Certified Coding Specialist: Questions With Easy-to-
Follow Solutions
This modifier indicates an increased service and is overused and results in an
increase in payment of 20% to 30%. As such, the assignment of this modifier
comes under particularly close scrutiny by third-party payers. What is this
modifier? Correct Answer - -22 Increased Procedural Services
When adding multiple CPT modifiers to a code, list in:
When adding multiple HCPCS modifiers, list in:
If CPT and HCPCS modifiers are both used, list: Correct Answer - CPT-
highest to lowest
HCPS-ascending alphabetical order
both- CPT (high to low) then HCPS (ascend. alpha.)
What part of the CPT manual lists a full description for all modifiers?
Correct Answer - appendix A
How many units of service may be billed when reporting the -50 modifier
(bilateral) to Medicare? Correct Answer - one unit
For medicare, just submit 27447-50 for procedure done left and right; other
payers may code it differently.
When reporting -51 modifier to indicate multiple procedure performed, which
procedure should be reported first on the claim? Correct Answer -
Primary Procedure (most expensive)
Medicare considers what service to be part of the surgery and bundled
payment not allowing the -56 modifier? Correct Answer - preoperative
,E&M services provided the day before or the day of a major surgery are
included in what package? Correct Answer - Global Day
Modifier -63 indicates procedure provided to a neonate or infant up to what
weight? Correct Answer - 4 kg or 8.8 lbs
A surgical team consists of how many physicians? Correct Answer -
More than two
How many modifier areas are available on a CMS-1500 (physician) insurance
claim form for one-line item charge? Correct Answer - four
Describing a physician's services in radiology or pathology.
Describing the services provided by the facility. Correct Answer -
Professional component (use modifier -26)
Technical Component (use modifier -TC)
Bundling together of time effort and services for a specific procedure into one
code instead of reporting each component separately Correct Answer -
Surgical Package
Code assignments in the E/M section varies according to three factors:
Correct Answer - 1. place of service
2. type of service
3. patient status
Six sections of the CPT manual Correct Answer - Evaluation and
Management
Anesthesia
Surgery
Radiology
Pathology and Laboratory
Medicine
Patient status (for E/M) Correct Answer - new, established, outpatient,
inpatient
,The key component of E/M service is _____. Correct Answer - medical
decision-making
The four levels of medical decision-making complexity are: Correct
Answer - 1.straightforward
2.low
3.moderate
4.high
The complexity of medical decision-making (for E/M) is based on:
Correct Answer - 1. number of diagnoses
2. amount or complexity of data to review
3. risk of complication or death if the condition is left untreated
UHDDS Correct Answer - Uniform Hospital Discharge Data. UHDDS is
the core data set for inpatient admissions. The data is collected on inpatient
hospital discharges for Medicare and Medicaid program.
UHDDS includes elements such as patient demographics (name, age, gender,
race), medical history (previous illnesses, surgeries), admission and discharge
dates, diagnosis codes (ICD-10 codes), procedures performed, and discharge
disposition (home, another facility).
The definition of a ____ ______ is one that is performed for definitive tx rather
than for diagnostic or exploratory purposes or when it is necessary to take
care of a complication Correct Answer - Principal procedure
What identifies where the patient is at conclusion of healthcare or the end
time of billing cycle Correct Answer - Discharge disposition
UB-04 is maintained by the Correct Answer - national U niform B illing
committee
What was created for hospital inpatient prospective payment to better to
reflect the patients severity of illness and expected risk of mortality
Correct Answer - MS- DRG, Medical severity Diagnostic related group
, Conditions that develop during an outpatient encounter, including ER,
observation or outpatient surgery are considered ______ Correct Answer -
Present on admission POA
Where are POA guidelines found in ICD-10-CM Correct Answer -
Appendix 1
Under the _____ each case is categorized into a DRG Correct Answer -
Inpatient prospective payment system IPPS
One _____ group per inpatient admission Correct Answer - DRG
MS-DRG variables
(UHDDS items that can affect ms-drg assignment) Correct Answer - -
principal diagnosis
-secondary diagnosis
-principal or significant procedure
-age/sex
- discharge disposition
modifier -51 Correct Answer - Multiple procedures
Can't be used with add-on codes.
Is used by physicians not hospitals!
To code lesion procedures you need ..........., .............., size of ............., and whether
the lesion is ...................... Correct Answer - the site, number, size of the
excised lesion, and whether the lesion is malignant or benign.
