CDEO CHAPTER 7 EXAM REVIEWED LATEST
(ACTUAL 2024-2025) QUESTIONS WITH
VERIFIEDANSWERS GRADED (A+)
Conversion Factor ---ANSWERS___this is a fixed dollar
amount used to translate the RVUs into fees
Other Health Plans ---ANSWERS___other than Medicare
may choose not to use the CMS calculations to determine
provider reimbursement
Global Surgery Package ---ANSWERS___The time, effort,
and services required to complete a procedure are bundled
together to form a surgery package . Payment is made for a
package of services and not each individual service provided
within the package.
Global Surgical Package ---ANSWERS___the services
included may be furnished in any service location that is:
A Hospital
An Ambulatory Surgical Center
A Physician Office
Modifier 50 ---ANSWERS___Indicates bilateral procedure
, CDEO CHAPTER 7 EXAM REVIEWED LATEST
(ACTUAL 2024-2025) QUESTIONS WITH
VERIFIEDANSWERS GRADED (A+)
Modifier 50 Bilateral Procedure ---ANSWERS___"unless
otherwise identified in the listings, bilateral procedures that
are performed at the same operative session should be
identified by adding modifier 50 to the appropriate five digit
code"
Payers differ on how to submit bilateral procedures. Some ask
that you submit the code as one line item on the claim form
with modifier 50 appended to it; others may request two line
items with modifier 50 on the second line; or they may want
two line items using HCPCS Level II modifier RT and/or LT
Modifier 50 ---ANSWERS___It is not appropriate to submit 2
line items, or to use modifiers LT/RT instead of a modifier 50
under OPPS
Modifier 50 ---ANSWERS___Pay close attention to the code
descriptions as some codes include in their description
"unilateral or bilateral." If the code indicates bilateral in the
descriptor do not append this modifier
Modifier 52 ---ANSWERS___used to indicate reduced
services. If a procedure is partially reduced or eliminated at
the provider's discretion, append to the code.
If a bilateral service is performed unilaterally, append this
modifier to the procedure code.
, CDEO CHAPTER 7 EXAM REVIEWED LATEST
(ACTUAL 2024-2025) QUESTIONS WITH
VERIFIEDANSWERS GRADED (A+)
Sometimes you will see a parenthetical instruction explaining
the circumstance in which to use this modifier, see codes:
93922, 43770,
Modifier 59 ---ANSWERS___indicates a distinct procedural
service and might be used in these instances:
1) Procedures not normally reported together
2) Different procedure or surgery
3) Different site or organ system
4) Separate Incision/Excision
5) Separate Lesion
6) Separate Injury
7) Different Session or Patient Encounter
Modifier 59 Distinct Procedural Service: Example ---
ANSWERS___A patient had a colonoscopy and a lesion is
removed proximal to the splenic flexure. During the same
colonoscopy a biopsy is taken of a different lesion using hot
biopsy forceps. Both codes are reportable using modifier 59
on the second procedure.
(ACTUAL 2024-2025) QUESTIONS WITH
VERIFIEDANSWERS GRADED (A+)
Conversion Factor ---ANSWERS___this is a fixed dollar
amount used to translate the RVUs into fees
Other Health Plans ---ANSWERS___other than Medicare
may choose not to use the CMS calculations to determine
provider reimbursement
Global Surgery Package ---ANSWERS___The time, effort,
and services required to complete a procedure are bundled
together to form a surgery package . Payment is made for a
package of services and not each individual service provided
within the package.
Global Surgical Package ---ANSWERS___the services
included may be furnished in any service location that is:
A Hospital
An Ambulatory Surgical Center
A Physician Office
Modifier 50 ---ANSWERS___Indicates bilateral procedure
, CDEO CHAPTER 7 EXAM REVIEWED LATEST
(ACTUAL 2024-2025) QUESTIONS WITH
VERIFIEDANSWERS GRADED (A+)
Modifier 50 Bilateral Procedure ---ANSWERS___"unless
otherwise identified in the listings, bilateral procedures that
are performed at the same operative session should be
identified by adding modifier 50 to the appropriate five digit
code"
Payers differ on how to submit bilateral procedures. Some ask
that you submit the code as one line item on the claim form
with modifier 50 appended to it; others may request two line
items with modifier 50 on the second line; or they may want
two line items using HCPCS Level II modifier RT and/or LT
Modifier 50 ---ANSWERS___It is not appropriate to submit 2
line items, or to use modifiers LT/RT instead of a modifier 50
under OPPS
Modifier 50 ---ANSWERS___Pay close attention to the code
descriptions as some codes include in their description
"unilateral or bilateral." If the code indicates bilateral in the
descriptor do not append this modifier
Modifier 52 ---ANSWERS___used to indicate reduced
services. If a procedure is partially reduced or eliminated at
the provider's discretion, append to the code.
If a bilateral service is performed unilaterally, append this
modifier to the procedure code.
, CDEO CHAPTER 7 EXAM REVIEWED LATEST
(ACTUAL 2024-2025) QUESTIONS WITH
VERIFIEDANSWERS GRADED (A+)
Sometimes you will see a parenthetical instruction explaining
the circumstance in which to use this modifier, see codes:
93922, 43770,
Modifier 59 ---ANSWERS___indicates a distinct procedural
service and might be used in these instances:
1) Procedures not normally reported together
2) Different procedure or surgery
3) Different site or organ system
4) Separate Incision/Excision
5) Separate Lesion
6) Separate Injury
7) Different Session or Patient Encounter
Modifier 59 Distinct Procedural Service: Example ---
ANSWERS___A patient had a colonoscopy and a lesion is
removed proximal to the splenic flexure. During the same
colonoscopy a biopsy is taken of a different lesion using hot
biopsy forceps. Both codes are reportable using modifier 59
on the second procedure.
