COBGC COBGC Modifiers and Special Billing 2 — Questions and Answers
Question 1: Modifier 25 is appended to an E&M code to indicate what?
- A significant, separately identifiable E&M on the same day as a procedure (Correct answer)
- A reduced E&M service
- A bilateral service
- An unrelated procedure
Correct answer: A significant, separately identifiable E&M on the same day as a procedure
Modifier 25 indicates the E&M service was significant, separately identifiable, and above and beyond the care associated with the same-day procedure.
Question 2: Which HCPCS modifier indicates that a PA, NP, or CNS acted as assistant surgeon?
- Modifier AS (Correct answer)
- Modifier 80
- Modifier 82
- Modifier 81
Correct answer: Modifier AS
HCPCS modifier AS is used specifically when a physician assistant, nurse practitioner, or clinical nurse specialist serves as assistant at surgery.
Question 3: When a procedure is performed during the global period of a prior surgery for an unrelated condition, which modifier is used?
- Modifier 79 (Correct answer)
- Modifier 78
- Modifier 58
- Modifier 24
Correct answer: Modifier 79
Modifier 79 indicates the service is unrelated to the original procedure and performed during its postoperative global period.
Question 4: Which modifier indicates a return to the operating room during the postoperative period due to a complication related to the original procedure?
- Modifier 78 (Correct answer)
- Modifier 79
- Modifier 76
- Modifier 58
Correct answer: Modifier 78
Modifier 78 is used when a patient returns to the OR during the global period for a complication related to the initial surgery.
Question 5: The global obstetric package for vaginal delivery (CPT 59400) includes how many antepartum visits?
- 13 visits (Correct answer)
- 10 visits
- 8 visits
- 7 visits
Correct answer: 13 visits
The global OB package (59400) includes 13 antepartum visits, the delivery, and postpartum care per standard payer guidelines.
Question 6: Which modifier indicates the same procedure was repeated by the same physician on the same day?
- Modifier 76 (Correct answer)
- Modifier 77
- Modifier 91
- Modifier 59
Correct answer: Modifier 76
Modifier 76 is appended when the same physician repeats the same procedure on the same day; Modifier 77 is used when a different physician repeats it.
COBGC COBGC Modifiers and Special Billing 2
Modifier 25 is appended to an E&M code to indicate what?