Radiology Certified Coder (RCC) — Questions and Answers

Question 1: Which procedure involves injecting contrast into the spinal canal to visualize the spinal cord?

Arteriography
Myelography (Correct answer)
Hysterosalpingography
Cystography

Correct answer: Myelography

Myelography is an imaging procedure that involves injecting a contrast agent directly into the subarachnoid space of the spinal canal. This allows for clear visualization of the spinal cord, nerve roots, and surrounding structures, helping to diagnose conditions affecting the spinal column. The contrast highlights abnormalities that might not be visible on standard X-rays.

Question 2: Which process verifies a patient's insurance eligibility and benefits before a radiology service is performed?

Remittance posting
Claims adjudication
Charge capture
Pre-authorization/pre-certification and eligibility verification (Correct answer)

Correct answer: Pre-authorization/pre-certification and eligibility verification

Eligibility and benefits verification, along with pre-authorization, confirms coverage before service delivery.

Question 3: Which imaging modality uses ionizing radiation to create cross-sectional images of the body?

PET Scan
CT Scan (Correct answer)
Ultrasound
MRI

Correct answer: CT Scan

A CT (Computed Tomography) scan uses X-rays (ionizing radiation) from multiple angles to create detailed cross-sectional images of organs, bones, soft tissues, and blood vessels. Unlike MRI or ultrasound, CT scans rely on radiation to generate these images. This makes ionizing radiation a key characteristic of this imaging modality.

Question 4: A radiologist reads a two-view lumbar spine X-ray. Which CPT code applies?

72110
72100 (Correct answer)
72120
72114

Correct answer: 72100

CPT 72100 describes a two-view radiograph of the lumbar spine.

Question 5: Which code set is used alongside ICD-10-CM to capture external causes for injury-related radiology studies?

S codes only
R codes
Z codes
V00–Y99 External Cause codes (Correct answer)

Correct answer: V00–Y99 External Cause codes

External cause codes (V00–Y99) are used to document how, where, and the activity at time of injury.

Question 6: Which type of iodinated contrast media is associated with a lower risk of adverse reactions due to its osmolality being closer to that of blood?

High-osmolality contrast media (HOCM)
Ionic contrast media
Low-osmolality contrast media (LOCM) (Correct answer)
Barium sulfate suspension

Correct answer: Low-osmolality contrast media (LOCM)

Low-osmolality contrast media (LOCM) has osmolality closer to blood plasma and is associated with significantly fewer adverse reactions than high-osmolality ionic contrast media.

Question 7: Which KPI measures the average number of days it takes to collect payment after a service is provided?

First-pass resolution rate
Net collection rate
Denial rate
Days in Accounts Receivable (AR) (Correct answer)

Correct answer: Days in Accounts Receivable (AR)

Days in AR measures the average time from service date to payment receipt, indicating billing efficiency.

Question 8: What is the correct action if a coder notices an incomplete radiology report?

Assign default codes
Ask the provider for clarification (Correct answer)
Leave it uncoded
Code based on similar cases

Correct answer: Ask the provider for clarification

If a coder notices an incomplete radiology report, the correct and ethical action is to query the ordering or performing provider for clarification or additional details. Coding based on assumptions, similar cases, or assigning default codes can lead to inaccurate billing and potential compliance issues. Ensuring documentation fully supports the codes is paramount.

Question 9: A dual-energy X-ray absorptiometry (DEXA) scan is ordered for osteoporosis screening. Which Z code applies?

Z12.31
Z13.820 (Correct answer)
Z13.6
Z13.5

Correct answer: Z13.820

Z13.820 is the ICD-10-CM code for encounter for screening for osteoporosis.

Question 10: Which of the following is the correct term for inflammation of the liver?

Gastritis
Colitis
Hepatitis (Correct answer)
Nephritis

Correct answer: Hepatitis

The medical term "hepatitis" is derived from "hepato-" meaning liver, and "-itis" meaning inflammation. Therefore, hepatitis specifically refers to the inflammation of the liver, which can be caused by various factors such as viral infections, alcohol, or autoimmune diseases. The other options refer to inflammation of different organs.

Question 11: Which ICD-10-CM code category is used for encounters for screening examinations?

