CPMA Coding and
Reimbursement
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A CRNA performs anesthesia for a tubal ligation on a healthy 35-year-old. The CRNA
is working independently. What is the correct code and modifier? - Answer✅✅Look
,in the CPT® Index for Anesthesia/tubal ligation. The CRNA is working without medical
direction (QZ) from an anesthesiologist and the patient is healthy (P1).
A 60-year-old female has pancreatic carcinoma. She is taken to the outpatient
surgical center and undergoes placement of Infuse-A-Port for chemotherapy.
Fluoroscopic guidance was used to help the physician with the placement of the port.
What CPT® coding is reported?
a.
36560
b.
36560, 77001-26
c.
36561, 77001-26
d.
36561 - Answer✅✅36561, 77001-26
The surgical procedure of the insertion of the port is being performed on a patient
that is age 5 years or older. The Infuse-A-Port is a central venous access device.
Guidance can be reported separately with modifier 26 because the provider
performs only the professional component.
A 4-year-old child received a mumps, measles, rubella and varicella (MMRV)
injection at a neighborhood clinic with provider counseling. What CPT® codes are
reported?
a. 90707, 90716, 90471, 90472 x 3
b. 90710, 90460
c. 90710, 90460, 90461 x 3
d. 90707, 90716, 90460, 90461 x 3 - Answer✅✅90710, 90460, 90461 x 3
In the CPT® Index look for Vaccine and Toxoids/Measles, Mumps, Rubella and
Varicella (MMRV) referring you to 90710. According to the CPT® guidelines for
Vaccines and Toxoids, an administration code from 90460-90474 is also reported. In
the CPT® Index look for Immunization Administration/Toxoid/with Counseling.
Because counseling was included, a code from 90460-90461 is used for the
administration. According to the guidelines, 90460 and 90461 are reported per
component of the vaccine. Although it is one vaccination, there are four separate
components, 90460 is reported for mumps and 90461 x 3 (measles, rubella, and
varicella).
Which modifier begins a new global period for unrelated procedure?
a.
Modifier 57
b.
Modifier 25
c.
Modifier 78
d.
Modifier 79 - Answer✅✅Modifier 79
,Modifier 78 does not extend the global period and allows for the intraoperative
percentage only of a procedure. The global period remains effective from the date of
the original surgery. Modifier 79 will begin a new global period for the unrelated
procedure.
Which one of the following would be an audit finding for psychiatric services?
a.
Reporting code 90863 only.
b.
Reporting codes 90791 and 90785 on the same date of service.
c.
Reporting codes 99214 and 90838 on the same date of service.
d.
Reporting code 90832 only. - Answer✅✅Reporting code 90863 only.
Code 90863 is an add-on code. It can only be reported with a code for psychotherapy.
Which scenario qualifies for modifier 25?
a.
A patient returns to the office for an injection ordered during the last E/M
b.
Preventive E/M performed in conjunction with a problem related E/M
c.
History and physical performed prior to a hysterectomy
d.
A nurse's assessment of the patient's BP prior to administering an IV -
Answer✅✅Preventive E/M performed in conjunction with a problem related E/M
According to CPT® coding guidelines, when a preventive E/M is performed on the
same date of service as a problem related E/M, report both E/M services and append
modifier 25 to the problem related E/M. Both services must be documented, and the
problem related E/M must be medically necessary and require significant additional
work, above the service performed for the preventive service.
Which of the following elements is NOT required for the physical therapy plan of
care?
Long-term goals.
b. Physician co-signature for each session.
c. Number of treatment sessions.
d. Duration of treatment sessions. - Answer✅✅b.
Physician co-signature for each session.
Physician co-signature for each sessionA physician's signature is not required on the
therapy session encounters
hat modifier is appended to indicate a service is provided under the primary care
exception without the presence of a teaching physician?
a. Modifier GE
b. Modifier 25
c. Modifier GC
, d. Modifier TC - Answer✅✅Modifier GE
If approved for the primary care exception, the resident can see patients on their
own and discuss the case with the teaching physician. The physician is not required
to perform a face-to-face encounter unless it is medically necessary. The highest E/M
level that can be billed is a level III. A GE modifier is appended to the code to indicate
the service was provided without the presence of the teaching physician.
