CPT FINAL EXAM 2023 (GUARANTEED SUCCESS )

CPT FINAL EXAM 2023 (GUARANTEED SUCCESS ) CPT and HCPCS codes are used in what type of healthcare setting? - CORRECT ANSWER-Hospital outpatient, physician offices CPT is - CORRECT ANSWER-current procedural terminology HCPCS is - CORRECT ANSWER-healthcare common procedure coding system Who publishes CPT (Level I HCPCS)? How often is it updated? When is it updated? - CORRECT ANSWER-AMA publishes cpt, it is updated annually, on Jan. 1 of each year CPT Category 1 codes consist of: - CORRECT ANSWER-Anesthesia, Evaluation and management, surgery, radiology, pathology and laboratory, medicine What are Category 2 CPT codes for? What does the Category 2 code consist of? - CORRECT ANSWER-Performance Measures consist of 4 numbers followed by a capital F, such as 1000F What are Category 3 CPT codes for? What does the Category 3 code consist of? - CORRECT ANSWER-New & Emerging Technology consist of 4 numbers followed by a capital T, such as 2000T What are modifiers Why are they used? - CORRECT ANSWER-Supplementary Codes to provide additional information to a code What is a HCPCS level II code used to report? What does the HCPCS level II code consist of? - CORRECT ANSWER-Are used for supplies, DME, injectable substances, dental and chiropractic as well as orthotics Structure: J1885 - capital letter followed by 4 numbers What are HCPCS level II codes also called? - CORRECT ANSWER-National codes Who developed the HCPCS level II codes? How often are they updated? When are they updated? - CORRECT ANSWER-Developed by CMS, they are updated yearly update Jan1 NCCI - CORRECT ANSWER-National Correct Coding Initiative What does the National Correct Coding Initiative edits do? - CORRECT ANSWER-Helps CMS to detect inappropriate codes submitted on claims - CPT coding guidelines - Current standards of medical/surgical coding practice - Advice from specialty societies List 3 NCCI edits and the definition of those edits. - CORRECT ANSWER-1. Comprehensive/component edit = edit pertains to HCPCS codes that should NOT be used together. 2. Mutually exclusive edit = edit applies to improbable or impossible combinations of codes 3. Medical unlikely edits = for part B claims, CMS has developed medical unlikely edits to reduce error rates for items on the claim form that reference units of service • (bullet) - CORRECT ANSWER-new code ; (semi-colon) - CORRECT ANSWER-main entry applies to & is part of all indented entries that follow Δ (triangle) - CORRECT ANSWER-revision code . ˃˂ (Facing triangles) - CORRECT ANSWER-beginning and ending of new or revised text + (plus symbol) - CORRECT ANSWER-add on code ʘ (circled bullet) - CORRECT ANSWER-moderate sedation Ø (Null symbol) - CORRECT ANSWER-exemptions to modifier 51 (Pending symbol) - CORRECT ANSWER-product pending FDA approval # - CORRECT ANSWER-Out of numerical sequence code ○ - CORRECT ANSWER-Recycled/reinstated code modifier -51 - CORRECT ANSWER-multiple procedures - used by Physicians ONLY What about modifier -66? - CORRECT ANSWER-Surgery Team - Physicians use ONLY modifier -59 - CORRECT ANSWER-distinct procedural service. Used by BOTH Physician and Hospital What all does the CPT definition of a surgical package include? - CORRECT ANSWER-1. Decision to perform procedure; E/M encounter 2. Surgical procedure 3. Anesthesia 4. Immediate postoperative care, including dictation of operative notes and talking to family and other physicians 5. Orders 6. valuation of the patient in the post-anesthesia recovery area 7. Typical post-operative follow-up care What is the definition of a "separate procedure"? - CORRECT ANSWER-Coded when a procedure is performed independently and not in conjunction with another procedure; a modifier, such as 59 (distinct services) ,may be added to explain special circumstances What 3 questions need to be answered prior to assigning the appropriate wound repair code? - CORRECT ANSWER-1. What type of repair is being performed; simple, intermediate, or complex? 2. What site or body part is involved, and what is the extent of the wound? 3. What is the length of the repair (in centimeters)? Excision of a lesion with an adjacent tissue transfer? - CORRECT ANSWER-1 Code Lesion excision is included with the the adjacent tissue transfer code When is it appropriate to assign an application of casts and strapping code? - CORRECT ANSWER-1. To identify replacement of a cast or strapping during or after the period of normal follow-up care 2. To identify an initial service performed without any restorative treatment or stabilization of the fracture, injury, or dislocation and/or to afford pain relief to the patient 3. To identify an initial cast or strapping when the same physician does not perform, or is not expected to perform any other treatment or procedure 4. To identify an initial cast or strapping when another physician provided or will provide restorative treatment Diagnostic endoscopy with a surgical endoscopy? - CORRECT ANSWER-1 code surgery endoscopy includes the diagnostic component What is the difference between selective and non-selective catheter placement - CORRECT ANSWER-Selective catheter placement is moved beyond the vessel punctured or beyond the aorta Non-selective means the catheter is not advanced beyond the access site Gastrointestinal Coding: A biopsy of a lesion is followed by an excision of the remaining lesion during the same operative episode, Can both be coded. - CORRECT ANSWER-NO only the excision can be coded. When one lesion is biopsied and different lesion is excised, assign code for the biopsy and code for the excision. This rule is applicable unless the excision code narrative includes the phrase with or without biopsy. In this case only excision is assigned - CORRECT ANSWER-It would be appropriate to append the biopsy code with modifier 59. In GI coding, if a biopsy code uses the terminology "with biopsy, single or multiple," would you use the code multiple times if 4 biopsies were taken? - CORRECT ANSWER-Only 1 code , regardless of the number of times In Radiology, what is the difference between the Professional component and the technical component? - CORRECT ANSWER-*professional component includes supervising the procedure, reading and interpreting the results, and documenting the interpretation in a report *technical component includes performance of the actual procedure and expenses for supplies and equipment. *technical component; HCPCS level ll modifier that indicates only the technical component was provided For ultrasounds that have "complete" or "limited" ultrasound codes, where would a person find out what is included in the examination? - CORRECT ANSWER-in the notes preceding the codes