CPT PDF

HCPCS Coding and
Reimbursement Issues
Billing and Coding Professional
Certification Exam Review : HCPCS
Coding and Reimbursement Issues
Lesson 2 Overview
You'll begin this lesson by

reviewing HCPCS coding.
You'll then review how to
resolve and prevent
reimbursement issues.
2.1 Identify when and

how to assign codes
from the Surgery
section of the CPT
Surgery Section (10004-69990)
READING ASSIGNMENT
Read this section. Then, read Chapter 19 in your textbook.
The surgery section is the largest section within the CPT manual. It's
divided by the following subspecialties:
Integumentary System (10040–19499)
Copyright Penn Foster, Inc. 2019 Page 1

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Musculoskeletal System (20100–29999)
Respiratory System (30000–32999)
Cardiovascular Surgery (33010–37799)
Hemic and Lymphatic System (38100–38999)
Mediastinum and Diaphragm (39000–39499)
Digestive System (40490–49999)
Urinary System (50010–53899)
Male Genital System (54000–55899)
Female Genital System (56405–58999)
Maternity Care and Delivery (59000–59899)
Endocrine System (60000–60699)
Nervous system (61000–64999)
Eye and Ocular (65091–68899)
Auditory System (69000–69979)
Cardiovascular in Radiology (75557–75774)
Cardiovascular in Medicine (92920–93799)
Code sets within each section have guidelines and notations. You
must read these sections and apply codes accordingly. Each section
gives instructions for how to use each code within that section. Failure
to read and follow these set guidelines can result in improper coding
and reimbursement issues.
Important Guidelines to Understand
The following guidelines in the Surgery section are some of the most
important and frequently used. Be sure to study these carefully.

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Bundled procedures. Some services are included in surgical
procedures. As a coder, it is important to read each CPT carefully
and identify what services are included. Be cautious and don't bill
these services separately:
Local infiltration, digital blocks, topical anesthesia
Immediate postop care
Post-anesthesia evaluation
Postop follow-up care
Global packages. Global procedures are classified per CPT code
and are assigned a global period of 0, 10, or 90 days. When
assigning a fee for service, insurance payers consider services
provided in the preoperative, intraoperative, and postoperative
stages. Knowledge of the CPT codes with assigned global
packages is vital to prevent inaccurate claim processing and
reimbursement.
Some services aren't included within the global package
Initial evaluation/consultation. Remember modifiers -56 and -
57 if applicable.
Unrelated evaluations or procedures. Remember modifier -
24 and -79.
Diagnostic tests
Postoperative complication requiring a return to the
operating room. Remember modifier -78.
Need for a more extensive procedure. Remember modifier -
58.
Critical care not related to the surgery

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Click to view more information on CPT code global reporting (www.cm
s.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/
global-surgery-data-collection-.html) .
Preparing for the Certification Exam
Reading lengthy documentation and choosing accurate codes under

the pressure of a timed exam is nerve-wracking for some people. For
this reason, it's important to put in the work before the exam by
reviewing your course materials, familiarizing yourself with the CPT
code book sections, guidelines and helpful notations, taking timed
practice exams, and so on.
Breaking down each section and understanding the differentiating

factors can also be useful.
Use the debridement subheading in Chapter 19 of your textbook as an

example. The CPT code set for this subheading is 11000-11047. Find
this set of codes in your CPT manual. CPT codes 11004-11006
describe debridement of skin, subcutaneous tissue, muscle and fascia
for necrotizing soft tissue infection. Remember that the (+) symbol
means the code is an add-on code. Therefore, CPT 11008 is reported
as an add-on code in addition to codes 11004–11006. Find this set of
codes and outline them together. Note the CPT code changes based
on the location of the procedure. Highlight or underline the
distinguishing factor within your book for quick reference.
11004—external genitalia and perineum

