Radiology Certified Coder (RCC) — Questions and Answers

Question 1: Medicare's facility fee schedule for outpatient radiology is governed by which system?

DRG/IPPS
TRICARE fee schedule
OPPS/APC (Correct answer)
RBRVS/MPFS

Correct answer: OPPS/APC

Outpatient hospital radiology services are paid under the Outpatient Prospective Payment System (OPPS) using Ambulatory Payment Classifications (APCs).

Question 2: Which guideline applies when a patient has a malignancy as the reason for a radiology study?

Always code metastasis first
Code Z12 screening codes only
Code the malignancy as the first-listed diagnosis (Correct answer)
Code only the primary site

Correct answer: Code the malignancy as the first-listed diagnosis

When radiology is performed due to a malignancy, the cancer code is listed as the principal/first-listed diagnosis.

Question 3: What does the 7th character 'A' indicate in an ICD-10-CM fracture code?

Subsequent encounter
Initial encounter for active treatment (Correct answer)
Sequela
Delayed healing

Correct answer: Initial encounter for active treatment

The 7th character 'A' designates the initial encounter, used while the patient is receiving active treatment.

Question 4: Bone scan CPT code 78300 describes which type of study?

Whole body bone scan
SPECT bone scan
Bone and/or joint imaging — limited area (Correct answer)
Three-phase bone scan

Correct answer: Bone and/or joint imaging — limited area

CPT 78300 reports a bone scan limited to a single area of the skeleton.

Question 5: Which act mandates the protection of patient health information?

HIPAA (Correct answer)
HITECH
ACA
MACRA

Correct answer: HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law that established national standards to protect sensitive patient health information (PHI) from being disclosed without the patient's consent or knowledge. It mandates strict rules for the privacy and security of PHI, making it the cornerstone of patient data protection. Other acts address different aspects of healthcare.

Question 6: When a patient presents for a follow-up imaging study after treatment for a fracture, which 7th character is used?

S – Sequela
D – Subsequent encounter (Correct answer)
A – Initial encounter
G – Delayed healing

Correct answer: D – Subsequent encounter

The 7th character 'D' designates subsequent encounters for routine healing after active treatment is complete.

Question 7: A radiology coder reviews a CT chest order noting 'CT chest with and without contrast.' The correct CPT code to report is:

71270 (CT thorax, without contrast followed by re-imaging with contrast) (Correct answer)
71250 (CT thorax, without contrast)
71275 (CT angiography, chest, with contrast)
71260 (CT thorax, with contrast)

Correct answer: 71270 (CT thorax, without contrast followed by re-imaging with contrast)

CPT 71270 describes CT of the thorax performed without contrast followed by re-imaging with contrast (the combined 'with and without' study), and is the correct code when both phases are performed.

Question 8: Which Medicare form is used to submit outpatient hospital radiology claims?

ADA Dental Claim
HCFA-1490
CMS-1450 (UB-04) (Correct answer)
CMS-1500

Correct answer: CMS-1450 (UB-04)

Outpatient hospital claims, including radiology, are submitted on the CMS-1450 (UB-04) claim form.

Question 9: Which imaging technique is best suited for soft tissue contrast without ionizing radiation?

MRI (Correct answer)
Ultrasound
X-ray
CT

Correct answer: MRI

Magnetic Resonance Imaging (MRI) uses strong magnetic fields and radio waves to generate detailed images of organs and soft tissues. Unlike X-rays or CT scans, MRI does not use ionizing radiation and provides superior contrast for soft tissues, making it ideal for visualizing structures like the brain, spinal cord, and joints. Ultrasound also avoids radiation but typically offers less detailed soft tissue contrast than MRI.

Question 10: A radiology claim denied as 'not medically necessary' should be appealed to which first level under Medicare?

Qualified Independent Contractor (QIC)
Redetermination by the MAC (Correct answer)
Medicare Appeals Council
Office of Medicare Hearings & Appeals (OMHA)

Correct answer: Redetermination by the MAC

The first level of Medicare appeal is Redetermination, filed with the Medicare Administrative Contractor (MAC).

Question 11: What is the purpose of fluoroscopy in interventional radiology?

To reduce exposure time
To measure radiation dose
To monitor contrast retention
To provide real-time imaging (Correct answer)

Correct answer: To provide real-time imaging

Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the internal structures of a patient. In interventional radiology, it is invaluable for guiding procedures such as catheter placements, biopsies, and stent insertions. It allows the radiologist to visualize instruments and anatomy in motion, ensuring precision and safety.

