CPT Ch. 14 Review
Theory & Practical from book
Terms in this set (52)
When more than two physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion of the surgery to complete, they are termed what?
No, because a note in CPT Appendix A states modifier -22 cannot be appended to an E/M code.
Can modifier -22 be assigned to 99291, 99292 codes?
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?
Intraoperative or surgery
When modifier -54 is assigned, payment for the ______ portion of the surgical procedure is being requested.
It is only appended to other than E/M codes
What statement is true about modifier -59
What is the weight in pounds of a 4-kilogram infant?
Describes circumstances in which the patient canceled the procedure and may be used to describe ASC reporting of previously scheduled procedure that is partially reduced as a result of extenuating circumstances.
What following two statements are NOT true about modifier -53?
T or F Modifier -57 can be added to surgery section codes.
Highest to lowest
When adding multiple CPT modifiers to a code, you would list the modifiers from:
Repeat procedure or service by same physician
Distinct procedural service
Indicates a service that is required by some third-party entity or Workers' Compensation mandated a physical examination of a covered patient. The third party usually waives the deductible.
Significant identifiable E/M service provided by the same individual on the same day as another service or procedure
Minimum assistant surgeon
Repeat procedure by another individual
Unrelated procedure or service by the same individual during the postoperative period
Unplanned return to the operating room for a related procedure during the postoperative period
Surgical care only; used correctly only when there has been a transfer of responsibility for care from one physician to another. Usually results in reimbursement to the surgeon for the intraoperative percentage of the global package payment.
Reduced service; when this modifier is reported, additional documentation, such as operative reports and/or physician explanation of the reason for the reduced price.
What appendix in the CPT manual contains a complete list of all modifiers?
What is the word that means assigning multiple codes when one code would do?
Preoperative services/Management or preop
What is the term that describes the services provided to a patient by the physician before surgery?
Postoperative services/Management or postop
What is another term for the time after the surgery that the physician provides to the patient?
Do all third-party payers recognize all modifiers as listed in the CPT manual?
What is the term that describes two physicians working together in the completion of a procedure when each has the same level of responsibility?
Assign unrelated E/M services by the same physician or other qualified health care professional during a postoperative period
Anesthesia by surgeon
Bilateral procedures; Medicare does not accept two line items to describe a bilateral procedure.
Multiple procedures; when reporting multiple surgeries, the primary procedure (procedure with the highest relative value unit) should be listed first on the claim form. After the first eligible procedure is reimbursed at 100%, the remaining procedures are reimbursed at 50% up to four additional procedures.
Discontinued procedure; describes circumstances in which a procedure was stopped because of the patient's status.
Postoperative management only
Preoperative management only
Decision for surgery;
added to surgical codes; rather, it is added only to E/M codes
Assigned Staged or Related Procedure or Service by the same physician or other qualified health care professional during the postoperative period
Assign procedure performed on infants less than 4 kg
Assistant surgeon (When qualified resident surgeon not available)
Reference (Outside) laboratory
Repeat Clinical Diagnostic Laboratory Test
Alternative Laboratory Platform Testing
According to the Medicare Claims Processing Manual, claims processing must maintain at least ____ full calendar years of fee schedules and related pricing data, regardless of the number of updates or pricing periods.
Simple open wound repair on the face of a two-year-old who is unable to sit still for the repair.
What is an example of "unusual anesthesia" circumstances?
Medicare does not _______ the surgeon for anesthesia service when he/she is the performing surgeon.
Ø symbol preceding a code indicates it is modifier -51 exempt.
What is the symbol in the CPT manual that indicates modifier -51 should not be used?
HCPCS modifiers are listed in ______ order when added to a code.
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