R00–R99
Z00–Z99 (Correct answer)
M00–M99
C00–C99

Correct answer: Z00–Z99

ICD-10-CM Z codes (Chapter 21) capture screening examinations and preventive health encounters.

Question 12: Which denial reason code category indicates a claim was denied because the service was not covered under the patient's plan?

CO-4 (Incorrect modifier)
CO-16 (Missing information)
CO-18 (Duplicate claim)
CO-96 (Non-covered charge) (Correct answer)

Correct answer: CO-96 (Non-covered charge)

Claim Adjustment Reason Code CO-96 indicates the service is not covered under the patient's current benefit plan.

Question 13: Prior authorization for advanced imaging studies is most commonly required by which payer type?

Medicaid only
Commercial/private insurers and Medicare Advantage plans (Correct answer)
Traditional Medicare FFS only
TRICARE only

Correct answer: Commercial/private insurers and Medicare Advantage plans

Commercial insurers and Medicare Advantage plans typically require prior authorization for advanced imaging, while traditional Medicare FFS generally does not.

Question 14: Which HCPCS Level II code category covers most low-osmolality iodinated contrast agents used for intravascular injection?

Q codes (Temporary Codes) (Correct answer)
J codes (Drugs Administered Other Than Oral Method)
A codes (Medical and Surgical Supplies)
C codes (Outpatient PPS New Technology)

Correct answer: Q codes (Temporary Codes)

Low-osmolality iodinated contrast agents are reported using Q-codes (temporary HCPCS codes such as Q9965-Q9967), which specify iodine concentration range and are billed per ml administered.

Question 15: Which CPT code is used to report a screening mammogram for one breast?

77065 (Correct answer)
77067
77063
77066

Correct answer: 77065

CPT 77065 reports a screening mammogram for a single breast (unilateral).

Question 16: Which modifier does an interpreting radiologist append to a CPT code when billing only for the professional component (interpretation and report)?

Modifier 26 (Professional Component) (Correct answer)
Modifier 52 (Reduced Services)
Modifier TC (Technical Component)
Modifier 59 (Distinct Procedural Service)

Correct answer: Modifier 26 (Professional Component)

Modifier 26 (Professional Component) is appended when the physician bills only for interpretation and report, separate from the facility's technical component.

Question 17: Why is ethics important in medical coding?

To increase reimbursement
To ensure accurate & lawful coding (Correct answer)
To improve coding speed
To avoid getting audited

Correct answer: To ensure accurate & lawful coding

Ethics in medical coding is paramount because it ensures that codes accurately reflect the services provided and comply with all legal and regulatory requirements. Ethical coding prevents fraudulent billing practices like upcoding or unbundling, protects the financial integrity of healthcare systems, and maintains trust between providers, payers, and patients. It prioritizes accuracy and legality over financial gain or speed.

Question 18: Which CPT code is used to report a PET scan of the whole body?

78813
78812
78816 (Correct answer)
78814

Correct answer: 78816

CPT 78816 reports a whole body PET scan performed with concurrent CT for attenuation correction and anatomic localization.

Question 19: Upcoding in medical billing is considered:

Fraudulent behavior (Correct answer)
A billing strategy
Acceptable if minor
An ethical error

Correct answer: Fraudulent behavior

Upcoding is the illegal and unethical practice of submitting billing codes for a more expensive or complex procedure than was actually performed or documented. This practice is considered healthcare fraud because it intentionally misrepresents the services provided to obtain higher reimbursement, leading to false claims and potential legal penalties. It is not an acceptable billing strategy.

Question 20: What does IMRT stand for in radiation oncology coding?

Intensity-Modulated Radiation Therapy (Correct answer)
Indirect Multifocal Radiation Technique
Internal Mammary Radiation Treatment
Integrated Modality Radiation Targeting

Correct answer: Intensity-Modulated Radiation Therapy

IMRT stands for Intensity-Modulated Radiation Therapy, a precise form of external beam radiation therapy.

Question 21: Which of the following CPT codes is used for fluoroscopy guidance for needle placement?

77012
76942
77021
77002 (Correct answer)

Correct answer: 77002

CPT 77002 reports fluoroscopic guidance for needle placement procedures.

Question 22: CPT code 77336 reports which radiation oncology service?

