Certified Professional Coder MCQ Flashcards

Which of the following is the correct way to report a bilateral procedure when the CPT code descriptor does not specify bilateral?

Answer: Either A or B depending on payer requirements

Bilateral procedures can be reported with modifier -50 or with separate line items using -RT and -LT modifiers; the approach depends on specific payer requirements.

What is the purpose of the National Correct Coding Initiative (NCCI) edits?

Answer: To prevent improper payment of procedures that should not be billed together

NCCI edits, developed by CMS, prevent improper payment when two or more procedure codes are submitted together that are mutually exclusive or represent components of a more comprehensive code.

A surgeon performs an open reduction and internal fixation (ORIF) of a closed distal radius fracture. The correct ICD-10-CM fracture code should indicate:

Answer: Type of fracture, laterality, and encounter type

ICD-10-CM fracture codes capture specificity including fracture type (displaced/nondisplaced), laterality, and the appropriate 7th character for encounter type.

When a physician provides care to a patient in a skilled nursing facility (SNF), which code set is used for subsequent care visits?

Answer: 99307-99310

CPT codes 99307-99310 are used for subsequent nursing facility care visits based on the level of medical decision making or time.

Which of the following conditions would be coded as an 'uncertain diagnosis' in the outpatient setting?

Answer: Chest pain listed as the chief complaint

In the outpatient setting, uncertain diagnoses (probable, suspected, possible) are not coded; instead, the presenting sign or symptom — such as chest pain — is coded.

A coder sees a note that a patient received 'moderate sedation' administered by the performing physician during a colonoscopy. How should the moderate sedation be coded?

Answer: It is bundled into the colonoscopy code and not coded separately

For procedures where moderate sedation is included in the procedure's work (as indicated by a bull's-eye symbol in CPT), it is bundled and not reported separately.

Which section of the CPT codebook contains codes for non-face-to-face physician services, such as online medical evaluations?

Answer: Evaluation and Management

Non-face-to-face E/M services including online digital evaluation and management services are found within the Evaluation and Management section of CPT.