CPT & HCPCS Coding True or False

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TRUE

Anesthesia services are reimbursed based in part on the amount of time anesthesia is administered.

TRUE

The anesthesia code for the most complex procedure is assigned when multiple procedures are performed during the same operative session under the same type of anesthesia.

FALSE

Preoperative and postoperative visits by the anesthesiologist can be reported in addition to the administration of the anesthesia.

FALSE

When a second physician provides moderate conscious sedation in a nonfacility setting then this physician can report a moderate conscious sedation code.

TRUE

When a physician performs the surgery and administers the anesthesia the modifier 47 (Anesthesia by surgeon) needs to be appended to the procedure code.

TRUE

Physical Status Modifiers are used to indicate the condition of the patient at the time the anesthesia was administered.

FALSE

The ASA Relative Value is a list of the charges for the anesthesia services performed.

FALSE

Only one Qualifying Circumstances Code can be reported during the same operative session.

FALSE

The appropriate Physical Status Modifier is decided by the medical coder and does not need to be documented by the anesthesiologist.

TRUE

The procedure with the highest basic unit value is reported when multiple surgical procedures are performed during the same operative session.

FALSE

Hospital Observation Services codes may only be assigned if the patient is in an area designated by the hospital as an observation area.

TRUE

When a patient is admitted to a hospital directly from a physician's office report a code from the Initial Hospital Care Subcategory.

FALSE

The anticoagulant management codes can be reported in the outpatient and inpatient setting.

FALSE

When a patient and/or the family initiates a consultation (instead of a physician initiating it), a consultation code is reported.

FALSE

HCPCS: When a physician orders that a patient be placed under observation, the patient's status is that of an inpatient.

FALSE

HCPCS: The codes listed in the Chemotherapy Drugs category cover the cost of the chemotherapy and the administration.

TRUE

Modifier 50 (Bilateral procedure) should be appended if a patient has bunionectomy procedures performed on both the right foot and the left foot during the same operative session (code 28292).

TRUE

If a patient had multiple procedures performed during the same operative session, modifier 51 (Multiple procedures) would be added to the additional procedure codes.

TRUE

When the description of a code includes the word bilateral you do not add the modifier 50 (Bilateral procedure) to the CPT® code.

FALSE

There are no exceptions to adding the modifier 51 (Multiple procedures) to a CPT code when more than one procedure is performed during the same operative session.

FALSE

For spine examinations using magnetic resonance angiography with contrast administered by intravascular injection, an additional code is reported for the intravascular injection.

FALSE

A code designated as a separate procedure can never be reported by itself or in addition to other procedures or services.

TRUE

The modifier 26 is reported when the physician provides only the professional component of the procedure.

TRUE

When a physician both performs the procedure and provides imaging supervision and interpretation, a combination of procedure codes is reported.

TRUE

The modifier TC is reported when the provider provides only the technical component of the procedure.

FALSE

Debridement must be coded separately when debridement is carried out in conjunction with an intermediate or complex wound repair.

TRUE

Code range 15002-15005 (Surgical preparation) is used for the initial wound recipient site preparation.

TRUE

Destruction means the ablation of benign, premalignant, or malignant tissues by any method.

TRUE

The initial cast application and removal are included in the open or closed treatment code.

FALSE

Coding separately for external fixation may be done even when external fixation is part of the main code description.

TRUE

All surgical endoscopies under the Surgery/Respiratory System include the diagnostic endoscopy.

FALSE

Lung allotransplantations involve four distinct physician work components.

TRUE

Backbench work in lung allograft includes work on the cadaver, single or double lung allograft, and preparation of pulmonary artery and bronchus.

TRUE

A physician performing two procedures on the same date of service during the same operative session would append modifier-51 to the second procedure code.

FALSE

It is not important to read special "notes" located under subheadings or subsections. Only notes that are part of the code description apply.

TRUE

Routine postoperative follow-up care is covered under the surgical global package.

TRUE

If follow-up care after a therapeutic surgical procedure is for a complication or other disease process the physician may code and report additional services separately.

FALSE

When a code description includes the note "separate procedure," it should never be reported separately.

FALSE

When destruction is carried out as part of a procedure, it is always coded separately.

FALSE

Category III codes cannot be used in the place of Category I unlisted codes.

