Certified Medical Coding Specialist CPT Procedure Coding 2 — Questions and Answers
Question 1: CPT modifier -25 is used when:
- A significant, separately identifiable E/M service is performed on the same day as a procedure (Correct answer)
- A procedure is performed by a different physician
- A procedure requires unusual anesthesia
- Services are provided in two separate locations
Correct answer: A significant, separately identifiable E/M service is performed on the same day as a procedure
Modifier -25 indicates that a significant, separately identifiable E/M service was provided by the same physician on the same day as a minor procedure.
Question 2: What does the surgical package (global surgical package) in CPT include?
- Pre-operative care, the surgery itself, and standard post-operative care (Correct answer)
- Only the surgical procedure itself
- All hospital services during the admission
- Only post-operative follow-up visits
Correct answer: Pre-operative care, the surgery itself, and standard post-operative care
The CPT global surgical package includes pre-operative visits (day of surgery), the intraoperative service, and standard uncomplicated post-operative care.
Question 3: Which CPT modifier indicates that a procedure was performed bilaterally?
- -50 (Correct answer)
- -51
- -52
- -53
Correct answer: -50
Modifier -50 is used to report bilateral procedures performed at the same operative session when the procedure code does not already indicate bilateral.
Question 4: Unbundling in CPT coding refers to:
- Reporting multiple codes for components of a procedure that should be reported with one comprehensive code (Correct answer)
- Reporting one code for multiple procedures
- Adding unnecessary modifiers
- Upcoding a service
Correct answer: Reporting multiple codes for components of a procedure that should be reported with one comprehensive code
Unbundling is the improper practice of billing separate CPT codes for individual components of a procedure that is correctly reported with a single comprehensive code.
Question 5: The National Correct Coding Initiative (NCCI) edits are designed to:
- Prevent improper payment of services that should not be reported together (Correct answer)
- Require prior authorization for procedures
- Determine medical necessity
- Assign ASA units for anesthesia
Correct answer: Prevent improper payment of services that should not be reported together
NCCI edits consist of procedure-to-procedure code pairs that Medicare and other payers use to prevent unbundling and improper code combinations.
Question 6: Which CPT modifier is used when a procedure is discontinued after anesthesia administration?
- -53 (Correct answer)
- -52
- -74
- -73
Correct answer: -53
Modifier -53 is used when a physician elects to terminate a surgical or diagnostic procedure after the patient has been prepared and anesthesia administered.
Certified Medical Coding Specialist CPT Procedure Coding 2
CPT modifier -25 is used when: