CPT Multiple Choice Identify the choice that best completes the statement or answers the question. ____
1. What three components are considered when Relative Value Units are established? a Physician work, Practice expense, Malpractice Insurance . b Geographic region, Practice expense, Malpractice Insurance . c Geographic region, Conversion factor, Physician fee schedule . d Physician work, Physician fee schedule, Conversion factor .
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2. What codes are reported voluntarily to payers to provide evidence-based performance-measure data? a CPT¨ Category I codes c CPT¨ Category III codes . . b CPT¨ Category II codes d HCPCS Level II codes . .
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3. CPT¨ Category III codes are reimbursable at what level of reimbursement? a 10 percent . b 100 percent . c 85 percent . d Reimbursement, if any, is determined by the payer .
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4. The Surgical Global Package applies to services performed in what setting? a Hospitals c PhysicianÕs offices . . b Ambulatory Surgical Centers d All of the above . .
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5. What surgical status indicator represents the Surgical Global Package for endoscopic procedures (without an incision)? a XXX c 000 . . b 010 d 090 . .
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6. What does the acronym HCPCS stand for? a Healthcare Physician Coding Standards . b Healthcare Common Procedure Coding System . c Healthcare Physician Communicating System . d Health Codes for Physicians and Coding Surgeries .
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7. What chapter in the HCPCS Level II codebook lists the code for Wheelchairs? a Transportation Services including Ambulance (A0021-A0999) . b Orthotic Procedures and Devices (L0000-L4999) . c Durable Medical Equipment (E0100-E9999) . d Prosthetic Procedures (L5000-L9999) .
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8. How many days does it take for CMS to implement HCPCS Level II Temporary Codes that have been reported as added, changed, or deleted? a 365 c 30 . . b 90 d 60 . .
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9. What temporary HCPCS Level II codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals? a C codes c H codes . . b G codes d Q codes . .
____ 10. Which statement is TRUE regarding the Instruction for use of the CPT¨ codebook? a Use an unlisted code when a procedure is c Select the name of the procedure or . modified. . service that most closely approximates the procedure or service performed. b Parenthetical instructions define each d Select the name of the procedure or . code listed in the codebook. . service that accurately identifies the service performed.
____ 11. What type of CPT¨ code is Òmodifier 51 exemptÓ even though there is no modifier 51 exempt symbol next to it? a Surgery codes c Mandated services
. b Add-on codes .
. d .
Bilateral procedures
____ 12. What agency maintains and distributes HCPCS Level II codes? a AMA c HIPAA . . b CMS d CPT¨ Assistant . .
____ 13. When procedures are ÒmandatedÓ by third party payers, what modifier would you use? a 26 c 32 . . b 52 d 76 . .
____ 14. HCPCS Level II includes code ranges which consist of what type of codes? a Category II codes, temporary national codes, and miscellaneous codes. . b Dental codes, morphology codes, miscellaneous codes, and, permanent national codes. . c Permanent national codes, dental codes, category II codes. . d Permanent national codes, miscellaneous codes, and temporary national codes. .
____ 15. What publications are copyrighted and maintained by AMA? a CPT¨, codebook, HCPCS Level II c AHA Coding Clinic . codebook, ICD-9-CM codebook . b CPT¨ codebook d CPT¨ codebook and CPT¨ Assistant . .
____ 16. How often is HCPCS Level II permanent national codes updated? a annually c bi-annually . . b quarterly d three times a year . .
____ 17. What does Ònon-facilityÓ describe when calculating Physician Fee Schedule payments? a hospitals c non-hospital owned physician practices . . b nursing homes d hospital owned physician practices . .
____ 18. What is the correct anesthesia CPT¨ code for surgery performed on the frontal lobe of the brain? a 00218 c 00212 . . b 00216 d 00210 . .
____ 19. A patient is seen in the OR for an arthroscopy of the medial compartment of his left knee. What is the correct coding to report for the anesthesia services? a 01400 c 29870-LT . . b 01402 d 29880-LT . .
____ 20. What is the correct CPT¨ code for the wedge excision of a nail fold of an ingrown toenail? a 11720 c 11765 . . b 11750 d 11760 . .
____ 21. What is the correct CPT¨ code for the excision of a benign lesion on the scalp with an excised diameter of 2.3 cm? a 11403 c 11423 . . b 11603 d 11623 . .
