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AAPC CPC chapter 6
CPT and HCPCS
| Question | Answer |
|---|---|
| CPT code set published in 1966 and established as system for physicians in _____ | 1983 |
| Category 1 CPT: ____ digit number code. Most commonly used. | 5 |
| CPT: AMA updates the code sets _____ | annually |
| CPT: category II: tracking codes designed to ____ administrative burdens because they facilitate data collection about quality care. | minimize |
| CPT: Category II: near the back of CPT book after ____. They are in _____ to eval and management services or clinical services (category I) | meds, addition |
| CPT Categroy II: alphanumeric with letter ____ in last position. | F |
| Category III (cpt) temporary codes for emerging ______, services and procedures. | technology |
| CPT category III: alpha numeric with a ____ in last position and can be reported ____ unlike category II codes. | T, alone |
| CPT: if category III fully represents a case, it is to be used instead of unlisted category ____ | I |
| ; semicolon and Indented procedure: not have to list the common portion for ____ code that shared the same common portion of code descriptors. | every |
| Common portion is the portion of the descriptor up until the _____ | semicolon |
| Semicolon ; is divided into 2 parts, the description ____ semicolon and the description after | before |
| When reporting indented codes it's _____ necessary to report the main code | not |
| + add on codes: list in Appendix D and never reported _____. Codes that specific add on code is reported in addition to are usually in _____ listed below add on code. | alone, parenthesis |
| When procedure reported with add on code is performed bilaterally, the add on code is reported _____ | twice |
| CPT: modifier _____ is not appended to add on codes. | 50 |
| All CPT add on codes are _____ from the multiple procedure concept (modifier 51 concept in Appendix A) | exempt |
| CPT add on codes are never listed as ____ service, never listed as only CPT code, never reported with modifier 50, never reported with modifier ____ | primary, 51 |
| o A bullet symbol to the left of a code indicates _____ procedures and services added. | new |
| Triangle symbol: description of the code has been ____ | revised |
| Opposing horizontal triangles: new and revised _____ other than precedure descriptors. | text |
| Forbidden symbol (circle with line through it): codes that are exempt from the use of modifier ___ | 51 |
| /\/ Lightning bolt symbol: codes for _____ pending FDA approval | vaccines |
| CPT: some vaccines assigned to category 1 code in anticipation of future _____ approval | FDA |
| Once vaccines FDA approved a revision notation will be provided on AMA CPT category 1 vaccine codes _____ | website |
| # Pound symbol: codes that have been resequenced and are out of ____ order. | numerical |
| * the star symbol: codes which can be reported when using synchronous _____ using both audio and video telecommunications. Modifier ____ is appended. | telemedicine, 93 |
| Audio icon (speaker): which codes can be reported when telemedicine services are used using _____ only. | audio |
| Audio icon: when telemedicine performed by audio only modifier ___ is appended | 93 |
| Each: each _____ instance, Each lesion, each incision etc. | separate |
| Each additional: each instance, above and beyond the _____ code, up to the amount given is reported with this code. | first |
| Included when performed: a procedure, when performed, is not reported _____ because it is considered included in the base procedure. "when performed" | separately |
| Part thereof: typically in add on codes. Part of the ______ listed up to the number or % listed. | amount |
| Separate procedure: when performed alone, however when reported with another procedure or service on the same pt during the same encounter and is _____, it may be considered inclusive to that procedure and Not reported separately. | related |
| Single or Multiple: the code is reported only _____ whether it refers to single procedures or lesions or multiple | once |
| Units: number of times a _____ CPT code is reported | single |
| Up to (time): any time ____ to the time specified. Will often have add on codes to report additional time and parenthetical instructions indicating _____ to report time. | up, how |
| Up to and Including: any amount leading up to the amount _____. Reported with 1 code. | given |
| CPT category I section numbers: divided into ____ main sections. Alphabetical order but E/M is 1st since most used. | 6 |
| CPT category I sections: E/M, Anesthesiology, _____, Radiology, Pathology, ______ | surgery, medicine |
| Section guidlines define which codes can be used _____ and necessary info. | together |