Question 12: Which type of iodinated contrast media is associated with a lower risk of adverse reactions due to its osmolality being closer to that of blood?

Ionic contrast media
Barium sulfate suspension
Low-osmolality contrast media (LOCM) (Correct answer)
High-osmolality contrast media (HOCM)

Correct answer: Low-osmolality contrast media (LOCM)

Low-osmolality contrast media (LOCM) has osmolality closer to blood plasma and is associated with significantly fewer adverse reactions than high-osmolality ionic contrast media.

Question 13: Which process verifies a patient's insurance eligibility and benefits before a radiology service is performed?

Claims adjudication
Pre-authorization/pre-certification and eligibility verification (Correct answer)
Remittance posting
Charge capture

Correct answer: Pre-authorization/pre-certification and eligibility verification

Eligibility and benefits verification, along with pre-authorization, confirms coverage before service delivery.

Question 14: Which modifier does an interpreting radiologist append to a CPT code when billing only for the professional component (interpretation and report)?

Modifier 26 (Professional Component) (Correct answer)
Modifier 52 (Reduced Services)
Modifier 59 (Distinct Procedural Service)
Modifier TC (Technical Component)

Correct answer: Modifier 26 (Professional Component)

Modifier 26 (Professional Component) is appended when the physician bills only for interpretation and report, separate from the facility's technical component.

Question 15: In nuclear medicine, what does the term 'planar imaging' refer to?

X-ray fluoroscopy
PET attenuation correction
Two-dimensional images acquired from a gamma camera (Correct answer)
Three-dimensional SPECT reconstruction

Correct answer: Two-dimensional images acquired from a gamma camera

Planar imaging produces 2D static or dynamic gamma camera images without tomographic reconstruction.

Question 16: Which code series covers therapeutic nuclear medicine services such as radioiodine therapy?

79000–79999 (Correct answer)
78000–78099
77750–77799
77600–77620

Correct answer: 79000–79999

CPT codes 79000–79999 cover therapeutic nuclear medicine procedures including radioiodine treatments.

Question 17: A hospital outpatient CT angiography uses 100 ml of iopamidol 370 mg/ml iodine concentration. Which HCPCS code correctly describes this low-osmolality contrast?

Q9965 (LOCM, 100-199 mg/ml iodine, per ml)
Q9967 (LOCM, 300-399 mg/ml iodine, per ml) (Correct answer)
Q9966 (LOCM, 200-299 mg/ml iodine, per ml)
Q9951 (LOCM, 400 or greater mg/ml iodine, per ml)

Correct answer: Q9967 (LOCM, 300-399 mg/ml iodine, per ml)

Iopamidol 370 mg/ml has an iodine concentration of 370 mg/ml, which falls in the 300-399 mg/ml range, corresponding to HCPCS Q9967.

Question 18: Which condition applies when Medicare is the secondary payer for a radiology claim?

Medicare denies all secondary claims
Medicare pays first regardless
Coordination of Benefits (COB) rules determine Medicare's payment (Correct answer)
HCPCS modifiers are not required

Correct answer: Coordination of Benefits (COB) rules determine Medicare's payment

When Medicare is secondary, Coordination of Benefits rules govern how Medicare pays after the primary insurer has paid.

Question 19: An ultrasound is ordered to evaluate a palpable abdominal mass. No definitive diagnosis is confirmed. What is coded?

Abdominal pain (R10.9)
Palpable abdominal mass (R19.00) (Correct answer)
Nothing — await pathology
Unspecified abdominal neoplasm

Correct answer: Palpable abdominal mass (R19.00)

For outpatient encounters without confirmed diagnoses, the sign or symptom — here, the palpable mass — is coded.

Question 20: When imaging reveals an incidental finding unrelated to the reason for the study, how is it coded?

It is not coded unless clinically evaluated (Correct answer)
It is the principal diagnosis
It replaces the ordering diagnosis
It is always coded as a secondary diagnosis

Correct answer: It is not coded unless clinically evaluated

Incidental findings are only coded when the physician clinically evaluates and documents them.

Question 21: Which CPT code range covers CT of the thorax?