____ 22. What is the correct code for the application of a short arm cast? a 29065 c 29125 . . b 29075 d 29280 . .
____ 23. What is the correct code for a Mayo type procedure to correct a hallux valgus? a 28290 c 28293 . . b 28292 d 28285 . .
____ 24. What is the correct CPT¨ code for the extensive excision of nasal polyps? a 30020 c 30110 . . b 30100 d 30115 . .
____ 25. What is the code for a secondary rhinoplasty, where a small amount of work is performed on the tip of the nose? a 30400 c 30435 . . b 30430 d 30462 . .
____ 26. What is the correct code for an intranasal radical maxillary sinusotomy? a 31020 c 31030 . . b 31050 d 31051 . .
____ 27. The Table of Drugs in the HCPCS Level II book indicates various medication routes of administration. What abbreviation represents the route where a drug is introduced into the subdural space of the spinal cord? a IM c INH . . b SC d IT . .
____ 28. What is the correct HCPCS Level II code for parenteral nutrition solution amino acid, 3.5%? a B4176 c B4168 . . b B4172 d B4178 . .
____ 29. What modifier would be used to report the termination of a surgery following induction of anesthesia due to extenuating circumstances or those that threaten the well being of the patient? a Modifier 52 c Modifier 53 . . b Modifier 22 d Modifier 54 . .
____ 30. What is the correct HCPCS Level II code for a removable metatarsal foot arch support which is premolded? a L3050 c L3080 . . b L3060 d L3090 . .
____ 31. A patient is seen in the physicianﾃ不 office for a 2,400,000 U injection of Bicillin LA. What is the code to represent this drug?
a J2540 x 4 . b J0561 x 24 .
c . d .
J2510 x 4 J0558 x 24
____ 32. What is the code for partial laparoscopic colectomy with anastomosis and coloproctostomy? a 44208 c 44145 . . b 44210 d 44207 . .
____ 33. What is the correct CPT¨ code for a complicated nephrolithotomy on a patient with a congenital kidney abnormality? a 50060 c 50070 . . b 50065 d 50075 . .
____ 34. What is the correct CPT¨ coding for a cystourethroscopy with brush biopsy of the renal pelvis? a 52007 c 52000, 52007 . . b 52005 d 52005, 52007 . .
____ 35. What is the correct CPT¨ code for strabismus reparative surgery performed on 2 horizontal muscles? a 67311 c 67314 . . b 67312 d 67316 . .
____ 36. What is the correct CPT¨ code for a complete, 4 views, chest X-ray with fluoroscopy? a 71034 c 71023 . . b 71030 d 71020 . .
____ 37. What is the correct CPT¨ code to report a microscopic urinalysis? a 81000 c 81003 . . b 81001 d 81015 . .
____ 38. What is the correct CPT¨ code for level IV surgical pathology? a 88305 c 88309 . . b 88304 d 88307 . .
____ 39. What is the CPT¨ code used to report a right heart cardiac catheterization for congenital anomalies? a 93451 c 93453 . . b 93530 d 93531 . .
____ 40. What is the correct coding of the performance measure for moderate rheumatoid arthritis disease activity? a 3476F c 3471F . . b 3475F d 3470F . .
____ 41. What is the correct code for the administration of one vaccine given intramuscularly for a child under eight years of ages when parents are counseled by the physician? a 90471 c 90461 . . b 94073 d 90460 . .
____ 42. What is the correct CPT¨ code for a MRI performed on the brain first without contrast and then with contrast? a 70554 c 70552 . . b 70553 d 70551 . .
____ 43. What is the appropriate modifier to use when two surgeons perform separate distinct portions of the same procedure? a 66 c 62 . . b 80 d 59 . .
____ 44. Where is the starting point for selective catheter placement for the vascular families in Appendix L in the CPT¨ codebook? a Femoral artery c Carotid artery . . b Aorta d Brachial artery . .
____ 45. What is the full description for code 11001? a Debridement of extensive eczematous or infected skin; up to 10% of body surface; each . additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure). b Debridement of extensive eczematous or infected skin; each additional 10% of the body . surface, or part thereof (List separately in addition to code for primary procedure) c Each additional 10% of the body surface, or part thereof (List separately in addition to . code for primary procedure) d Debridement of extensive eczematous or infected skin; up to 10% of body surface .