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11005—abdominal wall, with or without fascial closure
11006—external genitalia, perineum, and abdominal wall, with or
without fascial closure
Pay attention to the guidance under each code. Understanding the

stem of each CPT code set description and its distinguishing factor is
helpful in choosing accurate codes.
Consider another example: 11042-11047 Debridement code set stems
11042—subcutaneous tissue (up to 20 square centimeters)

11045—add-on for each additional 20 square centimeters
11043—muscle and/or fascia (up to 20 square centimeters)
11044—bone (up to 20 square centimeters)
Apply this tactic in each section of your CPT manual. It might seem
time-consuming, but the payoff will be well worth the effort when you
start coding with confidence.
Understanding Modifiers and Surgical Procedures
Before appending a modifier to surgical procedures, carefully review

the CPT description to ensure that size, location, and number aren't
already included. When appending modifiers, proper sequencing
includes adding the primary procedure first, then adding the second
procedure with the appropriate modifier.

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Modifier -51 Multiple Procedures
Do not use with codes sets 11102–11107, 11200, 11201.
Report with respiratory procedures (30000–30299) and
spine and spinal cord procedures (62263–63746).
Take caution with Cardiac catheterization codes (93451–
93572), as many are exempt.
Modifier -50 Bilateral Procedures
Report with breast procedures (19000–19499) and
respiratory/nose procedures (30000–32999).
Report with spine procedures (62263–63746).
Modifier -26 Professional Component
Report with cardiovascular radiology codes (75557–75774).
Key Points and Links

READING ASSIGNMENT
Key Points
The surgery section is the largest section within the CPT manual
and it is divided by the following subspecialties.
Review each of the section guidelines in the CPT manual.
Take time to review each section within your manual, group code
sets, and identify stem descriptions and differentiating factors for
each code.
Links
CPT Code Global Reporting (www.cms.gov/medicare/medicare-f

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ee-for-service-payment/physicianfeesched/global-surgery-data-co
llection-.html)
Discover More: CPT Surgery Section
Complete Quick Quiz 19.1 on Canvas. Then, complete Practice

Exercises 19.1 through 19.30 in Chapter 19 in your textbook.
Discover More Answer Key:

Discover More: CPT Surgery Section
Check your codes for the Practice Exercises in Appendix B in your

textbook. The answers to the Abstracting Questions follow.
Practice Exercise 19.1
1. Shaving
2. No
3. Yes
4. Yes
1. No
2. No
3. Yes
4. Yes
5. Yes, diagnosis code

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1. No
2. Recipient
3. Yes
4. F7
5. Yes, traumatic
6. External cause code
1. Simple
2. Yes
3. Yes
4. initial
5. Yes
1. Yes
2. Yes, modifier -78
1. Arthrocentesis
2. Yes
1. Arthroscopic

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2. Extensive
1. Carpometacarpal joint or wrist

2. No
3. Yes, -51 (multiple procedures), -LT (left)
1. Femur
2. No
3. No
4. Pathology report findings
1. Left knee
2. 0.5 cm
1. Appendix L
2. Both common carotids (right and left common carotids), right and
left vertebral arteries, and the cerebral arteries. The great vessel
origins were also examined.
3. Yes
4. No, right internal carotid is third order after right common, and
only the furthest extent is reported, not the vessels passed

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through to arrive at the furthest extent.
5. Yes, it's the first order and nothing further was examined in that
branch.
6. Yes, it's the second order.
7. It's not a selective vessel and is part of the approach through the
aorta for the evaluation of the other vessels.
1. Venous
2. Percutaneous
3. Central, into the right internal jugular vein in the neck. Peripheral
insertion would be access of a vein in the arm.
4. Replacement
5. Admission for dialysis catheter removal/replacement. The ESRF
is secondary.
1. Yes
2. Venous
3. Centrally
4. Yes
5. Yes
6. Yes
7. Ultrasound and fluoroscopic
8. Chemotherapy

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1. Left anterior oblique projection

2. A thin string of intravenous contrast material in the internal
carotid artery
1. superficial femoral artery; Third order
1. Kidney, ureter, and bladder

2. Feeding tube
1. Percutaneous
2. Yes
3. Yes
1. Exploratory laparotomy, cystotomy repair, adhesiolysis

2. Exploratory laparotomy
3. Yes, -78, return to the OR for a related procedure during the
postoperative period is required for the procedure performed by
Dr. Martinez. There were no co-surgery or assistant surgeon
modifiers required for Dr. Martinez.

