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CEU-Modifier3
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Question 1
Which statement is NOT true of modifiers?
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A) Modify the code description and change the core meaning B) Provide additional information regarding the service provided C) Tells the "story" more clearly D) Integral part of CPT and the HCPCS coding system
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback "Modify the code description and change the core meaning" is the correct answer because the core meaning of the CPT code description does not change with the application of a modifier. Feedback "Modify the code description and change the core meaning" is the correct answer because the core meaning of the CPT code description does not change with the application of a modifier.

Question 2
Which modifier may result in an increase in revenue?
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A) 54 B) 26 C) 22 D) 80
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback Modifier 22 - Increased Procedural Services states "When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service". Due to "substantially greater" work it is the modifier that is used when the expectation is that "substantially greater work" will mean an increase in reimbursement. Feedback Modifier 22 - Increased Procedural Services states "When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service". Due to "substantially greater" work it is the modifier that is used when the expectation is that "substantially greater work" will mean an increase in reimbursement.

Question 3
Which modifier is considered a global package modifier?

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A) 76 B) 26 C) 62 D) 50
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback Modifier 76 Repeat Procedure or Service by Same Physician states "It may be necessary to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service." Modifier 26 Professional Component states "Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number." Modifier 62 Two Surgeons states "When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. Note: If a co-surgeon acts as an assistant in the performance of additional procedure(s) during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate." Modifier 50 Bilateral Procedure states "Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session, should be identified by adding modifier 50 to the appropriate five digit code." The only modifier that would apply if you were in a global period out be modifier 76. After the first procedure is reported the next time it had to be reported would necessitate modifier 76 be applied to allow it to get through to be considered for payment. Feedback Modifier 76 Repeat Procedure or Service by Same Physician states "It may be necessary to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service." Modifier 26 Professional Component states "Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number." Modifier 62 Two Surgeons states "When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. Note: If a co-surgeon acts as an assistant in the performance of additional procedure(s) during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate." Modifier 50 Bilateral Procedure states "Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session, should be identified by adding modifier 50 to the appropriate five digit code." The only modifier that would apply if you were in a global period out be modifier 76. After the first procedure is reported the next time it had to be reported would necessitate modifier 76 be applied to allow it to get through to be considered for payment.

Question 4
Which level of HCPCS modifiers no longer exist?
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A) HCPCS Level I B) HCPCS Level II C) HCPCS Level III D) AMA CPT Manual Appendix A Modifiers
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback HCPCS Level III used to be used by local carriers but was discontinued. Feedback HCPCS Level III used to be used by local carriers but was discontinued.

Question 5
Which of the following is NOT a helpful tip when using modifiers.
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A) Know your payer and the settings they prefer. B) Do not trust the payer to increase your fee for you. C) Put modifiers that bundle first if appropriate. D) Trust the payer to know you have charged the reduced amount.
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback The payer does not know that you have charged a reduced amount. The only information they have is what you submit. It is best to never make assumptions when money is involved. Feedback The payer does not know that you have charged a reduced amount. The only information they have is what you submit. It is best to never make assumptions when money is involved.

Question 6
Mrs. Jones was seen in my office today and we made a decision for surgery but she will return next week for the pre-op visit. Which modifier would you use to inform the payer this visit is NOT a part of the global package?
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A) 25 B) 57 C) 24 D) 56
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback Modifier -57 is decision for surgery. E/M service resulting in the decision to perform the surgery on the day before major surgery or on the day of major surgery (90 day post-op) is not included in the global

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surgery payment and is separately billable.

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Feedback Modifier -57 is decision for surgery. E/M service resulting in the decision to perform the surgery on the day before major surgery or on the day of major surgery (90 day post-op) is not included in the global surgery payment and is separately billable.

Question 7
Mr. White returns to my office today for removal of his sutures following his open appendectomy. Which modifier would you use to inform the payor this was a staged procedure?
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A) 78 B) 77 C) 76 D) 62
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback Modifier -76, Repeat procedure by Same Physician shows the payer that, "I know this is the same CPT code as above (or reported earlier) but it is a repeat not a duplicate." Feedback Modifier -76, Repeat procedure by Same Physician shows the payer that, "I know this is the same CPT code as above (or reported earlier) but it is a repeat not a duplicate."

