CPCA Modifier Use in Dermatology — Questions and Answers

Question 1: A dermatologist performs a shave removal of a benign lesion on the back and, during the same session, destroys a premalignant actinic keratosis on the forearm. Which modifier is appended to the destruction code?

Modifier 51 (Correct answer)
Modifier 59
Modifier 25
Modifier 79

Correct answer: Modifier 51

Modifier 51 is used when multiple procedures are performed during the same operative session by the same physician.

Question 2: When a physician performs a biopsy and then a more definitive excision of the same lesion during the same encounter, which modifier allows separate billing for the biopsy?

Modifier 58
Modifier 59 (Correct answer)
Modifier 79
Modifier 78

Correct answer: Modifier 59

Modifier 59 indicates a distinct procedural service, allowing the biopsy to be billed separately from the excision performed at the same encounter.

Question 3: A patient has a malignant melanoma excised with a 2 cm margin from the right cheek. The surgeon also excises a basal cell carcinoma from the left cheek during the same session. What modifier is added to the second excision code?

Modifier 50
Modifier 51 (Correct answer)
Modifier 25
Modifier RT/LT

Correct answer: Modifier 51

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

Question 4: Modifier 52 is used in dermatology coding when:

A procedure is performed bilaterally
A procedure is performed at a reduced level of service (Correct answer)
An unplanned return to the OR occurs
A staged procedure is planned

Correct answer: A procedure is performed at a reduced level of service

Modifier 52 indicates that a service or procedure was partially reduced or eliminated at the physician's discretion.

Question 5: A dermatologist excises a squamous cell carcinoma from the scalp and repairs the wound with an adjacent tissue transfer. How should the repair be billed?

It is bundled into the excision code
Bill separately with modifier 51
Bill separately without a modifier (Correct answer)
Bill separately with modifier 59

Correct answer: Bill separately without a modifier

Adjacent tissue transfer or rearrangement repairs are separately billable from excision codes without an additional modifier because they are not considered bundled services.

Question 6: Which modifier would be appended to indicate that a procedure performed during a global period was unrelated to the original surgery?

Modifier 78
Modifier 79 (Correct answer)
Modifier 58
Modifier 24

Correct answer: Modifier 79

Modifier 79 indicates an unrelated procedure or service performed by the same physician during the postoperative period.

Question 7: A patient returns within the global period after a skin excision for a wound dehiscence repair. The repair is directly related to the original procedure. Which modifier applies?

Modifier 79
Modifier 24
Modifier 78 (Correct answer)
Modifier 58

Correct answer: Modifier 78

Modifier 78 is used for an unplanned return to the OR for a related procedure during the postoperative period.

Question 8: In dermatology, modifier 25 is appended to an E/M service code when:

The E/M is performed on a different date than the procedure
A significant, separately identifiable E/M is performed on the same day as a minor procedure (Correct answer)
The patient is seen for a follow-up within the global period
The E/M involves a new patient

Correct answer: A significant, separately identifiable E/M is performed on the same day as a minor procedure

Modifier 25 signals that a significant, separately identifiable evaluation and management service was provided on the same day as a procedure.

Question 9: A patient presents for destruction of multiple actinic keratoses. Five lesions are treated. How are the additional lesions (beyond the first) coded?

Each is billed with a separate CPT code and modifier 51
Additional lesions are included in the base code without separate billing
Additional lesions are reported with add-on codes (Correct answer)
Each additional lesion requires modifier 59

Correct answer: Additional lesions are reported with add-on codes

CPT includes add-on codes (e.g., 17003) for each additional actinic keratosis destroyed beyond the first two, which do not require modifier 51.

Question 10: When coding Mohs surgery, modifier 51 is NOT added to additional Mohs stage codes because:

Mohs stages are billed to different payers
Add-on codes are exempt from modifier 51 (Correct answer)
Mohs surgery is never billed with other procedures
Modifier 51 only applies to E/M codes

Correct answer: Add-on codes are exempt from modifier 51

Add-on codes, including those for additional Mohs stages, are inherently exempt from modifier 51 per CPT guidelines.

Question 11: A patient undergoes excision of a cyst on the neck and a separate excision of a lipoma on the back in the same session. Which modifier is required on the second procedure?

Modifier 59
Modifier 51 (Correct answer)
Modifier 52
Modifier 22

Correct answer: Modifier 51

Modifier 51 is appended to the second and subsequent procedures when multiple surgical procedures are performed at the same session by the same surgeon.

Question 12: Modifier 22 in dermatology is used to indicate:

A procedure performed on a newborn
Increased procedural services beyond what is usually required (Correct answer)
Bilateral procedures
A reduced service level

Correct answer: Increased procedural services beyond what is usually required

Modifier 22 is appended when the work required to perform the procedure is substantially greater than typically required, justifying additional reimbursement.

Question 13: Which modifier is used when the same procedure is performed on both the right and left sides of the body in dermatology?