____ 46. Services provided in the home by an agency are considered? a Facility services c Nursing services . . b Nonfacility services d Non covered services . .
____ 47. How are new additions and revisions indicated in your CPT¨ codebook each year? a Italic print c Green print . . b Red print d Bold print . .
____ 48. What hernia repair codes can be reported with add-on code 49568? a 49555-49557 c 49560-49566 . . b 49654-49659 d 49570-49572 . .
____ 49. How are ambulance modifiers used? a They identify mileage traveled during the encounter. . b They identify emergency or non-emergency transport types. . c They identify the time elements of the ambulance service. . d They identify ambulance place of origin and destination. .
____ 50. If a CPT¨ code and a HCPCS Level II code exist for the same service, which should you report? a The HCPCS Level II code. c Report both. . . b The CPT¨ code. d It depends on the payer.
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CPT Answer Section MULTIPLE CHOICE 1. ANS: A Rationale: Per CMS - Relative value units (RVUs) Ð RVUs capture the three following components of patient care: Physician work RVU, Practice Expense RVU, and Malpractice RVUs. PTS: 1
DIF: Moderate
2. ANS: B Rationale: Per AMA, CPT¨ Category II codes are a set of supplemental tracking codes that can be used for performance measurement. PTS: 1
DIF: Moderate
3. ANS: D Rationale: Per AMA, no relative value units (RVUs) are assigned to these codes. Payment for these services or procedures is based on the policies of payers. PTS: 1
DIF: Moderate
4. ANS: D Rationale: The Medicare approved amount for surgery includes the following services when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, eg, in hospitals, ASCs, and physicians' offices. Visits to a patient in an intensive or critical care unit are also included if made by the surgeon. PTS: 1
DIF: Moderate
5. ANS: C Rationale: Per CMS Internet-only manuals (IOM) Medicare Claims Processing Manual Ð surgical status indicator 000 = Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable. PTS: 1
DIF: Moderate
6. ANS: B Rationale: HCPCS stands for Healthcare Common Procedure Coding System. PTS: 1
DIF: Moderate
7. ANS: C Rationale: A wheelchair is considered durable medical equipment. In the HCPCS index, look for the term Wheelchair. Majority of the codes listed are E HCPCS codes. PTS: 1
DIF: Moderate
8. ANS: B Rationale: Per CMS Temporary codes can be added, changed, or deleted on a quarterly basis. Once established, temporary codes are usually implemented within 90 days, the time needed to prepare and issue implementation instructions and to enter the new code into CMS's and the contractors' computer systems and initiate user education. This time is needed to allow for instructions such as bulletins and newsletters to be sent out to suppliers to provide them with information and assistance regarding the implementation of temporary CMS codes. http://www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/LevelIICodingProcedures.pdf PTS: 1
DIF: Moderate
9. ANS: A Rationale: Outpatient PPS (C1300-C9899) Guideline explains C codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals to report new technology procedures, medical devices, drugs, biologicals, and radiopharmaceuticals; that do not have other HCPCS codes assigned. Other facilities may report C-codes at their discretion. PTS: 1
DIF: Moderate
10. ANS: D Rationale: CPT¨ Instructions for the use of the CPT¨ codebook include Òselect the name of the procedure or service that accurately identifies the service performed.Ó PTS: 1
DIF: Moderate
11. ANS: B Rationale: Per CPT¨ Òall add-on codes found in the CPT¨ codebook are exempt from the multiple procedure concept.Ó PTS: 1
DIF: Moderate
12. ANS: B Rationale: CMS has been delegated to maintain and distribute HCPCS Level II codes. PTS: 1
DIF: Moderate
13. ANS: C Rationale: Modifier 32 reports Òmandated servicesÓ PTS: 1
DIF: Moderate
14. ANS: D . Rationale: HCPCS Level II codes consist of permanent national codes, miscellaneous codes, and temporary national codes. PTS: 1
DIF: Moderate
15. ANS: D Rationale: CPT¨ (all three categories) and CPT¨ Assistant is published, copyrighted, and maintained by AMA. PTS: 1
DIF: Moderate
