Deck 7: CPT Coding

Question 1

What type of codes contain "emerging technology," are temporary codes assigned for data collection, and are still used by some third-party payers?

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

Answer 1

Category III codes

Question 2

Horizontal triangles surround revised __________.

A) codes and code descriptions
B) guidelines and notes
C) modifiers and descriptions
D) procedures and services

Answer 2

guidelines and notes

Question 3

Which are "performance measurements" tracking codes that are assigned an alphanumeric identifier with a letter in the last field?

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

Answer 3

Category II codes

Question 4

The plus symbol identifies __________ for procedures that are commonly, but not always, performed at the same time and by the same surgeon as the primary procedure.

A) add-on codes
B) indented codes
C) modifiers
D) parenthetical notes

Question 5

When an unlisted procedure or service code is reported, a __________ must accompany the claim to describe the nature, extent, and need for the procedure or service along with the time, effort, and equipment necessary to provide the service.

A) CMS-1500 claim
B) copy of the record
C) remittance advice
D) special report

Question 6

A triangle located to the left of a code number identifies a code description that has been __________.

A) added to CPT for new procedures and services
B) deleted from CPT since its last edition
C) reinstated or recycled since the last edition
D) revised since the last edition of CPT

Question 7

Procedures and services submitted on a claim must be linked to the __________ that justifies the need for the service or procedure.

A) CPT code
B) HCPCS code
C) ICD-10-CM code
D) HCPCS level I code

Question 8

With what type of codes are procedures/services identified by a five-digit CPT code and descriptor nomenclature (these are codes traditionally associated with the CPT and organized within six sections)?

A) Category I codes
B) Category II codes
C) Category I and II codes
D) Category III codes

Question 9

A bullet located to the left of a code number identifies codes that were __________.

A) added to CPT for new procedures and services
B) deleted from CPT since its last edition
C) reinstated or recycled since the last edition
D) revised since the last edition of CPT

Question 10

The forbidden symbol identifies codes that are not to be used with modifier __________.

A) -25
B) -26
C) -51
D) -59

Question 11

Which define terms and explain the assignment of codes for procedures and services located in a particular section of the CPT manual?

A) boldfaced terms
B) guidelines
C) symbols
D) unlisted codes

Question 12

Moderate (conscious) sedation is the administration of moderate __________, which results in a drug-induced depression of consciousness.

A) epidural injections
B) general anesthesia
C) local anesthetics
D) sedation or analgesia

Question 13

The bull's-eye symbol located next to a code number indicates that the procedure __________.

A) has been revised since the last edition of the CPT manual
B) includes moderate (conscious) sedation
C) is being performed on a patient of extreme age
D) was performed on both sides of the body

Question 14

Most CPT procedures and services are classified as __________ codes, which include a complete description of the procedure or service.

A) indented
B) individual
C) separate
D) stand-alone

Question 15

A semicolon is used to save space in CPT, which means __________.

A) add-on codes are assigned procedures performed during another procedure
B) modifiers are never assigned for described procedures and services
C) revised procedures and services have been added to the code description
D) some code descriptions are not printed in their entirety next to a code number

Question 16

The flash symbol indicates codes that classify products that are pending __________ approval but have already been assigned a CPT code.

A) CMS
B) FDA
C) HHS
D) MAC

Question 17

The hollow circle symbol next to a CPT code indicates a(n) __________ or recycled CPT code.

A) added
B) deleted
C) reinstated
D) revised

Question 18

To save space in CPT, some descriptions are not printed in their entirety next to a code number, and a(n) __________ code appears below a another code, requiring the coder to refer back to the common portion of the code description that is located before the semicolon.

A) indented
B) individual
C) separate
D) stand-alone

Question 19

The number symbol precedes CPT __________ codes, which appear out of numerical order.

A) added
B) deleted
C) resequenced
D) revised

Question 20

Which type of procedure or service code is assigned when the provider performs a procedure or service for which there is no CPT code?

A) add-on code
B) indented code
C) stand-alone code
D) unlisted code

Question 21

CPT modifiers __________ the meaning of services and procedures performed by providers.

A) clarify and alter
B) completely change
C) delete
D) revise

Question 22

The __________ components include counseling, coordination of care, nature of presenting problem, and time.

A) collaborative
B) key

Question 23

The __________ of service refers to the kind of health care services provided to patients.