Modifier 51
Modifier 50 (Correct answer)
Modifier 59
Modifier 52

Correct answer: Modifier 50

Modifier 50 is used to report bilateral procedures performed during the same operative session.

Question 14: A dermatologist sees a patient for follow-up within the 10-day global period of a shave removal and identifies and treats a new, unrelated skin infection. How should the E/M service be billed?

It cannot be billed separately during the global period
Bill with modifier 24 to indicate an unrelated E/M during the postoperative period (Correct answer)
Bill with modifier 25
Bill with modifier 79

Correct answer: Bill with modifier 24 to indicate an unrelated E/M during the postoperative period

Modifier 24 is used for an unrelated evaluation and management service provided during a postoperative period.

Question 15: When a dermatologist performs a simple repair of a wound that is separate from an excision site during the same session, which scenario MOST accurately describes billing?

The repair is always bundled with the excision
Simple repairs are bundled into the excision code; only intermediate or complex repairs may be billed separately (Correct answer)
Bill the repair with modifier 51 regardless of complexity
Bill the repair with modifier 59

Correct answer: Simple repairs are bundled into the excision code; only intermediate or complex repairs may be billed separately

Per CPT bundling rules, simple (linear) closures are included in excision codes; intermediate or complex repairs at a different site may be billed separately.

Question 16: A patient has a staged excision: the first stage is performed today and the second stage is planned. Which modifier is used for the second stage?

Modifier 78
Modifier 79
Modifier 58 (Correct answer)
Modifier 76

Correct answer: Modifier 58

Modifier 58 indicates a staged or related procedure performed during the postoperative period of the initial procedure.

Question 17: Which of the following best describes the use of modifier 47 in dermatology?

Anesthesia by the operating surgeon (Correct answer)
Reduced services by the surgeon
Bilateral procedure
Unusual anesthesia

Correct answer: Anesthesia by the operating surgeon

Modifier 47 indicates that regional or general anesthesia was provided by the operating surgeon, not a separate anesthesiologist.

Question 18: A dermatopathologist performs a histologic examination of two separately submitted skin specimens from the same patient. How is this billed?

Only one unit of the pathology code is billed
Two units of the pathology code are billed with modifier 59 on the second
Two units of the pathology code are billed without a modifier (Correct answer)
Bill with modifier 51 on the second specimen

Correct answer: Two units of the pathology code are billed without a modifier

Each separately submitted specimen is billed as a separate unit of the pathology code; modifier 59 is not required when separate containers are submitted.

Question 19: Modifier 76 in dermatology is used when:

A different physician repeats a procedure during the global period
The same physician repeats the same procedure on the same day (Correct answer)
A procedure is performed on the same lesion in a subsequent encounter
A procedure is staged and planned

Correct answer: The same physician repeats the same procedure on the same day

Modifier 76 is appended when the same physician repeats the same procedure or service on the same date.

Question 20: A patient's excision of a malignant lesion requires significantly more time and complexity due to involvement of underlying fascia. Which modifier best captures this?

Modifier 22 (Correct answer)
Modifier 52
Modifier 51
Modifier 59

Correct answer: Modifier 22

Modifier 22 indicates increased procedural services when the work is substantially greater than typically required for the procedure.

Question 21: For Medicare patients, which modifier must be appended to an E/M code billed on the same day as a minor dermatological procedure to ensure separate payment?

Modifier 59
Modifier 51
Modifier 25 (Correct answer)
Modifier 24

Correct answer: Modifier 25

Modifier 25 must be appended to the E/M code to indicate it is a significant, separately identifiable service from a minor procedure performed on the same day.

CPCA Modifier Use in Dermatology

A dermatologist performs a shave removal of a benign lesion on the back and, during the same session, destroys a premalignant actinic keratosis on the forearm.
Which modifier is appended to the destruction code?

🃏 CPCA Flashcards — Study This Quiz as Flip Cards →

📚 Want to go deeper? Read the Full CPCA Study Guide →

What Practice Test Geeks adds beyond an AI chat for CPCA

An AI chatbot can quiz you, but it can't reproduce the exam conditions or keep your record. Here you get:

A timed, full-length CPCA mock exam — 100 questions in 120 minutes with a 70% pass mark, modeled on the official exam's question count and time limit, followed by a score report broken down by exam domain.
A fixed CPCA question bank: the same test every attempt, so your score is comparable from one try to the next instead of changing with every regenerated quiz.
Progress saved on your device: completed tests, scores and missed questions stay in My Progress, so you can retake only what you got wrong.
A printable CPCA cheat sheet you can print or save as a PDF.
CPCA flashcards built from the same question bank.

Start the Timed CPCA Mock Exam →

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

knowledgebase.policeapp.com — Passing score, score release · verified Oct 2026
policeapp.com — Eligibility, fees, renewal, retake fee, retake policy, score validity · verified Oct 2026
cpcanet.org — Test delivery · verified Oct 2026