CPCA Surgical and Reconstructive Procedure Coding 1 — Questions and Answers
Question 1: What is the standard global surgery period for major surgical procedures under Medicare guidelines?
- 10 days
- 30 days
- 60 days
- 90 days (Correct answer)
Correct answer: 90 days
Major surgical procedures carry a 90-day global period, during which routine follow-up visits are included in the surgical fee and cannot be billed separately.
Question 2: In CPT coding, a procedure listed as a 'separate procedure' may be billed independently when:
- It is performed by a different surgeon
- It is performed alone and not as part of a more comprehensive service (Correct answer)
- It requires general anesthesia
- It is documented with a modifier -59
Correct answer: It is performed alone and not as part of a more comprehensive service
A 'separate procedure' designation means the code is ordinarily bundled with larger services but may be reported independently when it is the only service performed at that encounter.
Question 3: Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally during the same operative session?
- -51
- -59
- -50 (Correct answer)
- -76
Correct answer: -50
Modifier -50 reports a bilateral procedure performed during the same operative session on both sides of the body, and payers typically reimburse at 150% of the single procedure rate.
Question 4: For insurance reimbursement purposes, what primarily distinguishes a reconstructive procedure from a cosmetic procedure in an aesthetic practice?
- The cost of the procedure
- The physician's board certification
- Medical necessity and restoration of normal function or appearance after disease, injury, or birth defect (Correct answer)
- Whether the procedure is performed in a hospital or office setting
Correct answer: Medical necessity and restoration of normal function or appearance after disease, injury, or birth defect
Reconstructive procedures are covered by insurance because they correct abnormalities caused by congenital defects, developmental abnormalities, trauma, infection, or disease, making medical necessity the key distinguishing factor.
Question 5: Which CPT code range covers procedures of the integumentary system, the primary section used for most skin procedures in aesthetic practices?
- 10004–19499 (Correct answer)
- 20000–29999
- 30000–39999
- 40000–49999
Correct answer: 10004–19499
CPT codes 10004–19499 encompass the integumentary system, including procedures on the skin, subcutaneous tissue, and breast, making this the most used section in aesthetic coding.
Question 6: When a physician uses a qualified surgical assistant during an aesthetic procedure, which modifier is typically appended to the assistant's claim?
- -22
- -80 (Correct answer)
- -51
- -59
Correct answer: -80
Modifier -80 (Assistant Surgeon) is reported by the assistant surgeon's provider to indicate that a qualified physician assisted the primary surgeon during the procedure.
Question 7: What is the global surgery period for minor surgical procedures, such as excision of a small skin lesion?
- 0 days
- 10 days (Correct answer)
- 30 days
- 90 days
Correct answer: 10 days
Minor surgical procedures carry a 10-day global period, during which routine follow-up care is bundled and cannot be separately billed.
CPCA Surgical and Reconstructive Procedure Coding 1
What is the standard global surgery period for major surgical procedures under Medicare guidelines?