Brachytherapy applicator placement
Radiation field setup
Continuing medical physics consultation — weekly (Correct answer)
IMRT planning

Correct answer: Continuing medical physics consultation — weekly

CPT 77336 describes continuing medical physics consultation reported weekly during radiation therapy.

Question 23: What does the 7th character 'A' indicate in an ICD-10-CM fracture code?

Delayed healing
Initial encounter for active treatment (Correct answer)
Sequela
Subsequent encounter

Correct answer: Initial encounter for active treatment

The 7th character 'A' designates the initial encounter, used while the patient is receiving active treatment.

Question 24: An MRI is ordered for low back pain. Which ICD-10-CM code is most appropriate?

M51.16
M54.50 (Correct answer)
M47.816
M54.4

Correct answer: M54.50

ICD-10-CM M54.50 reports low back pain, unspecified, when no more specific diagnosis is available.

Question 25: What is the 'conversion factor' in the Medicare Physician Fee Schedule?

The geographic adjustment index
The hospital cost-to-charge ratio
A dollar amount multiplied by total RVUs to determine payment (Correct answer)
The ratio of allowed to billed charges

Correct answer: A dollar amount multiplied by total RVUs to determine payment

The conversion factor is a dollar multiplier applied to total adjusted RVUs to calculate Medicare payment amounts.

Question 26: Which component of the radiology bill should carry the HCPCS contrast media code when a facility and a physician both bill separately for the same imaging study?

Both the professional and technical component claims simultaneously
A separate claim filed under the patient's pharmacy benefit only
The technical component (Modifier TC) or facility claim (Correct answer)
The professional component (Modifier 26) claim filed by the radiologist

Correct answer: The technical component (Modifier TC) or facility claim

Contrast media is a supply consumed by the facility; therefore, the HCPCS contrast code is reported on the technical component or facility claim, not the physician's professional component claim.

Question 27: Medicare requires a written order for which imaging modality before services are rendered?

All advanced imaging under AUC program (Correct answer)
Only X-rays
All imaging over $500
Only MRI studies

Correct answer: All advanced imaging under AUC program

The Appropriate Use Criteria (AUC) program requires ordering physicians to consult AUC for advanced diagnostic imaging including CT, MRI, and nuclear medicine.

Question 28: A Medicare claim is flagged by a Recovery Audit Contractor (RAC). What is the RAC's primary function?

Conduct pre-authorization reviews
Identify and recover improper Medicare payments (Correct answer)
Issue coverage determinations
Process initial claims submissions

Correct answer: Identify and recover improper Medicare payments

RACs are tasked with identifying and recovering improper payments made to healthcare providers under Medicare.

Question 29: A radiology claim denied as 'not medically necessary' should be appealed to which first level under Medicare?

Redetermination by the MAC (Correct answer)
Office of Medicare Hearings & Appeals (OMHA)
Qualified Independent Contractor (QIC)
Medicare Appeals Council

Correct answer: Redetermination by the MAC

The first level of Medicare appeal is Redetermination, filed with the Medicare Administrative Contractor (MAC).

Question 30: Which Medicare program requires radiology providers to report quality measures for payment adjustments?

RAC audit program
MPFS only
MIPS (Merit-based Incentive Payment System) (Correct answer)
OPPS

Correct answer: MIPS (Merit-based Incentive Payment System)

MIPS under MACRA requires eligible clinicians including radiologists to report quality measures affecting payment.

Question 31: Which CPT code range covers radiation treatment management services?

77385–77387
77427–77432 (Correct answer)
77261–77263
77295–77301

Correct answer: 77427–77432

CPT codes 77427–77432 cover radiation treatment management, reported per five treatment sessions.

Question 32: Which structure is responsible for filtering blood in the kidney?

Nephron (Correct answer)
Neuron
Alveolus
Bronchiole

Correct answer: Nephron

The nephron is the microscopic structural and functional unit of the kidney, responsible for filtering blood, reabsorbing essential substances, and excreting waste products. Each kidney contains millions of nephrons, which are vital for maintaining fluid and electrolyte balance in the body. The other options are units of different organ systems.

Question 33: A chest X-ray is ordered for cough. The report shows pneumonia. Which diagnosis code is reported for radiology billing?

Cough (R05.9)
Both cough and pneumonia
No code needed
Pneumonia (J18.9) (Correct answer)

Correct answer: Pneumonia (J18.9)

When a definitive diagnosis is established from imaging, code the confirmed diagnosis rather than the symptom.