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1. Small intestine (small bowel)

2. This procedure took substantially greater time than typically
would be required.
1. Yes
2. -59 (separate procedure), -53 (discontinued procedure), -51
(multiple procedures)
3. Yes
4. Pyloroplasty, which was a portion of the Ivor-Lewis procedure
(partial esophagogastrostomy)
5. Yes
1. Yes
2. It's comparable that "unroofing" is part of the description for
excision.
3. No, hemoclips were used.
4. Yes, -RT
5. Acquired
1. Laproscopic

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1. Extent of the procedure

2. Type, in this case, unspecified. Detail information would be
obtained from the pathology report.
3. Fibroid
1. If the service includes postpartum care

2. Preterm delivery and outcome of delivery
1. Vulvar area
2. Complexity
3. Cancer involving cells in localized tissues that has not spread to
nearby tissues
1. Yes
2. Yes
3. Evacuation of hematoma (clot)
4. Yes
1. Reason for the burr holes, in this case, drainage of hematoma

2. Yes, extradural, subdural, or intracerebral; this case was

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subdural.
3. No, code states hole(s).
4. Yes
1. Decomposition
1. Abnormal collection of cerebrospinal fluid (CSF) leaking from the

subarachnoid space around the brain or spinal cord into a cavity
within the soft tissues.
2. Partial hemilaminectomy
3. Yes
4. -78, -LT
1. Facetectomy, documented “eventually removed the lamina and

the medial facets bilaterally of L3 through L5.”
2. L3, L4, and L5
3. Two. The base code for L3 and the add-on code x 2 for L4 and L5
4. None
2.2 Explain when and how to assign codes from the

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Radiology, Pathology and Laboratory, and Medicine
sections of the CPT
Radiology, Pathology and Laboratory, and Medicine Sections
READING ASSIGNMENT
Read this section. Then, read Chapters 20, 21, and 22 in your textbook.
Radiology
Radiology is the branch of medicine that uses radiant energy to

diagnosis and treat patients. It allows physicians to navigate within the
body. Services can be performed routinely, as a screening or for a
sign or symptom, depending on the specialty.
As a medical coder, it's important to understand anatomical locations

or body planes documented. The anatomical position, the standard
body position, is used as the basis of the directional positions. The
anatomical position is defined as upright, face forward, arms by the
side, palms forward, feet parallel and slightly apart.
The following directional positions and radiological terms are all

oriented from the anatomical position.
Directional Positions
Anterior Toward the front
Posterior Toward the back
Medial Toward the middle of the body
Lateral Toward the side of the body

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Proximal Near the point of attachment
Distal Farther from the point of attachment
Superior Above (toward the head)
Inferior Below (toward the end of the spine)
Sagittal Through the middle of the body
Frontal (coronal) Side to side; divides the body into anterior and posterior
sections
Transverse (horizontal; Separating the body into superior and inferior sections
axial)
Supine Lying down on the back face up
Prone Lying face down
Oblique Lying at an angle
Anteroposterior X-ray beam enters the front and exits the back
Posteroanterior X-ray beam enters the back and exits the front
Diagnostic radiology can be performed with or without contrast.