When coding the excision of a lesion, the size of the lesion is based on the
following measurement: Correct Answer - lesion and narrowest width
of margin
..................... requires no closure because no incision is made
....................includes simple closure but may require more complex closure
Follow Solutions
This modifier indicates an increased service and is overused and results in an
increase in payment of 20% to 30%. As such, the assignment of this modifier
comes under particularly close scrutiny by third-party payers. What is this
modifier? Correct Answer - -22 Increased Procedural Services
When adding multiple CPT modifiers to a code, list in:
When adding multiple HCPCS modifiers, list in:
If CPT and HCPCS modifiers are both used, list: Correct Answer - CPT-
highest to lowest
HCPS-ascending alphabetical order
both- CPT (high to low) then HCPS (ascend. alpha.)
What part of the CPT manual lists a full description for all modifiers?
Correct Answer - appendix A
How many units of service may be billed when reporting the -50 modifier
(bilateral) to Medicare? Correct Answer - one unit
For medicare, just submit 27447-50 for procedure done left and right; other
payers may code it differently.
When reporting -51 modifier to indicate multiple procedure performed, which
procedure should be reported first on the claim? Correct Answer -
Primary Procedure (most expensive)
Medicare considers what service to be part of the surgery and bundled
payment not allowing the -56 modifier? Correct Answer - preoperative
,E&M services provided the day before or the day of a major surgery are
included in what package? Correct Answer - Global Day
Modifier -63 indicates procedure provided to a neonate or infant up to what
weight? Correct Answer - 4 kg or 8.8 lbs
A surgical team consists of how many physicians? Correct Answer -
More than two
How many modifier areas are available on a CMS-1500 (physician) insurance
claim form for one-line item charge? Correct Answer - four
Describing a physician's services in radiology or pathology.
Describing the services provided by the facility. Correct Answer -
Professional component (use modifier -26)
Technical Component (use modifier -TC)
Bundling together of time effort and services for a specific procedure into one
code instead of reporting each component separately Correct Answer -
Surgical Package
Code assignments in the E/M section varies according to three factors:
Correct Answer - 1. place of service
2. type of service
3. patient status
Six sections of the CPT manual Correct Answer - Evaluation and
Management
Anesthesia
Surgery
Radiology
Pathology and Laboratory
Medicine
Patient status (for E/M) Correct Answer - new, established, outpatient,
inpatient
,The key component of E/M service is _____. Correct Answer - medical
decision-making
The four levels of medical decision-making complexity are: Correct
Answer - 1.straightforward
2.low
3.moderate
4.high
The complexity of medical decision-making (for E/M) is based on:
Correct Answer - 1. number of diagnoses
2. amount or complexity of data to review
3. risk of complication or death if the condition is left untreated
UHDDS Correct Answer - Uniform Hospital Discharge Data. UHDDS is
the core data set for inpatient admissions. The data is collected on inpatient
hospital discharges for Medicare and Medicaid program.
UHDDS includes elements such as patient demographics (name, age, gender,
race), medical history (previous illnesses, surgeries), admission and discharge
dates, diagnosis codes (ICD-10 codes), procedures performed, and discharge
disposition (home, another facility).
The definition of a ____ ______ is one that is performed for definitive tx rather
than for diagnostic or exploratory purposes or when it is necessary to take
care of a complication Correct Answer - Principal procedure
What identifies where the patient is at conclusion of healthcare or the end
time of billing cycle Correct Answer - Discharge disposition
UB-04 is maintained by the Correct Answer - national U niform B illing
committee
What was created for hospital inpatient prospective payment to better to
reflect the patients severity of illness and expected risk of mortality
Correct Answer - MS- DRG, Medical severity Diagnostic related group
, Conditions that develop during an outpatient encounter, including ER,
observation or outpatient surgery are considered ______ Correct Answer -
Present on admission POA
Where are POA guidelines found in ICD-10-CM Correct Answer -
Appendix 1
Under the _____ each case is categorized into a DRG Correct Answer -
Inpatient prospective payment system IPPS
One _____ group per inpatient admission Correct Answer - DRG
MS-DRG variables
(UHDDS items that can affect ms-drg assignment) Correct Answer - -
principal diagnosis
-secondary diagnosis
-principal or significant procedure
-age/sex
- discharge disposition
modifier -51 Correct Answer - Multiple procedures
Can't be used with add-on codes.
Is used by physicians not hospitals!
To code lesion procedures you need ..........., .............., size of ............., and whether
the lesion is ...................... Correct Answer - the site, number, size of the
excised lesion, and whether the lesion is malignant or benign.
When coding the excision of a lesion, the size of the lesion is based on the
following measurement: Correct Answer - lesion and narrowest width
of margin
..................... requires no closure because no incision is made
....................includes simple closure but may require more complex closure