Question 34: Which CPT code reports ultrasound guidance for vascular access?

76998
76942
76970
76937 (Correct answer)

Correct answer: 76937

CPT 76937 reports ultrasound guidance for vascular access including permanent image documentation.

Question 35: What Medicare rule limits self-referral for designated health services including radiology?

HIPAA Privacy Rule
Stark Law (Physician Self-Referral Law) (Correct answer)
Anti-Kickback Statute
False Claims Act

Correct answer: Stark Law (Physician Self-Referral Law)

The Stark Law prohibits physicians from referring Medicare patients to entities with which they have a financial relationship for DHS including radiology.

Question 36: A radiologist interprets a CT of the abdomen and pelvis with contrast. Which CPT code should be reported?

74181
74177
74176
74178 (Correct answer)

Correct answer: 74178

CPT 74178 describes combined CT abdomen and pelvis with contrast in a single examination.

Question 37: Which three components make up a Relative Value Unit (RVU)?

Volume, intensity, complexity
CPT code, modifier, diagnosis code
Labor, supplies, overhead
Physician work, practice expense, malpractice expense (Correct answer)

Correct answer: Physician work, practice expense, malpractice expense

RVUs consist of three components: physician work RVU, practice expense RVU, and malpractice (PLI) RVU.

Question 38: Bundling edits prevent separate billing of which two services when performed together?

Imaging guidance and the primary procedure it guides (Correct answer)
Professional and technical components
Two separate imaging modalities on different body parts
Pre-op and post-op X-rays

Correct answer: Imaging guidance and the primary procedure it guides

CCI edits bundle imaging guidance codes with the primary procedures they guide when performed together.

Question 39: When a patient presents for a follow-up imaging study after treatment for a fracture, which 7th character is used?

G – Delayed healing
D – Subsequent encounter (Correct answer)
S – Sequela
A – Initial encounter

Correct answer: D – Subsequent encounter

The 7th character 'D' designates subsequent encounters for routine healing after active treatment is complete.

Question 40: An ultrasound is ordered to evaluate a palpable abdominal mass. No definitive diagnosis is confirmed. What is coded?

Unspecified abdominal neoplasm
Nothing — await pathology
Palpable abdominal mass (R19.00) (Correct answer)
Abdominal pain (R10.9)

Correct answer: Palpable abdominal mass (R19.00)

For outpatient encounters without confirmed diagnoses, the sign or symptom — here, the palpable mass — is coded.

Question 41: Which ICD-10-CM code type is used when imaging is performed on a healthy patient for a preventive service?

S injury codes
Z codes (Correct answer)
E codes
R symptom codes

Correct answer: Z codes

Z codes capture preventive and screening services for patients without a current illness prompting the visit.

Question 42: When coding a contrast reaction during a radiology procedure, which ICD-10-CM category is used?

J68 chemical pneumonia
T80.6 series (Correct answer)
Z79 long-term drug use
T36–T50 drug poisoning

Correct answer: T80.6 series

Adverse effects from contrast media are coded using the T80.6xx series for complications of infusion/injection.

Question 43: In radiology revenue cycle, what does 'charge capture' refer to?

The process of recording all services rendered so they can be billed (Correct answer)
Auditing modifiers for compliance
Reconciling remittance advice with posted payments
Collecting patient copays at point of service

Correct answer: The process of recording all services rendered so they can be billed

Charge capture ensures every service performed is documented and entered into the billing system for claim submission.

Question 44: When a radiology study is ordered to rule out a suspected condition and findings are negative, what should the coder report?

The suspected diagnosis
The sign or symptom prompting the study (Correct answer)
No diagnosis code
The negative result code

Correct answer: The sign or symptom prompting the study

For outpatient/radiology services with ruled-out conditions, code the sign or symptom rather than the suspected diagnosis.

Question 45: Which term describes a condition of reduced bone mass and density?

Osteomyelitis
Osteoarthritis
Osteosarcoma
Osteoporosis (Correct answer)

Correct answer: Osteoporosis

Osteoporosis is a condition characterized by a significant decrease in bone mass and density, leading to fragile bones and an increased risk of fractures. The term combines "osteo-" (bone) and "porosis" (porous), accurately describing the weakened, porous structure of the bones. It is distinct from other bone conditions like inflammation (osteomyelitis) or cancer (osteosarcoma).