74176–74178
71250–71270 (Correct answer)
73200–73202
70490–70492

Correct answer: 71250–71270

CPT codes 71250–71270 cover CT thorax without contrast, with contrast, and without/with contrast.

Question 22: A radiologist interprets a CT of the abdomen and pelvis with contrast. Which CPT code should be reported?

74176
74177
74178 (Correct answer)
74181

Correct answer: 74178

CPT 74178 describes combined CT abdomen and pelvis with contrast in a single examination.

Question 23: Which metric measures the percentage of submitted claims that are paid on the first submission?

Days in AR
Denial rate
Net collection rate
First-pass resolution rate (Correct answer)

Correct answer: First-pass resolution rate

First-pass resolution rate measures the percentage of claims paid without rework on initial submission.

Question 24: Under OPPS, what is the status indicator 'S' for a radiology CPT code?

Significant procedure, not discounted when multiple (Correct answer)
Inpatient-only procedure
Ancillary service
Packaged service

Correct answer: Significant procedure, not discounted when multiple

OPPS status indicator 'S' identifies significant procedures that are not subject to multiple procedure discounting.

Question 25: What is brachytherapy in radiation oncology?

Stereotactic radiosurgery
Photon beam therapy
Radiation from radioactive sources placed inside or adjacent to the tumor (Correct answer)
External beam radiation at a distance

Correct answer: Radiation from radioactive sources placed inside or adjacent to the tumor

Brachytherapy involves placing radioactive seeds or sources directly inside or next to the tumor.

Question 26: Which HCPCS code is specifically assigned to gadoxetate disodium (Eovist/Primovist), a hepatocyte-specific MRI contrast agent used for liver imaging?

A9576
A9577
A9578 (Correct answer)
A9579

Correct answer: A9578

A9578 is the HCPCS code for gadoxetate disodium (Eovist), a hepatocyte-specific MRI contrast agent, while A9576 is gadopentetate dimeglumine, A9577 is gadobenate dimeglumine, and A9579 is gadolinium NOS.

Question 27: When a radiology study is ordered to rule out a suspected condition and findings are negative, what should the coder report?

No diagnosis code
The sign or symptom prompting the study (Correct answer)
The suspected diagnosis
The negative result code

Correct answer: The sign or symptom prompting the study

For outpatient/radiology services with ruled-out conditions, code the sign or symptom rather than the suspected diagnosis.

Question 28: Which HCPCS code set is used for Medicare-specific drugs and supplies used in radiology procedures?

HCPCS Level II (A–V codes) (Correct answer)
NDC codes only
CPT Level I codes
ICD-10-PCS codes

Correct answer: HCPCS Level II (A–V codes)

HCPCS Level II codes (alpha-numeric A–V) capture Medicare-specific items including contrast agents and radiopharmaceuticals.

Question 29: What ICD-10-CM code is used for a screening mammogram encounter?

Z12.11
Z12.39
Z13.6
Z12.31 (Correct answer)

Correct answer: Z12.31

ICD-10-CM Z12.31 designates an encounter for screening mammogram for malignant neoplasm of breast.

Question 30: In revenue cycle management, what does 'clean claim' mean?

A claim approved by a RAC
A claim that has been audited
A claim submitted without errors that can be processed immediately (Correct answer)
A claim with zero patient balance

Correct answer: A claim submitted without errors that can be processed immediately

A clean claim contains all required information and no errors, allowing immediate adjudication by the payer.

Question 31: Under Medicare, which component of a radiology service is billed by the radiologist personally?

Technical component (Modifier TC)
Facility fee
Professional component (Modifier 26) (Correct answer)
Global service

Correct answer: Professional component (Modifier 26)

Radiologists bill the professional component using Modifier 26, representing the physician's interpretation and report.

Question 32: What is the role of the Geographic Practice Cost Index (GPCI) in MPFS calculations?

Sets the national conversion factor
Adjusts RVUs to reflect regional cost differences (Correct answer)
Determines coding accuracy requirements
Establishes APC payment rates

Correct answer: Adjusts RVUs to reflect regional cost differences

GPCIs adjust each RVU component for geographic variation in physician work, practice costs, and malpractice premiums.

Question 33: Medicare requires a written order for which imaging modality before services are rendered?

Only MRI studies
Only X-rays
All advanced imaging under AUC program (Correct answer)
All imaging over $500

Correct answer: All advanced imaging under AUC program

The Appropriate Use Criteria (AUC) program requires ordering physicians to consult AUC for advanced diagnostic imaging including CT, MRI, and nuclear medicine.