| CPT alphabetic index: to locate code or range. After then go to _____ section for specifications. | numeric |
| CPT Index Alphabetized with main terms organized by: condition, _____, anatomic site, synonyms, eponyms and _____. | procedure, abbreviations |
| CPT: subterms further claify the _____ term | main |
| NCCI (national correct coding initiative): correct coding methodologies and control _____ coding assignments that result in inappropriate reimbursement. | improper |
| NCCI (PTP) procedure to procedure: edits used to determine codes considered by CMS to be _____ codes for procedures and services deemed necessary to accomplish a major procedure. | bundled |
| NCCI (PTP) : not repoted separtately and is included in _____ procedural codes. (it's bundled) | major |
| Reporting bundled codes for procedures in _____ to the major code is "unbundling" and if repeated enough times could be considered an act of Fraud | addition |
| CPT: correct coding file format includes a correct _____(CCM) indicator (carrier only). This indicator determines whether CCM causes the code pair to _____ the edit. | modifier, bypass |
| CPT CCM indicator will be either 0, 1 or _____ | 9 |
| CCM indicators: 0- a CCM is ____ allowed and will not bypass the edits. 1-a CCM is allowed and ____ bypass edits. 9- the cause of modifiers is not ______. | not, will, specified |
| CCM indicator 9-for all code pairs that have a _____ date that is the same as the effective date. So that no blank spaces would be in the indicator _____. | deletion, field |
| PTP edit rationale: includes ____ for edit. Can be useful when determining whether it is appropriate to report a modifier to _____ the edit. | reason, override |
| Sequencing CPT codes: are in the _____ section. | numeric |
| RBRBS- Resource based _____ value Scale. Helps with physician fee schedules, ______ and code sequencing. | relative, benchmarking |
| Physician Fee schedule look up tool on the _____ website. | CMS |
| Physician Fee Schedule: _____ dollar amount coded 1st | highest |
| Searching NCCI edits in _____ provides NCCI edits | codify |
| RBRVS: reimbursing physicians. Each code has RVU (relative value unit) assigned which when _____ by a conversion factor and a geographic region adjustment allowance, creates the reimbursement for the service. | multiplied |
| RVU's configured using 3 units: Physician work (time, skill, treatment etc), Practice _____ (cost of ancillary personal, supplies and office overhead), and Professional liability/malpractice insurance. | exspense |
| CMS annually publishes physicain fee schedule info on _____ and the formula for calculating the payment amounts. | Website |
| Physician fee schedule amounts vary depending on facility vs ____ facility | non |
| CF- conversion _____ is fixed dollar amount used to translate the RVU's into fees. | Factor |
| Health plans other than Medicare may choose ____ to use the CMS calculations for provider reimbursement. | not |
| The RBRVS: The Physician's Guide answered questions about RBRBS system and allows quick ____ to info about payment rules for sugical packages and code RVU's. | access |
| Steps for coding multiple procedure codes (CPT): 1. Select ____ procedure codes. 2. check the codes against NCCI and table for ______ to eliminate bundled codes. If the codes can be reported together modifier 59 appended. 3. RVU's | all, bundled |
| CPT Procedure coding: use of modifier for bundled codes, append appropriate modifier to column ____ code. | 2 |
| Check with individual payer to see if they follow NCCI guidelines for _____. | bundling |
| Codes exempt from modifier ____ are indentified with the universal forbidden symbol. | 51 |
| CCM indicator 0 means a CCM is not _____ and will not bypass the edits. | allowed |
| Place of service codes (CPT) for professional claims: 2 digit _____ codes on these that denote the setting in which the service was provided. | numeric |
| Place of service codes: if incorrect, may result in ____ of claim. Office visit P0S11, ER visit P0S23, _____ care P0S20 | denial, Urgent |
| CPT category II codes: 4 numerical digits with letter ____ in last. These codes have no RVU value, because they mainly describe components in E/M services or results from _____ and other procedures. | F, tests |
| CPT category II codes: Modifiers 1P, 2P, 3P and 8P are _____ appended to category 2 codes. | only |
| Category II codes (cpt) modifiers 1P, 2P and 3P are ____ modifiers, an action in category II code wasn't provided because of medical, patient or system reason. | exlusion |
| Category II code (cpt) modifier 8P: reporting modifier, used when an action in the measure is not _____and the reason not documented. | performed |
