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Inform third-party payers of circumstances that may affect the way payment is made.
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Appendix of the CPT manual that lists the full description for all modifiers and circumstances for their use.
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Week 3 CPT
Chapter 14
| Question | Answer |
|---|---|
| Inform third-party payers of circumstances that may affect the way payment is made. | Modifiers |
| Appendix of the CPT manual that lists the full description for all modifiers and circumstances for their use. | Appendix A |
| Modifiers indicate what type of information? | Altered service, bilateral procedure, multiple procedures, professional part of the service/procedure only, and/or more than one physician/surgeon. |
| True/False When there are multiple CPT modifiers assigned to one code, list the modifiers from highest to lowest. | True |
| What is another name for HCPCS modifiers? | National level modifiers |
| CPT modifiers are known as? | Level I HCPCS modifiers |
| CPT Codes are Level? | I |
| HCPC codes are level? | II |
| The National codes are also known as? | Level II codes |
| Modifier that indicates the service was greater than usual and required increased physician work above and beyond normal. | Modifier -22 |
| A __________ must accompany the use of modifier -22 to explain how the service was greater. | Special report |
| There is usually a payment increase of _____ to _____ for services that qualify for the use of modifier -22. | 20%, 30% |
| CMS developed __________ to promote national correct coding methods and to control improper coding leading to inappropriate payment in Part B claims. | National Correct Coding Initiative (NCCI) |
| According to The Medicare Claims Processing Manual 100-04, "Physicians and suppliers are subject to a _____ % reduction if their claims are processed more than _____ months after services are rendered. | 10, 12 |
| Modifier used by an anesthesiologist to indicate a service for which general anesthesia was used when normally the anesthesia would have been local or regional. | Modifier -23 |
| Modifier -23 can only be assigned with codes in the Anesthesia section by whom? | anesthesiologist/nurse anesthetist |
| Modifier used only with E/M codes. It is added to indicate that an E/M service was not part of the surgical package but was an unrelated service. | Modifier -24 |
| The postoperative period for a major surgical procedure is? | 90 days |
| The postoperative period for a minor surgery is? | 10 days |
| Modifier used to report an E/M service on a day when another service was provided to the patient by the same physician. | Modifier -25 |
| Modifier that is used to designate a physician (professional) component of procedures that have a professional and technical component, such as interpretation of ultrasounds or x-rays. | Modifier -26 |
| Modifier that indicates a service that is required by some third-party entity. | Modifier _32 |
| Modifier used to report a surgical procedure in which the surgeon administered regional or general anesthesia to the patient. | Modifier -47 |
| True/False Modifier -47 is added only to surgery codes and is never added to anesthesia codes. | True |
| If the same procedure is performed on a mirror-image organ of the body this modifier would be reported indicating a bilateral procedure. | Modifier -50 |
| True/False Medicare accepts two line items to describe a bilateral procedure. | False |
| Modifier that indicates more than one procedure was performed during any given operative session. | Modifier -51 |
| When reporting multiple surgeries, which procedure would be the primary procedure that would be listed first? | The procedure with the highest relative value unit. |
| Assigning multiple codes when one code would fully describe the service or procedure. | Unbundling |
| What are the three times when multiple procedures are reported? | Same operation, different site; multiple operations, same operative session; procedure performed multiple times. |
| Modifier used to indicate that a service was provided but was reduced in comparison to the full description of service. | Modifier -52 |
| Which modifier is used to identify bilateral procedures? | Modifier -50 |
| What modifier would you report if the E/M service was performed in addition to a procedure, during the same visit? | Modifier -25 |
| Which modifier indicates anesthesia administered by a surgeon? | Modifier -47 |
| A severely retarded individual requires the use of general anesthesia for a procedure in which no anesthesia would normally be used. What modifier would you use to indicate this situation? | Modifier -23 |
| Modifier that describes circumstances in which a procedure was stopped because of the patient's status. | Modifier -53 |
| Modifier that indicates the surgical care portion of a surgical procedure. It is used correctly only when there has been a transfer of responsibility for care from one physician to another. | Modifier -54 |
| Modifier used only for services provided to the patient after discharge from the hospital. It is used to report postoperative services that have been transferred to another physician by the physician providing surgical care. | Modifier -55 |
| Modifier added to the surgical code if a physician provides only the preoperative management to a patient in preparation for surgery. | Modifier -56 |
| Modifier reported with an E/M code to indicate the day the decision to perform a major surgery was made. | Modifier -57 |
| Modifier -57 is never added to surgical codes; rather, it is added only to? | E/M codes |
