Chapter 13 — Quiz

Twenty-two questions.


Multiple choice

1. CPT is maintained by:

  • A. CMS
  • B. the American Medical Association
  • C. NCHS
  • D. AAPC

2. CPT is updated effective:

  • A. October 1
  • B. January 1
  • C. quarterly
  • D. as needed

3. The body that decides what CPT codes exist is:

  • A. the RUC
  • B. the CPT Editorial Panel
  • C. CMS
  • D. the Cooperating Parties

4. A code ending in F is:

  • A. Category I
  • B. Category II
  • C. Category III
  • D. unlisted

5. A code ending in T is:

  • A. Category I
  • B. Category II
  • C. Category III
  • D. a modifier

6. Category II codes are:

  • A. required for payment
  • B. optional, for performance measurement, and not paid
  • C. emerging technology
  • D. temporary Category I codes

7. If a Category III code describes the service, the coder reports:

  • A. an unlisted Category I code
  • B. the Category III code
  • C. the nearest Category I code
  • D. either

8. Which section appears first in the CPT book?

  • A. Surgery
  • B. Anesthesia
  • C. Evaluation and Management
  • D. Pathology and Laboratory

9. A venipuncture (36415) is found in which section?

  • A. Medicine
  • B. Pathology and Laboratory
  • C. Surgery
  • D. Evaluation and Management

10. The symbol indicates:

  • A. a new code
  • B. a revised code
  • C. an add-on code
  • D. a resequenced code

11. The # symbol indicates:

  • A. a deleted code
  • B. a resequenced code
  • C. a Category III code
  • D. a telemedicine code

12. Add-on codes are:

  • A. reported alone when clinically appropriate
  • B. never reported alone and exempt from modifier 51
  • C. always Category III
  • D. subject to the multiple procedure reduction

13. The relationship between add-on codes and modifier-51-exempt codes is:

  • A. identical lists
  • B. all add-on codes are modifier-51 exempt, but not all exempt codes are add-on codes
  • C. mutually exclusive
  • D. all modifier-51-exempt codes are add-on codes

14. A "(separate procedure)" code is reported when:

  • A. always
  • B. performed independently or distinct from other procedures at the same session
  • C. never
  • D. only with an add-on code

15. An unlisted procedure code requires:

  • A. modifier 51
  • B. a special report
  • C. a Category III code
  • D. prior authorization in all cases

16. An indented CPT code inherits from the code above it:

  • A. nothing
  • B. everything before the semicolon
  • C. the parentheticals only
  • D. the symbols only

Short answer

17. Name the six CPT sections and their ranges.

18. Name four kinds of content found in a section guideline, and say why the index never takes you there.

19. Name five kinds of parenthetical note.

20. State the Category III rule and the reason it exists.

21. (Chapter 8) Compare the CPT index and the ICD-10-CM index. Name the one structural difference and why it exists.

22. (Chapter 6) A code marked ▲ produces no rejection. Explain the risk in one sentence and name the January routine that addresses it.


Answer key **1.** B. **2.** B. **3.** B — the RUC recommends **values**, not codes. **4.** B. **5.** C. **6.** B. **7.** B. **8.** C. **9.** C — Surgery, cardiovascular system. This is the location that breaks everyone's intuition. **10.** B. **11.** B. **12.** B. **13.** B. **14.** B. **15.** B. **16.** B. **17.** Evaluation and Management **99202–99499** · Anesthesia **00100–01999** · Surgery **10004–69990** · Radiology **70010–79999** · Pathology and Laboratory **80047–89398** · Medicine **90281–99607**. **18.** Definitions of terms used in the section; what the codes include (the surgical package being the most consequential); reporting rules on what may and may not be reported separately; modifier guidance; unlisted codes and special report requirements; and the "separate procedure" designation. (Any four.) **The index never takes you there** because the index points at codes, and the guidelines sit at the front of the section — several pages above whatever the index found. **19.** **Cross-references** ("For X, see…") · **prohibitions** ("Do not report … in conjunction with…") · **requirements** ("Use … in conjunction with…") · **conditional instructions** ("If imaging guidance is performed, use…") · **deletion notices**. **20.** **If a Category III code exists that describes the service, it must be used instead of an unlisted Category I code.** **The reason:** Category III codes are how the code set collects utilization data on a new service. If everyone reported unlisted codes, no data would accumulate and the service could never earn a permanent Category I code. Using the Category III code is the mechanism by which a new procedure eventually gets one. **21.** **In ICD-10-CM, main terms are conditions** and looking up a body part returns *"see condition."* **In CPT, the anatomic site is a legitimate entry point** — along with the procedure, the condition, and eponyms and abbreviations. **Why:** a procedure is done *to* something, so the site is a reasonable way to search for it; a diagnosis is not done to anything, so ICD-10-CM indexes what is wrong rather than where. **22.** **The number survives and the meaning changes**, so you bill the right number for the wrong service and nothing rejects. **The January routine:** review every ▲ on the codes your practice actually bills — a short list, and the single highest-yield hour of the update cycle.