Certified Professional Coder Flashcards

Which official guideline governs ICD-10-CM coding and must be followed by all coders?

Answer: ICD-10-CM Official Guidelines for Coding and Reporting

The ICD-10-CM Official Guidelines for Coding and Reporting, published annually, are the authoritative source for correct diagnosis coding.

A patient is admitted for a fracture repair. The coder finds a sign/symptom code and a definitive diagnosis code for the same condition. Which should be reported?

Answer: The definitive diagnosis code only

When a definitive diagnosis is established, ICD-10-CM guidelines instruct coders to report the definitive diagnosis rather than the signs or symptoms that led to the diagnosis.

Modifier -51 is used to indicate:

Answer: Multiple procedures were performed during the same operative session

Modifier -51 is appended to secondary procedures to indicate that multiple procedures were performed at the same operative session.

When coding an outpatient encounter, which diagnosis should be reported as the first-listed diagnosis?

Answer: The condition established after study to be chiefly responsible for the visit

For outpatient services, the first-listed diagnosis is the condition, after study, found to be chiefly responsible for the services provided during the encounter.

A coder is unsure how to assign a CPT code and checks the CPT Index. Which action should follow finding a term in the index?

Answer: Go directly to the listed code range in the tabular section to verify

The CPT Index directs coders to a possible code or range; coders must always verify the correct code by reading the full description in the tabular section.

Which type of E/M service is reported when a physician provides advice to another physician via telephone regarding a patient who is not present?

Answer: Interprofessional telephone/internet consultation (99446–99452)

CPT codes 99446–99452 are used for interprofessional telephone or internet consultations between physicians regarding a patient's condition.

What is the purpose of the NCCI (National Correct Coding Initiative) edits?

Answer: To prevent improper payment of procedure code pairs that should not be billed together

NCCI edits are CMS-developed code pair edits that prevent unbundling by identifying procedure combinations that should not be reported together.