16. ANS: A Rationale: Permanent national codes are updated once a year in January. PTS: 1
DIF: Moderate
17. ANS: C Rationale: ÒNon-facilityÓ location calculations are for private practices or non-hospital-owned physician practices. Reimbursement is higher for private practices because the practice incurs the full expense of providing the service. PTS: 1
DIF: Moderate
18. ANS: D Rationale: In the CPT¨ Index, look for Anesthesia/Brain. Here you are directed to see codes 00210-00218, 00220-00222. When you turn to these codes in the Anesthesia section and review them, it is code 00210 you would report. This represents Anesthesia for intracranial (brain) procedures, not otherwise specified. PTS: 1
DIF: Moderate
19. ANS: A Rationale: In the CPT¨ Index, look for Anesthesia/Knee. You are given multiple codes to choose from. When you turn to these codes in the Anesthesia section and review them, it is code 01400 you would report. This represents Anesthesia for arthroscopic procedures performed on the knee. PTS: 1
DIF: Moderate
20. ANS: C Rationale: In the CPT¨ Index, look for Excision/Nail Fold. The code you are directed to use is 11765. PTS: 1
DIF: Moderate
21. ANS: C . Rationale: In the CPT¨ Index, look for Excision/Skin/Lesion/Benign or look for Skin/Excision/Lesion/Benign. You are directed to see codes 11400-11471. When you turn to these codes in the Integumentary code section and review them, it is code 11423 you would report. This represents the excision of a benign lesion on the scalp, neck, hand feet or genitalia which is 2.1-3.0 cm in diameter excised including margins. PTS: 1 22. ANS: B
DIF: Moderate
Rationale: In the CPT¨ Index, look for Cast/Ambulatory/Short Arm. The code you are directed to use is 29075. PTS: 1
DIF: Moderate
23. ANS: B Rationale: In the CPT¨ Index, look for the term Mayo procedure. The code you are directed to use is 28292. PTS: 1
DIF: Moderate
24. ANS: D Rationale: In the CPT¨ Index, look for Excision/Polyp/Nose. You are directed to 30110, 30115. Looking at the description for each code in the Respiratory Section, 30115 is for extensive. PTS: 1
DIF: Moderate
25. ANS: B Rationale: In the CPT¨ Index, look for Rhinoplasty/Secondary. You are directed to see codes 30430-30450. Look at the codes in the Respiratory code section and review them, it is code 30430 you would report. This represents a small amount of work for a secondary rhinoplasty when performed on the tip of the nose. PTS: 1
DIF: Moderate
26. ANS: C Rationale: In the CPT¨ Index, look for Sinusotomy/Maxillary. You are directed to see codes 31020-31032. Look in the Respiratory Section and review the code descriptors, it is code 31030 you would report. PTS: 1
DIF: Moderate
27. ANS: D Rationale: In the HCPCS Level II codebook, there is an appendix that lists the abbreviations and acronyms and their meanings listed. IT stands for Intrathecal. IT is the route where a drug is introduced into the subdural space of the spinal cord. PTS: 1
DIF: Moderate
28. ANS: C Rationale: In the HCPCS Level II Index, look up Parenteral nutrition/solution. You are directed to codes B4164-B5200. When you turn to the B codes to review, it is code B4168 you would report. PTS: 1
DIF: Moderate
29. ANS: C Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well being of the patient. CPT¨ modifiers are found on the inside front cover and in Appendix A of your CPT¨ codebook. PTS: 1
DIF: Moderate
30. ANS: A Rationale: In the HCPCS Level II Index, look for Support/arch. You are directed to see codes L3040-L3090. When you turn to the L codes to review, it is code L3050 which represents a removable metatarsal foot arch support. PTS: 1
DIF: Moderate
31. ANS: B Rationale: In the HCPCS Level II Table of Drugs, look up Bicillin LA. Here you are directed to see Penicillin G benzathine, referring you to code J0561. J0561 is for 100,000 U so 24 units of J0561 are reported for 2,400,000 are reported. PTS: 1
DIF: Moderate
32. ANS: D Rationale: In the CPT¨ Index, look for Laparoscopy/Colon/Colectomy/Partial. You are directed to codes 44204-44208 and 44213. In the Digestive Section, review the codes, it is code 44207 which represents a partial colectomy with anastomosis and coloproctostomy performed laparoscopically. PTS: 1
DIF: Moderate
33. ANS: C . Rationale: In the CPT¨ Index, look for Nephrolithotomy. You are directed to see codes 50060-50075. In the Urinary Section, review the descriptions of these codes. Code 50070 represents a complicated nephrolithotomy performed on a patient having a congenital kidney abnormality. PTS: 1
DIF: Moderate
34. ANS: A Rationale: In the CPT¨ Index, look for Cystourethroscopy/Biopsy/Brush. The code you are directed to is 52007. PTS: 1
DIF: Moderate
35. ANS: B Rationale: In the CPT¨ Index, look for Strabismus/Repair/Two Horizontal Muscles. The code you are directed to use is 67312. PTS: 1
DIF: Moderate
36. ANS: A . Rationale: In the CPT¨ Index, look for X-ray/Chest/Complete (Four Views) with Fluoroscopy. The code you are directed to use is 71034. PTS: 1 37. ANS: D
DIF: Moderate
Rationale: In the CPT¨ Index, look for Urinalysis/Microscopic. The code you are directed to use is 81015. PTS: 1
DIF: Moderate
38. ANS: A Rationale: In the CPT¨ Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam/ Level IV. The code you are directed to use is 88305. PTS: 1
DIF: Moderate
39. ANS: B Rationale: In the CPT¨ Index, look for Catheterization/Cardiac and you are directed to see Cardiac Catheterization. Cardiac Catheterization/Right Heart/Congenital Cardiac Anomalies directs you to use is 93530. PTS: 1
DIF: Moderate
40. ANS: C Rationale: In the CPT¨ Index, look for Performance Measures/Rheumatoid Arthritis/ Diagnostic/Screening Processes or Results/Rhematoid Arthritis Disease Activity Assessment. You are directed to see codes 3470F3472F. When you turn to these codes found with the Category II codes and review them, it is code 3471F you would use. This represents the measurement of moderate disease activity in a patient with rheumatoid arthritis. PTS: 1
DIF: Moderate
41. ANS: D Rationale: In the CPT¨ Index, look for Immunization Administration/One Vaccine/Toxoid/ with Counseling. Here you are directed to use code 90460 . Code 90461 is an add-on code and would not be reported alone. PTS: 1
DIF: Moderate
42. ANS: B Rationale: In the CPT¨ Index, look for Magnetic Resonance Imaging (MRI) /Diagnostic/Brain. You are directed to see codes 70551-70555. In the Radiology Section, review these codes, it is code 70553 you would report. This represents an MRI performed on the brain. First this is done without contrast materiel then with contrast material. PTS: 1
DIF: Moderate
43. ANS: C Rationale: Modifier 62 is used when two surgeons work together as primary surgeons performing distinct part(s) of a procedure. Modifiers and their descriptions can be found on the inside front cover and Appendix A of your CPT¨ codebook. PTS: 1 44. ANS: B
DIF: Moderate
Rationale: Look in Appendix L of yourCPT¨ codebook. The guidelines for Appendix L states the assumption is made that the starting point is catheterization of the aorta. PTS: 1
DIF: Moderate
45. ANS: B Rationale: Look at code 11001 in the Integumentary Section of the CPT¨ codebook. The code description of an indented code includes the portion before the semicolon in the main code. In this example, the common potion of the code is shown in 11000 which is ÒDebridement of extensive exzemetous or infected skin;Ó The remaining portion of the code descriptor is stated next to add-on code 11001, Òeach additional 10% of the body surface, or part therof.Ó PTS: 1
DIF: Moderate
46. ANS: A Rationale: The Introduction section of the CPT¨ codebook (after the Table of Contents) includes instructions under the subheading, Place of Service and Facility Reporting, states services provided in the home by an agency are considered facility services. PTS: 1
DIF: Moderate
47. ANS: C Rationale: New additions and revisions are indicated in your CPT¨ codebook each year by green print. PTS: 1
DIF: Moderate
48. ANS: C Rationale: Look in your CPT¨ codebook for 49568. The parenthetical instruction under code 49568 states, ÒUse 49568 in conjunction with 11004-11006, 49560-49566.Ó PTS: 1
DIF: Moderate
49. ANS: D Rationale: Transportation (ambulance) services utilize modifiers made up of two letters identifying the origin and the destination according to the guidelines in the A section (Transportation Services Including Ambulance A0021-A0999) of the HCPCS codebook. PTS: 1
DIF: Moderate
50. ANS: D Rationale: The payer determines whether a CPT¨ or HCPCS Level II code is reported. PTS: 1
DIF: Moderate