Questions and Answers
What modifier is used for a patient returning to the operating room by the same physician for removal of deep pins during the postoperative period due to complication after an open repair of a humerus fracture?
78
What modifier is used when a physician must repeat coronary bypass due to complications of an initial procedure performed on the same day?
76
What modifier is used for a bilateral tympanoplasty?
50
Which modifier would you use to indicate that two or more modifiers are required to describe a service?
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What modifier should be used to indicate a procedure on a neonate weighing 9 kg that was extremely complicated?
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What modifier indicates postoperative care following discharge when performed by a different physician?
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What modifier would you add to the procedure code to indicate that Dr. Meredith served as an assistant surgeon?
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What Level II modifier would indicate the left thumb for a surgical procedure?
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What Level II modifier indicates the upper left eyelid?
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The diagnosis code -32 corresponds to what classification?
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According to The Medicare Claims Processing Manual 100-04, Chapter 12, 20.6, claims processing contractors must maintain at least __________ full calendar years of fee schedules and related pricing data.
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Which of the following may be an example of 'unusual anesthesia' circumstances? (Select all that apply)
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What is the CPT Code and Modifier for the repair of an enterocele using an abdominal approach on a morbidly obese patient?
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What is the CPT Code and Modifier for a radical orchiectomy with abdominal exploration for a malignant neoplasm that extended the surgery due to hemorrhage?
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What modifier would the anesthesiologist report for a case where general anesthesia was used due to the patient's inability to cooperate?
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What modifier would be added to a skilled nursing facility admission for a patient with advanced dementia during the global period for a prior procedure?
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What modifier would be added to the second office visit code for a patient who came to see the same physician for unrelated problems on the same day?
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If coding for the radiologist, what modifier would you add to indicate the service provided by the radiologist for x-rays?
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What is the symbol in the CPT manual that indicates modifier -51 should not be used?
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What modifier would be added to the examination service for a mandatory examination referred by Workers' Compensation?
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What modifier would be added to the surgical code when regional anesthesia is administered by the surgeon?
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When coding for a bilateral carpal tunnel surgery, what modifier would you be certain to use?
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What are the CPT codes, Modifier, and ICD-10-CM code used for the destruction of primary malignant lesions of the neck and arm?
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What are the CPT codes, Modifier, and ICD-10-CM code used for bilateral supratentorial burr holes for chronic subdural hematomas?
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What CPT codes and Modifier are used for treatment of two tarsal bone fractures without manipulation?
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What modifier and ICD-10-CM code are used for a bilateral total knee replacement?
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Which modifier describes a procedure that was reduced at the direction of the physician?
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What are the codes for bilateral arthrotomy of the elbows?
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List three ways the bilateral modifier could be used to indicate that a bilateral radical mastectomy was performed.
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What modifier would be used with the lymphadenectomy code for Mrs. Knight after a diagnostic surgical biopsy?
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What are the CPT code and modifier used for the inoperative service for a total esophagectomy without reconstruction?
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What modifier is applied to a surgical procedure to indicate increased physician work was performed?
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What modifier indicates that multiple modifiers apply?
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What modifier would be added to the laboratory procedure code to indicate testing by an outside laboratory?
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What part of the CPT manual lists a full description for all modifiers?
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What is the word that means assigning multiple codes when one code would do?
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What is the term that describes the services provided to a patient by the physician before surgery?
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Do all third-party payers recognize all modifiers as listed in the CPT manual?
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What is the term that describes two physicians working together in the completion of a procedure when each has the same level of responsibility?
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What are the modifier and ICD-10-CM codes used for a patient admitted for bilateral arthroscopy of the knees due to Baker's cysts?
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What modifier would be submitted to report the services of a surgical resident assisting in surgery in a teaching hospital?
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What are the modifier and ICD-10-CM codes used when a procedure is discontinued due to complications during surgery?
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What are the modifier, ICD-10-CM code, external cause W code, and external cause Y code used for a 10-month-old child needing anesthesia for a wound repair?
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What is the modifier and ICD-10-CM code used for a radiological examination confirming Crohn's disease?
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What is the modifier and ICD-10-CM code used for anesthesia provided during a tympanoplasty?
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What is the modifier and ICD-10-CM code for a complete physical examination referred by Workers' Compensation?
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Study Notes
Key Concepts of Modifiers in Medical Coding
- Medicare claims contractors must retain at least five years of fee schedules and pricing data.
- "Unusual anesthesia" circumstances include scenarios such as treating anxious children or patients with cognitive impairments.
CPT Codes and Modifiers
- CPT code 57270 requires modifier -22 for a prolonged surgery due to patient obesity.
- A radical orchiectomy with complications uses CPT 54535 with modifier -22, accompanied by ICD-10 codes C62.12 and N99.61 for cancer and complication management.
Appropriate Use of Anesthesia Modifiers
- Modifier -23 is used when general anesthesia is necessary instead of local for patients unable to cooperate due to mental health conditions.
- Modifier -24 indicates an unrelated evaluation and management service during a global period.
Multiple Office Visits
- Modifier -25 is added to the second office visit on the same day for unrelated issues.
Radiology and Professional Services
- Radiology interpretations by a radiologist require modifier -26 to indicate the professional component of the service rendered.
Various Modifiers and Their Applications
- Modifier Ø indicates that modifier -51 should not be applied as per CPT guidelines.
- Modifier -32 indicates services mandated by insurance, such as examinations for legitimacy.
- Bilateral procedures use modifier -50, such as bilateral carpal tunnel surgery coded as G56.03.
Co-Surgeon, Surgical Assistant, and Team Concepts
- Modifier -62 indicates that the surgical services were provided by co-surgeons from different specialties.
- Surgical assistants' contributions are reported with modifier -80, while minimum assistance is noted with modifier -81.
Postoperative Care and Complications
- Transfer of postoperative care to another physician is reported with modifier -54.
- Continued postoperative services after hospital discharge require modifier -55.
Global Surgery Package and Modifier Use
- Preoperative and postoperative services are bundled unless specified otherwise.
- Modifier -58 indicates planned procedures that follow one another.
- Modifiers -76 and -78 are used to indicate repeated services by the same or different physicians during the postoperative period.
Condition-Specific Codes
- Diagnostic tests and procedures must include ICD-10 codes reflecting the exact conditions being treated, such as K50.10 for Crohn's disease.
Teaching Facilities and External Laboratory Usage
- Teaching facilities are accredited hospitals associated with educational institutions.
- Outside labs are responsible for billing for diagnostic tests performed, often requiring modifier -90.
Special Considerations for Specific Patient Groups
- Modifier -63 applies to procedures for neonates or infants weighing up to 4 kg (8.8 lbs).
- Modifiers like -22 indicate increased complexity for surgical procedures, especially in pediatric cases.
Billing and Payer Specifics
- Not all third-party payers accept all CPT modifiers, impacting billing accuracy.
- Use of modifier -99 indicates the application of multiple modifiers to a single service.
External Causes and Specific Procedure Cases
- External cause codes such as W18.30XA provide context for injury occurrences during procedures.
Summary
- Mastery of modifiers in medical coding ensures accurate reporting, compliance with payer requirements, and appropriate payment for services rendered. Understanding the specific applications and meanings of each modifier is essential for professionals in the healthcare field.
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Description
Test your knowledge on Medicare Modifiers with these flashcards from Chapter 10. The quiz covers important definitions and examples related to fee schedule services and anesthesia circumstances. Perfect for students and professionals in healthcare billing.
