CCS CCS CPT & HCPCS Procedure Coding 1 — Questions and Answers
Question 1: CPT codes are maintained and published by which organization?
- Centers for Medicare & Medicaid Services (CMS)
- American Health Information Management Association (AHIMA)
- American Medical Association (AMA) (Correct answer)
- World Health Organization (WHO)
Correct answer: American Medical Association (AMA)
The American Medical Association (AMA) owns, maintains, and annually updates the CPT code set.
Question 2: What is the purpose of CPT modifier -25?
- Indicates a reduced service was performed
- Indicates a significant, separately identifiable E/M service was performed by the same physician on the same day as a procedure (Correct answer)
- Indicates a bilateral procedure
- Indicates the procedure was performed by a different provider
Correct answer: Indicates a significant, separately identifiable E/M service was performed by the same physician on the same day as a procedure
Modifier -25 is appended to an E/M code to indicate that a separate, significant E/M service was provided on the same day as a procedure or service.
Question 3: HCPCS Level II codes are used primarily to report:
- Physician services coded in CPT
- Medical supplies, durable medical equipment, drugs, and services not covered by CPT (Correct answer)
- Inpatient hospital procedures
- ICD-10-PCS procedure codes
Correct answer: Medical supplies, durable medical equipment, drugs, and services not covered by CPT
HCPCS Level II codes cover supplies, equipment, drugs, ambulance services, and other items not captured by CPT codes.
Question 4: The 'global surgical package' concept in CPT means:
- All procedures are bundled into one payment regardless of complexity
- The surgical fee includes pre-operative, intra-operative, and post-operative services for a defined period (Correct answer)
- Global billing requires use of a modifier on all surgical codes
- Only the surgeon's fee is included in the package
Correct answer: The surgical fee includes pre-operative, intra-operative, and post-operative services for a defined period
The global surgical package bundles the surgeon's pre-op evaluation, the procedure itself, and post-op care within the defined global period into one fee.
Question 5: 'Unbundling' in CPT coding refers to:
- Combining multiple codes into one comprehensive code
- Separately coding components of a procedure that should be reported with a single comprehensive code (Correct answer)
- Using modifiers to reduce payment for a service
- Splitting E/M services across multiple dates
Correct answer: Separately coding components of a procedure that should be reported with a single comprehensive code
Unbundling is the improper practice of billing multiple component codes separately when a single comprehensive CPT code exists to describe the complete service.
Question 6: CPT add-on codes (identified by a '+' symbol) must:
- Always be used alone as a standalone code
- Be reported in conjunction with the primary procedure code they supplement and cannot be reported alone (Correct answer)
- Be reported only with a modifier -51
- Apply exclusively to E/M services
Correct answer: Be reported in conjunction with the primary procedure code they supplement and cannot be reported alone
CPT add-on codes represent additional work performed alongside a primary procedure and are never reported as standalone codes.
CCS CCS CPT & HCPCS Procedure Coding 1
CPT codes are maintained and published by which organization?