A CRNA performs anesthesia for a tubal ligation on a healthy 35-year-old. The CRNA is work-
ing independently. What is the correct code and modifier? - ANSWER Look in the CPT®
Index for Anesthesia/tubal ligation. The CRNA is working without medical direction (QZ)
from an anesthesiologist and the patient is healthy (P1).
A 60-year-old female has pancreatic carcinoma. She is taken to the outpatient surgical center
and undergoes placement of Infuse-A-Port for chemotherapy. Fluoroscopic guidance was
used to help the physician with the placement of the port. What CPT® coding is reported?
a.
36560
b.
36560, 77001-26
c.
36561, 77001-26
d.
36561 - ANSWER 36561, 77001-26
The surgical procedure of the insertion of the port is being performed on a patient that is
age 5 years or older. The Infuse-A-Port is a central venous access device. Guidance can be re-
ported separately with modifier 26 because the provider performs only the professional
component.
A 4-year-old child received a mumps, measles, rubella and varicella (MMRV) injection at a
neighborhood clinic with provider counseling. What CPT® codes are reported?
a. 90707, 90716, 90471, 90472 x 3
b. 90710, 90460
c. 90710, 90460, 90461 x 3
1
,d. 90707, 90716, 90460, 90461 x 3 - ANSWER 90710, 90460, 90461 x 3
In the CPT® Index look for Vaccine and Toxoids/Measles, Mumps, Rubella and Varicella
(MMRV) referring you to 90710. According to the CPT® guidelines for Vaccines and Toxoids,
an administration code from 90460-90474 is also reported. In the CPT® Index look for Im-
munization Administration/Toxoid/with Counseling. Because counseling was included, a
code from 90460-90461 is used for the administration. According to the guidelines, 90460
and 90461 are reported per component of the vaccine. Although it is one vaccination, there
are four separate components, 90460 is reported for mumps and 90461 x 3 (measles, ru-
bella, and varicella).
Which modifier begins a new global period for unrelated procedure?
a.
Modifier 57
b.
Modifier 25
c.
Modifier 78
d.
Modifier 79 - ANSWER Modifier 79
Modifier 78 does not extend the global period and allows for the intraoperative percentage
only of a procedure. The global period remains effective from the date of the original sur-
gery. Modifier 79 will begin a new global period for the unrelated procedure.
Which one of the following would be an audit finding for psychiatric services?
a.
Reporting code 90863 only.
b.
Reporting codes 90791 and 90785 on the same date of service.
c.
Reporting codes 99214 and 90838 on the same date of service.
2
,d.
Reporting code 90832 only. - ANSWER Reporting code 90863 only.
Code 90863 is an add-on code. It can only be reported with a code for psychotherapy.
Which scenario qualifies for modifier 25?
a.
A patient returns to the office for an injection ordered during the last E/M
b.
Preventive E/M performed in conjunction with a problem related E/M
c.
History and physical performed prior to a hysterectomy
d.
A nurse's assessment of the patient's BP prior to administering an IV - ANSWER Preven-
tive E/M performed in conjunction with a problem related E/M
According to CPT® coding guidelines, when a preventive E/M is performed on the same date
of service as a problem related E/M, report both E/M services and append modifier 25 to
the problem related E/M. Both services must be documented, and the problem related E/M
must be medically necessary and require significant additional work, above the service per-
formed for the preventive service.
Which of the following elements is NOT required for the physical therapy plan of care?
Long-term goals.
b. Physician co-signature for each session.
c. Number of treatment sessions.
d. Duration of treatment sessions. - ANSWER b.
Physician co-signature for each session.
Physician co-signature for each sessionA physician's signature is not required on the therapy
session encounters
3
, hat modifier is appended to indicate a service is provided under the primary care exception
without the presence of a teaching physician?
a. Modifier GE
b. Modifier 25
c. Modifier GC
d. Modifier TC - ANSWER Modifier GE
If approved for the primary care exception, the resident can see patients on their own and
discuss the case with the teaching physician. The physician is not required to perform a face-
to-face encounter unless it is medically necessary. The highest E/M level that can be billed is
a level III. A GE modifier is appended to the code to indicate the service was provided with-
out the presence of the teaching physician.
DOS: January 31CC: Follow up tibial osteomyelitis PI: Patient is a 58-year-old male. He has
had the tibial osteomyelitis treated with sterile debridement and irrigation. He has a vac. He
has been on IV Vancomycin and po Levaquin.PE: The vac is removed. He has gross purulence
in the tibia calcaneal and in the wound. There is draining puss. IMP: Left tibial osteomyelitis
Plan: He is admitted to the hospital today. We essentially failed limb salvage with this pa-
tient. He has had five or six debridements. He looked great at the time of discharge last
week. Apparently, his wound looked good on Saturday and it has worsened just over the last
several days. We are going to recommend amputation at this point. Please see H&P and hos-
pital notes for further details. We will proceed tomorrow. What modifier is applied to this
office visit?
a.
Modifier 58
b.
Modifier 78
c.
Modifier 25
d.
