Coding Guidelines and Conventions Flashcards
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Read the first 7 Coding Guidelines and Conventions flashcards as text
Which CPT modifier indicates a distinct procedural service that is not normally reported with another procedure but is appropriate under certain circumstances?
Answer: Modifier 59
Modifier 59 indicates a distinct procedural service that is separate and independent from another procedure performed on the same day, overriding NCCI edits when appropriate.
According to ICD-10-CM guidelines, when a delivery occurs and no complication is documented, which code is used?
Answer: O80 – Encounter for full-term uncomplicated delivery
O80 is assigned for a completely normal delivery with no complications, and it is the only code needed for such an encounter along with a Z37 outcome code.
In CPT, an add-on code is characterized by which of the following?
Answer: It is never reported alone and is always used in conjunction with a primary procedure
Add-on codes (identified by the + symbol in CPT) are supplementary codes that describe additional work performed with a primary procedure and cannot be reported alone.
The ICD-10-CM guideline for 'uncertain diagnosis' in the inpatient setting states that:
Answer: Conditions described as 'probable,' 'suspected,' or 'questionable' may be coded as if confirmed for inpatient encounters
For inpatient encounters, ICD-10-CM guidelines allow coding of conditions described as 'probable,' 'suspected,' or 'questionable' as if confirmed, because additional testing can occur during the stay.
Which HCPCS Level II modifier indicates that a service was provided to the left side of the body?
Answer: Modifier LT
HCPCS modifier LT (left side) is appended to indicate a procedure was performed on the patient's left side, commonly required by Medicare and Medicaid.
When coding an ectopic pregnancy in ICD-10-CM, what additional information is required to select the most specific code?
Answer: The anatomic site of the ectopic pregnancy (e.g., tubal, ovarian, abdominal)
ICD-10-CM category O00 (ectopic pregnancy) requires identification of the anatomic site — such as fallopian tube, ovary, or abdomen — to assign the most specific code.
Under CPT guidelines, modifier 25 is appended to indicate:
Answer: A significant, separately identifiable evaluation and management service was performed by the same physician on the same day as a procedure
Modifier 25 is used to report that a significant, separately identifiable E/M service was provided by the same provider on the same day as a procedure or other service.