Question 46: Which entity provides guidance on coding compliance programs?

FDA
CMS
OIG (Correct answer)
AMA

Correct answer: OIG

The Office of Inspector General (OIG) within the Department of Health and Human Services (HHS) is responsible for combating fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs. The OIG provides extensive guidance, including compliance program guidance, to healthcare entities to help prevent fraudulent billing practices and ensure adherence to regulations. CMS focuses on administering Medicare/Medicaid, FDA on drug/device safety, and AMA on physician advocacy.

Question 47: Which condition applies when Medicare is the secondary payer for a radiology claim?

Medicare pays first regardless
Medicare denies all secondary claims
Coordination of Benefits (COB) rules determine Medicare's payment (Correct answer)
HCPCS modifiers are not required

Correct answer: Coordination of Benefits (COB) rules determine Medicare's payment

When Medicare is secondary, Coordination of Benefits rules govern how Medicare pays after the primary insurer has paid.

Question 48: What does RBRVS stand for in physician fee schedule calculations?

Reimbursement-Based Radiology Value System
Risk-Based Relative Volume Scale
Revenue-Based Resource Value Schedule
Resource-Based Relative Value Scale (Correct answer)

Correct answer: Resource-Based Relative Value Scale

RBRVS stands for Resource-Based Relative Value Scale, the foundation of the Medicare Physician Fee Schedule.

Question 49: Which CPT code describes stereotactic body radiation therapy (SBRT) delivery?

77373 (Correct answer)
77371
77372
77385

Correct answer: 77373

CPT 77373 reports SBRT treatment delivery, per fraction.

Question 50: Which CPT code represents a CT of the abdomen and pelvis performed WITH intravenous contrast material?

74182
74176
74177 (Correct answer)
74178

Correct answer: 74177

CPT 74177 describes a CT of the abdomen and pelvis with contrast; 74176 is without contrast, 74178 is without followed by with contrast, and 74182 is MRI abdomen with contrast.

Question 51: Which body plane divides the body into left and right halves?

Coronal
Transverse
Frontal
Sagittal (Correct answer)

Correct answer: Sagittal

The sagittal plane is an anatomical division that runs vertically, dividing the body or an organ into left and right portions. A midsagittal plane specifically divides the body into equal left and right halves. This plane is fundamental for describing the location and orientation of structures within the body.

Question 52: A CT scan of the chest is ordered for a patient with a personal history of lung cancer. Which code is reported first?

Lung cancer (C34.x)
Personal history of lung cancer (Z85.118) (Correct answer)
Z13.6 screening
Chest pain (R07.9)

Correct answer: Personal history of lung cancer (Z85.118)

A personal history code (Z85.118) is used when the cancer has been excised and there is no current evidence of the disease.

Question 53: Which CPT code describes a limited ultrasound of the abdomen?

76700
76770
76856
76705 (Correct answer)

Correct answer: 76705

CPT 76705 reports a limited abdominal ultrasound when not all required organs are examined.

Question 54: A hospital outpatient CT angiography uses 100 ml of iopamidol 370 mg/ml iodine concentration. Which HCPCS code correctly describes this low-osmolality contrast?

Q9951 (LOCM, 400 or greater mg/ml iodine, per ml)
Q9967 (LOCM, 300-399 mg/ml iodine, per ml) (Correct answer)
Q9966 (LOCM, 200-299 mg/ml iodine, per ml)
Q9965 (LOCM, 100-199 mg/ml iodine, per ml)

Correct answer: Q9967 (LOCM, 300-399 mg/ml iodine, per ml)

Iopamidol 370 mg/ml has an iodine concentration of 370 mg/ml, which falls in the 300-399 mg/ml range, corresponding to HCPCS Q9967.

Question 55: An anaphylactoid reaction to iodinated contrast media is best characterized by which set of clinical findings occurring within minutes of administration?

Urticaria, bronchospasm, and hypotension requiring immediate treatment (Correct answer)
Mild nausea and warmth sensation that resolves spontaneously
Contrast-induced nephropathy with rising creatinine over 48 hours
Delayed urticaria appearing 1-3 days after administration

Correct answer: Urticaria, bronchospasm, and hypotension requiring immediate treatment

An anaphylactoid (immediate hypersensitivity-type) contrast reaction presents with urticaria, bronchospasm, and hypotension within minutes and requires immediate treatment with epinephrine.

