CCS Outpatient & Ambulatory Coding (CPT/APC)

Question 1

In hospital outpatient coding, what is the OPPS 'packaging' concept?

Accepted Answer

Certain ancillary services (labs, minor drugs, supplies) are packaged into the APC payment for the primary service and not separately payable

Answer

Under OPPS packaging, certain ancillary items and services - such as minor laboratory tests, low-cost drugs, and supplies - are bundled into the APC payment for the primary procedure and are not separately reimbursed.

Question 2

According to CPT coding guidelines, what is the definition of a 'new patient' for E/M office visits?

Accepted Answer

A patient who has not received professional services from the physician or another physician of the same specialty in the same group practice within the past 3 years

Answer

CPT defines a new patient as one who has not received professional services from the physician, or another physician of the same exact specialty and subspecialty in the same group practice, within the past 3 years.

Question 3

Under the 2023 CPT E/M guidelines for outpatient office visits, what are the two elements used to select the level of service?

Accepted Answer

Medical decision making (MDM) or total time on the date of encounter

Answer

The revised CPT 2021+ E/M guidelines for office/outpatient visits base code selection on either Medical Decision Making (MDM) or total time spent on the date of service - history and exam are no longer separately scored.

Question 4

Which modifier is appended to a CPT code to indicate a service was a distinct procedural service separate from another procedure performed the same day?

Accepted Answer

Modifier -59

Answer

Modifier -59 (Distinct Procedural Service) indicates that a procedure or service is distinct or independent from other services performed on the same day - overriding bundling edits when the services are truly separate.

Question 5

In hospital outpatient coding, the 'significant, separately identifiable E/M service' performed the same day as a procedure is reported with which modifier?

Accepted Answer

-25

Answer

Modifier -25 is appended to the E/M code to indicate that a significant, separately identifiable E/M service was performed by the same physician on the same day as a procedure or other service.

(CCS) Certified Coding Specialist Practice Test

(CCS) Certified Coding Specialist Practice Test

CCS Outpatient & Ambulatory Coding (CPT/APC)