Outpatient & Ambulatory Coding (CPT/APC) Flashcards
6 cards from real CCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Outpatient & Ambulatory Coding (CPT/APC) flashcards as text
When coding outpatient hospital services, what does the 'charge capture' process refer to?
Answer: The process of identifying and documenting all billable services rendered to generate accurate claims
Charge capture is the process of identifying, capturing, and recording all billable services and supplies provided during a patient encounter to ensure complete and accurate claim submission.
A hospital outpatient clinic performs a bilateral diagnostic mammography. Which modifier should be appended to the CPT mammography code?
Answer: -50 (Bilateral Procedure)
Modifier -50 is used for bilateral procedures performed during the same session, indicating the procedure was performed on both sides - resulting in a 150% payment rather than two separate full-fee payments.
What is the National Correct Coding Initiative (NCCI) and its relevance to outpatient hospital coding?
Answer: A CMS initiative that establishes code pair edits preventing inappropriate billing of CPT code combinations that should be bundled
NCCI (CCI) contains tables of CPT code pairs that cannot be billed together by the same provider on the same day - one is the 'comprehensive' code, the other is the 'component,' and billing both is considered unbundling.
In CPT coding, what is the distinction between a 'diagnostic' and 'therapeutic' procedure code?
Answer: Diagnostic procedures are performed to identify a condition; therapeutic procedures are performed to treat a condition - different CPT codes exist for each
Diagnostic procedures (e.g., diagnostic bronchoscopy) are performed to identify or evaluate a condition. Therapeutic procedures (e.g., therapeutic bronchoscopy with foreign body removal) are performed to treat a condition. Separate CPT codes reflect this distinction.
Which CPT code range covers Evaluation and Management services for Emergency Department visits?
Answer: 99281-99285
CPT codes 99281-99285 are the Emergency Department E/M codes, assigned by the facility and physician based on the medical decision making and presenting problem severity.
Under OPPS, what is a 'Comprehensive APC' (C-APC)?
Answer: A payment model where a primary service drives a single comprehensive payment that includes all related services on the claim
Comprehensive APCs (C-APCs) are OPPS payment groups where the primary procedure drives a single comprehensive payment encompassing all related items and services on the claim, replacing individual APC payments.