Question 56: Which of the following is NOT a gadolinium-based contrast agent (GBCA) used in MRI?

Gadobutrol (Gadavist)
Gadopentetate dimeglumine (Magnevist)
Iohexol (Omnipaque) (Correct answer)
Gadobenate dimeglumine (MultiHance)

Correct answer: Iohexol (Omnipaque)

Iohexol (Omnipaque) is a non-ionic iodinated contrast agent used primarily for CT and myelography; the other three are gadolinium-based MRI contrast agents.

Question 57: Revenue code 0320 on a UB-04 claim represents which radiology service category?

Diagnostic radiology — general (Correct answer)
Nuclear medicine
CT scan
Ultrasound

Correct answer: Diagnostic radiology — general

Revenue code 0320 (Radiology — Diagnostic) is used on institutional claims for general diagnostic radiology services.

Question 58: What does CPT code 76376 represent in radiology?

PET/CT image fusion
CT angiography post-processing
3D rendering performed on same workstation (Correct answer)
3D rendering with separate workstation

Correct answer: 3D rendering performed on same workstation

CPT 76376 is used when 3D rendering is performed on the same workstation as the primary image acquisition.

Question 59: When should a global radiology code be reported without modifiers?

Only when outsourced
If only interpretation is done
When both components are provided by same entity (Correct answer)
Only for emergency procedures

Correct answer: When both components are provided by same entity

A global radiology code encompasses both the professional component (interpretation and report) and the technical component (equipment, supplies, technologist). When a single entity, such as a hospital or an imaging center, provides both the performance of the scan and the interpretation by their radiologist, the global code is reported without any modifiers.

Question 60: In nuclear medicine, what does the term 'planar imaging' refer to?

Three-dimensional SPECT reconstruction
X-ray fluoroscopy
Two-dimensional images acquired from a gamma camera (Correct answer)
PET attenuation correction

Correct answer: Two-dimensional images acquired from a gamma camera

Planar imaging produces 2D static or dynamic gamma camera images without tomographic reconstruction.

Question 61: What ICD-10-CM code is used for a screening mammogram encounter?

Z12.11
Z12.39
Z13.6
Z12.31 (Correct answer)

Correct answer: Z12.31

ICD-10-CM Z12.31 designates an encounter for screening mammogram for malignant neoplasm of breast.

Question 62: When imaging reveals an incidental finding unrelated to the reason for the study, how is it coded?

It is always coded as a secondary diagnosis
It is the principal diagnosis
It replaces the ordering diagnosis
It is not coded unless clinically evaluated (Correct answer)

Correct answer: It is not coded unless clinically evaluated

Incidental findings are only coded when the physician clinically evaluates and documents them.

Question 63: Which term describes the movement of a limb away from the midline of the body?

Adduction
Rotation
Flexion
Abduction (Correct answer)

Correct answer: Abduction

Abduction is a movement that draws a limb or part away from the midline of the body. For example, lifting your arm out to the side is an act of abduction. Conversely, adduction is movement towards the midline, while flexion and rotation describe bending and turning movements, respectively.

Question 64: Oral contrast media administered to a patient undergoing a CT of the abdomen is typically handled how under Medicare billing?

Generally bundled into the CT procedure and not separately billable to Medicare (Correct answer)
Reported separately using HCPCS Q-codes for contrast volume used
Reported using a separate CPT code for ingestion supervision
Billed using J-codes as an oral drug administration

Correct answer: Generally bundled into the CT procedure and not separately billable to Medicare

Oral contrast media for CT studies is considered packaged by Medicare and most payers and is not separately billable, unlike intravenous contrast agents which have specific HCPCS codes.

Question 65: What is the purpose of a National Provider Identifier (NPI) in radiology billing?

An insurer-assigned provider number
A state licensure tracking number
A Medicare-only billing number
Unique identifier for providers used in all HIPAA standard transactions (Correct answer)

Correct answer: Unique identifier for providers used in all HIPAA standard transactions

The NPI is a unique 10-digit identifier required on all HIPAA standard claim transactions.

