CPT & Procedural Coding Flashcards
6 cards from real CMC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CPT & Procedural Coding flashcards as text
Under the 2021 E/M guideline changes, what are the two main elements that determine the level of an office visit?
Answer: Medical decision-making or total time, not both combined with history/exam
The 2021 AMA E/M revisions base outpatient visit levels on either the complexity of medical decision-making (MDM) or total time spent on the encounter — no longer requiring history and exam scoring.
Which HCPCS Level II code series is used for durable medical equipment (DME)?
Answer: E codes
HCPCS Level II 'E' codes (E0100–E8002) are assigned to durable medical equipment such as wheelchairs, walkers, hospital beds, and oxygen equipment.
What is the correct approach when a CPT code description includes the phrase 'each additional' or 'list separately'?
Answer: Report it only as an add-on code alongside the primary procedure code
Phrases like 'each additional' or 'list separately' identify add-on codes that must always be reported with a specified primary procedure code, never independently.
When coding surgical destruction of a benign lesion, which factor primarily determines the correct CPT code?
Answer: Size of the lesion and whether it is benign or malignant
CPT lesion destruction codes are selected based on the size of the lesion (in centimeters) and whether it is benign or malignant.
Which CPT modifier indicates that only the professional component of a diagnostic procedure is being billed?
Answer: -26
Modifier -26 is appended to a procedure code to bill only the professional component (physician interpretation and report) when the technical component is billed separately.
In CPT, what does the term 'unbundling' refer to?
Answer: Separating a global package into its components to increase reimbursement inappropriately
Unbundling is the improper practice of billing multiple component codes separately when a single comprehensive CPT code should be used, inflating reimbursement fraudulently.