Deck 19: Procedure Coding

Question 1

For reporting purposes, CPT considers a patient "new" if the patient has not received professional services within the past ____ year(s).

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

Answer 1

three

Question 2

To ensure reimbursement at the highest allowed level, CPT codes must ____.

A) include codes and modifiers that reflect the services performed
B) include only the modifiers
C) include all of the unbundled procedures
D) reflect a procedure or service higher than what was actually performed
E) reflect a procedure or service lower than what was actually performed

Answer 2

include codes and modifiers that reflect the services performed

Question 3

Medical offices usually have a(n) ____ to help minimize the risk of fraud by discovering and correcting coding and billing problems.

A) quality assurance program
B) billing software program
C) financial management plan
D) compliance plan
E) external auditor

Answer 3

compliance plan

Question 4

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.

A) ethical
B) invalid
C) noncompliant
D) fraudulent
E) erroneous

Question 5

A healthcare provider who practices under false qualifications or credentials is guilty of ____.

A) slander
B) defamation
C) assault
D) libel
E) fraud

Question 6

An act of deception used to take advantage of another person or entity is called ____.

A) liability
B) coercion
C) slander
D) fraud
E) defamation

Question 7

When a patient has no symptoms of a disease and the provider performs the tests for that disease at the patient's request, the provider has committed which of these fraudulent coding and billing practices?

A) Reporting services that were not performed
B) Reporting services at a higher level than was carried out
C) Performing procedures not related to the patient's condition
D) Billing separately for services that are bundled in a single procedure code
E) Reporting the same service twice

Question 8

If a laboratory bills for a general health panel but fails to perform one of the tests, it is guilty of which of these fraudulent coding and billing practices?

A) Reporting services that were not performed
B) Reporting services at a higher level than was carried out
C) Performing procedures not related to the patient's condition
D) Billing separately for services that are bundled in a single procedure code
E) Reporting the same service twice

Question 9

Analysis of the connection between the diagnostic and procedural information on a claim is called ____.

A) code verification
B) code analysis
C) claim processing
D) code linkage
E) claim association

Question 10

National codes issued by CMS that cover many supplies and durable medical equipment are ____.

A) CPT modifiers
B) HCPCS Level I codes
C) HCPCS Level II codes
D) ICD-9-CM codes
E) ICD-10-CM codes

Question 11

Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except ____.

A) exclusion from payers' programs
B) denied claims
C) reduced payments
D) internal coding audits
E) prison sentences

Question 12

The Healthcare Common Procedure Coding System (HCPCS) was developed for use in coding services for ____.

A) Blue Cross
B) HMOs
C) Medicare patients
D) Medicaid patients
E) managed care patients

Question 13

Having a medical practice compliance plan in place ____.

A) eliminates the risk of an audit
B) ensures adherence to state regulations
C) shows a "good-faith" effort to be compliant with coding regulations
D) simplifies the tasks of the medical assistant
E) replaces the insurance company's compliance checks

Question 14

HCPCS Level I codes ____.

A) duplicate ICD-9-CM codes
B) duplicate ICD-10-CM codes
C) supplement CPT codes
D) are also known as CPT codes
E) modify CPT codes

Question 15

Modifiers to CPT codes indicate ____.

A) that additional codes are needed
B) that some special circumstance applies to the service
C) synonyms
D) inclusions
E) exclusions

Question 16

The most frequently used CPT codes are the ____.

A) anesthesiology codes
B) evaluation and management codes
C) surgery codes
D) pathology and laboratory codes
E) radiology codes

Question 17

Billing for a moderate level evaluation and management service when only a simple BP check and injection were carried out is an example of ____.

A) Reporting services that were not performed
B) Reporting services at a higher level than was carried out
C) Performing procedures not related to the patient's condition
D) Billing separately for services that are bundled in a single procedure code
E) Reporting the same service twice

Question 18

A plus sign (+) is used to indicate ____.

A) modifiers
B) primary codes
C) stand-alone codes
D) V codes
E) add-on codes

Question 19

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?

A) The current CPT
B) Last year's CPT
C) ICD-9-CM for last year
D) ICD-9-CM for this year
E) ICD-10-CM

Question 20

A physician bills separately for a comprehensive metabolic panel and a quantitative glucose test, which is normally included in the metabolic panel. This is an example of which of the following fraudulent coding and billing practices?

A) Reporting services that were not performed
B) Reporting services at a higher level than was carried out
C) Performing procedures not related to the patient's condition
D) Billing separately for services that are bundled in a single procedure code
E) Reporting the same service twice

Question 21

The CPT is updated and new codes are provided for use beginning ____.

A) on the first day of each month
B) semiannually on January 1 and July 1
C) quarterly on the first day of January, April, July, and September
D) annually on January 1
E) annually on July 1

Question 22

What symbol appears next to a code that appears out of numerical sequence?

A) Red dot
B) Blue triangle
C) Lightning bolt
D) Pound (#) sign
E) Green arrows

Question 23

Which of the following best describes the CPT code format?

