Outpatient & Ambulatory Coding (CPT/APC) Flashcards

In CPT surgery coding, what is included in the 'global surgical package'?

Answer: Pre-operative evaluation, the surgical procedure, and post-operative care within the global period (0, 10, or 90 days)

The CPT global surgical package includes pre-operative care (day before for major surgery), intraoperative care, and post-operative follow-up care within the global period - all included in the single surgical CPT fee.

A surgeon performs a laparoscopic cholecystectomy and, during the same session, also performs a laparoscopic appendectomy for incidentally discovered appendicitis. How are these coded?

Answer: Both procedures are coded, with Modifier -51 (Multiple Procedures) on the secondary procedure

When multiple distinct procedures are performed during the same session, CPT allows separate coding. Modifier -51 (Multiple Procedures) is appended to the secondary procedure to indicate it is an additional procedure subject to reimbursement reduction.

What is the purpose of the HCPCS Level II code set?

Answer: To supplement CPT codes for services, supplies, and equipment not described in CPT

HCPCS Level II codes (A0000-V9999) supplement CPT codes by describing non-physician services, supplies, equipment, drugs, and other items that CPT does not adequately represent.

In outpatient radiology coding, when is it appropriate to code both the 'professional component' and 'technical component' separately?

Answer: When the radiologist and the facility are billing separately (e.g., radiology group bills professional, hospital bills technical)

When the interpreting physician (radiologist) and the facility owning the equipment are different entities, they bill separately using Modifier -26 (Professional Component) and Modifier -TC (Technical Component).

A patient presents to the hospital outpatient department for a scheduled wound debridement. The wound is debrided and re-dressed. What is the correct claim type for this service?

Answer: Outpatient claim (837I) - hospital facility bill for the outpatient procedure visit

Hospital outpatient services, including wound care procedures performed in the outpatient department, are billed by the facility on an institutional claim form (837I/UB-04) under the hospital outpatient claim type.

Under CPT guidelines for surgical coding, what does 'separate procedure' mean when it appears in a CPT code description?

Answer: The procedure is commonly performed as an integral part of a more complex service and should not be billed separately when performed as part of that larger service

CPT 'separate procedure' designation means the code describes a service that is routinely included when performed as part of a major procedure, and should only be billed separately when performed independently.