A) complexity
B) level
C) place
D) type

Question 24

Which appear throughout CPT sections to clarify the assignment of codes?

A) add-on codes
B) guidelines
C) instructional notes
D) special reports

Question 25

Which typeface is used for cross-reference terms in the CPT index?

A) all capitals
B) boldface
C) italics
D) underlining

Question 26

Main terms in the CPT index are printed in __________.

A) all capitals
B) boldface type
C) italics
D) underlined type

Question 27

An established patient is one who has received professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ years.

A) one
B) two
C) three
D) four

Question 28

Which is a CPT cross-reference that directs coders to an index entry under which codes are listed?

A) See
B) See also
C) See category
D) See code

Question 29

A history is an interview of the patient that includes which of the following elements?

A) chief complaint, history of present illness, past/family/social history
B) chief complaint, history of present illness, past/family/social history, physical examination
C) chief complaint, history of present illness, past/family/social history, review of systems
D) chief complaint, past/family/social history, physical examination, review of systems

Question 30

Which are terms that clarify the assignment of a CPT code and can occur in the middle of a main clause or after the semicolon, and may or may not be enclosed in parentheses?

A) code descriptions
B) descriptive qualifiers
C) instructional notes
D) modifiers

Question 31

The Evaluation and Management section is located at the beginning of CPT because these codes describe __________.

A) encounters that have unusual circumstances
B) health care rendered by nonphysicians only
C) procedures performed by anesthesiologists
D) services most frequently provided by physicians

Question 32

A new patient is one who has not received any professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ year(s).

A) one
B) two
C) three
D) four

Question 33

To save space in the CPT index when referencing subterms, __________ words are used.

A) add-on
B) inferred
C) presumptive
D) speculative

Question 34

Concurrent care is the provision of similar services, such as hospital inpatient visits, to __________ on the same day.

A) different patients by more than one provider
B) different patients by the same provider
C) the same patient by more than one provider
D) the same patient by the same provider

Question 35

The CPT __________ of history is categorized according to four levels.

A) extent
B) level
C) range
D) type

Question 36

The __________ components of history, examination, and medical decision making are required when selecting an evaluation and management level of service code.

A) collaborative
B) key

Question 37

The Evaluation and Management __________ of service reflects the amount of work involved in providing health care to a patient.

A) complexity
B) level
C) place
D) type

Question 38

CMS developed Evaluation and Management Documentation Guidelines, which explain how CPT evaluation and management codes are assigned according to __________ associated with comprehensive multisystem and single-system examinations.

A) documentation
B) elements
C) office visits
D) reimbursement

Question 39

Transfer of care occurs when a physician who is managing some or all of a patient's problems releases the patient to the care of another physician who is __________.

A) consulting on the case in the office
B) not providing consultative services
C) providing consultative services
D) terminating all care provided

Question 40

The __________ of service refers to the physical location where health care is provided to patients.

A) complexity
B) level
C) place
D) type

Question 41

The CPT comprehensive history includes the __________.

A) chief complaint and brief history of present illness or problem
B) chief complaint, brief history of present illness or problem, and problem-pertinent system review
C) chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient's problem
D) chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH

Question 42

Observation services furnished in a hospital outpatient setting where the patient is considered an outpatient __________.

A) are reimbursed when ordered by a physician
B) include a bed but no monitoring procedures
C) must be preauthorized by Medicare
D) routinely convert to an inpatient admission

Question 43

When the physician makes arrangements with other providers or agencies for services to be provided to a patient, this is called __________ of care.

A) coordination
B) delivery
C) quality
D) transfer

Question 44

The CPT comprehensive examination includes a(n) __________.

A) extended examination of the affected body areas and other symptomatic or related organ systems
B) general multisystem examination or a complete examination of a single organ system
C) limited examination of the affected body area or organ system
D) limited examination of the affected body areas or organ systems and other symptomatic or related organ systems

Question 45

Which is an assessment of the patient's body areas and organ systems?

A) physical examination
B) review of systems

Question 46

The CPT problem-focused history includes the __________.

A) chief complaint and brief history of present illness or problem
B) chief complaint, brief history of present illness or problem, and problem-pertinent system review
C) chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient's problem
D) chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH

Question 47

The CPT expanded problem-focused history includes the __________.

