CPT Final Exam Questions with Certified
Solutions
CPT and HCPCS codes are used in what type of healthcare setting? ✔✔Hospital outpatient,
physician offices
CPT is ✔✔current procedural terminology
HCPCS is ✔✔healthca
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CPT Final Exam Questions with Certified
Solutions
CPT and HCPCS codes are used in what type of healthcare setting? ✔✔Hospital outpatient,
physician offices
CPT is ✔✔current procedural terminology
HCPCS is ✔✔healthcare common procedure coding system
Who publishes CPT (Level I HCPCS)?
How often is it updated? When is it updated? ✔✔AMA publishes cpt,
it is updated annually, on Jan. 1 of each year
CPT Category 1 codes consist of: ✔✔Anesthesia, Evaluation and management, surgery,
radiology, pathology and laboratory, medicine
What are Category 2 CPT codes for?
What does the Category 2 code consist of? ✔✔Performance Measures
consist of 4 numbers followed by a capital F, such as 1000F
What are Category 3 CPT codes for?
What does the Category 3 code consist of? ✔✔New & Emerging Technology
consist of 4 numbers followed by a capital T, such as 2000T
What are modifiers
Why are they used? ✔✔Supplementary Codes
to provide additional information to a code
What is a HCPCS level II code used to report?
What does the HCPCS level II code consist of? ✔✔Are used for supplies,
DME, injectable substances, dental and chiropractic as well as orthotics
Structure: J1885 - capital letter followed by 4 numbers
What are HCPCS level II codes also called? ✔✔National codes
Who developed the HCPCS level II codes? How often are they updated? When are they
updated? ✔✔Developed by CMS,
they are updated yearly update Jan1
NCCI ✔✔National Correct Coding Initiative
What does the National Correct Coding Initiative edits do? ✔✔Helps CMS to detect
inappropriate codes submitted on claims
- CPT coding guidelines
- Current standards of medical/surgical coding practice
- Advice from specialty societies
List 3 NCCI edits and the definition of those edits. ✔✔1. Comprehensive/component edit = edit
pertains to HCPCS codes that should NOT be used together.
2. Mutually exclusive edit = edit applies to improbable or impossible combinations of codes
3. Medical unlikely edits = for part B claims, CMS has developed medical unlikely edits to
reduce error rates for items on the claim form that reference units of service
• (bullet) ✔✔new code
; (semi-colon) ✔✔main entry applies to & is part of all indented entries that follow
Δ (triangle) ✔✔revision code
. ˃˂ (Facing triangles) ✔✔beginning and ending of new or revised text
+ (plus symbol) ✔✔add on code
ʘ (circled bullet) ✔✔moderate sedation
Ø (Null symbol) ✔✔exemptions to modifier 51
(Pending symbol) ✔✔product pending FDA approval
# ✔✔Out of numerical sequence code
○ ✔✔Recycled/reinstated code
modifier -51 ✔✔multiple procedures - used by Physicians ONLY
What about modifier -66? ✔✔Surgery Team - Physicians use ONLY
modifier -59 ✔✔distinct procedural service. Used by BOTH Physician and Hospital
What all does the CPT definition of a surgical pac
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