CPC Knowledge Skill 4 — Questions and Answers
Question 1: A physician performs a diagnostic colonoscopy and removes a polyp during the same session. How should this be coded?
- Code only the colonoscopy with polypectomy (Correct answer)
- Code the diagnostic colonoscopy and the polypectomy separately
- Code only the diagnostic colonoscopy
- Code the polypectomy with modifier -52
Correct answer: Code only the colonoscopy with polypectomy
When a therapeutic service is performed during a procedure that started as diagnostic, only the therapeutic (higher-level) code is reported.
Question 2: Under the outpatient coding guidelines, the coder should code the condition to the highest degree of certainty when:
- The physician documents 'probable' or 'suspected' diagnosis
- A definitive diagnosis has been established and documented (Correct answer)
- The patient is admitted to the hospital
- Laboratory results are still pending
Correct answer: A definitive diagnosis has been established and documented
For outpatient encounters, only confirmed diagnoses should be coded; uncertain conditions are coded to the presenting sign or symptom.
Question 3: Which of the following best describes a 'global surgical package'?
- A bundle of unrelated services billed on the same day
- Pre-operative, intra-operative, and standard post-operative care included in one surgical fee (Correct answer)
- All services provided during a hospital stay
- A package of E/M and diagnostic service codes
Correct answer: Pre-operative, intra-operative, and standard post-operative care included in one surgical fee
The global surgical package bundles the pre-op visit, the surgery itself, and routine post-op care within the global period into one payment.
Question 4: ICD-10-CM code Z23 is reported to indicate:
- Encounter for screening examination
- Encounter for immunization (Correct answer)
- History of vaccination
- Adverse effect of vaccine
Correct answer: Encounter for immunization
Z23 is used to report an encounter for immunization/vaccination as the reason for the visit.
Question 5: Which type of CPT code requires additional documentation and narrative to identify the service performed?
- Add-on codes
- Unlisted procedure codes (Correct answer)
- Category II codes
- Category III codes
Correct answer: Unlisted procedure codes
Unlisted procedure codes (e.g., 29999) require a special report explaining the nature, extent, and need for the procedure.
Question 6: A coder is reviewing a claim where a physician billed for a high-complexity office visit but the documentation only supports a low-complexity visit. This is an example of:
- Downcoding
- Upcoding (Correct answer)
- Unbundling
- Fragmentation
Correct answer: Upcoding
Upcoding is billing for a higher level of service than the documentation supports, which constitutes fraud.
Question 7: In CPT surgery coding, the term 'incidental appendectomy' during another abdominal procedure is:
- Always coded and billed separately
- Not separately reported unless the appendix was diseased (Correct answer)
- Required to be coded with modifier -51
- Reported only if the patient specifically requests it
Correct answer: Not separately reported unless the appendix was diseased
An incidental appendectomy performed prophylactically during another procedure is not separately billable unless the appendix was diseased.
CPC Knowledge Skill 4
A physician performs a diagnostic colonoscopy and removes a polyp during the same session.
How should this be coded?