Question 34: Which modifier would you use to indicate a repeat procedure by the same physician?

-24
-59
-77
-76 (Correct answer)

Correct answer: -76

The modifier -76 is used to indicate a repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is applied when the same procedure needs to be performed again on the same day or during the same operative session due to medical necessity. It ensures proper reimbursement for the repeated service.

Question 35: What Medicare rule limits self-referral for designated health services including radiology?

Stark Law (Physician Self-Referral Law) (Correct answer)
False Claims Act
HIPAA Privacy Rule
Anti-Kickback Statute

Correct answer: Stark Law (Physician Self-Referral Law)

The Stark Law prohibits physicians from referring Medicare patients to entities with which they have a financial relationship for DHS including radiology.

Question 36: Which character in ICD-10-CM typically indicates laterality?

6th character (Correct answer)
7th character
4th character
5th character

Correct answer: 6th character

The 6th character in ICD-10-CM most commonly designates laterality (right, left, bilateral).

Question 37: What is the purpose of an 'add-on' CPT code in radiology?

Used only for imaging guidance
Applied when a modifier is unavailable
Billed alone for standalone services
Reported separately only when a primary procedure is also reported (Correct answer)

Correct answer: Reported separately only when a primary procedure is also reported

Add-on codes are always reported in conjunction with a primary procedure and cannot be billed alone.

Question 38: Which CPT code describes stereotactic body radiation therapy (SBRT) delivery?

77371
77385
77373 (Correct answer)
77372

Correct answer: 77373

CPT 77373 reports SBRT treatment delivery, per fraction.

Question 39: What is the correct action if a coder notices an incomplete radiology report?

Assign default codes
Code based on similar cases
Ask the provider for clarification (Correct answer)
Leave it uncoded

Correct answer: Ask the provider for clarification

If a coder notices an incomplete radiology report, the correct and ethical action is to query the ordering or performing provider for clarification or additional details. Coding based on assumptions, similar cases, or assigning default codes can lead to inaccurate billing and potential compliance issues. Ensuring documentation fully supports the codes is paramount.

Question 40: Which code set is used alongside ICD-10-CM to capture external causes for injury-related radiology studies?

Z codes
V00–Y99 External Cause codes (Correct answer)
S codes only
R codes

Correct answer: V00–Y99 External Cause codes

External cause codes (V00–Y99) are used to document how, where, and the activity at time of injury.

Question 41: What does the suffix '-oma' typically indicate in medical terminology?

Inflammation
Infection
Tumor (Correct answer)
Bleeding

Correct answer: Tumor

In medical terminology, the suffix '-oma' is commonly used to indicate a tumor or a mass. This can refer to both benign (non-cancerous) and malignant (cancerous) growths, such as fibroma or carcinoma. Understanding this suffix helps in deciphering the meaning of many medical terms related to abnormal tissue growth.

Question 42: Which structure is responsible for filtering blood in the kidney?

Alveolus
Bronchiole
Neuron
Nephron (Correct answer)

Correct answer: Nephron

The nephron is the microscopic structural and functional unit of the kidney, responsible for filtering blood, reabsorbing essential substances, and excreting waste products. Each kidney contains millions of nephrons, which are vital for maintaining fluid and electrolyte balance in the body. The other options are units of different organ systems.

Question 43: Which CPT code modifier is used when a service or procedure is distinct or independent from other services?

-26
-LT
-RT
-59 (Correct answer)

Correct answer: -59

The modifier -59 is used to indicate that a service or procedure was distinct or independent from other services performed on the same day. This modifier is crucial for preventing unbundling issues and ensuring appropriate reimbursement when multiple procedures are performed that are not typically bundled together. It signifies a separate encounter, different anatomical site, or distinct service.

Question 44: Which radiopharmaceutical is most commonly used in thyroid uptake and scan studies?

Gallium-67
Iodine-131 (I-131) (Correct answer)
Technetium-99m (Tc-99m)
Thallium-201

Correct answer: Iodine-131 (I-131)

Iodine-131 is used for thyroid uptake, scan, and therapeutic ablation due to selective thyroid uptake.

Question 45: Under the Hospital Outpatient Prospective Payment System (OPPS), how are contrast agents below the CMS packaging threshold typically reimbursed?

