Deck 6: Procedural Coding

Question 1

Included in a global surgery policy and a surgical package is/are

A) postoperative visits in and out of the hospital.
B) digital block or topical anesthesia.
C) preoperative visit and complications after surgery.
D) both a and b

Answer 1

both a and b

Question 2

What is the name of the book that contains a coded listing of procedures with unit values that indicate the relative value of various services?

A) ICD-10-CM
B) CPT
C) RVS
D) HCPCS

Answer 2

RVS

Question 3

The resource-based relative value scale (RBRVS) was developed for

A) the Centers for Medicare and Medicaid Services.
B) Blue Cross and Blue Shield.
C) managed care organizations.
D) workers' compensation insurance plans.

Answer 3

the Centers for Medicare and Medicaid Services.

Question 4

When a service is rendered that is not listed in the CPT codebook,

A) list 00000 on the insurance claim form and send supporting documentation that clearly identifies the procedure that was done.
B) write the description of service on the claim form in place of the code.
C) you cannot bill for unlisted services.
D) use a code with a description stating "unlisted."

Question 5

A listing of accepted charges or established allowances for specific medical procedures is called a/an ____________________.

Question 6

The CPT publication is updated and revised

A) annually.
B) biannually.
C) every 3 years.
D) every 5 years.

Question 7

What does bundling mean?

A) When the code system used on a claim submitted to an insurance carrier does not match the code system used by the company receiving the claim.
B) Deliberate manipulation of CPT codes for increased payment.
C) Coding and billing numerous CPT codes to identify procedures that are usually described by a single code.
D) Grouping codes that are related to a procedure.

Question 8

The E/M code 99203 is considered a level ____________________ code.

Question 9

When multiple lacerations of the same classification are repaired in the same body area

A) report only the largest wound.
B) add the lengths of all lacerations and report them with a single code.
C) list the codes for all lacerations separately in descending order of value.
D) be sure to add a code for the anesthesia and chemical or electrocauterization if needed.

Question 10

CPT uses a basic ____________________-digit system for coding services rendered by physicians, plus ____________________-digit add-on modifiers.

Question 11

Insurance companies go by the rule: "If it is not documented, then it was not ____________________."

Question 12

The largest section in the CPT book is the

A) surgery section.
B) musculoskeletal section.
C) evaluation and management section.
D) medicine section.

Question 13

The key components that determine an evaluation and management code are documented by

A) the medical assistant.
B) the physician.
C) the insurance billing specialist.
D) none of the above.

Question 14

What code is used for an intramuscular injection of prochlorperazine (Compazine)?

A) 96365
B) 96372
C) 90749
D) 90702

Question 15

When counseling and coordination of care dominate ____________________% of face-to-face physician/patient encounters, then time is considered the key to qualify for a particular level of E/M service.

Question 16

What is the name of the book used in the physician's office to code procedures?

A) Clinical Procedure Terminology (CPT)
B) Current Procedural Terminology (CPT)
C) International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10-CM)
D) Systematized Nomenclature of Human and Veterinary Medicine (SNOMED International)

Question 17

The surgical package for non-Medicare cases includes the

A) operation, local infiltration, digital block or topical anesthesia, and normal uncomplicated postoperative care.
B) preoperative visit, operation, local infiltration, digital block or topical anesthesia, and normal uncomplicated postoperative care.
C) operation, local infiltration, digital block or topical anesthesia, and all postoperative care.
D) operation, local infiltration, digital block or topical anesthesia, and normal uncomplicated postoperative care occurring outside the hospital.

Question 18

The two-digit modifier -57 means

A) prolonged E/M services.
B) reduced services.
C) decision for surgery.
D) mandated services.

Question 19

When coding for x-ray films taken of both knees, list

A) the proper x-ray code twice and use the modifier -76 (repeat procedure by same physician) with the second code.
B) the proper x-ray code twice and use the modifier -51 (multiple procedure) with the second code.
C) the proper x-ray code once and modify it with -51 (multiple procedure).
D) the proper x-ray code twice and use the modifiers RT (right) with the first code and LT (left) with the second code.

Question 20

The CPT code for office services provided on an emergency basis is

A) 99302.
B) 99312.
C) 99282.
D) 99058.

Question 21

A medical practice can have more than one fee schedule unless specific state laws restrict this practice.

Question 22

Mrs. Burke is a 54-year-old patient seen by her physician for an annual routine physical examination. She has no complaints or symptoms. A nonautomated urinalysis with microscopy and bilateral screening mammography were done. Code for the office visit, urinalysis, and mammography.

Question 23

In coding a surgical procedure, postoperative care and follow-up visits may not be coded separately if they fall within the global period for the procedure.

Question 24

The CPT codebook includes a description of the number of follow-up days that are allowed after surgery at no additional charge.

Question 25

Private health insurance plans using the UCR system may pay a physician's full charge if it does not exceed UCR charges.

Question 26

A patient appears at an outpatient medical facility with extensive lacerations. Simple repair of wounds measuring 2.5, 4.6, and 3.5 cm on the hands, along with complex repair of a 1.5-cm wound on the nose and intermediate repair of wounds measuring 7.3 and 4.6 cm on the scalp, are performed. List the code(s) required for the repairs.

Question 27

If you are billing services for an assistant surgeon, use modifier ____________________ after the surgery procedure number.

Question 28

UCR (usual, customary, reasonable) is used mostly in reference to managed care services.

Question 29

Some managed care plans develop "internal codes" for use by the plan only to code specific procedures.

Question 30

Deliberate manipulation of CPT codes for increased payment is called ____________________.

Question 31

If a procedure requires more than one modifier code, use the multiple two-digit code ____________________ after the usual five-digit code number.

Question 32

Coding and billing numerous CPT codes to identify procedures that are usually described by a single code is called ____________________.

Question 33

In a UCR system, payment can be extremely high for a rarely performed but highly complex procedure because there may be no history of billed charges from other physicians on which to base payment.

Question 34

A 46-year-old new patient is seen in an internal medicine office for a routine annual checkup. The patient is asymptomatic, with no complaints. A comprehensive history is taken, and a comprehensive physical examination is performed. A chest x-ray (two views), an ECG, an automated urinalysis with microscopy, and an automated CBC with manual differential WBC count are obtained in the office. List the code(s) required to complete the Health Insurance Claim Form.

Question 35

A patient required arthroplasty of the tibial plateaus of both knees. Code this procedure for the surgeon.

Question 36

Some private insurance companies may or may not accept HCPCS codes.

Question 37

The Medicare global surgery policy for major operations is similar to the surgical package concept.

Question 38

When there is a choice of two or three somewhat similar codes, the insurance claims examiner will choose the highest-paying code.

Question 39

The Healthcare Common Procedure Coding System (HCPCS) consists of two levels of codes.

Question 40

When a new CPT code is used, it may take as long as 6 months before an insurance company has a mandatory value assignment.