CPC Knowledge Skill 3 — Questions and Answers
Question 1: A patient is seen for a sprained ankle sustained while playing basketball. Under ICD-10-CM, which code category captures the external cause of injury?
- S93
- Y93 (Correct answer)
- W18
- V90
Correct answer: Y93
Category Y93 captures activity codes, such as playing basketball, as external cause supplemental information.
Question 2: Which CPT code range is used for anesthesia services?
- 00100–01999 (Correct answer)
- 10004–19499
- 20100–29999
- 30000–39999
Correct answer: 00100–01999
CPT anesthesia codes are found in the 00100–01999 range and are reported by anesthesiologists and CRNAs.
Question 3: When a patient has a condition that is both acute and chronic, ICD-10-CM guidelines instruct the coder to:
- Code only the acute condition
- Code only the chronic condition
- Code the acute condition first, followed by the chronic condition
- Assign a single combination code if available, otherwise code both (Correct answer)
Correct answer: Assign a single combination code if available, otherwise code both
ICD-10-CM guidelines direct coders to use a combination code if one exists; otherwise, sequence the acute condition first.
Question 4: What does HCPCS Level II primarily cover that CPT does not?
- Surgical procedures
- Evaluation and management services
- Durable medical equipment, supplies, and non-physician services (Correct answer)
- Radiology procedures
Correct answer: Durable medical equipment, supplies, and non-physician services
HCPCS Level II codes cover items like DME, orthotics, prosthetics, drugs, and ambulance services not found in CPT.
Question 5: Modifier -59 is used to indicate:
- A distinct procedural service not typically reported together with another code (Correct answer)
- A bilateral procedure performed on the same day
- A service performed in the postoperative period
- A reduced or discontinued procedure
Correct answer: A distinct procedural service not typically reported together with another code
Modifier -59 identifies procedures/services not normally reported together but appropriate under the circumstances.
Question 6: In CPT, a 'separate procedure' designation means:
- The procedure must always be billed separately
- The procedure may be billed alone but not with related services on the same day (Correct answer)
- The procedure requires a modifier to be billed
- The procedure is included in all surgical packages
Correct answer: The procedure may be billed alone but not with related services on the same day
A 'separate procedure' is integral to a larger service and should not be billed separately when performed with related procedures.
Question 7: Which federal law primarily governs fraudulent billing practices in healthcare, including false claims submitted to Medicare and Medicaid?
- HIPAA
- The False Claims Act (Correct answer)
- The Stark Law
- The Anti-Kickback Statute
Correct answer: The False Claims Act
The False Claims Act imposes liability on individuals and companies that knowingly submit false claims to federal healthcare programs.
CPC Knowledge Skill 3
A patient is seen for a sprained ankle sustained while playing basketball.
Under ICD-10-CM, which code category captures the external cause of injury?