CPC Practice 5 — Questions and Answers
Question 1: Which of the following best describes the 'correct coding initiative' (CCI) edits?
- A list of codes requiring prior authorization
- Automated prepayment edits preventing improper code combinations from being billed together (Correct answer)
- A set of modifiers used to bypass bundling
- Guidelines for sequencing diagnosis codes
Correct answer: Automated prepayment edits preventing improper code combinations from being billed together
CCI (Correct Coding Initiative) edits are CMS automated prepayment edits that prevent improper billing of code combinations that are considered mutually exclusive or bundled.
Question 2: A patient has a confirmed HIV infection and also presents with Pneumocystis pneumonia. Which is the correct coding approach?
- Code only B20 (HIV disease)
- Code only the Pneumocystis pneumonia
- Code B20 first, followed by a code for the Pneumocystis pneumonia (Correct answer)
- Code the Pneumocystis pneumonia first, then B20
Correct answer: Code B20 first, followed by a code for the Pneumocystis pneumonia
ICD-10-CM guidelines instruct sequencing B20 (HIV disease) first, followed by additional codes for all associated conditions.
Question 3: Modifier -25 is used to indicate what?
- A procedure was discontinued after anesthesia
- A significant, separately identifiable E/M service was performed on the same day as a procedure (Correct answer)
- A service was performed by two surgeons
- The procedure was unrelated to the postoperative diagnosis
Correct answer: A significant, separately identifiable E/M service was 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 procedure or other service.
Question 4: Which of the following is true regarding CPT add-on codes?
- They can be reported alone without a primary code
- They are always reported with modifier -51
- They are reported in addition to the primary procedure and never reported alone (Correct answer)
- They replace the primary procedure code
Correct answer: They are reported in addition to the primary procedure and never reported alone
CPT add-on codes (marked with a '+') are always reported with a primary procedure code and cannot be used as stand-alone codes.
Question 5: A patient sustains a fracture of the right distal radius in a car accident. The accident occurred in a parking lot. Which external cause code category would be used?
- V49 (Car occupant injured in other transport accidents)
- W18 (Other slipping, tripping, stumbling falls)
- V03 (Pedestrian injured in collision with car)
- V47 (Car occupant injured in collision with fixed or stationary object) (Correct answer)
Correct answer: V47 (Car occupant injured in collision with fixed or stationary object)
A collision in a parking lot involving a car hitting a fixed or stationary object falls under category V47 for the car occupant.
Question 6: Which of the following describes a 'cross-reference' instruction in ICD-10-CM?
- An instruction to add more digits to a code
- Directions such as 'See,' 'See also,' or 'See condition' guiding the coder to the correct term (Correct answer)
- A note listing codes that cannot be used together
- An instruction to sequence a code as secondary
Correct answer: Directions such as 'See,' 'See also,' or 'See condition' guiding the coder to the correct term
Cross-reference instructions in the ICD-10-CM Index, such as 'See' and 'See also,' redirect coders to the most appropriate main term or code.
Question 7: For a procedure performed in an ambulatory surgery center (ASC), which coding system determines the facility payment?
- ICD-10-PCS with MS-DRGs
- CPT/HCPCS with ASC payment groups (Correct answer)
- Revenue codes only
- Charge Description Master (CDM) rates exclusively
Correct answer: CPT/HCPCS with ASC payment groups
ASC payments are based on CPT and HCPCS codes, which are grouped into ASC payment groups under the Medicare ASC payment system.
CPC Practice 5
Which of the following best describes the 'correct coding initiative' (CCI) edits?