Question 66: CPT code 77295 describes which radiation therapy planning service?

Three-dimensional (3D) radiotherapy plan (Correct answer)
Simple simulation
IMRT plan
Brachytherapy isodose plan

Correct answer: Three-dimensional (3D) radiotherapy plan

CPT 77295 reports three-dimensional radiotherapy planning using CT-based simulation and 3D dose calculation.

Question 67: Which character in ICD-10-CM typically indicates laterality?

5th character
7th character
6th character (Correct answer)
4th character

Correct answer: 6th character

The 6th character in ICD-10-CM most commonly designates laterality (right, left, bilateral).

Question 68: Which document authorizes a radiology group to bill Medicare on behalf of its physicians?

DEA registration
Medicare Group Enrollment / Provider Transaction Access Number (PTAN) (Correct answer)
NPI registration
Credentialing certificate

Correct answer: Medicare Group Enrollment / Provider Transaction Access Number (PTAN)

A PTAN (Provider Transaction Access Number) is issued by Medicare to enrolled providers authorizing billing.

Question 69: What is 'balance billing' in radiology billing practices?

Billing two insurers simultaneously
Billing for a higher-level service than performed
Billing a global service with separate components
Billing the patient for the difference between the provider's charge and insurer's payment (Correct answer)

Correct answer: Billing the patient for the difference between the provider's charge and insurer's payment

Balance billing occurs when a provider bills the patient for the remaining balance after the insurer's payment, beyond the contracted amount.

Question 70: What is the purpose of an 'add-on' CPT code in radiology?

Used only for imaging guidance
Billed alone for standalone services
Applied when a modifier is unavailable
Reported separately only when a primary procedure is also reported (Correct answer)

Correct answer: Reported separately only when a primary procedure is also reported

Add-on codes are always reported in conjunction with a primary procedure and cannot be billed alone.

Question 71: CPT codes 71045 through 71048 describe chest X-rays based on which factor?

Equipment type
Patient position
Number of views (Correct answer)
Contrast use

Correct answer: Number of views

Chest X-ray CPT codes 71045–71048 are differentiated by the number of views obtained.

Question 72: Medicare's timely filing deadline for initial claims is generally how many months from the date of service?

6 months
3 months
24 months
12 months (Correct answer)

Correct answer: 12 months

Medicare requires claims to be filed within 12 months (one calendar year) from the date of service.

Question 73: Under Medicare Advantage (MA) plans, which imaging service is most commonly subject to prior authorization requirements related to contrast use?

MRI brain with gadolinium contrast for headache evaluation (Correct answer)
Plain abdominal radiograph, two views
Routine chest X-ray with contrast markers
CT colonoscopy without contrast material

Correct answer: MRI brain with gadolinium contrast for headache evaluation

Many Medicare Advantage plans require prior authorization for advanced imaging studies with contrast such as MRI with gadolinium, as these represent higher-cost services subject to utilization management.

Question 74: Gadolinium-based contrast agents used in MRI are primarily reported using which HCPCS code series?

C9399 (unlisted drug, outpatient PPS)
Q9965-Q9967 (iodinated contrast by concentration)
A9576-A9579 (gadolinium-based MRI contrast agents) (Correct answer)
J0636-J0640 (injectable drug codes)

Correct answer: A9576-A9579 (gadolinium-based MRI contrast agents)

Gadolinium-based MRI contrast agents are reported with HCPCS A-codes: A9576 (gadopentetate dimeglumine), A9577 (gadobenate dimeglumine), A9578 (gadoxetate disodium), and A9579 (NOS).

Question 75: What is the role of the Geographic Practice Cost Index (GPCI) in MPFS calculations?

Adjusts RVUs to reflect regional cost differences (Correct answer)
Determines coding accuracy requirements
Establishes APC payment rates
Sets the national conversion factor

Correct answer: Adjusts RVUs to reflect regional cost differences

GPCIs adjust each RVU component for geographic variation in physician work, practice costs, and malpractice premiums.

Radiology Certified Coder (RCC)

The RCC certification, administered by the Radiology Coding Certification Board (RCCB), validates expertise in radiology coding including CPT procedure coding, ICD-10-CM diagnosis coding, HCPCS Level II supplies and contrast media, and Medicare billing compliance for radiology services.

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