DOS: January 31CC: Follow up tibial osteomyelitis PI: Patient is a 58-year-old male.
He has had the tibial osteomyelitis treated with sterile debridement and irrigation.
He has a vac. He has been on IV Vancomycin and po Levaquin.PE: The vac is removed.
He has gross purulence in the tibia calcaneal and in the wound. There is draining
puss. IMP: Left tibial osteomyelitis Plan: He is admitted to the hospital today. We
essentially failed limb salvage with this patient. He has had five or six debridements.
He looked great at the time of discharge last week. Apparently, his wound looked
good on Saturday and it has worsened just over the last several days. We are going
to recommend amputation at this point. Please see H&P and hospital notes for
further details. We will proceed tomorrow. What modifier is applied to this office
visit?
a.
Modifier 58
b.
Modifier 78
c.
Modifier 25
d.
Modifier 57 - Answer✅✅Modifier 57
The patient was seen in the office and it was determined the patient would need an
amputation which was scheduled for the next day. For major surgery, the global
period includes the day before the surgery. Modifier 57 should be appended to
identify the decision for surgery was made during this office visit.
A patient with sickle cell anemia with painful sickle crisis received normal saline IV
100 cc per hour to run over 5 hours for hydration in the provider's office. She will be
given Morphine & Phenergan, prn (as needed). What codes are reported?
a.
96360 x 5, J7050, D57.1
b.
96360, 96361 x 3, J7030, D57.00
c.
96360, J7030, D57.819
d.
96360, 96361 x 4, J7050 x 2, D57.00 - Answer✅✅96360, 96361 x 4, J7050 x 2,
D57.00
In the CPT® Index look for Hydration/Intravenous referring you to codes 96360-
96361. The hydration will run 5 hours at 100 cc per hour. Codes are time based.
Code the hydration therapy as 96360 for the first hour, and 96361 x 4 for a total
Reimbursement
Exam|Brand New Expert
Exam Questions with Clear
Detailed Correct Verified
Answers|All Graded
A+|Latest Premium
Update(2025-2026)|1005
Guaranteed Success.
A CRNA performs anesthesia for a tubal ligation on a healthy 35-year-old. The CRNA
is working independently. What is the correct code and modifier? - Answer✅✅Look
,in the CPT® Index for Anesthesia/tubal ligation. The CRNA is working without medical
direction (QZ) from an anesthesiologist and the patient is healthy (P1).
A 60-year-old female has pancreatic carcinoma. She is taken to the outpatient
surgical center and undergoes placement of Infuse-A-Port for chemotherapy.
Fluoroscopic guidance was used to help the physician with the placement of the port.
What CPT® coding is reported?
a.
36560
b.
36560, 77001-26
c.
36561, 77001-26
d.
36561 - Answer✅✅36561, 77001-26
The surgical procedure of the insertion of the port is being performed on a patient
that is age 5 years or older. The Infuse-A-Port is a central venous access device.
Guidance can be reported separately with modifier 26 because the provider
performs only the professional component.
A 4-year-old child received a mumps, measles, rubella and varicella (MMRV)
injection at a neighborhood clinic with provider counseling. What CPT® codes are
reported?
a. 90707, 90716, 90471, 90472 x 3
b. 90710, 90460
c. 90710, 90460, 90461 x 3
d. 90707, 90716, 90460, 90461 x 3 - Answer✅✅90710, 90460, 90461 x 3
In the CPT® Index look for Vaccine and Toxoids/Measles, Mumps, Rubella and
Varicella (MMRV) referring you to 90710. According to the CPT® guidelines for
Vaccines and Toxoids, an administration code from 90460-90474 is also reported. In
the CPT® Index look for Immunization Administration/Toxoid/with Counseling.
Because counseling was included, a code from 90460-90461 is used for the
administration. According to the guidelines, 90460 and 90461 are reported per
component of the vaccine. Although it is one vaccination, there are four separate
components, 90460 is reported for mumps and 90461 x 3 (measles, rubella, and
varicella).
