CPT and HCPCS Code Assignment Flashcards
6 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CPT and HCPCS Code Assignment flashcards as text
What does CPT stand for in the context of medical procedure coding?
Answer: Current Procedural Terminology
CPT stands for Current Procedural Terminology. It is a code set maintained by the American Medical Association (AMA) used to report medical, surgical, and diagnostic procedures and services, primarily in outpatient and physician settings.
HCPCS Level II codes are alphanumeric codes maintained by CMS primarily used to report which of the following?
Answer: Durable medical equipment, prosthetics, orthotics, supplies, and services not found in CPT
HCPCS Level II codes (e.g., A-codes for supplies, E-codes for DME, J-codes for injectable drugs) are CMS-maintained alphanumeric codes that cover items and services not represented in CPT, most commonly durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
In the outpatient hospital facility setting, CPT codes drive reimbursement under which Medicare payment system?
Answer: Ambulatory Payment Classifications (APCs)
Outpatient hospital services billed by facilities to Medicare are reimbursed through the Outpatient Prospective Payment System (OPPS), which groups services into Ambulatory Payment Classifications (APCs) based on CPT codes. RBRVS is used for physician professional fees, not facility payments.
An operative report documents 'excision of a 2.3 cm benign lesion of the back,' but the coder assigned a CPT code for destruction of the lesion. What is the most appropriate action for the CDI specialist?
Answer: Communicate with the coding/HIM staff to review the documentation and resolve the discrepancy
Excision (removal with margins) and destruction (ablation of tissue) are distinct CPT procedures with different codes and reimbursement levels. The CDI specialist's role is to facilitate resolution by communicating with coding/HIM staff — not to change codes unilaterally or alter physician documentation to match an incorrect code.
A physician documents 'intravenous infusion of therapeutic drug' without specifying the drug name or infusion duration. Why does this documentation gap matter for CPT coding?
Answer: CPT infusion codes require the drug identity and total infusion time to select the correct code, making a query to the physician appropriate
CPT infusion codes (e.g., 96365–96368 for therapeutic infusions) are selected based on the drug administered and the duration of infusion. Without this information, the correct code cannot be determined. A compliant, non-leading query to the physician or nursing staff to clarify these details is appropriate.
Which of the following statements correctly distinguishes CPT Category I codes from Category III codes?
Answer: Category III codes are temporary, five-digit T-codes for new and emerging technologies and services that may lack sufficient data for permanent Category I status
CPT Category III codes are temporary tracking codes (formatted as four digits plus the letter T) used for emerging technologies, services, and procedures. They allow data collection that may support eventual promotion to permanent Category I status. Category I codes represent established procedures with documented clinical efficacy and significant utilization.