CBCS CPT Procedure Coding 2 — Questions and Answers
Question 1: What CPT modifier is appended when a service is reduced or eliminated at the physician's discretion?
- -22
- -52 (Correct answer)
- -53
- -58
Correct answer: -52
Modifier -52 (Reduced Services) is used when a service is partially reduced or eliminated at the physician's discretion.
Modifier -52 is appended to a CPT code to indicate that a service or procedure was partially reduced or eliminated at the physician's discretion. Under certain circumstances, a service or procedure is partially reduced. The physician may elect to use the CPT code with the -52 modifier to indicate that the service is reduced. This modifier does not apply to evaluation and management services.
Question 2: Which section of CPT covers anesthesia services?
- 00100–01999 (Correct answer)
- 10004–69990
- 70010–79999
- 90281–99199
Correct answer: 00100–01999
CPT codes 00100–01999 cover anesthesia services.
Anesthesia services in CPT are coded using codes 00100–01999. Anesthesia reimbursement is calculated differently than other procedures — it uses base units (assigned to each procedure) plus time units (15-minute increments), multiplied by a conversion factor. Qualifying circumstances (such as emergency anesthesia or the age of the patient) may also affect the calculation.
Question 3: What does the symbol '▲' (triangle) before a CPT code indicate?
- The code is new
- The code description has been revised (Correct answer)
- The code has been deleted
- The code requires a modifier
Correct answer: The code description has been revised
A triangle (▲) before a CPT code indicates the code description has been revised from the previous edition.
CPT uses several symbols to flag changes from the previous year's edition. A bullet (●) indicates a new code; a triangle (▲) indicates a revised code description; a horizontal triangle (◄►) around a description indicates new or revised text in guidelines; a circle with a line (⊘) indicates the code is exempt from the use of modifier -51; and a plus (+) indicates an add-on code.
Question 4: When a surgeon performs an arthroscopic knee procedure, which CPT code range applies?
- 27300–27499
- 29800–29999 (Correct answer)
- 27580–27599
- 20900–20999
Correct answer: 29800–29999
Arthroscopic knee procedures are found in the 29800–29999 range of CPT (arthroscopy section under musculoskeletal).
Arthroscopic procedures are coded from the 29800–29999 range in the CPT Musculoskeletal System section. Knee arthroscopy codes begin around 29870. The specific code depends on what was performed arthroscopically (e.g., diagnostic only, with meniscectomy, with chondroplasty, with ligament repair). Arthroscopic codes are generally used instead of the corresponding open procedure codes.
Question 5: What is the purpose of CPT modifier -59?
- To indicate a service was performed by a different provider
- To identify a distinct procedural service not normally reported together (Correct answer)
- To indicate services were provided in a surgical center
- To report a repeat procedure by the same physician
Correct answer: To identify a distinct procedural service not normally reported together
Modifier -59 identifies a distinct procedural service that is not normally reported together with another code but is appropriate for reporting separately.
Modifier -59 (Distinct Procedural Service) is used to indicate that a procedure or service is distinct or independent from other services performed on the same day. It is commonly used to override NCCI edits when two codes that are normally bundled together were performed separately or on different sites, during different sessions, or for different diagnoses. CMS developed more specific NCCI PTP modifiers (XE, XS, XP, XU) as alternatives.
Question 6: A new patient office visit requires documentation of which of the following under 2021 E/M guidelines?
- Comprehensive history and comprehensive physical exam
- Medical decision making or total time, with a minimum problem-focused history
- Medical decision making or total time on date of encounter (Correct answer)
- High-complexity MDM regardless of time
Correct answer: Medical decision making or total time on date of encounter
Under 2021 guidelines, office E/M levels for new and established patients are selected based on MDM or total time.
The 2021 AMA E/M revisions eliminated the three-component approach (history, exam, MDM) for office and outpatient visits. Now, the E/M level is determined by either the level of medical decision making or the total time spent by the reporting physician/other qualified health professional on the date of the encounter. This applies to both new (99202-99205) and established (99211-99215) patients.
Question 7: CPT modifier -TC indicates what?
- Technical component only (Correct answer)
- Telephone consultation
- Terminated procedure
- Total care provided
Correct answer: Technical component only
Modifier -TC indicates the technical component of a diagnostic service was performed.
Modifier -TC (Technical Component) is used to report only the technical portion of a diagnostic service — the equipment, supplies, and non-physician personnel involved. This is used when the facility or non-physician entity performed the test but did not provide the interpretation. The professional component (physician interpretation) is billed separately with modifier -26. When a physician performs and interprets the study in a non-facility setting, no modifier is needed (global billing).
Question 8: Which CPT code is used for an initial hospital care visit with high medical decision making?
- 99221
- 99223 (Correct answer)
- 99231
- 99222
Correct answer: 99223
99223 is the highest-level initial hospital inpatient or observation care code, requiring high MDM or 75 or more minutes.
CPT codes 99221-99223 are initial hospital inpatient and observation care codes. Code 99221 represents straightforward or low MDM (or 40+ minutes), 99222 represents moderate MDM (or 55+ minutes), and 99223 represents high MDM (or 75+ minutes). Under 2023 revisions, inpatient E/M levels are also now selected based on MDM or time, similar to the 2021 office visit revisions.
CBCS CPT Procedure Coding 2
What CPT modifier is appended when a service is reduced or eliminated at the physician's discretion?