CPC Medicine Section and Modifiers 2 — Questions and Answers
Question 1: What is the correct reporting for a vaccine administration with counseling for a child under 18?
- 90460 for first component, 90461 for each additional component (Correct answer)
- 90471 for each vaccine
- 90472 for the first vaccine
- One flat fee code regardless of components
Correct answer: 90460 for first component, 90461 for each additional component
For patients under 18, vaccine administration with physician counseling uses 90460 for the first vaccine component and 90461 for each additional component.
Question 2: In physical medicine coding, what does 'therapeutic procedure' require compared to a 'modality'?
- Therapeutic procedures require direct therapist interaction; modalities do not require constant attendance (Correct answer)
- Modalities require more time than therapeutic procedures
- Therapeutic procedures are always unsupervised
- Modalities always require one-on-one contact
Correct answer: Therapeutic procedures require direct therapist interaction; modalities do not require constant attendance
Therapeutic procedures (e.g., therapeutic exercises) require direct, one-on-one therapist contact, whereas modalities such as hot packs may be supervised without constant attendance.
Question 3: Which modifier is used when a service or procedure is reduced or eliminated at the physician's discretion?
- -52 (Correct answer)
- -53
- -22
- -47
Correct answer: -52
Modifier -52 indicates a service was reduced in scope or eliminated at the physician's election, with documentation explaining the reduction.
Question 4: What does the -GY modifier signify in Medicare billing?
- Item or service is statutorily excluded from Medicare coverage (Correct answer)
- Service was not medically necessary per payer
- Service was provided by a non-participating provider
- Service requires advance beneficiary notice
Correct answer: Item or service is statutorily excluded from Medicare coverage
Modifier -GY indicates that a service is statutorily excluded from Medicare or does not meet the definition of any Medicare benefit.
Question 5: Which psychiatry code is used to report add-on interactive complexity during a psychotherapy session?
- 90785 (Correct answer)
- 90832
- 90837
- 90847
Correct answer: 90785
CPT 90785 is an add-on code for interactive complexity, reported with primary psychotherapy codes when communication factors complicate the session.
Question 6: When a provider performs a separate E/M service during the global period of a minor procedure (10-day global), which modifier is appropriate?
- -24 (Correct answer)
- -57
- -58
- -79
Correct answer: -24
Modifier -24 is used for an unrelated E/M service by the same physician during the postoperative period of any global procedure.
CPC Medicine Section and Modifiers 2
What is the correct reporting for a vaccine administration with counseling for a child under 18?