CPT CODING EXAM QUESTIONS AND
ANSWERS
Z CODES (ICD-10)
PREVENTIVE MEDICINE - Answer-Exams performed without patient complaint. i.e.,
Routine Pap smear/pelvic exam, annual physical exam, well-child check. Requires
"Z" code in ICD-10-CM to indicate medical necessity.
CATEGORY II CODES - Answer-Supplemental tracking codes used for performance
measurement. Optional use. Four digit followed by F
CATEGORY III CODES - Answer-Data collection for certain services / procedures.
Used instead of category 1 unlisted code. Four digit followed by T
DIAGNOSTIC - Answer-performed when a routine screening reveals an abnormality
or cause to identify or investigate to determine a condition or diagnosis.
THERAPEUTIC - Answer-treatment or therapy to treat or condition or diagnosis to
achieve healing. i.e., Physical therapy, injections
VENIPUNCTURE - Answer-CPT code 36415 - the usual method, especially in the
outpatient setting, to obtain venous blood.
CAPILLARY STICK - Answer-CPT code 36416 - the pricking of a finger (finger stick)
to obtain capillary blood. Laceration repair wound - skin; Metric conversion 1 inch =
2.54 cm.
CPT MODIFIERS - Answer-Appendix
-25 Significant Separate E/M
-32 mandated services - i.e., Consultations, medical testimony or Deposition. Also
includes court ordered procedures, exams, etc.
-50 bilateral procedure
-53 discontinued procedure (elected by physician due to patient well-being)
-80 assistant surgeon (modifiers 81 and 82 relate to special circumstances and not
assigned in normal surgical cases)
CHART - Answer-The patients Medical record documenting patient history, medical
events, etc
CPT CODING (CURRENT PROCEDURAL TERMINOLOGY) - Answer-used to code
medical and service/procedures in the medical office or other outpatient setting
DIAGNOSTIC - Answer-To identify or investigate for purposes of determining a
condition or diagnosis
ESTABLISHED PATIENT - Answer-Per CPT definition one who has received
professional services from a physician or provider within 3 years
, FEE-FOR-SERVICE - Answer-The traditional form of reimbursement where a
provider bills for each visit, service or procedure rather than global or surgical
package fee.
GLOBAL FEE - Answer-Also package concept or surgical package that includes the
procedure, topical anesthesia, if used, and any normal, routine follow-up car.
(bundled services)
HEALTH CARE SPECIALIST - Answer-A health care provider not primary care but
specializes, sometimes requiring PCP referral
INPATIENT - Answer-A person admitted to a hospital who occupies a bed for over a
24-hour period
MODIFIER - Answer-An additional 2-digit code used after the 5-digit main code
when it is necessary to indicate that the service preformed deviates from the average
service for that specific code number. Used with CPT and HCPCS
NEW PATIENT - Answer-Per CPT definition, one who has not received any
professional services from a physician or its practice within the past 3 years
OUTPATIENT - Answer-A person receiving medical services or treatment at a
hospital or facility to return home the same day. This also includes a patient admitted
to an observation bed for a period for 24 or less
PROVIDER - Answer-The person or facility who provides services and/or supplies to
beneficiaries
QUALIFIED HEALTHCARE PROFESSIONAL - Answer-Per CPT definition, a
physician, nurse practitioner, physician assistant that can provide medical
treatment/services for reimbursement
REFERRING PHYSICIAN/PROVIDER - Answer-Physician who sends the patient to
another physician, specialist, or health care provider for consultation or treatment.
3Rs
THERAPEUTIC - Answer-to achieve a therapeutic result or reason to treat a
condition or diagnosis
SYMBOLS IN CPT - Answer-+ Add-on code Triangle pointing up - Revised code
• New code
Triangle pointing right - New or revised wording
Lighting bolt - Pending FDA approval
# Resequenced
◉ Moderate sedation
+ - Answer-Add on code
▲ - Answer-Revised code
ANSWERS
Z CODES (ICD-10)
PREVENTIVE MEDICINE - Answer-Exams performed without patient complaint. i.e.,
Routine Pap smear/pelvic exam, annual physical exam, well-child check. Requires
"Z" code in ICD-10-CM to indicate medical necessity.