A) 3- to 5-character alphanumeric codes
B) 3- to 7-character alphanumeric codes
C) 4-digit numeric codes
D) 5-character alphabetic codes
E) 5-digit numeric codes

Question 24

Where in the CPT manual can you find a complete listing of all add-on codes?

A) Introduction
B) Appendix A
C) Appendix B
D) Appendix C
E) Appendix D

Question 25

An example of a Category II code is a code used for ____.

A) weight reduction counseling
B) annual physical examinations
C) fracture management
D) total replacement heart systems
E) pain management

Question 26

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?

A) Blue triangle
B) Green arrows
C) Bull's-eye
D) Lightning bolt
E) Red dot

Question 27

If a code description has changed since the last revision of the CPT manual, what symbol is placed next to the CPT code?

A) Green arrows
B) Lightning bolt
C) Red dot
D) Blue triangle
E) Pound (#) sign

Question 28

What is the maximum number of modifiers that can be used per CPT code?

A) 1
B) 2
C) 3
D) 4
E) As many as necessary

Question 29

A modifier indicates that ____.

A) special circumstances apply to the procedure
B) surgical or other supplies were used during the procedure
C) other procedures were done in addition to the main procedure
D) medications were used during the procedure
E) an anesthetic was used during the procedure

Question 30

Dr. Moore is scheduled to perform a routine removal of a mole from Ralph's left shoulder under local anesthesia. Dr. Moore has injected the local anesthetic and is about to begin the procedure when Ralph suddenly has a panic attack and states, "I just can't handle this!" Dr. Moore halts the procedure. When you code for this procedure, which of the following modifiers will you use?

A) 23: Unusual Anesthesia
B) 47: Anesthesia by Surgeon
C) 52: Reduced Services
D) 53: Discontinued Procedure
E) 56: Preoperative Management Only

Question 31

What symbol appears next to codes that are new since the last CPT revision?

A) Red dot
B) Pound (#) sign
C) Circle with diagonal line
D) Blue triangle
E) Bull's-eye

Question 32

To find information regarding prefixes and suffixes used in the CPT manual, you would look in the ____.

A) Evaluation and Management section of the manual
B) general index for the manual
C) Introduction to the manual
D) office procedures manual
E) beginning of each section of the manual

Question 33

Dr. Breckell is scheduled to perform a cyst removal on Haley's right hand. After he begins the procedure, he notices that the cyst is much larger than anticipated and is involved with nerves and ligaments in the right thumb. Complete cyst removal takes 30 minutes longer than expected. Which modifier would you use to describe this special circumstance?

A) 22: Increased Procedural Services
B) 26: Professional Component
C) TC: Technical Component
D) 50: Bilateral Procedure
E) 51: Multiple Procedures

Question 34

Which of the following is not one of the six main sections in the CPT manual?

A) Anesthesiology
B) Physical Therapy
C) Pathology and Laboratory
D) Surgery
E) Evaluation and Management

Question 35

Counseling codes are used only if ____.

A) counseling is provided during a complete physical examination
B) the patient is referred to a third party for counseling
C) a complete history and physical exam does not occur
D) counseling is provided by a physician assistant or nurse practitioner
E) the patient specifically requests a counseling referral

Question 36

Where in the CPT manual should you look to find information about the proper use of modifiers?

A) Introduction
B) Appendix A
C) Appendix B
D) Appendix C
E) Appendix D

Question 37

Which of the following items is not required for a service to be considered a consultation?

A) Request from another physician
B) Documentation of the findings
C) Record of recommendations
D) Revision of the initial diagnosis
E) Report to the referring physician

Question 38

Which of the following is not a potential reason for downcoding?

A) The insurance carrier does not cover the services included on the claim.
B) The coding system used by the insurer does not match that used by the provider.
C) A workers' compensation carrier converts a CPT code to the lowest-paying code in the system.
D) The payer discovers that documentation does not back up the level of code used.
E) The provider uses a HCPCS code the insurer does not recognize.

Question 39

An add-on code describes ____.

A) special circumstances that apply to a procedure
B) surgical or other supplies that were used during a procedure
C) other procedures done in addition to a main procedure
D) medications used during a procedure
E) the type of anesthetic that was used during a procedure

Question 40

To complete the description for a CPT code that has an indented description, you should ____.

A) refer to the next CPT code for further information
B) refer to the description for the previous CPT code to complete the description
C) use the index to find the main CPT code to be combined with this one
D) try to think of another way to describe the procedure being coded
E) refer to the previous year's CPT manual for guidance

Question 41

A(n) ________ patient is one that has been seen by the physician within the past three years.

Question 42

A plus sign (+) is used for ________ codes, indicating procedures that are carried out in addition to a main procedure.

Question 43

_______ codes are the most frequently used of all CPT codes because they are used by all physicians in any medical specialty.

Question 44

Which of the following best describes HCPS Level II codes?

A) The codes have five characters: numbers, letters, or a combination of both.
B) The codes have six characters, including two initial letters followed by four numbers.
C) The codes have five numeric digits.
D) The codes have six alphabetic characters (letters).
E) The codes have five alphabetic characters (letters).