| Modifier that notifies a payer that a subsequent surgery was planned or staged at the time of the first surgery. | Modifier -58 |
| True/False A new global period begins with each subsequent procedure modified with -58. | True |
| Modifier reported to indicate that services that are usually bundled into one payment were provided as separate services. | Modifier -59 |
| Lists of codes that cannot be reported together and have been established to ensure that providers do not report services that are included in a pre-established bundle. | edits |
| Which modifier would be used to identify that only the postoperative management portion of the service was provided? | Modifier -55 |
| Using the CPT manual, locate the modifier that would be added to indicate a discontinued procedure. | Modifier -53 |
| Which modifier would you use to indicate care provided to the patient prior to surgery? | Modifier -56 |
| Which modifier would you report to indicate a staged procedure? | Modifier -58 |
| Modifier that indicates two surgeons acted as co-surgeons which used different skills during the surgery. | Modifier -62 |
| Modifier that is used to identify procedures provided to neonate or infant up to 4kg (8.8lbs) | Modifier -63 |
| Modifier used with very complex surgical procedures that require several physicians, usually different specialties, to complete the procedure. | Modifier -66 |
| Consists of physicians (more than two), technicians, and other trained personnel who function together to complete a complex procedure. | Surgical team |
| Modifier requests payment for a service that was repeated by the same physician. If the modifier was not used, the subsequent service would be denied as a duplicate service. | Modifier -76 |
| Modifier requests payment for a service that was repeated by a physician other than the physician who originally provided the service or procedure. | Modifier -77 |
| Modifier is assigned to indicate a circumstance in which a patient is returned to the operating room for surgical treatment of a complication that resulted from the first procedure. | Modifier -78 |
| A place of service specifically equipped and staffed for the sole purpose of performing procedures. | Operating/procedure room |
| Modifier that explains that a patient requires surgery for a condition totally unrelated to the condition for which the first operation was performed. | Modifier -79 |
| One who provides service (an extra pair of hands) to the primary surgeon during a surgical period. | Surgical assistant |
| An assistant surgeon's services are reported using the same codes as the primary surgeon's, but what modifier is added to alert the third-party payer to the assistant surgeon's status? | Modifier -80 |
| Usually, the assistant surgeon receives ____% to _____% of the usual charge for a surgery when acting in the assistant capacity. | 15,30 |
| A physician assistant providing assist at surgery would us the HCPCS modifier______, not modifier -80. | -AS |
| Modifier indicates and assistant surgeon who provides services that are less extensive in which the assistant surgeon is present and assists for only a portion of the procedure. | Modifier-81 |
| Modifier used when a teaching hospital has a residency program, but no resident is available to serve as an assistant surgeon. | Modifier-82 |
| Physicians who are completing a required surgical training period in the hospital during which they serve as employees of the hospital who are there to receive training and provide assistance as a part of the hospital's agreement with the school. | Residents |
| Hospitals that have affiliations with medical schools are considered? | Teaching facilities |
| Modifier used to indicate that services of an outside laboratory were used. | Modifier -90 |
| Modifier that reports a laboratory test that was performed on the same day as the original laboratory test. This modifier is correctly assigned when a lab test has been repeated so as to produce multiple test results. | Modifier -91 |
| Modifier that reports those incidents when a kit or transportable instrument is used in a lab test. | Modifier -92 |
| Modifier is needed only if the third-party payer does not accept multiple modifiers. | Modifier -99 |
| Which modifier would you report to indicate a staged procedure? | No |
| What modifier is used to indicate multiple modifiers? | Modifier -99 |
| When the same procedure is performed on a mirror-image part of the body, indicating: | Bilateral |
| What is the term that means assigning multiple codes when one code would do? | Unbundling |
| What is the term for services provided by the surgeon after surgery? | Postoperative services |
| What is the term that describes two physicians working together in the completion of a procedure when each has the same level of responsibility? | Co-surgeons |
| What is the modifier used to indicate that the patient underwent a bilateral subcutaneous mastectomy? | -50 |
| Dr. Miles sees a patient whom he sends to the laboratory for a blood clotting test. The patient then receives a medication and returns to the lab later that same day for a repeat test. The second laboratory test would need which modifier? | -91 |
| The physician performs a service for which there is only a bilateral code in the CPT manual, but the physician performed the service unilaterally. Which modifier would you use to indicate this unilateral service? | -52 |
| Dr. Evans, a reconstructive surgeon, has a two-stage procedure planned for reconstruction of a cleft palate. The second procedure performed within the global period would require which modifier?? | -58 |
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