1. Which one of the following is an example B. Reporting a biopsy and
excision performed
of fraud? A. Craniotomy with
elevation of bone
A. Reporting the code for
ultrasound guidance when used
to perform a liver biopsy
B. Reporting a biopsy and excision
per- formed on the same skin
lesion during the same
encounter
C. Failing to append modifier 26
on an X-ray that is performed and
interpreted in the physician's
office
D. Reporting a lab panel with an
addi- tional lab test that is not
included in the lab panel
2. Which place of service code is
reported for fracture care
performed by an ortho- pedic
physician in the ED?
A. 11
B. 20
C. 22
D. 23
3. What is the full CPT® code
description for 61535?
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, CPC Practice Exam D AAPC Medical Coding Test Prep
on the same skin lesion during the same en- counter
Answer B is the only example of unbundling of CPT® which
would result in a fraudulent claim. According to National
Correct Coding Initiative (NCCI) and CPT® coding
guidelines, a biopsy performed on the same lesion as
an excision during the same encounter is an incidental
ser- vice and is not reported separately. If ultrasound
guidance is performed for a liver biopsy, it is billable. X-
rays performed in a physician's of- fice do not require
modifier 26, because the physician owns the equipment
and performs the interpretation, he bills the global
service.
Lab panels can be reported with additional lab tests that are
not listed in a lab panel.
D. 23
Place of service codes are reported on the claim form to identify
the site of the service provided. In this case, the services are
rendered in the ED which is reported with place of service
(POS) 23. The place of service codes can be found in the
CPT® codebook.
B. Craniotomy with elevation of bone flap; for
removal of epidural or subdural electrode ar- ray, without
excision of cerebral tissue (separate procedure)
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