| CPT category III codes: 4 numerical digits followed by letter ___. Temporary codes for data _____ in the FDA approval process for new and emerging technology services and procedures. | T, collection |
| CPT Category III codes: updated ___ a year on AMA website on Jan 1st and July 1st then implemented 6 mo afterwards. | twice |
| If category III (cpt) code available it must be listed instead of a category ____ unlisted code | 1 |
| Category III (cpt) when FDA approved it becomes Category 1, if not ______ in 5 years the code is either renewed for another 5 years or ______ | approved, removed |
| Category III codes (cpt): no RVU assigned, reimbursement may be _____ through health plans. | available |
| Category II codes released ____ times a year | 3 |
| Appendix A (cpt) modifiers level 1: all the modifiers applicable to CPT codes: Anesthesia physical status modifiers, Level 1 modifiers approved for _____ surgery center (ASC) hospital outpatient use and Level _____ modifiers | ambulatory, 2 |
| Appendix B (cpt): summary of ____, deletions and revisions. Contains actual changes and additions to the cpt codes from previous year to current. | additions |
| Appendix C (cpt): clinical examples _____ from cpt book | removed |
| Appendix D (cpt): summary of cpt add on codes . Codes not reported as ____ or stand alone code. With the + symbol. | single |
| Appendix E (cpt): codes from modifier ___. Codes that are exempt from the use of modifier 51, forbidden symbol. | 51 |
| Appendix F (cpt): codes exempt from modifier ____. Identified by convention of parenthetical instruction. | 63 |
| CPT: do not report modifier 63 "In _____ with" | conjunction |
| Appendix's removed from CPT book: G, ____, I | H |
| Appendix J (cpt): Electrodiagnostic medicine. Assigns each sensory, ____ and mixed nerve with its appropriate nerve conduction study code. | motor |
| Appendix K (cpt): product pending FDA approval, same ____ products in Category I, lightening bolt symbol. | vaccines |
| Appendix L (cpt): vascular families that emerge from the aorta,vena cava, _____ artery or portal vein, using brackets to identify the order of vessels (catheterizations). | pulmonary |
| Appendix L (cpt): 1st, 2nd and 3rd order and _____ 3rd order branches. The largest 1st order branch emerges from _____. 2nd order branch emerges from 1st order and so on. | beyond, aorta |
| Appendix M (cpt): Renumbered codes- citations crosswalk. Crosswalked, _____ and renumbered cpt codes, descriptors and assistance references for deleted codes. | deleted |
| Appendix N (cpt): ______ codes, not appearing in numeric sequence. Allows existing codes to be re-located to an apporopriate location. | resequenced |
| Appendix O (cpt): multianalyte assays with Algorithmic Analyses (MAAA) procedures. Typically unique to a single clinical _____ or manufacturer. | laboratory |
| Appendix P (cpt): synchronous ____ service, appended by modifiers 95. Star symbol. | telemedicine |
| Appendix Q (cpt): Severe acute _____ syndrome Coronavirus 2 Vaccines. Which vaccine code for cornavirus and administration code is reported. | respiratory |
| Appendix R (cpt): digital medicine services taxonomy. To promote increased awareness of approaches to pt care. Taxonomy and ____ for services that can be provided through digital services. | definitions |
| Appendix S (cpt): Artificial intelligence. Classified AI applications for medical services and procedures into one of 3 categories: _____, argumentive and autonomous. | assitive |
| Appendix T (cpt): may be used for syncrhonous real-time _____ only telemedicine. | audio |
| AMA maintains and publishes CPT codes. 3 categories of cpt codes: I, II, III. 3 methods to list ____ terms: condition, synonyms and abbreviations. | main |
| CPT codes used to configure RVU's, malpractice insurance costs, _____ work, quality pt performance measures. | physician |
| Category III codes (cpt): new and _____ codes | emerging |
| Global package as defined by cpt: payment for surgery procedures includes a standard package of pre-op, _____ and post-op services. | inoperative |
| Global package: the pre-op and post-op periods will ____ based on classifications as major or minor surgery. | differ |
| Global package: may be in any service _____. Visits to pt in intensive or critical care by the ____ also included. | location, surgeon |
| Some circumstances ____ considered part of the Global Package | not |
| Some health plans write variances within their policies instead of _____ Global package concept. | CMS |
| Global Package Non Medicare: has leniency to determine if Global period is ______ to surgery and procedures. | applicable |
| If health plan determins a global package it will establish ____-op periods of 0, 10 or 90 days to surgical CPT codes. | post |