Modifier 57 - ANSWER Modifier 57
4
ing independently. What is the correct code and modifier? - ANSWER Look in the CPT®
Index for Anesthesia/tubal ligation. The CRNA is working without medical direction (QZ)
from an anesthesiologist and the patient is healthy (P1).
A 60-year-old female has pancreatic carcinoma. She is taken to the outpatient surgical center
and undergoes placement of Infuse-A-Port for chemotherapy. Fluoroscopic guidance was
used to help the physician with the placement of the port. What CPT® coding is reported?
a.
36560
b.
36560, 77001-26
c.
36561, 77001-26
d.
36561 - ANSWER 36561, 77001-26
The surgical procedure of the insertion of the port is being performed on a patient that is
age 5 years or older. The Infuse-A-Port is a central venous access device. Guidance can be re-
ported separately with modifier 26 because the provider performs only the professional
component.
A 4-year-old child received a mumps, measles, rubella and varicella (MMRV) injection at a
neighborhood clinic with provider counseling. What CPT® codes are reported?
a. 90707, 90716, 90471, 90472 x 3
b. 90710, 90460
c. 90710, 90460, 90461 x 3
1
,d. 90707, 90716, 90460, 90461 x 3 - ANSWER 90710, 90460, 90461 x 3
In the CPT® Index look for Vaccine and Toxoids/Measles, Mumps, Rubella and Varicella
(MMRV) referring you to 90710. According to the CPT® guidelines for Vaccines and Toxoids,
an administration code from 90460-90474 is also reported. In the CPT® Index look for Im-
munization Administration/Toxoid/with Counseling. Because counseling was included, a
code from 90460-90461 is used for the administration. According to the guidelines, 90460
and 90461 are reported per component of the vaccine. Although it is one vaccination, there
are four separate components, 90460 is reported for mumps and 90461 x 3 (measles, ru-
bella, and varicella).
Which modifier begins a new global period for unrelated procedure?
a.
Modifier 57
b.
Modifier 25
c.
Modifier 78
d.
Modifier 79 - ANSWER Modifier 79
Modifier 78 does not extend the global period and allows for the intraoperative percentage
only of a procedure. The global period remains effective from the date of the original sur-
gery. Modifier 79 will begin a new global period for the unrelated procedure.
Which one of the following would be an audit finding for psychiatric services?
a.
Reporting code 90863 only.
b.
Reporting codes 90791 and 90785 on the same date of service.
c.
Reporting codes 99214 and 90838 on the same date of service.
2
,d.
Reporting code 90832 only. - ANSWER Reporting code 90863 only.
Code 90863 is an add-on code. It can only be reported with a code for psychotherapy.
Which scenario qualifies for modifier 25?
a.
A patient returns to the office for an injection ordered during the last E/M
b.
Preventive E/M performed in conjunction with a problem related E/M
c.
History and physical performed prior to a hysterectomy
d.
A nurse's assessment of the patient's BP prior to administering an IV - ANSWER Preven-
tive E/M performed in conjunction with a problem related E/M
According to CPT® coding guidelines, when a preventive E/M is performed on the same date
of service as a problem related E/M, report both E/M services and append modifier 25 to
the problem related E/M. Both services must be documented, and the problem related E/M
must be medically necessary and require significant additional work, above the service per-
formed for the preventive service.
Which of the following elements is NOT required for the physical therapy plan of care?
Long-term goals.
b. Physician co-signature for each session.
c. Number of treatment sessions.
d. Duration of treatment sessions. - ANSWER b.
Physician co-signature for each session.
Physician co-signature for each sessionA physician's signature is not required on the therapy
session encounters
3
, hat modifier is appended to indicate a service is provided under the primary care exception
without the presence of a teaching physician?
a. Modifier GE
b. Modifier 25
c. Modifier GC
d. Modifier TC - ANSWER Modifier GE
If approved for the primary care exception, the resident can see patients on their own and
discuss the case with the teaching physician. The physician is not required to perform a face-
to-face encounter unless it is medically necessary. The highest E/M level that can be billed is
a level III. A GE modifier is appended to the code to indicate the service was provided with-
out the presence of the teaching physician.
DOS: January 31CC: Follow up tibial osteomyelitis PI: Patient is a 58-year-old male. He has
had the tibial osteomyelitis treated with sterile debridement and irrigation. He has a vac. He
has been on IV Vancomycin and po Levaquin.PE: The vac is removed. He has gross purulence
in the tibia calcaneal and in the wound. There is draining puss. IMP: Left tibial osteomyelitis
Plan: He is admitted to the hospital today. We essentially failed limb salvage with this pa-
tient. He has had five or six debridements. He looked great at the time of discharge last
week. Apparently, his wound looked good on Saturday and it has worsened just over the last
several days. We are going to recommend amputation at this point. Please see H&P and hos-
pital notes for further details. We will proceed tomorrow. What modifier is applied to this
office visit?
a.
Modifier 58
b.
Modifier 78
c.
Modifier 25
d.
Modifier 57 - ANSWER Modifier 57
4