Question 8
Which modifier would you use for an abdominal ultrasound performed on Mr. Blue after his appendectomy to rule out gall stones.
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A) 76 B) 78 C) 77 D) 79
Type: Multiple choice Category: CEU-Modifier Points: 1 Randomize answers: No Feedback Modifier -79, Unrelated Procedure or Service by the Same Physician During the Postoperative Period. Without this modifier the payer's computer system would kick it out as being part of the follow up period for the previous surgery. Feedback Modifier -79, Unrelated Procedure or Service by the Same Physician During the Postoperative Period. Without this modifier the payer's computer system would kick it out as being part of the follow up period for the previous surgery.

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Question 9
Which of the following codes and modifier pair violate CPT guidelines?
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A) 78451-26 B) 68520-RT C) 20985-51 D) 00120-P1

Type: Multiple choice Category: PBC Midterm Points: 1 Randomize answers: No

Question 10
It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding what modifier?
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A) 79 B) 78 C) 77 D) 76
Type: Multiple choice Category: PBC Midterm Points: 1 Randomize answers: No

Question 11
CPT codes 22840-22848 are modifier 62 exempt?
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A) True B) False
Type: True/False Category: 2012CPCExam Points: 1 Feedback Just prior to code 22840 there are some code specific coding guidelines. In the third paragraph it states, "do not append modifier 62 to spinal instrumentation codes 22840-22848 and 22850-20938". Feedback Just prior to code 22840 there are some code specific coding guidelines. In the third paragraph it states, "do not append modifier 62 to spinal instrumentation codes 22840-22848 and 22850-20938".

Question 12
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Which of the following codes allows the use of modifier 51?

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A) 20975 B) 93600 C) 31500 D) 45392

Type: Multiple choice Category: 2012CPCExam Points: 1 Randomize answers: No Feedback Appendix E lists all CPT codes that are modifier 51 exempt. Also beside each code in the tabular there is a convention that looks like a circle with a backslash through it. This convention means that the code next to it is modifier 51 exempt. Code 45392 is the only code not listed in appendix E and that does not have this convention beside it. Feedback Appendix E lists all CPT codes that are modifier 51 exempt. Also beside each code in the tabular there is a convention that looks like a circle with a backslash through it. This convention means that the code next to it is modifier 51 exempt. Code 45392 is the only code not listed in appendix E and that does not have this convention beside it.

Question 13
What modifier is appropriate for a separately billable antenatal service during the global OB package period?
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A) 24 B) 25 C) 57 D) No modifier is needed
Type: Multiple choice Category: PMCC12-13 Female Points: 1 Randomize answers: No Feedback Rationale: An antenatal service is performed before the baby is delivered. According to the guidelines in Maternity Care and Delivery section in the CPT manual states: "Antepartum care includes the initial and subsequent history, physical examinations, recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery." Feedback Rationale: An antenatal service is performed before the baby is delivered. According to the guidelines in Maternity Care and Delivery section in the CPT manual states: "Antepartum care includes the initial and subsequent history, physical examinations, recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery."

Question 14
A patient with uterine prolapse presents for laparoscopic hysterectomy and colpopexy. After induction of general anesthesia the laparoscope is introduced into the abdomen with separate placement of ports for visualization. The surgeons began to tie off the uterine artery when the patient had a sudden drop in blood pressure and could not be stabilized. The procedure was discontinued. No procedures were completed. What are the CPT and
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modifier code(s) for this service?

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A) 58570-52, 57425-52 B) 58570-53, 57425-53 C) 58570-53 D) 58570-73

Type: Multiple choice Category: PMCC12-13 Female Points: 1 Randomize answers: No Feedback [b]Rationale:[/b] After general anesthesia was given and the surgery for the laparoscopic hysterectomy had started, the patient's blood pressure dropped and could not be stabilized. Using the CPT Index, there are two ways to find the code for a laparoscopic hysterectomy. Start with Hysterectomy/Laparoscopic/Total or see Laparoscopy/Hysterectomy/Total. Both indicate code range 58570-58573. Modifier 53 is the correct modifier to append because there was a threat to the well being of the patient during the surgery. You do not code for the colpopexy (57425) because the colpopexy surgery had not begun. Feedback Rationale: After general anesthesia was given and the surgery for the laparoscopic hysterectomy had started, the patient's blood pressure dropped and could not be stabilized. Using the CPT Index, there are two ways to find the code for a laparoscopic hysterectomy. Start with Hysterectomy/Laparoscopic/Total or see Laparoscopy/Hysterectomy/Total. Both indicate code range 58570-58573. Modifier 53 is the correct modifier to append because there was a threat to the well being of the patient during the surgery. You do not code for the colpopexy (57425) because the colpopexy surgery had not begun.

