CBCS CPT Procedure Coding 1 — Questions and Answers
Question 1: CPT codes are organized into how many main sections?
- 4
- 5
- 6 (Correct answer)
- 7
Correct answer: 6
CPT is organized into 6 main sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology/Laboratory, and Medicine.
The CPT code book is divided into six main sections: Evaluation and Management (99202–99499), Anesthesia (00100–01999), Surgery (10004–69990), Radiology (70010–79999), Pathology and Laboratory (80047–89398), and Medicine (90281–99199). Each section contains codes specific to procedures and services in that clinical area.
Question 2: Which CPT modifier indicates a procedure was performed bilaterally?
- -50 (Correct answer)
- -51
- -52
- -53
Correct answer: -50
Modifier -50 is used to indicate that a procedure was performed bilaterally during the same operative session.
CPT Modifier -50 (Bilateral Procedure) is appended to a procedure code when the same procedure is performed on both sides of the body during the same operative session. Payer rules vary — some require the code listed once with modifier -50, while others require it listed twice on separate lines, the second with modifier -50. Always verify payer-specific billing guidelines.
Question 3: What does the CPT modifier -25 indicate?
- Reduced services
- Significant, separately identifiable E/M service on the same day as a procedure (Correct answer)
- Multiple procedures performed
- Repeat procedure by same physician
Correct answer: Significant, separately identifiable E/M service on the same day as a procedure
Modifier -25 indicates a significant, separately identifiable E/M service was provided on the same day as a procedure or other service.
CPT Modifier -25 is appended to an Evaluation and Management (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. The E/M service must be above and beyond the usual pre- and post-operative care associated with the procedure. Documentation must clearly support both the E/M service and the procedure.
Question 4: In CPT E/M coding for office visits (2021 guidelines), what two components determine the level of service?
- History and physical exam
- Medical decision making and time (Correct answer)
- Chief complaint and history
- Number of diagnoses and data reviewed
Correct answer: Medical decision making and time
Under 2021 revised guidelines, office/outpatient E/M levels are based on medical decision making (MDM) or total time.
Beginning January 1, 2021, AMA revised the E/M guidelines for office and outpatient visits. The level of service is now determined by either medical decision making (MDM) or total time spent by the physician on the date of the encounter. History and physical exam are no longer used to select the E/M level but are still documented for clinical purposes.
Question 5: What is an 'add-on code' in CPT?
- A code that can be reported alone without a primary procedure
- A code that is always reported in addition to a primary procedure code (Correct answer)
- A code appended to indicate a reduced service
- A code used for unlisted procedures
Correct answer: A code that is always reported in addition to a primary procedure code
Add-on codes are designated with a '+' symbol and must always be reported with a primary procedure code; they are never reported alone.
Add-on codes in CPT are identified with a '+' symbol before the code number and represent procedures that are commonly performed in addition to a primary procedure. Add-on codes are exempt from the multiple procedure reduction and the -51 modifier because they are always reported with a primary code. They are never reported alone. Examples include +99292 (additional 30 minutes of critical care) and +11001 (debridement of each additional 20 sq cm).
Question 6: Which CPT modifier is used when a physician performs only part of a procedure and another physician performs the rest?
- -54
- -55
- -56 (Correct answer)
- -62
Correct answer: -56
Modifier -56 is used when the physician performed the preoperative care only.
The CPT surgical global package is divided into preoperative, intraoperative, and postoperative components. Modifier -54 indicates the surgeon performed only the surgical care, modifier -55 indicates only postoperative management, and modifier -56 indicates only preoperative management. These modifiers are used to divide reimbursement among multiple physicians who each handle different portions of the global surgical package.
Question 7: In CPT, what does the term 'bundling' refer to?
- Grouping unrelated procedures under one code
- Including multiple related services within one procedure code (Correct answer)
- Combining professional and technical components
- Billing multiple units of the same code
Correct answer: Including multiple related services within one procedure code
Bundling means that related services are included within a single procedure code and should not be billed separately.
Bundling in CPT means that certain services are considered part of (included in) a larger procedure and should not be separately reported. The National Correct Coding Initiative (NCCI) edits identify code pairs where one code is considered bundled into another. Separately billing bundled services (unbundling) is considered fraudulent unless a specific modifier justifies the separate reporting.
Question 8: CPT code 99213 is an example of which type of service?
- Inpatient hospital visit
- Office or other outpatient visit (Correct answer)
- Nursing facility visit
- Emergency department visit
Correct answer: Office or other outpatient visit
99213 is a Level 3 established patient office or outpatient visit code.
CPT code 99213 is a Level 3 established patient office or other outpatient visit, characterized by low to moderate medical decision making or 20-29 minutes of total time. The 99202-99215 range covers office and outpatient E/M visits, where codes 99202-99205 are for new patients and 99211-99215 are for established patients.
CBCS CPT Procedure Coding 1
CPT codes are organized into how many main sections?