FALSE

Category II codes are used to report emerging technologies.

TRUE

Qualifying Circumstances Codes are considered Add-on Codes which means they cannot be reported without an anesthesia code.

FALSE

The anesthesia formula is basic units + time units + conversion factor = total units. Total units X conversion factor = reimbursement rate.

TRUE

The insertion of a central venous catheter is an example of an unusual form of monitoring and can be coded and billed separately from the anesthesia service code.

TRUE

The cost of practicing medicine varies from one location to another. Therefore, the conversion factor is based on geographic location where the anesthesia service was performed.

FALSE

Physical Status Modifiers are represented by the initial letter P followed by a single digit from 1 to 5.

TRUE

The conversion factor is multiplied by the number of units to determine the reimbursement for the anesthesia services provided.

TRUE

The basic unit value for each anesthesia code is listed in the Relative Value Guide (RVG) which is published by The American Society of Anesthesiologists (ASA).

FALSE

When multiple procedures are performed during the same operative session under the same type of anesthesia each code is reported separately.

FALSE

When you cannot find a code that accurately describes a service or procedure you should report the code that most closely matches the service or procedure.

TRUE

Modifiers provide additional information about the services provided to a patient.

TRUE

Add-on codes are only reported when a procedure or service is performed by the same physician.

FALSE

Evaluation and Management codes are used to report facility charges.

TRUE

The guidelines for each section are listed at the beginning of each section.

FALSE

The indented codes include the full code descriptions.

TRUE

The guidelines contained within each section only apply to the codes that the guideline precedes.

TRUE

The four types of main terms are procedure or service, organ or other anatomic site, condition, and synonyms, eponyms and abbreviations.

FALSE

CPT® codes are organized by specialty and the use of them are restricted by specialty.

TRUE

Instructional notes contain information about additional codes, modifiers, alternative code assignments, and deleted codes.

FALSE

HCPCS: The Red Color Bar indicates contractor discretion.

FALSE

HCPCS: The HCPCS code should be assigned when the CPT® and HCPCS code descriptions are identical.

TRUE

HCPCS: A special report is used when a HCPCS modifier is reported.

FALSE

HCPCS: The Yellow Color Bar indicates a service not covered by or invalid for patients covered by Medicare.

TRUE

HCPCS: The route of administration column in the Table of Drugs lists the most common methods of delivering the referenced generic drug.

TRUE

HCPCS: The use of HCPCS codes is mandatory on all Medicare and Medicaid claims submitted for payment of services provided by healthcare providers.

TRUE

HCPCS: The Blue Color Bar instructs the coder there are special instructions associated with the assignment of the code.

FALSE

HCPCS: The place of service codes listed in Appendix 6 are reported on hospital claims to describe the location where the services were provided.

FALSE

HCPCS: The codes located in the Table of Drugs are provided only for the brand name of a drug.

TRUE

HCPCS: The modifiers in the HCPCS codebook have the same purpose as the modifiers in the CPT codebook.

TRUE

When a code does not exist that accurately describes the procedure/treatement, the coder should report an unlisted code.

FALSE

Modifiers are used to identify when no procedure is done.

TRUE

Appendix C contains coding examples to assist in the selection of the Evaluation and Management codes.

TRUE

In Appendix A, modifier 22, applies to codes in the Surgical Section, as opposed to Evaluation and Management codes, because typical procedure times are not listed.

FALSE

All procedures performed by physicians are found in the CPT codebook.

TRUE

Evaluation and management visits represent the most common patient-physician interactions.

FALSE

The chief complaint must be located under the heading CHIEF COMPLAINT.

TRUE

The number of minutes a physician spends face-to-face with a patient can be a factor in selecting the correct E/M code.

TRUE

Physician visits to hospital inpatients are coded and billed by an outpatient coder.

TRUE

Medical coding specialists working for a healthcare facility such as a surgery center, hospital, or nursing home would bill facility charges, not E/M services.

FALSE

Every E/M code category requires the medical coder to distinguish between new and established patients.

TRUE

When selecting an E/M code, the chief complaint must always be identified.

TRUE

Information in the physical examination should be objective information reported by the provider.

FALSE

Surgery is defined as what takes place when the surgeon scrubs up to the moment the last stitch is placed.

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