CPT CH 13

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CPT coding (Step-By-Step Chapter 13)

Modifier

provides additional information to the third party payer

Special Report

Required when reporting a unusual or variable service. Pertinent information should include adequate definition or description of the NATURE, EXTENT, and NEED for the procedure and the TIME, EFFORT, and EQUIPMENT necessary to provide the service.

Procedures that are experimental, newly approved, or seldom used are reported with what type of code?

Unlisted or Category III

Where is specific coding information about each section located?

Guidelines

Procedure/Service Descriptor

The words that follow a code number in the CPT manual

Nomenclature

According to the notes preceding the Category III codes in the CPT manual, the digits of the Category III codes are not intended to reflect the placement of the code in the Category I section of the CPT

Category I codes in the CPT manual have ___ digits.

5

A code that has all of the words that describe the code that follows is what type of code?

stand alone

Which punctuation mark between codes in the index of the CPT manual indicates two codes are available?

comma

Who publishes the CPT manual?

AMA
(American Medical Association)

Who requires a special report with the use of unlisted codes?

third-party payers

According to the CPT manual, modifier -91 is not to be used when tests are ____ to confirm initial results.

rerun

The universal health insurance form for submission of outpatient services is the?

CMS-1500

According to the E/M Guidelines, time is not a descriptive component for the ____ department levels of E/M service.

emergency

Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is available>

hyphen

In which CPT appendix would all modifiers be found?

Appendix A

The range of codes 10021-69990 would be found in this section of the CPT manual:

Surgery

An unlisted procedure code is

located in the Section Guidelines, at the end of a subsection or subheading, and is a procedure/service not found in the CPT manual.

A list of the unlisted procedures for use in a specific section of the CPT manual is contained in:

Guidelines

What is NOT a reason for the CPT coding system?

increased reimbursement

Two digit modifier for a return to the operating room for an unplanned related procedure during a postoperative period.

-78

The ______ section Guidelines contain the definition of a chief complaint.

E/M
(evaluation and management)

The correct order from largest to smallest division of the CPT hierarchy in the CPT manual is:

Section, Subsection, Subheading, and Category

Appendix C of the CPT manual contains examples of ___________ codes.

clinical

-76

repeat procedure by the same physician

-51

multiple procedures

-50

bilateral procedure

-54

surgical care only

T/F: According to the Surgery guidelines, surgical destruction may be considered part of a surgical procedure.

TRUE

T/F: If a coder is unable to locate a code that describes the exact service provided, it is acceptable to use a code that approximates the services provided.

FALSE

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