Question 45

You have consulted the index in the CPT and discovered that a dressing for a burn is found in procedure codes 16010-16030. To correctly code the dressing for the burn, you should ____.

A) check each code in the range to choose the correct code
B) use the codes 16010 and 16030
C) use the code 16010
D) choose any code within this code range
E) use the code 16030

Question 46

Which of the following statements about surgical coding for the musculoskeletal system is not true?

A) Fracture repair assumes and includes cast application.
B) If a diagnostic procedure becomes a therapeutic procedure, only the therapeutic procedure is coded.
C) Cast application is coded only when the physician applying the cast did not initially treat the fracture.
D) A fracture treatment is closed unless stated otherwise.
E) Musculoskeletal subheadings begin with the foot and toes and work their way up to the head.

Question 47

The period of time that is covered for follow-up care after surgery is called the ________ period.

Question 48

Nathan is in the office today complaining of a sore throat and fever. After ruling out strep throat, the physician diagnoses a common cold and tells Nathan to take over-the-counter medications for symptom relief. In which category does Nathan's chief complaint fall?

A) Minimal complaint
B) Self-limited complaint
C) Low-severity complaint
D) Moderate-severity complaint
E) High-severity complaint

Question 49

Organ- or disease-oriented ________ listed in the pathology and laboratory section of the CPT include tests that are frequently ordered together.

Question 50

After you decide on the appropriate CPT code(s) for a procedure, you should ____.

A) consult Appendix C in the CPT to find examples of each code type
B) consult Appendix D in the CPT to determine which add-ons to use
C) consult Appendix A in the CPT to check for applicable modifiers
D) consult Appendix 2 of the HCPCS manual for applicable modifiers
E) code the procedure; no further action is necessary

Question 51

The CPT contains codes that represent medical ________, such as surgery and diagnostic tests, and medical services, such as an examination to evaluate a patient's condition.

Question 52

The CPT considers a patient ________ if that person has not received professional services from the physician within the last three years.

Question 53

Insurance company representatives analyze the connection between the diagnostic and procedural information, called code ________, to evaluate the medical necessity of the reported charges.

Question 54

When coding a surgical code, where should you look to be sure you find the correct code?

A) Go directly to the E/M section in the front of the CPT manual
B) Use the alphabetic listing of procedures at the back of the CPT manual
C) Consult the Introduction to the CPT manual
D) Use the numeric index to find the code
E) Use the superbill that describes the patient encounter

Question 55

Which subsection of the surgery section include procedures on the spleen and bone marrow?

A) Cardiovascular System
B) Digestive System
C) Hemic/Lymphatic Systems
D) Endocrine System
E) Laboratory Procedures

Question 56

How many codes are required for an injection of a vaccine?

A) 0
B) 1
C) 2
D) 3
E) Depends on the type of vaccine

Question 57

For coding purposes, which of the following is not a level of patient history?

A) Problem-focused
B) Expanded problem-focused
C) Detailed
D) Expanded detailed
E) Comprehensive

Question 58

The use of a(n) ________ with a CPT code shows that some special circumstance applies to the service or procedure the physician performed.

Question 59

For coding purposes, which of the following is not a complexity level for medical decision making?

A) Straightforward MDM
B) General-purpose MDM
C) Low-complexity MDM
D) Moderate-complexity MDM
E) High-complexity MDM

Question 60

A(n) ________ plan is a strategy for finding, correcting, and preventing fraudulent medical office practices.

Question 61

The ________ of the medical decision making is a key factor in determining the level of E/M codes selected.

Question 62

The extent of the patient ________ taken is a key factor in determining the level of E/M codes selected.

Question 63

The fraudulent practice of coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement is known as code creep, overcoding, overbilling, or ________.

Question 64

Care provided to unstable, critically ill patients that require constant bedside attention is known as ________ care.

Question 65

The ________ coding system has two levels and is used for coding services for Medicare patients.

Question 66

When an insurance carrier bases reimbursement on a code level lower than the one submitted by the provider, this is called ________.

Question 67

Each procedure or service performed on or for a patient during a patient encounter is reported on healthcare claims using a(n) ________ code.

Question 68

Any code that includes more than one procedure in its description is considered a(n) ________ code.

Question 69

One of the elements of a physical exam is the ________ exam, which can include any of the following: BP sitting or lying, pulse, respirations, temperature, height, weight, and general appearance.

Question 70

Similar care that is being provided to the same patient by more than one physician is known as ________ care.

Question 71

The HCPCS ________ codes are more commonly known as CPT codes.

Question 72

You will locate procedure codes in the __________ manual.

Question 73

The extent of the __________ conducted is one of the key factors that determine the level of service based on guidelines in the E/M section of the CPT.

Question 74

HCPCS Level II codes are called ________ codes and cover supplies and DME.

Question 75

An example of an HCPCS Level ________ code is E0781, for an ambulatory infusion pump.