Contrast is a substance used to light up structures for easier
visualization. Diagnostic ultrasound radiology uses sound waves to
visualize anatomic structures. Radiologic guidance is used during
procedures. Mammography, bone/joint studies, and nuclear medicine
are used as diagnostic tools. Radiology and nuclear medicine are
used for treatment.
Modifier -26 and the technical component modifier -TC are the most
commonly used with radiology CPT codes. Modifiers -76, -77, -79, -

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RT, and -LT are also used within this section. Remember, modifier -26
is appended for physician interpretation and report of a radiological
exam (professional component). Modifier -TC is appended to report
the examination (technical component). If the technical and
professional component is performed by the same physician, don't
append a modifier.
As advised in the Surgery sections previously, take time to outline

coding sets within the radiology section. Identify the stem and
highlight or underline the differentiating factor.
Example: Head and Neck Subheading; CPT code 70250, 70260

Stem: radiologic examination, skull
70250—less than 4 views
70260—minimum of 4 views
Pathology and Laboratory
Pathology and laboratory CPT codes represent tests performed on

body tissue or fluid. These tests are performed by physicians or under
physician supervision. To establish testing standards and ensure
accuracy, reliability, and timeliness of results, the Clinical Laboratory
Improvement Amendments (CLIA) were passed. CLIA established
quality standards for all laboratory tests and places tests into
categories:
Waived
Moderate complexity

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High complexity
CLIA numbers must be included when billing for these services,

therefore clinics or labs performing diagnostic testing must have a
CLIA number.
Modifiers specific to pathology and laboratory code sets are modifiers

-90, -91, -92, and -QW. Modifier 26 is rarely appended with pathology
and laboratory code sets. Modifier -TC applies if tests are performed
within an office and sent out for interpretation.
Organ or Disease-Oriented Testing Panels (80047–80081)
Organ/disease testing panels are often ordered in groups. Note, only

code a panel if all the tests listed are performed. If one test listed is
not performed, the tests must be coded separately. In the event more
tests are performed, code the panel then list each additional test
separately.
During the day to day responsibilities as a coder, for the sake of time,
it may be tempting to code the panel with modifier -52 to explain tests
not performed. Do not do this. It's inaccurate and can result in
reimbursement denials.
Drug Assay (80305–80307)
Drug assay code sets are classified as presumptive drugs or definitive

drugs. These tests are used to identify drug presence or absence
(presumptive) as well as to identify specific drugs (definitive). Modifier

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-59 may be used with this code set.
Therapeutic Drug Assays (80150–80299)
This coding set is used to monitor prescribed medications that may

have negative effects if not maintained at specific therapeutic levels.
Therapeutic drug assays confirm drug levels. CPT 80299 is applied if
no code is listed for the drug being tested. Be sure to check the
therapeutic drug code as well as the chemistry code before using CPT
80299.
Evocative/Suppression Testing (80400–80439)
Evocative/suppression testing evaluates the function of endocrine

glands. It's important to note that these codes are appended with an
additional code for the evocative/suppression agent given prior to
testing.
Consultations (Clinical Pathology) (80500–80502)
In the event a specimen requires additional information or a second

opinion, a clinical pathology consultation can be requested. A written
report must be prepared by the consulted provider. Append 80550 for
limited consultations not including the review of the patient's medical
records. Append 80502 for comprehensive consultations.
Urinalysis (81000–81099)
Urinalysis testing is performed on urine specimens. In your CPT

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manual, use the question stem/differentiating factor method advised
earlier for faster CPT reference.
Molecular Pathology (81105-81408, 81479)
Molecular pathology involves gene analysis. CPT codes in this section

are selected based on the specific gene being studied. The terms and
definitions in this section in the CPT manual are important for coders
to recognize. Take time to carefully read and review this section of
your manual.
Multianalyte Assays with Algorithmic Analyses (81490–81599)
These tests are used to predict disease risk factors. Review

guidelines outlined in the CPT manual along with notes located in
Appendix O of your review textbook.
Chemistry (82009–84999)
Chemistry tests are used for quantitative screenings unless requested

otherwise. These tests can detect natural, therapeutic, or non-
therapeutic elements. When researching a code not found here, it
may be located in the therapeutic drug section. During a certification
exam, if the name of a test is known, the alphabetic index in the CPT
manual may be helpful in locating an accurate CPT code.
Hematology and Coagulation (85002–85999)
Hematology and coagulation code sets don't cover blood bank