Denied as non-covered supplies
Paid separately under the Physician Fee Schedule
Packaged into the APC payment for the associated imaging procedure (Correct answer)
Paid as a pass-through drug under a separate APC

Correct answer: Packaged into the APC payment for the associated imaging procedure

Under OPPS, contrast agents below CMS's packaging threshold are packaged into the Ambulatory Payment Classification (APC) for the imaging procedure rather than reimbursed separately.

Question 46: Which ICD-10-CM chapter contains codes for fractures?

Chapter 19 – Injury, Poisoning & External Causes (Correct answer)
Chapter 1 – Infectious Diseases
Chapter 21 – Factors Influencing Health
Chapter 13 – Musculoskeletal

Correct answer: Chapter 19 – Injury, Poisoning & External Causes

Traumatic fractures are classified in ICD-10-CM Chapter 19, covering injuries and external causes.

Question 47: A facility administers contrast media intravenously during a CT scan. Which separate CPT code should be reported for the IV injection of the contrast agent?

90765 (IV push injection for therapy)
No additional injection code; contrast administration is bundled into the imaging CPT (Correct answer)
96365 (IV infusion, initial, up to 1 hour)
36000 (Introduction of needle or catheter into a vein)

Correct answer: No additional injection code; contrast administration is bundled into the imaging CPT

Contrast administration (injection) is considered integral to the radiology procedure and is included in the imaging CPT code; it should not be reported separately.

Question 48: Which term describes a condition of reduced bone mass and density?

Osteoarthritis
Osteomyelitis
Osteosarcoma
Osteoporosis (Correct answer)

Correct answer: Osteoporosis

Osteoporosis is a condition characterized by a significant decrease in bone mass and density, leading to fragile bones and an increased risk of fractures. The term combines "osteo-" (bone) and "porosis" (porous), accurately describing the weakened, porous structure of the bones. It is distinct from other bone conditions like inflammation (osteomyelitis) or cancer (osteosarcoma).

Question 49: A dual-energy X-ray absorptiometry (DEXA) scan is ordered for osteoporosis screening. Which Z code applies?

Z13.820 (Correct answer)
Z12.31
Z13.5
Z13.6

Correct answer: Z13.820

Z13.820 is the ICD-10-CM code for encounter for screening for osteoporosis.

Question 50: Which term describes the movement of a limb away from the midline of the body?

Rotation
Abduction (Correct answer)
Flexion
Adduction

Correct answer: Abduction

Abduction is a movement that draws a limb or part away from the midline of the body. For example, lifting your arm out to the side is an act of abduction. Conversely, adduction is movement towards the midline, while flexion and rotation describe bending and turning movements, respectively.

Question 51: Which ICD-10-CM code type is used when imaging is performed on a healthy patient for a preventive service?

R symptom codes
E codes
Z codes (Correct answer)
S injury codes

Correct answer: Z codes

Z codes capture preventive and screening services for patients without a current illness prompting the visit.

Question 52: Which body plane divides the body into left and right halves?

Sagittal (Correct answer)
Coronal
Frontal
Transverse

Correct answer: Sagittal

The sagittal plane is an anatomical division that runs vertically, dividing the body or an organ into left and right portions. A midsagittal plane specifically divides the body into equal left and right halves. This plane is fundamental for describing the location and orientation of structures within the body.

Question 53: Which ICD-10-CM code category is used for encounters for screening examinations?

R00–R99
C00–C99
M00–M99
Z00–Z99 (Correct answer)

Correct answer: Z00–Z99

ICD-10-CM Z codes (Chapter 21) capture screening examinations and preventive health encounters.

Question 54: Which entity provides guidance on coding compliance programs?

AMA
OIG (Correct answer)
FDA
CMS

Correct answer: OIG

The Office of Inspector General (OIG) within the Department of Health and Human Services (HHS) is responsible for combating fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs. The OIG provides extensive guidance, including compliance program guidance, to healthcare entities to help prevent fraudulent billing practices and ensure adherence to regulations. CMS focuses on administering Medicare/Medicaid, FDA on drug/device safety, and AMA on physician advocacy.

Question 55: Under Medicare Advantage (MA) plans, which imaging service is most commonly subject to prior authorization requirements related to contrast use?

