Chapter 17 — Quiz

26 questions. Answers and explanations are in the instructor guide.

1. The surgical package includes all of the following EXCEPT:

  • A. Local anesthesia
  • B. Dictating the operative note
  • C. The visit at which the decision for surgery was made
  • D. Typical postoperative follow-up care

2. The largest silent revenue loss in surgical billing described in this chapter is:

  • A. Failing to report modifier 51
  • B. Writing off the decision-for-surgery visit
  • C. Reporting simple repairs separately
  • D. Failing to report diagnostic arthroscopy

3. A global period indicator of 000 means:

  • A. The code has no global period assigned yet
  • B. A minor procedure with no postoperative days
  • C. The global concept does not apply
  • D. The payer determines the period

4. A 090 global period includes:

  • A. The day of surgery and 90 days after
  • B. One preoperative day, the day of surgery, and 90 days after
  • C. 90 days before and after
  • D. 90 business days after

5. A code carrying a ZZZ indicator is:

  • A. An unlisted code
  • B. An add-on code, included in another code's global period
  • C. A code to which the global concept does not apply
  • D. A code the payer prices individually

6. Whether a procedure is "minor" or "major" for modifier selection is determined by:

  • A. The coder's judgment about complexity
  • B. Whether general anesthesia was used
  • C. The global period indicator — 000/010 minor, 090 major
  • D. The charge amount

7. When the "Procedure Performed" heading and the body of an operative note disagree:

  • A. The heading governs; the surgeon wrote it
  • B. The body governs, and you query
  • C. Report both
  • D. Report neither and return the chart

8. A lesion measures 1.8 cm and is excised with 0.4 cm margins. The excised diameter is:

  • A. 1.8 cm
  • B. 2.2 cm
  • C. 2.6 cm
  • D. Whatever the pathology report says

9. Coding a lesion excision from the pathology report's specimen measurement:

  • A. Is the preferred method, because pathology is objective
  • B. Systematically undersizes the excision, because tissue shrinks in formalin
  • C. Systematically oversizes the excision
  • D. Is required by CPT

10. The defect size is used to code:

  • A. The excision
  • B. The repair
  • C. Both
  • D. Neither

11. Three separate lesions are excised. They are:

  • A. Added together and reported as one
  • B. Coded separately, each with its own measurement
  • C. Reported with one code and three units
  • D. Reported with modifier 51 on the largest

12. An intermediate repair requires:

  • A. A wound longer than 5 cm
  • B. Layered closure, or single-layer closure of a heavily contaminated wound requiring extensive cleaning
  • C. General anesthesia
  • D. A physician rather than a mid-level practitioner

13. With respect to lesion excision:

  • A. Simple repair is included; intermediate and complex are separately reportable
  • B. All repairs are included
  • C. All repairs are separately reportable
  • D. Only complex repair is separately reportable

14. Two intermediate repairs, 3.0 cm on the trunk and 1.5 cm on the hand:

  • A. Are added: 4.5 cm, one code
  • B. Are reported separately, because they are in different anatomic groupings
  • C. Are reported as one code with two units
  • D. Require modifier 59

15. Adjacent tissue transfer:

  • A. Is reported in addition to the lesion excision
  • B. Includes the lesion excision
  • C. Is measured in linear centimeters
  • D. May not be reported with a repair

16. Debridement depth is determined by:

  • A. The deepest tissue exposed
  • B. The deepest tissue actually removed
  • C. The type of instrument used
  • D. The wound's original cause

17. For a procedure to be Mohs micrographic surgery:

  • A. A dermatologist must perform it
  • B. A single physician must act as both surgeon and pathologist
  • C. It must be performed in an operating room
  • D. At least three stages must be required

18. In Mohs micrographic surgery:

  • A. The surgical pathology is separately reported; the repair is not
  • B. The surgical pathology is not separately reported; the repair is
  • C. Neither is separately reported
  • D. Both are separately reported

19. A knee is classified as:

  • A. A small joint
  • B. An intermediate joint
  • C. A large joint
  • D. It depends on the patient

20. A large joint injection is performed with ultrasound guidance. The note documents the guidance but there is no permanent recording and no report. You report:

  • A. 20611, because guidance was used
  • B. 20610, because 20611 requires permanent recording and report
  • C. 20610 plus a separate ultrasound code
  • D. 20611 with modifier 52

21. "Closed treatment" of a fracture means:

  • A. The fracture was not compound
  • B. The fracture site was not surgically opened
  • C. A cast was applied
  • D. The fracture healed without complication

22. An emergency physician splints a wrist fracture and refers the patient to orthopedics. The correct reporting is generally:

  • A. Global fracture care, because a fracture was treated
  • B. An E/M service plus the splint application, because they are not managing the fracture through healing
  • C. Global fracture care with modifier 54
  • D. Nothing; the orthopedist reports everything

23. When global fracture care is reported, the initial cast application and the casting material are, respectively:

  • A. Included; included
  • B. Included; separately reportable
  • C. Separately reportable; included
  • D. Separately reportable; separately reportable

24. Surgical arthroscopy:

  • A. May be reported with a diagnostic arthroscopy when both are documented
  • B. Always includes diagnostic arthroscopy
  • C. Includes diagnostic arthroscopy only in the same compartment
  • D. Requires modifier 59 when both are performed

25. A code marked "(separate procedure)" is reportable:

  • A. Always
  • B. Only when performed alone, or independently of and unrelated to other services at the same session
  • C. Only with modifier 59
  • D. Only in the office setting

26. In Account 31-2245, eleven of the forty-two claims were probably defensible. The practice repaid all forty-two because:

  • A. The payer refused to review them individually
  • B. The operative notes did not establish a distinct anatomic region, and the defense could not be built retroactively
  • C. Modifier 59 is never permitted with 29822
  • D. The statute of limitations had expired