Chapters 13, 14

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Question

Answer

The words that follow a code number in the CPT manual are called?

Procedure and service descriptions

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A code that has all of the words that describe the code that follows is what type of code?

stand-alone code

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Procedures that are experimental, newly approved, or seldom used are reported with what type of code?

unlisted and Category III

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Who requires a special report with the use of unlisted codes?

third-party payers

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Name three of the six elements that a special report must contain?

nature, time, effort.

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Which punctuation mark between codes in the index of the CPT manual indicates a range of codes available?

hyphen

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Which punctuation mark between codes in the index of the CPT manual indicates two codes are available?

comma

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A list of the unlisted procedures for use in a specific section of the CPT manual is contained in:

Surgery Guidelines

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In which CPT appendix would additions, deletions, and revisions be found?

Appendix B

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In which CPT appendix would all modifiers be found?

Appendix A

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CPT stands for?

Current Procedural Terminology

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Which term reflects the technologic advances made in medicine that are incorporated into the CPT manual?

revisions

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Where is specific coding information about each section located?

Guidelines

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This act mandated the adoption of national uniform standards for electronic transmission of financial and administrative health information.

HIPAA

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What year was CPT first developed and published?

1966

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Who publishes CPT?

American Medical Association AMA

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Health care providers are ____ based on the codes submitted on a claim form for procedures and services rendered.

reimbursed

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Category I CPT codes have __ digits.

five

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The universal health insurance form for submission of outpatient services is the:

CMS-1500 form

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Which of the following is NOT a reason for the CPT coding system?

increased reimbursement

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What is the function of an add-on code?

Never used alone, always used with a primary procedure or service code, adds more to the procedure.

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The rules that govern coding in various health care settings are:

variable

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How many main sections are in the CPT manual?

Six chapters (sections)

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A modifier does what?

Provides additional information to the third-party payer about services provided to the patient.

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An unlisted procedure code:

Procedure or service not found in CPT Manual, can be found in guidelines, some subsections or subheadings

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How often are Category III codes released?

twice a year (January and July)

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According to the notes preceding the Category III codes in the CPT manual, the digits of the Category III codes are not intended to reflect the placement of the code in the Category I section of the CPT:

Nomenclature

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According to the CPT manual, modifier -91 is not to be used when tests are ___ to confirm initial results.

rerun

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According to the E/M Guidelines, time is not a descriptive component for the ____ department levels of E/M service.

emergency

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According to the Radiology Guidelines, these are the methods that qualify as "with contrast."

intravascular, intra-articularly, and intrathecally.

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The range of codes 10021-69990 would be found in this section of the CPT manual.

Surgery

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Level II codes are not used in which setting?

Inpatient

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Which of the following would be used to code drugs?

J codes

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Modifiers may affect:

payment (the way payment is made)

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Modifier -57 decision for surgery, is used on what type of service?

E/M service

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Modifier -79, unrelated procedure or service by the same physician during the postoperative period, is used on what type of service?

surgery

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Modifier -51, Multiple Procedure, is used on what type of services?

surgery

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Modifier -80, Assitant Surgeon, is used when:

A surgical assistant is one who provides service to the primary surgeon during a surgical procedure.

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Modifier -32, is used to indicate a service is mandated.

certain tests, workers comp.

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Modifier -25, significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service, is used to report an E/M service that was:

on a day when another minor service was provided to the patient by the same physician.

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Modifier -59, distinct procedure service, is used to indicate that:

services that are usually bundled into one payment and were provided as separate services.

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Modifier -58, staged or related procedure or service by the same physician during the postoperative period, is used to indicate:

that a subsequent surgery was planned or staged at the time of the first surgery.

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Modifier -52, reduced services, is used to indicate:

that a service was provided but was reduced in comparison to the full description of the service, without changing code of service.

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The modifier -AA is an example of what type of modifier?

anesthesia HCPCS code

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A ____________ ____________ must accompany claims when using an unlisted procedure code.

special report

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