Deck 13: Procedural, Evaluation and Management, and HCPCS Coding

Question 1

An updated version of the CPT manual is published:

A) every month.
B) twice a year.
C) every year.
D) every 2 years.

Answer 1

every year.

Question 2

One of the ways a CPT code cannot be displayed is as:

A) a single code.
B) binary codes.
C) multiple codes.
D) a range of codes.

Answer 2

binary codes.

Question 3

Levels of service are based on three key components,including all of the following,except:

A) history.
B) chief complaint.
C) examination.
D) complexity of medical decision making.

Answer 3

chief complaint.

Question 4

How many levels of procedural coding are there?

A) 2
B) 3
C) 4
D) 5

Question 5

Codes used by most physicians for reporting key categories of their services are called _____ codes.

A) A&B
B) M&M
C) E/M
D) A-Z

Question 6

The first step in CPT coding is to identify the:

A) main term.
B) procedure or service to be coded.
C) allowable charge.
D) attending physician.

Question 7

____________ codes deal with what the healthcare provider does during the time spent with the patient rather than merely with the amount of time spent.

A) Unit floor time
B) E/M
C) Combination
D) Consultation

Question 8

A main term can stand alone,or it can be followed by up to three _____ terms.

A) modifying
B) subsequent
C) secondary
D) procedural

Question 9

In the CPT manual,the Alphabetic Index is presented:

A) first.
B) last.
C) immediately before the category III codes.
D) after the introduction and before the main body.

Question 10

The time the healthcare provider spends in direct contact with a patient is called _____ time.

A) face-to-face
B) unit/floor
C) counseling
D) treatment

Question 11

Level I of the HPCS codes contains:

A) HCPCS national codes.
B) codes used to report medical services and supplies.
C) codes used for generating physicians' charges.
D) the AMA Physicians' CPT codes.

Question 12

A manual containing a list of descriptive terms and identifying codes used in reporting medical codes and procedures is called the:

A) ICD-9-CM.
B) CPT-4.
C) HCPCS Level II.
D) Procedural Coding Manual.

Question 13

Which symbol is used to show that the code has been changed or modified?

A) A bullet (·)
B) Plus sign (+)
C) A triangle ( )
D) Horizontal triangles

Question 14

What must accompany the claim when a rarely used,unusual,variable,or new service is performed?

A) A modifier
B) A special report
C) A special symbol
D) An EOB

Question 15

Place of service,type of service,and patient status are three factors to consider for directing the health insurance professional to the correct category in the:

A) stand-alone codes.
B) category III codes.
C) appendices A through N.
D) E/M coding section.

Question 16

The type of code that contains the full description of the procedure without additional explanation is the _____ code.

A) stand-alone
B) indented
C) single
D) multiple

Question 17

Which E/M codes are used for new patients who have been treated in a physician's office?

A) 99221-99223
B) 99281-99288
C) 99211-99215
D) 99201-99205

Question 18

E/M documentation guidelines first became effective in 1995.In what year did the second set become effective?

A) 1995
B) 1996
C) 1997
D) 1998

Question 19

In what year was the CPT adopted as part of HCFA's Common Procedure Coding System?

A) 1983
B) 1985
C) 1993
D) 1995

Question 20

Following the six sections listed in the main body of the CPT manual are the:

A) level codes.
B) category II codes.
C) category IV codes.
D) appendices A-N.

Question 21

The information provided by the patient is referred to as:

A) subjective information.
B) voluntary information.
C) credible information.
D) independent information.

Question 22

If Jane Smith schedules an appointment with Dr.Allen,and neither Dr.Allen nor any of his colleagues at Broadmoor Medical Clinic have treated her before,Jane's status would be:

A) new patient.
B) traditional patient.
C) established patient.
D) customary patient.

Question 23

What are the two major subcategories of nursing facilities?

A) Initial/subsequent
B) Inpatient/outpatient
C) Critical/observation
D) Emergency/nonemergency

Question 24

How many key components must be met or exceeded for established patients?

A) None
B) One
C) Two
D) Three

Question 25

If Jane was seen the previous year by Dr.Hunter,Dr.Allen's partner,Jane's status on her visit to Dr.Allen would be:

A) new patient.
B) traditional patient.
C) established patient.
D) customary patient.

Question 26

The level of _____________ is determined by the complexity involved in the healthcare provider's assessment of and professional judgment regarding the patient's diagnosis and care.

A) UCR schedule fees
B) medical decision making
C) the patient's status
D) the patient's examination

Question 27

What is the service type that includes those provided to hospital inpatients,as well as those in a "partial hospital" setting?

A) Outpatient service
B) Observation service
C) Partial inpatient service
D) Inpatient service

Question 28

The most important thing to remember when using modifiers is that the health record must contain ______________ to support the modifier.

A) adequate documentation
B) signatures of two physicians
C) an operative report
D) proof of insurance coverage

Question 29

How many key components must be met or exceeded for new patients?

A) None
B) One
C) Two
D) Three

Question 30

The health insurance professional must determine three factors that would direct him or her to the proper category in the E/M coding section,which include all except the following.

A) Place of service
B) Type of service
C) Time spent with patient
D) Patient status

Question 31

_________ is AMA's ongoing effort to improve the structure and processes of CPT codes to reflect today's coding demands,as well as HIPAA challenges.

A) The CPT-5 project
B) HCPCS Level II
C) The crosswalk design
D) The Patient Affordable Care Act

Question 32

Main terms in CPT-4 are organized by four primary classes of main entries.Which of the following is not one of these primary classes?

A) A condition
B) An eponym
C) An abbreviation
D) A device

Question 33

HCPCS Level II codes are mandated by CMS for reporting codes for nonphysician procedures and services on ____________ claims.

