Chapter 13 — Exercises
Items marked † have worked solutions in Answers to Selected Exercises, along with every odd-numbered item.
Do these with a current CPT professional edition open. The chapter is about navigation and cannot be practiced from a page. Where you do not have a current edition, a prior year's is adequate for the structural items — and never for billing.
A. Recall and vocabulary
13.1 Who maintains CPT? Name the body that decides what codes exist and the separate body that recommends what they are worth.
13.2 When does CPT change? Which kind of change is most dangerous, and why?
13.3 † Name three practical consequences of CPT being copyrighted.
13.4 Distinguish Category I, II, and III by format and purpose.
13.5 † State the Category III rule and the reason it exists.
13.6 Name the six sections and their ranges. What is unusual about the order?
13.7 † What is in a section guideline? Name four kinds of content.
13.8 Why does almost nobody read the section guidelines?
13.9 † Name seven CPT symbols and what each warns you about. Which is the most dangerous and why?
13.10 Name five kinds of parenthetical note.
13.11 † State the three rules governing add-on codes. Then state the one-way relationship between add-on codes and modifier-51-exempt codes.
13.12 State the "separate procedure" rule in both directions. Why is the name misleading?
13.13 † State the three rules for unlisted procedure codes. What must accompany one, and what must that document contain?
13.14 How is the CPT index organized? Name the one structural difference from the ICD-10-CM index.
13.15 Explain the semicolon convention and the error it causes.
B. Navigate the book
Do each with a book open and record what you find.
13.16 † Find the Surgery section guidelines. How many pages? Name three things they define or state.
13.17 Find the Musculoskeletal subsection notes. What do they add that the Surgery guidelines do not?
13.18 † Find 20610. Record: the complete descriptor, every parenthetical beneath it, and any symbol in the margin.
13.19 Find 36415. Which section and subsection? Does its location surprise you? Explain why the classification put it there.
13.20 † Find one add-on code in the Surgery section. Record its symbol, its descriptor, and the parenthetical naming its permitted primary procedures.
13.21 Find one code carrying the "(separate procedure)" designation. State a circumstance in which it would be reported and one in which it would not.
13.22 † Find one code family using the semicolon convention with at least three indented codes. Write out the complete descriptor of the third indented code.
13.23 Find the appendix summarizing this year's additions, deletions, and revisions. How many codes changed in a section you work in?
C. Apply the rules
13.24 † A service is performed for which no Category I code exists. A Category III code describes it exactly. What do you report, and what would be wrong with the alternative?
13.25 An add-on code appears on a claim with no other procedure code. What happens and why?
13.26 † An add-on code appears with a primary procedure that is not among those named in its parenthetical. Is this correct? What would you check?
13.27 A code marked ▲ appears in your practice's superbill, unchanged from last year. State the risk and the check you would run.
13.28 † A coder reports a code whose indented descriptor reads "; with ultrasound guidance." The procedure note documents no guidance. Diagnose the error and name its cause.
13.29 A separate-procedure code was performed as part of a more extensive procedure at the same site and session. Report it or not? Now change the site.
13.30 † A service has no Category I code, no Category III code, and no close match. Describe exactly what you report and what you must produce alongside it.
D. Judgment and process
13.31 Your practice is building an internal coding cheat sheet reproducing CPT descriptors. State the issue and who should be consulted.
13.32 † A colleague answers a CPT question by searching the internet. Describe the order of operations you would recommend instead, and say why it is faster as well as more reliable.
13.33 Design the January update routine for a practice, focused specifically on ▲ revised codes. Who does what, when, and what is the output?
13.34 † A practice avoids unlisted procedure codes because they are slow and underpaid, and instead reports the closest available coded service. Give the three-part response.
E. Certification-style questions
13.35 † A CPT code ending in the letter T is:
- A. Category I
- B. Category II
- C. Category III
- D. an unlisted code
13.36 Category II codes are:
- A. required for payment
- B. optional supplemental tracking codes for performance measurement
- C. emerging technology codes
- D. modifiers
13.37 † The + symbol indicates:
- A. a new code
- B. a revised code
- C. an add-on code
- D. a resequenced code
13.38 The ▲ symbol indicates:
- A. a new code
- B. a revised code
- C. an add-on code
- D. a modifier-51-exempt code
13.39 † Add-on codes are:
- A. reported alone when appropriate
- B. never reported alone, and exempt from modifier 51
- C. subject to the multiple procedure reduction
- D. always Category III
13.40 A code designated "(separate procedure)" is reported:
- A. always, because it is separate
- B. when performed independently or distinct from other procedures at the same session
- C. never
- D. only with modifier 51
13.41 † Which section of CPT appears first in the book?
- A. Anesthesia
- B. Surgery
- C. Evaluation and Management
- D. Medicine
13.42 If a Category III code describes the service performed, the coder should report:
- A. an unlisted Category I code
- B. the Category III code
- C. the closest Category I code
- D. either, at the coder's discretion
13.43 † An indented CPT code inherits:
- A. nothing from the code above it
- B. everything before the semicolon in the code above it
- C. the parenthetical notes only
- D. the modifier requirements only
F. Write it
13.44 † Write the 120-word explanation you would give a new coder of why the section guidelines matter, with a concrete example of a question they answer.
13.45 Write the special report you would submit with an unlisted procedure code, using a constructed procedure of your choosing. Maximum 200 words, and include every element CPT's guidelines require.
13.46 Draft the symbol reference card you would tape inside your CPT book. Then state why §6.2's exam rules matter to how you make it.
G. The Encounter
13.47 † Locate all three CPT codes on Account 10-4471 by section, subsection, and heading. Which one's location is most surprising, and why is it there?
13.48 Find the parenthetical that governs the choice between 20610 and 20611. Quote it, then quote the clause in Figure 4.2 that answers it.
13.49 † The chapter says this is the second documented negative to decide this file. Name both, say what each decides, and explain why a negative finding is unusual in clinical documentation.
13.50 Suppose the procedure note had said nothing about imaging guidance — neither that it was used nor that it was not. State what a coder may and may not conclude, and what you would do.
13.51 Update your Encounter Workbook (Appendix C) with the CPT location of each code and the governing parenthetical.