A) chief complaint and brief history of present illness or problem
B) chief complaint, brief history of present illness or problem, and problem-pertinent system review
C) chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient's problem
D) chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH

Question 48

Subcategories of hospital inpatient evaluation and management services include observation or inpatient care services, which include the __________.

A) admission and discharge from observation/inpatient status on the same day
B) final examination of the patient, discussion of hospital stay with patient or caregiver, instructions for continued care, and preparation of discharge records, prescriptions, and referral forms
C) inpatient's first encounter
D) review of the chart for changes in patient's condition, results of diagnostic studies, and/or reassessment of patient's condition since performance of last assessment

Question 49

CPT defines counseling as it relates to evaluation and management coding as a(n) __________ concerning areas that involve diagnostic results, impressions, recommended diagnostic studies, and so on.

A) assessment that impacts patient care
B) discussion with a patient and/or family
C) order for further ancillary testing
D) way to guarantee quality patient care

Question 50

Subcategories of hospital inpatient evaluation and management services include initial hospital care, which includes the __________.

A) admission and discharge from observation/inpatient status on the same day
B) final examination of the patient, discussion of hospital stay with patient or caregiver, instructions for continued care, and preparation of discharge records, prescriptions, and referral forms
C) inpatient's first encounter
D) review of the chart for changes in patient's condition, results of diagnostic studies, and/or reassessment of patient's condition since performance of last assessment

Question 51

The CPT __________ of examination is categorized according to four levels.

A) extent
B) level
C) range
D) type

Question 52

Which is the amount of time the provider spends at the patient's bedside and at management of the patient's care on the inpatient unit or floor?

A) face-to-face time
B) unit/floor time

Question 53

CPT medical decision making refers to the complexity of __________ as measured by the number of diagnoses or management options, amount and/or complexity of data to be reviewed, and risk of complications and/or morbidity or mortality.

A) assessing patient data in a group or single practice
B) completing a comprehensive history and physical examination
C) establishing a diagnosis and/or selecting a management option
D) ordering ancillary tests and interpreting their results

Question 54

The CPT detailed examination includes a(n) __________.

A) extended examination of the affected body areas and other symptomatic or related organ systems
B) general multisystem examination or a complete examination of a single organ system
C) limited examination of the affected body area or organ system
D) limited examination of the affected body areas or organ systems and other symptomatic or related organ systems

Question 55

The CPT expanded problem-focused examination includes a(n) __________.

A) extended examination of the affected body areas and other symptomatic or related organ systems
B) general multisystem examination or a complete examination of a single organ system
C) limited examination of the affected body area or organ system
D) limited examination of the affected body areas or organ systems and other symptomatic or related organ systems

Question 56

Which is considered when determining the number of diagnoses or management options for medical decision-making complexity? It includes a disease, condition, illness, injury, symptom, sign, finding, complaint, or other reason for the encounter, with or without a diagnosis being established at the time of the encounter.

A) chief complaint
B) history of present illness
C) nature of presenting problem
D) review of systems

Question 57

The CPT problem-focused examination includes a(n) __________.

A) extended examination of the affected body areas and other symptomatic or related organ systems
B) general multisystem examination or a complete examination of a single organ system
C) limited examination of the affected body area or organ system
D) limited examination of the affected body areas or organ systems and other symptomatic or related organ systems

Question 58

The CPT detailed history includes the __________.

A) chief complaint and brief history of present illness or problem
B) chief complaint, brief history of present illness or problem, and problem-pertinent system review
C) chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient's problem
D) chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH

Question 59

Subcategories of hospital inpatient evaluation and management services include subsequent hospital care, which includes the __________.

A) admission and discharge from observation/inpatient status on the same day
B) final examination of the patient, discussion of hospital stay with patient or caregiver, instructions for continued care, and preparation of discharge records, prescriptions, and referral forms
C) inpatient's first encounter
D) review of the chart for changes in patient's condition, results of diagnostic studies, and/or reassessment of patient's condition since performance of last assessment

Question 60

Which is the amount of time the office or outpatient care provider spends with the patient and/or family?

A) face-to-face time
B) unit/floor time

Question 61

A nursing facility comprehensive assessment is documented when the patient is __________.

