NAME:_____________________ EAI CONSULTING & TRAINING ...

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1. How is the CPT updated ? ANSWER = Annually

2. When is the updated version of the CPT released ? ANSWER = Late Fall

3. When do Federal programs generally implement the new codes ? ANSWER = January 1st

4. The CPT is a listing of descriptive terms and identifying codes for reporting ___MEDICAL_______ __SERVICES______ and _______PROCEDURES_________.

5. What must each procedure submitted on a claim be linked to ? ___________________________________


ANSWER = An ICD-9-CM code that justifies the need for the service or procedure.

6. A ________ code number and a narrative description identify each procedure and service listed in the CPT ?

ANSWER = five-digit

7. How many symbols are located throughout the CPT coding book ? ANSWER = seven

8. List the six sections of Category I procedures and services (list in the order in which they appear):

a). ______________________________________________________________________

b). ______________________________________________________________________

c). ______________________________________________________________________

d). ______________________________________________________________________

e). ______________________________________________________________________

f). ______________________________________________________________________

ANSWER = The Six sections of Category I procedures and services of the CPT are:

a. Evaluation & Management

b. Anesthesia

c. Surgery

d. Radiology

e. Pathology

f. Medicine

9. CPT Modifiers indicate that the description of the service or procedure performed has been ___________?

ANSWER = Altered

10. Describe the contents of the following {IN THE CPT}:

a. APPENDIX “A”:______________________________________________________________________

b. APPENDIX “B”:______________________________________________________________________

c. APPENDIX “C”:______________________________________________________________________

d. APPENDIX “D”:______________________________________________________________________

e. APPENDIX “E”:______________________________________________________________________


a. APPENDIX “A” = Detailed descriptions for each CPT modifier

b. APPENDIX “B” = Annual CPT coding changes.

c. APPENDIX “C” = Clinical examples for codes in E & M

d. APPENDIX “D” = Add-on codes

e. APPENDIX “E” = Codes exempt from modifier – 51 reporting rules

11. MATCHING: Match the CPT term or symbol in the first column with its definition or description in the 2nd column:

a. bullet = a new code added to CPT [B]

b. triangle = code description revision [F]

c. horizontal triangles = surround revised guidelines and notes [E]

d. asterisk = indicates variable preoperative and postoperative services[D]

e. circle with slash = the code is not to be used with modifier – 51 [A]

f. plus symbol = add-on codes [C]

g. boldface type = main terms in the CPT [H]

h. See = directs coders to an index entry [I]

i. italicized type = used for the cross reference term, See, in the CPT index[G]

j. inferred words = used to save space in the CPT index. [J]

12. CPT Modifiers are reported as ________numeric codes added to the 5-digit CPT code ? ANSWER = Two-digit

13. Describe the function of the guidelines located at the beginning of each section in the CPT code book:



ANSWER = Carefully reviewed before attempting to code.

14. When would an unlisted procedure or service code be assigned ?



ANSWER = When the provider performs a procedure or service for which there is no CPT code.

15. The CPT index is organized by ? ____________________________________________________________.

ANSWER = Alphabetical main terms printed in boldface.



16. Describe what “main terms” represent ?

ANSWER = Procedures or services, organs, anatomic sites, conditions, eponyms or abbreviations.

17. Assign codes and modifiers to the following:

a. Bilateral partial mastectomy CODE: ____19301 [50 ]___

b. Vasovasostomy discontinued after anesthesia due to heart CODE: _____55400[ 74 ]__

arrhythmia, hospital outpatient.

c. Decision for surgery during initial office visit, comprehensive . CODE: _____99205______

d. Expanded office visit for follow-up mastectomy, new onset diabetes CODE: _____99242______

was discovered and treated.

e. Cholecystectomy, postoperative management only. CODE: _____47600_[55]_

f. Difficult and complicated resection of external cardiac tumor. CODE: ______33130_____

g. Hemorrhoidectomy by simple ligature discontinued prior to anesthesia CODE: ______46221_[73]__

due to severe drop in blood pressure, hospital outpatient.

h. Assistant surgeon, modified radical mastectomy. CODE: ______19307 [80]_

i. Total abdominal hysterectomy, preoperative management only. CODE: ______58150 [56 ]_

j. Total urethrectomy, including cystostomy, female, surgical care only. CODE: ______53210 [54]_

k. Simple repair of a 2-inch laceration on the right foot discontinued CODE(ICD): 892.2 CODE(CPT): 12001[53]

due to severe dizziness, physician’s office.

18. List the seven basic steps for coding procedures:

STEP#1: Read the introduction located in the CPT coding manual.

STEP#2: Review the guidelines located at the beginning of each CPT section.

STEP#3: Review the procedure or service listed on the office source document.

STEP#4: Refer to the CPT index and locate the main term for the procedure or service.

STEP#5: Locate the necessary subterms and cross references listed in the index.

STEP#6: Review the description of the procedure /service codes listed in the index.

STEP#7: Assign the applicable primary code number, any add on (+) or additional codes needed, and finally

accurately classify the statement being coded.

19. Medicare pays only a portion of a patient’s acute care hospitalization expenses and the patient’s out-of-pocket expenses are calculated on a _____BENEFIT___ _____PERIOD______ basis.

20. General Medicare eligibility requires individuals or spouses to ?

a. Have worked at least ___10__years in medicare covered employment.

b. Be a minimum of ___65___years old.

c. Be a citizen or permanent resident of the ____UNITED______ _____STATES________.

21. After 90 continuous days of hospitalization, the patient may elect to use some or all of the allotted _______lifetime reserve days ? ANSWER = 60

22. Persons confined to a psychiatric hospital are allowed ________ lifetime reserve days ? ANSWER = 190

a. 24 . Assign codes and modifiers to the following:

b. Tonsillectomy and adenoidectomy, age 10, and a wart CODE#1:__42820(28.3)___ CODE#2:__078.1(17000)

removed from the patient’s neck while in the OR.

c. Excision, malignant lesion 0.6 to 1.0 cms., face and layer CODE#1:__11641__ CODE#2:__M8000__

closure of wounds of face, 2.0 cms.

d. incision and drainage, perianal abscess, superficial and CODE#1:__10160__ CODE#2:__49.1___

puncture aspiration of abscess, hematoma, cyst.

e. Muscle repair of forearm and suture of major peripheral CODE#1:__64857__ CODE#2:__83.65__

nerve, arm, without transposition.

25 All payments for medical expenses incurred by a kidney donor are made directly to the _______ ?

ANSWER = Health care providers

26. Heart and heart-lung transplants are covered if the person is Medicare eligible and the transplant takes place in a medicare certified regional________? ANSWER = Transplant center

27. Liver transplants for adults are covered if the person is Medicare eligible and does not have ______?

ANSWER = A malignancy





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