CPC Procedure Coding & Documentation 3 — Questions and Answers
Question 1: Under CPT guidelines, a 'separate procedure' designation means the code should be:
- Always billed with modifier -59
- Reported only when performed independently and not as part of a larger procedure (Correct answer)
- Bundled automatically with all surgical codes
- Reported only for outpatient services
Correct answer: Reported only when performed independently and not as part of a larger procedure
A 'separate procedure' in parentheses means that code is only reported when the service is performed independently, not as part of a more comprehensive procedure.
Question 2: A physician performs an excision of a 2.2 cm malignant lesion on the back with 0.5 cm margins. What is the correct CPT code diameter used for code selection?
- 2.2 cm
- 2.7 cm
- 3.2 cm (Correct answer)
- 0.5 cm
Correct answer: 3.2 cm
For excision of malignant lesions, the size is calculated as the lesion diameter plus the required margins on each side: 2.2 + 0.5 + 0.5 = 3.2 cm.
Question 3: Which type of wound closure is classified as 'complex repair' in CPT?
- Closure with simple sutures in a single layer
- Closure requiring steri-strips only
- Closure involving debridement, extensive undermining, or retention sutures (Correct answer)
- Closure of a wound less than 2.5 cm
Correct answer: Closure involving debridement, extensive undermining, or retention sutures
Complex repair involves one or more of these elements: debridement, extensive undermining, layer closure, or use of retention sutures, beyond what simple or intermediate repairs require.
Question 4: For outpatient hospital coding, the principal procedure is defined as:
- The most expensive procedure performed
- The procedure most related to the reason for the visit or principal diagnosis (Correct answer)
- The first procedure listed in the operative note
- The procedure with the highest CPT RVU
Correct answer: The procedure most related to the reason for the visit or principal diagnosis
In outpatient coding, the principal procedure is the one most closely related to the reason for the encounter or the principal diagnosis.
Question 5: CPT modifier -76 is appended when:
- A different physician repeats the same procedure on the same day
- The same physician repeats the same procedure on the same day (Correct answer)
- A procedure is performed bilaterally
- A procedure requires unusual anesthesia
Correct answer: The same physician repeats the same procedure on the same day
Modifier -76 (Repeat Procedure or Service by Same Physician) indicates the same physician repeated a procedure or service on the same day.
Question 6: A physician places a central venous catheter (CVC) and also performs an ultrasound for guidance. How are these services reported?
- CVC code only; ultrasound is bundled
- CVC code and ultrasound guidance code separately with documentation (Correct answer)
- Ultrasound code only when used for guidance
- CVC code with modifier -22 for ultrasound use
Correct answer: CVC code and ultrasound guidance code separately with documentation
Ultrasound guidance (76937) may be separately reported with the CVC placement code when the physician documents real-time ultrasound use and permanently records the image.
Question 7: Which statement accurately describes CPT Category III codes?
- They are permanent codes for established technology
- They are temporary codes for emerging technologies and services (Correct answer)
- They replace Category I codes when technology becomes outdated
- They are used exclusively for vaccines and immunizations
Correct answer: They are temporary codes for emerging technologies and services
Category III codes are temporary tracking codes for emerging technologies, services, and procedures that may lack sufficient evidence for Category I code status.
CPC Procedure Coding & Documentation 3
Under CPT guidelines, a 'separate procedure' designation means the code should be: