Download NWCA Procedural Coding Basics Exam and more Exams Technology in PDF only on Docsity!
Question 1. Which section of the CPT manual provides the alphabetical listing of procedures and related terms? A) Introduction B) Tabular List C) Alphabetic Index D) Guidelines Section Answer: C Explanation: The Alphabetic Index is the alphabetical listing that helps coders locate the main term and any associated subterms before confirming the code in the Tabular List. Question 2. A code marked with the symbol “†” in the CPT manual indicates: A) Revised code B) Add‑on code C) New code D) Code deleted from the manual Answer: B Explanation: The dagger (†) symbol identifies an add‑on code, which must be reported in addition to the primary procedure code. Question 3. Category II CPT codes are primarily used for: A) Emerging technologies B) Performance measurement and quality reporting C) Surgical procedures only D) Billing for anesthesia services Answer: B Explanation: Category II codes are optional, tracking performance and quality metrics rather than defining a specific service.
Question 4. When a CPT code is followed by the modifier “‑ 51 ”, it indicates: A) Bilateral procedure B) Multiple procedures C) Reduced services D) Professional component only Answer: B Explanation: Modifier‑51 denotes a multiple‑procedure reduction when more than one distinct service is performed in the same encounter. Question 5. The three‑year rule for determining a new patient status applies to: A) Patients who have not visited the same provider within three years B) Patients who have not visited any provider of the same specialty within three years C) Patients who have not been seen in the same geographic location within three years D) Patients who have not received any CPT code in three years Answer: B Explanation: A patient is considered “new” if they have not received a service from the same specialty provider in the past three years. Question 6. Which CPT modifier is used to indicate that a service was performed on both sides of the body? A) 26 B) 50 C) 59 D) 91 Answer: B
Explanation: Add‑on codes are supplemental services that are reported in addition to the primary procedure code. Question 10. The purpose of the “Exempt from modifier‑ 51 ” symbol (⊤) is to: A) Indicate the code cannot be used with any modifier B) Show the code is automatically reduced when multiple procedures are performed C) Identify codes that are not subject to the multiple‑procedure reduction D) Mark codes that are obsolete Answer: C Explanation: The “⊤” symbol marks codes that are exempt from the modifier‑51 reduction, meaning they retain full payment even when multiple services are billed. Question 11. Which CPT modifier is used when only the technical component of a service is performed? A) 26 B) TC C) 59 D) 76 Answer: A Explanation: Modifier 26 indicates that only the technical component (equipment, supplies, staff) of a service is being billed. Question 12. In E/M coding, which of the following can be used to select the level of service when time is the determining factor? A) Number of diagnoses B) Total time spent on the date of the encounter C) Number of procedures performed
D) Length of stay in the hospital Answer: B Explanation: When time is the primary factor, the total minutes spent on the date of the encounter (including counseling and coordination) determines the E/M level. Question 13. The “Place of Service” (POS) code for an office visit is: A) 02 B) 11 C) 21 D) 22 Answer: C Explanation: POS 21 designates a physician’s office, the typical setting for outpatient evaluation and management services. Question 14. Which CPT category contains codes for experimental or emerging technologies? A) Category I B) Category II C) Category III D) Category IV Answer: C Explanation: Category III codes are temporary codes for emerging services, technologies, and procedures not yet widely adopted. Question 15. When abstracting clinical data, the coder must identify: A) Only the physician’s signature B) The chief complaint, history, exam, and medical decision making
B) Only the operative time C) Only the anesthesia services D) Only the post‑operative follow‑up visits after 30 days Answer: A Explanation: The global surgical package bundles pre‑operative evaluation, intra‑operative services, and routine post‑operative care (usually 0, 10, or 90 days depending on the procedure). Question 19. Which CPT modifier is used to indicate a reduced services code when the service is not performed? A) 52 B) 53 C) 54 D) 55 Answer: A Explanation: Modifier 52 signals that a service was partially reduced or not performed as described. Question 20. In the CPT manual, the “Guidelines” section at the beginning of each chapter provides: A) A list of all codes in alphabetical order B) Instructions on how to apply the codes in that section C) The fee schedule for each code D) A history of the code’s development Answer: B Explanation: Section‑specific guidelines clarify coding rules, definitions, and special circumstances for the codes within that chapter.
Question 21. The symbol “‡‡” next to a CPT code indicates: A) New code B) Revised code that has been updated in the current year C) Code deleted from the current edition D) Code that is exempt from modifier‑ 51 Answer: B Explanation: Double double‑dagger (‡‡) denotes a revised code where the description has been updated for the current edition. Question 22. Which modifier is used when a service is performed by a different provider than the one who rendered the primary service, but on the same day? A) 59 B) 76 C) 77 D) 78 Answer: B Explanation: Modifier 76 indicates a repeat procedure or service by the same provider on the same day. Question 23. The “three‑year rule” does not apply when determining patient status for: A) A patient who switches from primary care to cardiology B) A patient who returns to the same specialist after two years C) A patient who receives telehealth services from a different provider D) A patient who receives a new diagnosis from the same specialty after four years Answer: D Explanation: The three‑year rule is based on specialty; if a patient has not been seen by the same specialty in three years, they are considered new, regardless of the time elapsed.
Explanation: Pathology services are reported separately when performed on the same day, but they are not add‑on codes; they are distinct services. Question 27. Which of the following is a correct use of modifier – 24? A) To indicate a postoperative follow‑up visit unrelated to the original procedure B) To indicate a surgical assistant’s services C) To indicate a service performed in a different anatomical region D) To indicate a reduced service Answer: A Explanation: Modifier 24 is used for unrelated evaluation and management services performed during the postoperative period. Question 28. In the CPT manual, the “Alphabetic Index” entry for “appendectomy” will most likely direct the coder to which type of code? A) Category II B) Category III C) Category I surgical code D) HCPCS Level II code Answer: C Explanation: Appendectomy is a standard surgical procedure, listed under Category I codes in the Tabular List. Question 29. Which modifier is applied when a service is performed only for the professional component? A) 26 B) TC C) 59
D) 91
Answer: A Explanation: Modifier 26 indicates that only the professional component (physician’s work) of a service is being billed. Question 30. When a CPT code is marked with the symbol “△” (triangle), it means: A) The code is a Category III code B) The code is no longer used (deleted) C) The code is a new code for the current edition D) The code is exempt from the global period Answer: B Explanation: The triangle (△) denotes a deleted code that is no longer valid for billing. Question 31. Which of the following best describes “downcoding”? A) Assigning a higher‑level code than the service performed B) Assigning a lower‑level code than the service performed, often unintentionally C) Reporting a code without a modifier when required D) Using a Category III code for a Category I service Answer: B Explanation: Downcoding is the practice of selecting a lower‑level code than warranted, which can lead to underpayment and potential compliance issues. Question 32. A provider performs a bilateral knee arthroscopy in one session. Which coding approach is correct? A) Report one code with modifier 50 B) Report two separate codes without modifiers C) Report one code with modifier 59
D) Multiple Diagnostic Modules Answer: B Explanation: MDM (Medical Decision Making) is a core component used to determine the level of E/M service based on complexity. Question 36. Which CPT category is primarily used for quality reporting and does not affect reimbursement directly? A) Category I B) Category II C) Category III D) Category IV Answer: B Explanation: Category II codes are optional and designed for performance measurement; they are not tied to payment. Question 37. The symbol “‡‡‡” next to a CPT code indicates: A) The code is new for the current year B) The code has been revised and is a new version of a previously existing code C) The code is deleted from the manual D) The code is a Category III code Answer: B Explanation: Triple double‑dagger (‡‡‡) signals a revised code that replaces a previous version. Question 38. For a service performed in a hospital outpatient department, which POS code is used? A) 21 B) 22
C) 23
D) 24
Answer: B Explanation: POS 22 designates a hospital outpatient department. Question 39. Which modifier is used when a service is performed by a resident under supervision and the teaching physician also provides a separate service? A) 24 B) 25 C) 26 D) 57 Answer: D Explanation: Modifier 57 indicates a significant, separately identifiable E/M service performed by the teaching physician. Question 40. When a CPT code includes the phrase “add‑on” in its description, the coder must: A) Report it alone without a primary code B) Report it in addition to the primary procedure code C) Use modifier 59 to indicate distinct service D) Never report it if the primary code is bundled Answer: B Explanation: Add‑on codes are always reported with the associated primary procedure code. Question 41. The “Alphabetic Index” entry for “fracture, closed” will most likely direct the coder to which type of code? A) Diagnosis code (ICD)
A) 24
B) 25
C) 59
D) 76
Answer: A Explanation: Modifier 24 is used for unrelated E/M services performed during the postoperative global period. Question 45. The CPT code for a routine office visit for an established patient is most likely found in which range? A) 99201‑ 99205 B) 99211‑ 99215 C) 99341‑ 99350 D) 99401‑ 99404 Answer: B Explanation: Established patient office visits are coded in the 99211‑99215 range. Question 46. Which of the following statements about “Category III” codes is correct? A) They are mandatory for all new technologies B) They have a five‑year lifespan before deletion if not adopted C) They are used for quality measurement only D) They are bundled into Category I codes automatically Answer: B Explanation: Category III codes are temporary; if the technology does not become widely used within five years, the code is typically deleted.
Question 47. A provider performs a single surgical procedure and a separate anesthesia service on the same day. Which modifier should be attached to the anesthesia code to indicate it is a separate service? A) 26 B) 59 C) 51 D) 91 Answer: D Explanation: Modifier 91 indicates that the anesthesia service was distinct and separate from the surgical procedure. Question 48. When using the Alphabetic Index, the coder should first locate the: A) Modifier list B) Main term (e.g., “excision”) C) Global period table D) Fee schedule Answer: B Explanation: The coder starts with the main term in the Alphabetic Index, then follows any sub‑entries to find the appropriate code. Question 49. The symbol “††” next to a CPT code indicates: A) Add‑on code B) New code for the current edition C) Revised code that has been updated D) Code deleted from the manual Answer: A
D) 26
Answer: A Explanation: Modifier 59 is used for distinct procedural services that are not bundled or add‑on. Question 53. Which CPT code range is designated for radiology procedures? A) 10000‑ 19999 B) 20000‑ 29999 C) 30000‑ 39999 D) 60000‑ 69999 Answer: B Explanation: Radiology codes are located in the 20000‑29999 range. Question 54. A code preceded by the symbol “‡‡‡‡” indicates: A) A code that has been revised multiple times in the current edition B) A new code introduced this year C) A code that has been deleted D) A code that is exempt from global period Answer: A Explanation: Multiple double‑daggers (‡‡‡‡) signal that the code has undergone several revisions within the current edition. Question 55. Which modifier would you append to a surgical code when a separate anesthesia code is submitted for the same procedure? A) 26 B) 59 C) 51 D) 91
Answer: D Explanation: Modifier 91 indicates a distinct anesthesia service separate from the surgical code. Question 56. The CPT manual’s “Introduction” section primarily provides: A) Detailed code descriptions B) Historical background and purpose of CPT C) Fee schedules for each code D) Lists of all modifiers Answer: B Explanation: The Introduction explains the purpose, development, and usage of CPT coding. Question 57. When a CPT code is marked with the symbol “⊤”, it means the code: A) Is exempt from modifier‑51 reduction B) Is a new code for the current year C) Is a Category III code D) Is deleted from the manual Answer: A Explanation: The “⊤” symbol indicates that the code is not subject to the multiple‑procedure reduction (modifier‑51). Question 58. Which CPT modifier indicates that a service was performed on the same day as a previous identical service by the same provider? A) 76 B) 77 C) 78 D) 79 Answer: A