A) admitted as a new patient to the facility
B) admitted or readmitted to the facility
C) readmitted to the nursing facility
D) reassessed on a routine basis

Question 62

Home services are provided to individuals in __________ to promote, maintain, or restore health and/or to minimize the effects of disability and illness, including terminal illness.

A) an inpatient hospice
B) ambulatory care settings
C) health care facilities
D) their place of residence

Question 63

Which is the examination of a patient by a health care provider, usually a specialist, for the purpose of advising the referring or attending physician in the evaluation and/or management of a specific problem with a known diagnosis?

A) consultation
B) discharge
C) referral
D) transfer

Question 64

Which are provided in a hospital that is open 24 hours for the purpose of providing unscheduled episodic services to patients who require immediate medical attention?

A) ambulatory services
B) emergency department services
C) inpatient services
D) outpatient services

Question 65

A physical status modifier is added to each reported CPT Anesthesia section code to indicate the patient's condition __________.

A) at the time anesthesia was administered
B) during the post-anesthesia recovery period
C) for the purpose of increasing reimbursement
D) to reduce the complexity of services provided

Question 66

Which occurs when a patient reports that another provider sent the patient to the provider, but the first provider did not schedule the appointment or document a request for services?

A) consultation
B) discharge
C) referral
D) transfer

Question 67

Which cover physicians who spend prolonged periods of time without direct patient contact, until physician's services are required?

A) critical care services
B) face-to-face services
C) standby services
D) unusual services

Question 68

Prolonged physician service with direct patient contact refers to __________ patient contact on an inpatient or outpatient basis.

A) critical care
B) face-to-face
C) standby
D) unusual

Question 69

Which include processes in which a physician is responsible for direct care of a patient and for coordinating and controlling access to or initiating and/or supervising other health care services needed by the patient?

A) case management services
B) face-to-face services
C) standby services
D) unusual services

Question 70

Physicians' services involving patient contact that are considered beyond the usual service in either an inpatient or outpatient setting may be reported as __________ services.

A) case management
B) critical care
C) prolonged
D) unlisted

Question 71

When anesthesia services are provided during situations or circumstances that make anesthesia administration more difficult, report a qualifying circumstances code from the CPT __________ section.

A) Anesthesia
B) Evaluation and Management
C) Medicine
D) Surgery

Question 72

Subcategories of hospital inpatient evaluation and management services include hospital discharge services, which include the __________.

A) admission and discharge from observation/inpatient status on the same day
B) final examination of the patient, discussion of hospital stay with patient or caregiver, instructions for continued care, and preparation of discharge records, prescriptions, and referral forms
C) inpatient's first encounter
D) review of the chart for changes in patient's condition, results of diagnostic studies, and/or reassessment of patient's condition since performance of last assessment

Question 73

Which occurs when a surgeon requests a specialist or other physician to examine a patient to determine if the patient can withstand the expected risks of a specific surgery?

A) consultation
B) preoperative clearance
C) referral
D) transfer

Question 74

Which are provided at an intermediate care facility or mentally handicapped, long-term care facility, or psychiatric residential treatment facility?

A) critical care services
B) inpatient services
C) nursing facility services
D) outpatient services

Question 75

Care plan oversight services cover the physician's time __________ the complex and multidisciplinary care treatment program for a specific patient who is under the care of a domiciliary or rest home or who resides at home.

A) auditing
B) justifying
C) operating
D) supervising

Question 76

Newborn care includes services provided to newborns in a(n) __________.

A) ambulatory care setting
B) inpatient hospital
C) nursing facility
D) variety of health care settings

Question 77

Prolonged physician service without direct patient contact refers to __________ patient contact on an inpatient or outpatient basis.

A) critical care
B) non-face-to-face
C) standby
D) unusual

Question 78

Which include routine examinations or risk management counseling for children and adults who exhibit no overt signs or symptoms of a disorder while presenting to the medical office for a preventive medical physical?

A) case management services
B) preventive medicine services
C) prolonged services
D) standby services

Question 79

Which describes the short-term, intensive treatment program where individuals who are experiencing an acute episode of an illness can receive medically supervised treatment during a significant number of daytime or nighttime hours?

A) inpatient hospitalization
B) outpatient hospitalization
C) partial hospitalization
D) skilled nursing facility hospitalization

Question 80

Which are reported when a physician directly delivers medical care for a critically ill or critically injured patient?

A) critical care services
B) emergency department services
C) inpatient services
D) outpatient services