CPT Modifier Study Guide Test.
Modifiers - CORRECT ANSWER additional numeric digits appended to CPT® codes to further explain the
service provided.
Procedure name = code
Special circumstances = modifier
Modifier + code = complete description
Reasons a modifier may need to be appended to the CPT code: - CORRECT ANSWER - A service or
procedure had both a professional and technical component.
- A service or procedure was performed by more than one physician and/or in more than one location.
- A service or procedure was increased or reduced.
- Only part of a service was performed.
- An adjunctive service was performed.
- A bilateral procedure was performed.
- A service or procedure was provided more than once.
- Unusual events occurred.
Evaluation - CORRECT ANSWER A diagnosis or diagnostic study of a physical or mental condition.
Management: - CORRECT ANSWER The whole system of care and treatment of a disease or a sick
individual.
Inpatient Coders: - CORRECT ANSWER Inpatient coders code inpatient diagnoses and procedures
provided at inpatient facilities for patients receiving care as inpatients. Professional services would only
be coded by inpatient coders if the facility directly employs the healthcare professional.
, Outpatient Coders - CORRECT ANSWER Outpatient coders code diagnoses and procedures (including
evaluation and management services) provided at outpatient facilities, provided at inpatient facilities for
outpatients, and provided to both inpatients and outpatients when the healthcare provider is NOT
directly employed by the inpatient facility.
E/M - CORRECT ANSWER evaluation and management visits represent the most common patient-
physician interactions
22 - Increased Procedural Services - CORRECT ANSWER - a service is substantially greater than typically
required.
- only for use with surgery codes—not for use with E/M codes.
- Documentation of additional work and the reason for the additional work (increased intensity, time,
difficulty of procedure, severity of patient's condition, physical/mental effort required by provider)
- Copies of the documentation are submitted to the third-party payer with the invoice.
23 - Unusual Anesthesia - CORRECT ANSWER -Anesthesia is not routinely given for some procedures.
When special circumstances require general anesthesia to be given in a case where no anesthesia or
local anesthesia is typical
- 22 and 23 are for use with procedure codes and should not be used with E/M codes.
24 - Same Physician but Unrelated to Postoperative - CORRECT ANSWER - when a visit is made during
the time period following surgery NOT for post-surgical care.
- cases where a patient has a procedure by a physician and is seen in the postoperative time frame by
the same physician for a different reason.
- 24 and 25 are for use with E/M codes. Modifiers
- For minor surgeries, the postoperative period is up to 10 days; for major surgery, the postoperative
period is up to 90 days.
25 - Same Physician and Day, Different Diagnosis - CORRECT ANSWER - A visit to the doctor is usually
prompted by one specific complaint, but patients will bring up other problems/issues they are having at
the same time.
- should only be used when services are provided by the same physician to the same patient on the
same day as another procedure/other service
Modifiers - CORRECT ANSWER additional numeric digits appended to CPT® codes to further explain the
service provided.
Procedure name = code
Special circumstances = modifier
Modifier + code = complete description
Reasons a modifier may need to be appended to the CPT code: - CORRECT ANSWER - A service or
procedure had both a professional and technical component.
- A service or procedure was performed by more than one physician and/or in more than one location.
- A service or procedure was increased or reduced.
- Only part of a service was performed.
- An adjunctive service was performed.
- A bilateral procedure was performed.
- A service or procedure was provided more than once.
- Unusual events occurred.
Evaluation - CORRECT ANSWER A diagnosis or diagnostic study of a physical or mental condition.
Management: - CORRECT ANSWER The whole system of care and treatment of a disease or a sick
individual.
Inpatient Coders: - CORRECT ANSWER Inpatient coders code inpatient diagnoses and procedures
provided at inpatient facilities for patients receiving care as inpatients. Professional services would only
be coded by inpatient coders if the facility directly employs the healthcare professional.
, Outpatient Coders - CORRECT ANSWER Outpatient coders code diagnoses and procedures (including
evaluation and management services) provided at outpatient facilities, provided at inpatient facilities for
outpatients, and provided to both inpatients and outpatients when the healthcare provider is NOT
directly employed by the inpatient facility.
E/M - CORRECT ANSWER evaluation and management visits represent the most common patient-
physician interactions
22 - Increased Procedural Services - CORRECT ANSWER - a service is substantially greater than typically
required.
- only for use with surgery codes—not for use with E/M codes.
- Documentation of additional work and the reason for the additional work (increased intensity, time,
difficulty of procedure, severity of patient's condition, physical/mental effort required by provider)
- Copies of the documentation are submitted to the third-party payer with the invoice.
23 - Unusual Anesthesia - CORRECT ANSWER -Anesthesia is not routinely given for some procedures.
When special circumstances require general anesthesia to be given in a case where no anesthesia or
local anesthesia is typical
- 22 and 23 are for use with procedure codes and should not be used with E/M codes.
24 - Same Physician but Unrelated to Postoperative - CORRECT ANSWER - when a visit is made during
the time period following surgery NOT for post-surgical care.
- cases where a patient has a procedure by a physician and is seen in the postoperative time frame by
the same physician for a different reason.
- 24 and 25 are for use with E/M codes. Modifiers
- For minor surgeries, the postoperative period is up to 10 days; for major surgery, the postoperative
period is up to 90 days.
25 - Same Physician and Day, Different Diagnosis - CORRECT ANSWER - A visit to the doctor is usually
prompted by one specific complaint, but patients will bring up other problems/issues they are having at
the same time.
- should only be used when services are provided by the same physician to the same patient on the
same day as another procedure/other service