| Surgery as defined by Medicare: what services are included and not in global package and classified ____ and minor surgery. Also, the pre-op and post-op ____ allowed. | major, days |
| Pre-op period included in global fee for major surgery is _____ day, and post-op is 90 days | 1 |
| Minor surgery included in global fee for pre op period is the day of ____ with Post-op period of either 0 or ___ days depending on procedure. | surgery, 10 |
| Endoscopic procedures: (except ones requiring incision) there is ____ post-op period for global package. | no |
| Global period days are on _____ website | CMS |
| Each CPT code also has a global period status _____ as per CMS payment policies. Surgical codes have global surgery indicator for classification for minor and ____ surgery as determined by RVU calculations | indicator, major |
| MMM: ______ codes | maternity |
| XXX: global concept does ____ apply | not |
| YYY: unlisted codes subject to individual _____ | pricing |
| ZZZ: add- ons, are related to another service and are _____ included in the global period of the primary service. | always |
| Gobal package: pre-op visits on day before or day of a _____ procedure and pre-ops performed on the day of a minor procedure. | major |
| Global package: intraoperative services that's considered ____ and necessary part of a surgical procedure. | usual |
| Global package: complications following surgery required of the surgeon during the post-op period which do ____ require additional trips to O.R. | not |
| Global package: post-op visits (follow up visits) within post-op period related to ____ from surgery | recovery |
| Global package: post surgical ____ management by the surgeon | pain |
| Global package: miscellaneous services. Items like dressing ____, local incisional care, removal of operative pack, staples, _____, drains etc. | changes, cast |
| Global package- not included: initial consultation or eval of the _____ to determine need for surgery. Visits unrelated to the diagnosis for wich surgery was ______, unless visits occured due to complications of surgery. | problem, performed |
| Global package- not included: Treatment for the underlying condition or an added course of treatment that isn't part of the _____ recovery from surgery. | normal |
| Global package-not included: diagnostic tests and procedures including diagnostic ______ procedure. Treatement for post-op ______ requiring a return trip to the O.R. | radiology, complication |
| Global package- not included: clearly distinct surgical procedures during the post-op period that aren't re-operations or _____ for complications. | treatment |
| Global package-not included: less exstensive procedure _____ and a more exstensive procedure is required, the 2nd procedure is payable separately. Certain services performed in doctor's _____. | fails, office |
| Global package- not included: immunosuppressant therapy management for ______ transplants. Critical care services _____ to the surgery. | organ, unrelated |
| Global package-not included: will not pay separately for an E/M service on the ____ day as minor surgery or endoscopy unless a significant, separately identifiable _____ is performed. | same, service |
| Modifiers appended to E/M to report payable services in gloabal package: 24, 25, _____ | 57 |
| HCPCS level II: created by CMS to report supplies, materials, _____ and certain procedures and services that may not be in CPT book. | injections |
| When CPT code and HCPCS level II code exist for ______ service, check with payer to determine which code to use. | same |
| HCPCS level II: codes begin with a single letter followed by ____ digits. Grouped by ____ of service or supply. | 4, type |
| Permanent National Codes: blue cross blue sheild, Health _____ association and CMS maintain these. Updated _____ a year on Jan 1st | Insurance, once |
| Miscellaneous codes: when no code describes the item/service. Must be clearly described and _____ info included. | pricing |
| Temporary National Codes: allows insurers to establish codes needed _____ the annual update. Implemented within 90 days. | before |
| C codes: may qualify for OPPS (outpatient prospective payment system) and only on Medicare claims submitted by hospital _____ departments. Temporary | outpatient |
| G codes: procedures that would be coded in CPT but _____ CPT code for them. Temporary | no |
| H codes: ______ health services such as drug treatment services. Temporary | mental |
| K codes: Durable ______ Equipment. S codes: BCBSA and HIAA to report drugs, services, supplies that have no national _____ but are needed for claims processing, policies and programs. Temporary | medical, codes |