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services, but they do cover laboratory procedures on blood. Medical
documentation for this code set frequently uses the abbreviation
"H&H," which means "hematocrit and hemoglobin." Locate these
codes in your CPT manual and notate them.
Immunology (86000–86849)
Immunology CPT codes classify antigens and antibodies. Blood bank

services and tissue typing are also found in this code set. To code for
blood bank services, the service must be performed in a blood bank.
Take this time to highlight blood bank services and tissue typing CPT
code sets.
Transfusion Medicine (86850–87999)
Transfusion codes describe the work involved dealing with blood and
blood types, including blood typing, screening, preparation, and
storage. Transfusion is not required for these codes to be used.
Microbiology (87003–87999)
Microbiology codes specify the source material used. Many code

descriptions in this section are similar to immunology, with technique
being the differentiating factor. Refer to the use the question stem
method advised above for faster CPT reference during certification
exams.
Example: CPT 87040–87077 as a stem description and separate

differentiating factors. Locate coding sets in your manual, highlight the

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stem as well as the distinguishing factors of each.
Modifiers used in this code set are -59 and -91. If multiple sites or
specimens are used, append modifier -59. If laboratory tests are
repeated on the same day, append modifier -91.
Anatomic Pathology (88000–88099)
This section describes exams performed after death. If an outside lab

is used, modifier 90 is appended.
Cytopathology (88104–88199)
Cytopathology identifies cell changes. The most common study

performed is a Pap smear. CPT codes in this section are chosen
based on the procedure and the technique used.
Surgical Pathology (88300–88399)
Surgical pathology documentation must include accession,

examination, and reporting. In this section, the type of specimen as
well as how the specimen was obtained determines the CPT code.
Medicine
The medicine section covers non-invasive and minimally invasive

procedures. Review the CPT manual guidelines at the beginning of
each subheading in the medicine section.
Immune Globulin (90281–90399)

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Immune globulin codes are anti-infective specific and must be
reported separately. Administration of immune globulins is also
reported, in addition to the specific anti-infective code. The textbook
cites Botulism antitoxin report administration separately as an
example. Note that you should use an ICD-10 code from category Z if
a substance is ordered because of infection exposure.
Vaccine Product Codes (90476–90749)
Combination vaccines require reporting of administration codes more

than once. Report the first CPT to the first component of the vaccine,
then report the additional CPT. This CPT can be added more than
once or multiplied. To the example in your textbook that reads
"Reporting Administration for Each Dose."
For administration of vaccines to a patient younger than 18 years old

along with parental, face-to-face counseling, report codes 90460,
90461. For administration of vaccines to a patient older than 18 years
or administering vaccines to a patient younger than 18 years without
providing parental counseling, use CPT 90471–90474. Do not append
modifier -51 to this code set.
Biofeedback (90901, 90911)
Biofeedback is a technique used to help patients gain control over

body functions. Some illnesses biofeedback is used to help manage
include anxiety/stress, asthma, chronic pain, and muscle weakness.

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Dialysis (90935–90999)
Dialysis is the process of cleansing the blood to remove harmful

waste, excess salt, and water, a necessary treatment as a result of
kidney failure. There are two types of dialysis treatments:
Hemodialysis
Peritoneal dialysis
Hemodialysis CPT codes (90935–90940) includes the procedure and

the evaluation and management of the patient's disease. If an
evaluation is performed for a condition other than renal disease,
append modifier -25 to the appropriate E/M code.
End-Stage Renal Disease (ESRD) CPT codes are 90951–90970.