Plain abdominal radiograph, two views
Routine chest X-ray with contrast markers
CT colonoscopy without contrast material
MRI brain with gadolinium contrast for headache evaluation (Correct answer)

Correct answer: MRI brain with gadolinium contrast for headache evaluation

Many Medicare Advantage plans require prior authorization for advanced imaging studies with contrast such as MRI with gadolinium, as these represent higher-cost services subject to utilization management.

Question 56: Bundling edits prevent separate billing of which two services when performed together?

Two separate imaging modalities on different body parts
Professional and technical components
Pre-op and post-op X-rays
Imaging guidance and the primary procedure it guides (Correct answer)

Correct answer: Imaging guidance and the primary procedure it guides

CCI edits bundle imaging guidance codes with the primary procedures they guide when performed together.

Question 57: What does RBRVS stand for in physician fee schedule calculations?

Reimbursement-Based Radiology Value System
Revenue-Based Resource Value Schedule
Resource-Based Relative Value Scale (Correct answer)
Risk-Based Relative Volume Scale

Correct answer: Resource-Based Relative Value Scale

RBRVS stands for Resource-Based Relative Value Scale, the foundation of the Medicare Physician Fee Schedule.

Question 58: Why is ethics important in medical coding?

To improve coding speed
To ensure accurate & lawful coding (Correct answer)
To increase reimbursement
To avoid getting audited

Correct answer: To ensure accurate & lawful coding

Ethics in medical coding is paramount because it ensures that codes accurately reflect the services provided and comply with all legal and regulatory requirements. Ethical coding prevents fraudulent billing practices like upcoding or unbundling, protects the financial integrity of healthcare systems, and maintains trust between providers, payers, and patients. It prioritizes accuracy and legality over financial gain or speed.

Question 59: CT colonography for screening is reported with which CPT code?

74261
74263 (Correct answer)
74270
74262

Correct answer: 74263

CPT 74263 is used for CT colonography performed as a screening examination.

Question 60: Which imaging modality uses ionizing radiation to create cross-sectional images of the body?

Ultrasound
MRI
PET Scan
CT Scan (Correct answer)

Correct answer: CT Scan

A CT (Computed Tomography) scan uses X-rays (ionizing radiation) from multiple angles to create detailed cross-sectional images of organs, bones, soft tissues, and blood vessels. Unlike MRI or ultrasound, CT scans rely on radiation to generate these images. This makes ionizing radiation a key characteristic of this imaging modality.

Question 61: Which CPT code range covers radiation treatment management services?

77385–77387
77427–77432 (Correct answer)
77295–77301
77261–77263

Correct answer: 77427–77432

CPT codes 77427–77432 cover radiation treatment management, reported per five treatment sessions.

Question 62: Which document authorizes a radiology group to bill Medicare on behalf of its physicians?

DEA registration
Medicare Group Enrollment / Provider Transaction Access Number (PTAN) (Correct answer)
Credentialing certificate
NPI registration

Correct answer: Medicare Group Enrollment / Provider Transaction Access Number (PTAN)

A PTAN (Provider Transaction Access Number) is issued by Medicare to enrolled providers authorizing billing.

Question 63: What is the 'conversion factor' in the Medicare Physician Fee Schedule?

A dollar amount multiplied by total RVUs to determine payment (Correct answer)
The hospital cost-to-charge ratio
The geographic adjustment index
The ratio of allowed to billed charges

Correct answer: A dollar amount multiplied by total RVUs to determine payment

The conversion factor is a dollar multiplier applied to total adjusted RVUs to calculate Medicare payment amounts.

Question 64: What does the term 'write-off' mean in a radiology practice's revenue cycle?

Payments received from insurers
Charges submitted to secondary payers
Amounts contractually adjusted off the billed charge per payer agreement (Correct answer)
Patient deductible amounts

Correct answer: Amounts contractually adjusted off the billed charge per payer agreement

Write-offs are contractual adjustments reducing the billed charge to the payer-contracted rate.

Question 65: Gadolinium-based contrast agents used in MRI are primarily reported using which HCPCS code series?

J0636-J0640 (injectable drug codes)
C9399 (unlisted drug, outpatient PPS)
Q9965-Q9967 (iodinated contrast by concentration)
A9576-A9579 (gadolinium-based MRI contrast agents) (Correct answer)

Correct answer: A9576-A9579 (gadolinium-based MRI contrast agents)

Gadolinium-based MRI contrast agents are reported with HCPCS A-codes: A9576 (gadopentetate dimeglumine), A9577 (gadobenate dimeglumine), A9578 (gadoxetate disodium), and A9579 (NOS).

