CCS Outpatient & Ambulatory Coding (CPT/APC)

Question 1

In hospital outpatient coding, what is the OPPS 'packaging' concept?

Accepted Answer

Certain ancillary services (labs, minor drugs, supplies) are packaged into the APC payment for the primary service and not separately payable

Answer

Bundling all services from multiple visits into one monthly claim

Answer

Grouping outpatient claims by diagnosis for quality reporting

Answer

Combining all physician and facility charges onto a single claim form

Question 2

According to CPT coding guidelines, what is the definition of a 'new patient' for E/M office visits?

Accepted Answer

A patient who has not received professional services from the physician or another physician of the same specialty in the same group practice within the past 3 years

Answer

A patient who has never seen any physician in their life

Answer

A patient presenting for the first time to the current facility

Answer

A patient who has changed insurance plans within the past year

Question 3

Under the 2023 CPT E/M guidelines for outpatient office visits, what are the two elements used to select the level of service?

Accepted Answer

Medical decision making (MDM) or total time on the date of encounter

Answer

History and physical examination

Answer

Chief complaint and review of systems

Answer

Number of diagnoses and diagnostic tests ordered

Question 4

Which modifier is appended to a CPT code to indicate a service was a distinct procedural service separate from another procedure performed the same day?

Accepted Answer

Modifier -59

Answer

Modifier -22

Answer

Modifier -51

Answer

Modifier -25

Question 5

In hospital outpatient coding, the 'significant, separately identifiable E/M service' performed the same day as a procedure is reported with which modifier?

Accepted Answer

-25

Answer

-57

Answer

-59

Answer

-91

Question 6

Under OPPS, which type of service is assigned to 'APC status indicator V'?

Accepted Answer

Clinic or emergency department visit - paid under the visit APC

Answer

Packaged service - no separate APC payment

Answer

Significant procedure - paid under a procedure APC

Answer

Device-dependent procedure requiring cost report settlement