A) all third-party
B) Medicare
C) electronic
D) paper

Question 34

When the amount of time spent face to face with the patient exceeds the usual length of service,this extra time is reported using ___________ codes.

A) observation
B) combination
C) consultation
D) prolonged services

Question 35

What is the type of status that allows patients to be monitored in the hospital so that physicians can determine if they need to be admitted as inpatients or can be discharged?

A) Outpatient status
B) Observation status
C) Partial inpatient status
D) Swing bed status

Question 36

The health insurance professional must establish what level of service the patient received,which is based on all but which of the following three key components?

A) History
B) Examination
C) Time
D) Complexity of medical decision making

Question 37

Contributing factors that affect the E/M coding level reported include all of the following,except:

A) counseling.
B) coordination of care.
C) nature of presenting problem.
D) whether or not a modifier is used.

Question 38

If Cheryl Parker was having an excision of an ovarian cyst,the main term would be:

A) excision.
B) ovary.
C) cyst.
D) any of the above

Question 39

If a patient is transferred to a specialist who then assumes ongoing responsibility for all or a portion of the patient's care,this is considered a/an:

A) referral.
B) consultation.
C) critical care service.
D) observation status.

Question 40

The direct delivery of medical care by a physician for a severely ill or seriously injured patient is a definition for:

A) a referral.
B) a consultation.
C) a critical care service.
D) observation service.

Question 41

The cross-referencing term ____ is used as a cross-reference term in the CPT-4 Alphabetic Index and directs the coder to an alternative main term.

Question 42

Current Procedural Terminology (CPT)was first developed and published by the _______________ in 1966.

Question 43

HCPCS National Codes used to report medical services,supplies,drugs,and durable medical equipment are Level ________ codes.

A) I
B) II
C) III
D) IV

Question 44

Supplemental tracking codes,intended to be used for performance measurement,are Category _____ codes.

A) I
B) II
C) III
D) IV

Question 45

A ____________ is a procedure by which codes used for data in one database are translated into the codes of another database,making it possible to relate information between or among databases.

Question 46

At the end of each subsection or subheading,a code is provided under the heading "other procedures," which typically ends in _______.

Question 47

A patient's medical record must contain sufficient documentation to support the use of ____________________.

Question 48

E/M codes 99281 through 99288 are used for both new and established patients who have been treated in a/an ______________ that is part of a hospital.

A) Outpatient facility
B) Long-term care unit
C) emergency department
D) ambulatory surgery

Question 49

The Affordable Care Act required all state Medicaid programs to incorporate _________________ in their claims processing systems by March 31,2011.

A) HCPCS codes
B) Category III Codes
C) ICD-10-CM diagnosis codes
D) National Correct Coding Initiatives

Question 50

Main terms can stand alone,or they can be followed by ______________terms.

Question 51

The time the healthcare provider spends in direct contact with a patient during an office visit,which includes taking a history,performing an examination,and discussing results,is _____ time.

A) unit floor
B) face-to-face
C) E&M
D) counseling

Question 52

A __________ is used to report or indicate that a service or procedure has been altered by some specific circumstance but not changed in its definition or code.

A) Modifier
B) Level III code
C) Crosswalk code
D) Special report

Question 53

In the CPT-4,each main section is preceded by _______________ specific to that section.

Question 54

The CPT index is organized by ____________ listed alphabetically.

Question 55

The category of codes established by the AMA as a set of temporary CPT codes for emerging technologies,services,and procedures is Category _____ codes.

A) I
B) II
C) III
D) IV

Question 56

Five-digit CPT codes accompanied by descriptive terms and used for reporting services performed by healthcare professionals are Level _____ codes.

A) I
B) II
C) III
D) IV

Question 57

Similar to the ICD-9 and ICD-10-CM manuals,CPT-4 is made up of several sections beginning with a/an ___________,identified by lowercase Roman numerals.

Question 58

A CPT code can be displayed one of three ways: as ____________,____________,or ______________.

Question 59

The time the physician spends on bedside care of the patient and reviewing the health record and writing orders is _____ time.

A) unit floor
B) face-to-face
C) E/M
D) counseling

Question 60

In preparation of standardization for the full implementation of HIPAA,CMS has instructed carriers to eliminate Level _______ codes from their claim processing systems.

A) I
B) II
C) III
D) IV

Question 61

The use of a semicolon (;)has special significance and importance when assigning a CPT code.Explain and give an example.

Question 62

Levels of service are based on what three key components?

Question 63

In CPT coding a "new" patient is distinguished from an "established" patient using specific descriptions.Define both types of patients.

Question 64

Explain the purpose of CPT coding.

Question 65

MATCHING

Symbol denoting modifier-exempt codes

Question 66

MATCHING

Symbol indicating code description has been changed/modified

Question 67

Like history-taking,there are four degrees of patient examination.Name these four degrees.

Question 68

List the six basic steps of CPT coding discussed in the book.

Question 69

Name and briefly explain the three levels of procedural coding.

Question 70

List items that must be included in a "special report" if and when one becomes necessary to accompany a claim to explain unusual circumstances.

Question 71

MATCHING

Symbol representing a code that is new to the CPT book

Question 72

MATCHING

Symbol identifying a change in wording of a new/revised code

Question 73

List the four primary classes of main term entries and give an example of each.

Question 74

What are the four contributing factors that may impact the E&M coding level reported?

Question 75

What specific factors direct the health insurance professional to the proper category in the E&M coding section of CPT?

Question 76

Name the four levels of history-taking.

Question 77

MATCHING

Symbol indicating an add-on code

Question 78

List the three ways CPT codes can be displayed and give an example of each.

Question 79

MATCHING

Reinstated or recycled code

Question 80

List and explain the four formatting classifications for codes appearing in the tabular section of CPT.