Question 15
A 22-year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service not usually requiring anesthesia. What modifier would be appended to the service?
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A) 22 B) 23 C) 47 D) 52
Type: Multiple choice Category: PMCC12-16 Anesthesia Points: 1 Randomize answers: No Feedback Rationale: Modifier 23 may be reported to describe a procedure not usually requiring anesthesia (either none or local) - but due to unusual circumstances general anesthesia is necessary. Feedback Rationale: Modifier 23 may be reported to describe a procedure not usually requiring anesthesia (either none or local) - but due to unusual circumstances general anesthesia is necessary.

Question 16
42-year-old patient was undergoing anesthesia in an ASC and began having complications prior to the administration of anesthesia. The surgeon immediately discontinued the planned surgery. If the insurance company requires a reported modifier, what modifier best describes the extenuating circumstances?
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A) 53 B) 23 C) 73 D) 74
Type: Multiple choice Category: PMCC12-16 Anesthesia Points: 1 Randomize answers: No Feedback Rationale: Although not typically reported by physicians, insurance companies may require specific modifiers. The modifier 73 best describes an anesthesia service discontinued prior to administration of anesthesia in an ASC. Feedback Rationale: Although not typically reported by physicians, insurance companies may require specific modifiers. The modifier 73 best describes an anesthesia service discontinued prior to administration of anesthesia in an ASC.

Question 17
A patient has a fine needle aspiration with the aspirant sent to cytopathology for examination. Once the specimen is reviewed, it is found to be inadequate to perform the test. A new specimen must be obtained which is then examined and returns a diagnosis. What modifier is appropriate to indicate that two specimens were examined?
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A) 76 B) 77 C) 91 D) no modifier
Type: Multiple choice Category: PMCC12-18 Path and Lab Points: 1 Randomize answers: No Feedback Rationale: The first test cannot be billed if there is not a sufficient specimen to perform the examination. Feedback Rationale: The first test cannot be billed if there is not a sufficient specimen to perform the examination.

Question 18
What modifier is used to report an evaluation and management service mandated by a court order?
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A) 24 B) 32 C) 57 D) 62
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Type: Multiple choice Category: PMCC12-19 EM Points: 1 Randomize answers: No

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Feedback Rationale: Modifier 32 is used for services related to mandated consultation and/or related services by a third party payer, governmental, legislative, or regulatory requirements. Feedback Rationale: Modifier 32 is used for services related to mandated consultation and/or related services by a third party payer, governmental, legislative, or regulatory requirements.

Question 19
What modifier would be used to report the termination of a surgery following induction of anesthesia due to extenuating circumstances or those that threaten the well being of the patient?
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A) Modifier 52 B) Modifier 22 C) Modifier 53 D) Modifier 54

Type: Multiple choice Category: PMCC12-06 Intro to CPT Points: 1 Randomize answers: No Feedback Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well being of the patient. CPT modifiers are found on the inside front cover and in Appendix A of your CPT codebook. Feedback Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well being of the patient. CPT modifiers are found on the inside front cover and in Appendix A of your CPT codebook.

Question 20
What is the appropriate modifier to use when two surgeons perform separate distinct portions of the same procedure?
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A) 66 B) 80 C) 62 D) 59
Type: Multiple choice Category: PMCC12-06 Intro to CPT Points: 1 Randomize answers: No Feedback Rationale: Modifier 62 is used when two surgeons work together as primary surgeons performing distinct part(s) of a procedure. Modifiers and their descriptions can be found on the inside front cover and Appendix A of your CPT codebook.

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Feedback Rationale: Modifier 62 is used when two surgeons work together as primary surgeons performing distinct part(s) of a procedure. Modifiers and their descriptions can be found on the inside front cover and Appendix A of your CPT codebook.

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