CDIP CPT and HCPCS Code Assignment

Question 1

What does CPT stand for in the context of medical procedure coding?

Accepted Answer

Current Procedural Terminology

Answer

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.

Question 2

HCPCS Level II codes are alphanumeric codes maintained by CMS primarily used to report which of the following?

Accepted Answer

Durable medical equipment, prosthetics, orthotics, supplies, and services not found in CPT

Answer

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).

Question 3

In the outpatient hospital facility setting, CPT codes drive reimbursement under which Medicare payment system?

Accepted Answer

Ambulatory Payment Classifications (APCs)

Answer

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.

Question 4

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?

Accepted Answer

Communicate with the coding/HIM staff to review the documentation and resolve the discrepancy

Answer

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.

Question 5

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?

Accepted Answer

CPT infusion codes require the drug identity and total infusion time to select the correct code, making a query to the physician appropriate

Answer

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.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP CPT and HCPCS Code Assignment