CPC Procedure Coding & Documentation 4

Question 1

A patient undergoes arthroscopic surgery of the knee; the surgeon also performs an arthroscopic chondroplasty during the same session. How is this coded?

Accepted Answer

Both arthroscopic procedures; modifier -59 may apply per payer

Answer

Only the primary arthroscopic procedure

Answer

Both arthroscopic procedures with modifier -51 on the secondary

Answer

The chondroplasty only, as it is the more complex procedure

Question 2

Physician documentation states 'I reviewed the X-ray personally.' For radiology coding, this supports:

Accepted Answer

Professional component only

Answer

Technical component only

Answer

Global billing

Answer

No reimbursement — radiologist must read all films

Question 3

A surgeon performs a total knee replacement and the assistant surgeon actively assists throughout. How should the assistant surgeon bill?

Accepted Answer

Same CPT code with modifier -80

Answer

Separate E/M code for consulting on the case

Answer

Same CPT code with modifier -62 (co-surgeon)

Answer

No separate billing is allowed for assistant surgeons

Question 4

Which documentation element is essential when billing prolonged services with modifier -99?

Accepted Answer

Start and stop times of direct patient contact

Answer

Patient's insurance card number

Answer

The attending physician's NPI

Answer

The number of diagnoses addressed

Question 5

Under the global surgical package, which service is NOT included in the global period?

Accepted Answer

Initial pre-operative consultation (new problem, not same surgeon)

Answer

Postoperative E/M visits related to the surgery

Answer

Complications managed without return to the OR

Answer

Suture removal by the operating surgeon

Question 6

What is the purpose of the CMS-1500 Block 24D on a claim form?

Accepted Answer

CPT/HCPCS procedure code and modifier

Answer

Diagnosis pointer linking procedure to diagnosis

Answer

Date of service

Answer

Rendering provider NPI

Question 7

A patient has a biopsy of a skin lesion, and the pathology report returns malignant. The physician then excises the lesion at a later date. How are these coded?

Accepted Answer

Biopsy coded on its date; excision coded on its date — separate encounters

Answer

Biopsy and excision coded together on the date of excision

Answer

Only the excision is coded; biopsy is bundled regardless of date

Answer

Excision with modifier -58 if within the global period of the biopsy