| Q codes: services that would not be given a CPT code such as drugs, _____and other medical equipment, services and are not identified as National codes but are needed for claims. Temporary | biologicals |
| T codes: items with no permanent national codes. Not used by ______ but can be used by private insurers, temporary. | Medicare |
| Code modifier: additional ____ about the service, level II. Alphanumeric or _____ letters | info, 2 |
| B codes: enteral and ______ therapy. M codes: _____ services | parenteral, medical |
| J codes: drugs admin other than ____ method and injectable chemo drugs. | oral |
| L codes: _____ procedures, services and prostetic procedures. P codes: pathology and _____ services | othotic, lab |
| R codes: diagnostic _____ services. U codes: _____ diagnostic panel | radiology, coronavirus |
| V codes: vision services and _____, also includes speech language pathology services | hearing |
| Table of drugs: based on method of ____ or admin or specific to chemo | delivery |
| Medicare B: will cover certain prescription drugs under specific circumstances. CMS _____ local carriers and 4 DMEMAC's to establish reimbursement amounts for covered drugs. Generally Reimbursement amount is ____% of the drugs average wholesale price | requires, 85 |
| IA- intra _____. IT: intrathecal, subdural space of ____ cord. INH: inhaled | arterial, spinal |
| Medicare Carriers Manual References (MCM) : CMS regulations and rulings about coverage for procedures, services and supplies. Includes Coverage _____ Manual (CIMS) references. | Issues |
| Medicare Statutes: statutory coverage issues exclusions from coverage and Medicare as _____ payer. | secondary |
| HCPCS level II modifiers: 2 levels, _____ level I and Level II | CPT |
| Level I modifiers of CPT codes are 2 digits appended to the procedures for _____ circumstances. | special |
| Physical status of a patient who's recieving anesthesia is reported using 2 character alpha numeric modifier appended to _____ digit CPT anesthesia code. Numeric portion of modifier is health ____ of the pt | 5, status |
| Normal healthy patient- P1, _____ systemic disease- P2, Severe- P3, Severe disease that's a constant threat to life- P4, Pt not expected to survive the operation- _______ and declared brain dead who's donating organs- P6 | mild, P5 |
| Level II modifiers are 2 _____ characters followed by a digit | alpha |
| Modifiers appended to ambulance services HCPCS level II codes: 1st character is ____of ambulance, 2nd character for the destination. Ex: RH- ambulance from pts residence to hosp | origin |
| HCPCS level II _____ modifiers (single character) are listed. Ex: G- hospital based dialysis facility | ambulance |
| A codes:, level II ____ services, medical and surgical supplies, administrative, misc., and _____ supllies, procedures and services | transport, investigative |
| Ambulance services (air and ground) are divided into different levels of service based on medically necessary treatment provided ____ transport. | during |
| Ambulance services: for gound, BLS, ALS level 1 (ALS1), Specialty care transport (SCT) _____ ALS intercept (PI) | paramedic |
| Ambulance services: for air, fixed wing air ambulance (FW), _____ wing air ambulance (RW) | rotary |
| B codes: Level II codes for supplies and equipment for ____ and parenteral therapy. Enteral- digestive tract, Parenteral- intravenously | enteral |
| E codes. DME: Must meet the following: can withstand ____ use, used to serve medical purpose, not ____ useful to a person in the absence of an illness or injury, appropriate for use within the _____. | generally, home |
| J codes: specific dosage units. When admin dosage exceeds "dosage units" in code description the additional _____ must be reported. | units |
| R codes: transportation of equipment from a facility to a home or nursing home to perform _____ tests | diagnostic |
| HCPCS, level II codes can be updated _____. | quarterly |
| HCPCS, When reporting codes with more than 1 modifier enter the _____ modifier immediately after the code, also referred to as "pricing modifier." Next, report info ____ to clarify certain aspects of procedure or service | funtional, modifiers |
| Coders should contact their _____to obtain a list of modifiers cause each payer has different reporting requirements. | carrier |
| CPT modifiers: ___ digit numbers. | 2 |
| HCPCS level II modifiers: 2 alphabetic characters and 1 ____. Requires adding specificity to CPT procedure codes performed for ____, fingers, toes and cornary arteries. | number, eyelids |
| Diagnosis pointer field: on medical claim form, relates to the line item to the diagnosis on the ____ claim | base |
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