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

When multiple arthroscopic procedures are performed in the same joint during the same session, both are coded; modifier -59 or an XS modifier may be required based on payer edits.

Question 2

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

Accepted Answer

Professional component only

Answer

When a non-radiologist physician reviews and interprets an image and documents findings, they may bill the professional component (modifier -26) of the radiology code.

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

An assistant surgeon who assists throughout an operative procedure bills the same CPT code with modifier -80 (Assistant Surgeon).

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

To support prolonged service codes, the physician must document the start and stop times of face-to-face time with the patient.

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

A pre-operative consultation for a new problem by a different physician is not part of the global surgical package and may be separately billed.

(CPC) Certified Procedural Coder Practice Test

(CPC) Certified Procedural Coder Practice Test

CPC Procedure Coding & Documentation 4