Question 66: When a radiologist performs both the professional and technical components, which modifier indicates the global service?

Modifier 59
Modifier 26
Modifier TC
No modifier needed (Correct answer)

Correct answer: No modifier needed

When a physician performs the global service (both components), no modifier is appended to the CPT code.

Question 67: In radiation therapy, what is a 'treatment field' or 'port'?

A defined beam entry area directed at the treatment target (Correct answer)
The simulation imaging setup
A shielding device
The radiation machine room

Correct answer: A defined beam entry area directed at the treatment target

A treatment field (port) is the specific beam area aimed at the tumor target from a defined direction.

Question 68: What is the Medicare global period for most radiology procedures?

90 days
10 days
000 days
0 days (XXX indicator) (Correct answer)

Correct answer: 0 days (XXX indicator)

Most radiology procedures carry the 'XXX' global period indicator, meaning the concept of global period does not apply.

Question 69: What does the placeholder 'X' serve in ICD-10-CM codes?

Replaces a missing laterality
Fills empty character positions to reach the required 7th character (Correct answer)
Denotes a new code
Indicates unknown diagnosis

Correct answer: Fills empty character positions to reach the required 7th character

The placeholder X is used to fill character positions so that a required 7th character can be assigned.

Question 70: Which denial reason code category indicates a claim was denied because the service was not covered under the patient's plan?

CO-18 (Duplicate claim)
CO-16 (Missing information)
CO-4 (Incorrect modifier)
CO-96 (Non-covered charge) (Correct answer)

Correct answer: CO-96 (Non-covered charge)

Claim Adjustment Reason Code CO-96 indicates the service is not covered under the patient's current benefit plan.

Question 71: What does CPT code 76376 represent in radiology?

3D rendering performed on same workstation (Correct answer)
3D rendering with separate workstation
PET/CT image fusion
CT angiography post-processing

Correct answer: 3D rendering performed on same workstation

CPT 76376 is used when 3D rendering is performed on the same workstation as the primary image acquisition.

Question 72: An MRI is ordered for low back pain. Which ICD-10-CM code is most appropriate?

M47.816
M54.4
M54.50 (Correct answer)
M51.16

Correct answer: M54.50

ICD-10-CM M54.50 reports low back pain, unspecified, when no more specific diagnosis is available.

Question 73: Barium sulfate administered for an upper GI (UGI) series in a hospital outpatient setting is typically handled under OPPS as:

Covered only under the patient's Part D pharmacy benefit
Packaged into the APC payment and not separately reimbursed by Medicare (Correct answer)
Separately billable using a HCPCS Q-code for the volume administered
Reported with a J-code for oral administration of a contrast agent

Correct answer: Packaged into the APC payment and not separately reimbursed by Medicare

Barium sulfate for GI studies falls below CMS's packaging threshold and is packaged into the APC payment under OPPS, making it non-separately reimbursable to the outpatient facility.

Question 74: What is 'balance billing' in radiology billing practices?

Billing the patient for the difference between the provider's charge and insurer's payment (Correct answer)
Billing a global service with separate components
Billing two insurers simultaneously
Billing for a higher-level service than performed

Correct answer: Billing the patient for the difference between the provider's charge and insurer's payment

Balance billing occurs when a provider bills the patient for the remaining balance after the insurer's payment, beyond the contracted amount.

Question 75: Which of the following is NOT a gadolinium-based contrast agent (GBCA) used in MRI?

Gadobutrol (Gadavist)
Gadobenate dimeglumine (MultiHance)
Iohexol (Omnipaque) (Correct answer)
Gadopentetate dimeglumine (Magnevist)

Correct answer: Iohexol (Omnipaque)

Iohexol (Omnipaque) is a non-ionic iodinated contrast agent used primarily for CT and myelography; the other three are gadolinium-based MRI contrast agents.

Radiology Certified Coder (RCC)

The RCC certification, administered by the Radiology Coding Certification Board (RCCB), validates expertise in radiology coding including CPT procedure coding, ICD-10-CM diagnosis coding, HCPCS Level II supplies and contrast media, and Medicare billing compliance for radiology services.

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