54-RT

Question 26

When excision of two sentinel lymph nodes is performed, what services are coded? 1. axillary lymphadenectomy with modifier -52 2. axillary lymphadenectomy with modifier -53 3. axillary lymphadenectomy 4. excision of lymph nodes

Answer 26

4. excision of lymph nodes

Question 27

When only the interpretation and report are provided to an ancillary service, what modifier(s) is assigned? 1. Modifier -TC 2. Modifier -26 3. Modifier -LT 4. Modifier -RT

Answer 27

2. Modifier -26

Question 28

A scope was introduced into the esophagus and advanced to the stomach and duodenum. Multiple erosions were biopsied through the scope. The remainder of the EGD was normal. With the patient repositioned in the left lateral position, a scope was introduced into the rectum and advanced through the colon to the cecum. With the exception of hemorrhoids, the scope was normal. The practice coded 43235 and 45378 for these services Are the codes submitted correct, and, if not, what correction needs to be made? 1. No, code 43235 should be corrected to 43239 as biopsies were performed. 2. No, code 45378 should be assigned 45330. 3. No, code 43235 should be corrected to 43250. 4. Yes, codes submitted are correct.

Answer 28

1. No, code 43235 should be corrected to 43239 as biopsies were performed.

Question 29

What is the minimum number of codes that should be assigned when two lesions are excised through two separate excision sites? 1. No minimum 2. One 3. Two 4. Three

Answer 29

4. Three

Question 30

Patient who had an A&P colporrhaphy performed four days prior was taken to the OR for bright red vaginal bleeding, which revealed a bleeding site. The same surgeon who performed the colporrhaphy controlled the bleeding with placement of sutures. What modifier(s) would be appropriate for this service? 1. -59 2. -79 3. -78 4. -58

Answer 30

3. -78

Question 31

Neurosurgeon and otolaryngologist both participate in performing a cochlear implant on a 6-year-old female. Neurosurgeon codes and submits 69930-RT and is paid 100% of the fee schedule allowance. Otolaryngologist submits code 69930-RT and is denied payment for "services paid to another provider." What was incorrect in regard to the coding for these services? 1. Billed appropriately, only one provider should be paid. 2. Neurosurgeon should append modifier -62. 3. Both providers must append modifier -62 for both providers to be paid appropriately. 4. ENT should append modifier -66.

Answer 31

3. Both providers must append modifier -62 for both providers to be paid appropriately.

Question 32

When bilateral tympanostomies requiring general anesthesia are performed during the same surgical session, what code(s) are reported? 1. 69436-50 2. 69436-RT, 69436-LT 3. 69420 4. 69436

Answer 32

1. 69436-50

Question 33

Procedure Performed: Resection of 3 cm left posterior neck lesion/mass. A natural skin crease incision was made. Care was taken to resect the entire mass, however, taking care to avoid the underlying cranial nerve. Once the entire mass was resected free, the wound was closed in layers, using 3-0 chromic for the deep subcutaneous and 4-0 Prolene for the skin. 1. 11423, 12041 2. 11423, 12031 3. 11420 4. 11423

Answer 33

1. 11423, 12041

Question 34

What should be reported for a complex extracapsular cataract extraction with intraocular lens implantation? 1. 66984 2. 66984-CX 3. 66820 4. 66982

Answer 34

4. 66982

Question 35

When multiple biopsies are performed at four different sites during the course of a colonoscopy, what code(s) should be reported? 1. 45380, 45380-59, 45380-59, 45380-59 2. 45380 X 4 3. 45380, 45380-51, 45380-51, 45380-51 4. 45380 once only

Answer 35

4. 45380 once only

Question 36

When the physician makes the medical decision to discontinue a procedure in the hospital operating room due to a decline of the patient's medical condition, how should the service be coded? 1. Append modifier -73 2. Append modifier -52 3. Append modifier -74 4. Append modifier -53