Which modifier begins a new global period for unrelated procedure?
a.
Modifier 57
b.
Modifier 25
c.
Modifier 78
d.
Modifier 79 - Answer✅✅Modifier 79
,Modifier 78 does not extend the global period and allows for the intraoperative
percentage only of a procedure. The global period remains effective from the date of
the original surgery. Modifier 79 will begin a new global period for the unrelated
procedure.
Which one of the following would be an audit finding for psychiatric services?
a.
Reporting code 90863 only.
b.
Reporting codes 90791 and 90785 on the same date of service.
c.
Reporting codes 99214 and 90838 on the same date of service.
d.
Reporting code 90832 only. - Answer✅✅Reporting code 90863 only.
Code 90863 is an add-on code. It can only be reported with a code for psychotherapy.
Which scenario qualifies for modifier 25?
a.
A patient returns to the office for an injection ordered during the last E/M
b.
Preventive E/M performed in conjunction with a problem related E/M
c.
History and physical performed prior to a hysterectomy
d.
A nurse's assessment of the patient's BP prior to administering an IV -
Answer✅✅Preventive E/M performed in conjunction with a problem related E/M
According to CPT® coding guidelines, when a preventive E/M is performed on the
same date of service as a problem related E/M, report both E/M services and append
modifier 25 to the problem related E/M. Both services must be documented, and the
problem related E/M must be medically necessary and require significant additional
work, above the service performed for the preventive service.
Which of the following elements is NOT required for the physical therapy plan of
care?
Long-term goals.
b. Physician co-signature for each session.
c. Number of treatment sessions.
d. Duration of treatment sessions. - Answer✅✅b.
Physician co-signature for each session.
Physician co-signature for each sessionA physician's signature is not required on the
therapy session encounters
hat modifier is appended to indicate a service is provided under the primary care
exception without the presence of a teaching physician?
a. Modifier GE
b. Modifier 25
c. Modifier GC
, d. Modifier TC - Answer✅✅Modifier GE
If approved for the primary care exception, the resident can see patients on their
own and discuss the case with the teaching physician. The physician is not required
to perform a face-to-face encounter unless it is medically necessary. The highest E/M
level that can be billed is a level III. A GE modifier is appended to the code to indicate
the service was provided without the presence of the teaching physician.
DOS: January 31CC: Follow up tibial osteomyelitis PI: Patient is a 58-year-old male.
He has had the tibial osteomyelitis treated with sterile debridement and irrigation.
He has a vac. He has been on IV Vancomycin and po Levaquin.PE: The vac is removed.
He has gross purulence in the tibia calcaneal and in the wound. There is draining
puss. IMP: Left tibial osteomyelitis Plan: He is admitted to the hospital today. We
essentially failed limb salvage with this patient. He has had five or six debridements.
He looked great at the time of discharge last week. Apparently, his wound looked
good on Saturday and it has worsened just over the last several days. We are going
to recommend amputation at this point. Please see H&P and hospital notes for
further details. We will proceed tomorrow. What modifier is applied to this office
visit?
a.
Modifier 58
b.
Modifier 78
c.
Modifier 25
d.
Modifier 57 - Answer✅✅Modifier 57
The patient was seen in the office and it was determined the patient would need an
amputation which was scheduled for the next day. For major surgery, the global
period includes the day before the surgery. Modifier 57 should be appended to
identify the decision for surgery was made during this office visit.
A patient with sickle cell anemia with painful sickle crisis received normal saline IV
100 cc per hour to run over 5 hours for hydration in the provider's office. She will be
given Morphine & Phenergan, prn (as needed). What codes are reported?
a.
96360 x 5, J7050, D57.1
b.
96360, 96361 x 3, J7030, D57.00
c.
96360, J7030, D57.819
d.
96360, 96361 x 4, J7050 x 2, D57.00 - Answer✅✅96360, 96361 x 4, J7050 x 2,
D57.00
In the CPT® Index look for Hydration/Intravenous referring you to codes 96360-
96361. The hydration will run 5 hours at 100 cc per hour. Codes are time based.
Code the hydration therapy as 96360 for the first hour, and 96361 x 4 for a total