CATEGORY II CODES - Answer-Supplemental tracking codes used for performance
measurement. Optional use. Four digit followed by F
CATEGORY III CODES - Answer-Data collection for certain services / procedures.
Used instead of category 1 unlisted code. Four digit followed by T
DIAGNOSTIC - Answer-performed when a routine screening reveals an abnormality
or cause to identify or investigate to determine a condition or diagnosis.
THERAPEUTIC - Answer-treatment or therapy to treat or condition or diagnosis to
achieve healing. i.e., Physical therapy, injections
VENIPUNCTURE - Answer-CPT code 36415 - the usual method, especially in the
outpatient setting, to obtain venous blood.
CAPILLARY STICK - Answer-CPT code 36416 - the pricking of a finger (finger stick)
to obtain capillary blood. Laceration repair wound - skin; Metric conversion 1 inch =
2.54 cm.
CPT MODIFIERS - Answer-Appendix
-25 Significant Separate E/M
-32 mandated services - i.e., Consultations, medical testimony or Deposition. Also
includes court ordered procedures, exams, etc.
-50 bilateral procedure
-53 discontinued procedure (elected by physician due to patient well-being)
-80 assistant surgeon (modifiers 81 and 82 relate to special circumstances and not
assigned in normal surgical cases)
CHART - Answer-The patients Medical record documenting patient history, medical
events, etc
CPT CODING (CURRENT PROCEDURAL TERMINOLOGY) - Answer-used to code
medical and service/procedures in the medical office or other outpatient setting
DIAGNOSTIC - Answer-To identify or investigate for purposes of determining a
condition or diagnosis
ESTABLISHED PATIENT - Answer-Per CPT definition one who has received
professional services from a physician or provider within 3 years
, FEE-FOR-SERVICE - Answer-The traditional form of reimbursement where a
provider bills for each visit, service or procedure rather than global or surgical
package fee.
GLOBAL FEE - Answer-Also package concept or surgical package that includes the
procedure, topical anesthesia, if used, and any normal, routine follow-up car.
(bundled services)
HEALTH CARE SPECIALIST - Answer-A health care provider not primary care but
specializes, sometimes requiring PCP referral
INPATIENT - Answer-A person admitted to a hospital who occupies a bed for over a
24-hour period
MODIFIER - Answer-An additional 2-digit code used after the 5-digit main code
when it is necessary to indicate that the service preformed deviates from the average
service for that specific code number. Used with CPT and HCPCS
NEW PATIENT - Answer-Per CPT definition, one who has not received any
professional services from a physician or its practice within the past 3 years
OUTPATIENT - Answer-A person receiving medical services or treatment at a
hospital or facility to return home the same day. This also includes a patient admitted
to an observation bed for a period for 24 or less
PROVIDER - Answer-The person or facility who provides services and/or supplies to
beneficiaries
QUALIFIED HEALTHCARE PROFESSIONAL - Answer-Per CPT definition, a
physician, nurse practitioner, physician assistant that can provide medical
treatment/services for reimbursement
REFERRING PHYSICIAN/PROVIDER - Answer-Physician who sends the patient to
another physician, specialist, or health care provider for consultation or treatment.
3Rs
THERAPEUTIC - Answer-to achieve a therapeutic result or reason to treat a
condition or diagnosis
SYMBOLS IN CPT - Answer-+ Add-on code Triangle pointing up - Revised code
• New code
Triangle pointing right - New or revised wording
Lighting bolt - Pending FDA approval
# Resequenced
◉ Moderate sedation
+ - Answer-Add on code
▲ - Answer-Revised code