Answer 36

4. Append modifier -53

Question 37

When performing the interpretation only for an electrocardiogram, what code(s) should be assigned? 1. 93005 2. 93000 3. 93000-52 4. 93010

Answer 37

4. 93010

Question 38

When a malignant lesion has been removed previously and requires additional re-excision, what CPT code range will be utilized? 1. biopsy 2. unlisted integumentary skin service 3. excision benign lesions 4. excision malignant lesions

Answer 38

4. excision malignant lesions

Question 39

With the excision of lesion codes, the size of the lesion is determined by the size of the: 1. lesion and any necessary margins at the time of the excision. 2. margins only 3. lesion with modifier -22 appended. 4. lesion only.

Answer 39

1. lesion and any necessary margins at the time of the excision.

Question 40

When snare polypectomy is performed on one polyp during the course of a colonoscopy as well as polypectomy by hot biopsy forceps to another polyp during the same session, what service(s) are reportable? 1. 45384 only 2. 45385, 45384-59 3. 45385 only 4. 45385, 45384-51

Answer 40

2. 45385, 45384-59

Question 41

When a radiology service is performed without contrast, followed by the same radiology service with intravenous contrast, how should it be coded? 1. without contrast, followed by with contrast 2. code with modifier -51 3. without contrast 4. with contrast only

Answer 41

1. without contrast, followed by with contrast

Question 42

When a procedure is designated with a + sign, how are they handled in CPT? 1. coded in addition to “parent” code with modifier -51 2. coded in addition to “parent” code 3. coded in addition to other services 4. coded in addition to “parent” code with modifier -52

Answer 42

2. coded in addition to “parent” code

Question 43

When a procedure is started laparoscopically, however, it is necessary to complete the procedure open, what procedure(s) should be assigned? 1. open and laparoscopic with modifier -53 2. laparoscopic with modifier -53 and open 3. open only 4. laparoscopic and open

Answer 43

3. open only

Question 44

When an evaluation and management service also involves performance of a minor surgical procedure, what services can be reported? 1. Both services are always reportable. 2. Only the minor surgical procedure is reported. 3. It depends on whether the decision to perform the minor surgical procedure was determined at a previous encounter or the same encounter. 4. Only the E & M is reportable

Answer 44

3. It depends on whether the decision to perform the minor surgical procedure was determined at a previous encounter or the same encounter.

Question 45

When an intravenous hydration infusion is performed as well as an intravenous injection (IVP) during the same encounter, which service is reported first? 1. IVP, 96374 2. Primary code would be the service that prompted the encounter, which could be the infusion or the IVP 3. 96360 4. 96365

Answer 45

2. Primary code would be the service that prompted the encounter, which could be the infusion or the IVP

Question 46

When anesthesia is performed by the surgeon rather than an anesthesia professional, what modifier is appended? 1. Modifier -80 2. Modifier -47 3. Modifier -22 4. Modifier -62

Answer 46

2. Modifier -47

Question 47

When performing an angioplasty on the left circumflex coronary artery, what modifier(s) should be appended for these services? 1. -LC 2. -51 3. -52 4. -LD

Answer 47

1. -LC

Question 48

When a radiology service is performed utilizing oral contrast only, how should it be coded? 1. modifier -52 2. with contrast 3. without contrast 4. modifier -22

Answer 48

3. without contrast

Question 49

What modifier is appended when multiple procedures are performed during the same operative session that are different sites/structures and appropriate to bill separately? 1. modifier -GA 2. modifier -59 3. modifier -RT/LT 4. modifier -51

Answer 49

2. modifier -59

Question 50

A cardiologist is called to the ED to perform a consultation. The service was coded as follows: 01/01/XX with Place of Service Inpatient Hospital and CPT Code 99251. Why will the claim be denied? 1. CPT code is incorrect. 2. Service in ER cannot be coded/billed as consultation. 3. Place of service is incorrect. 4. Place of service and CPT code are incorrect.

Answer 50

4. Place of service and CPT code are incorrect.