These codes are reported once per month and are selected based on
the patient's age and the number of physician encounters within that
month. In the event the patient was not treated the entire month, daily
CPT codes 90967–90970 are reported for each visit.
Gastroenterology (91010–91299)
CPT codes in the gastroenterology section cover tests/treatments for

the esophagus, stomach, and intestine not procedures. Procedures
related to these organs can be located within the surgery section of
your CPT manual. As outlined in previous sections, use the highlight
technique here for quick reference to differentiate each code. Pay
close attention to the guidelines given below each CPT code in this

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section.
Ophthalmology (92002–92499)
Ophthalmology services are divided into intermediate, comprehensive,

initiation of treatment program, and special. Intermediate services
include a new or existing condition that may be complicated by an
additional diagnosis. The additional diagnosis may not be related to
the primary problem. Intermediate services are reported with codes
99202 or 92012. Comprehensive services include complete visual
system evaluation. Corresponding CPT codes for comprehensive
services are 92004 and 92014.
Special services (92015–92287) include an evaluation of the visual

system that goes beyond a general evaluation. These services may
be reported separately, in addition to general services. Remember to
sequence the general CPT code first, then the appropriate special
services CPT.
Special Otorhinolaryngologic Services (92502–92700)
This CPT code set includes treatments and diagnostic procedures that
are reported as E/M services. Do not code a special
otorhinolaryngologic service with an E/M CPT. Review the guidelines
for this subheading in your CPT manual, and make notations in your
review book for easy reference.
Noninvasive Vascular Diagnostic Studies (93880–93998)

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Noninvasive vascular studies investigate blood flow. These studies are
indicated in conditions such as arterial syndromes, occlusions, and
injury. An example is a transient ischemic attack (TIA).
Allergy and Clinical Immunology (95004–95199)
Allergy and clinical immunology testing is indicated for individuals with

reactions to certain materials. These tests identify specific causes.
Rendering providers must include an interpretation and a report. In the
event a report is not supplied, modifier -52 should be appended to the
CPT code.
Medical Genetics and Genetic Counseling Services (96040)
CPT code 96040 is time-based; therefore, it should be reported in 30-

minute intervals. If the documentation states 90 minutes was spent
face-to-face with the patient and/or the patient's family, 96040 × 3
should be coded.
Hydration, Therapeutic, Prophylactic, Diagnostic Injections

and Infusions, and Chemotherapy and other Highly Complex
Drug or Highly Complex Biologic Agent Administration
(96360–96549)
Hydration (96360, 96361)
Hydration codes are time-based codes that should not be used for the
infusion of other substances. The hydration fluid, as well as the start
and stop times, must be recorded.

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Non-Chemotherapy Drugs (96365–96379)
These codes are reported based on setup of new infusion, substance

added, technique required and time. If multiple drugs are being
infused at the same time, it's a concurrent infusion and is only
reported once.
Chemotherapy (96401–96549)
Local anesthesia, starting an IV or IV access, flushing, and supplies

are included in infusion time. An IV push should be reported for
infusion times of 15 minutes or less.
Only one administration code is reported when multiple substances

are delivered. The exception is if a separate IV site is utilized.
Active Wound Care Management (97597–97610)
Debridement is defined as the removal of devitalized tissue to

promote healing. CPT codes for wound care management are based
on wound size; therefore, the wound must be measured in centimeters
and documented. If multiple wounds are present, a total wound size is
calculated and reported. Wounds are measured as length × width ×
depth in cm. The length and the width of each wound are added,
divided by 20, and summated for total wound size to be reported.
For example: Wound 1 measures 5 cm × 1.5 cm × 0.2 cm, wound 2

measures 4 cm × 2 cm × 0.5 cm. Wound 1 = 7.5 cm. Wound 2 = 8 cm.
Wound 1 + wound 2 = 15.5 cm. A CPT code for the first 20 square cm

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or less should be reported. Add-on codes do not apply.
Key Points and Links

READING ASSIGNMENT
Key Points
Notate modifiers applicable to each CPT code set.

Radiology is a branch of medicine that used radiant energy to
diagnose and treat patients.
Pathology and laboratory CPT codes represent tests performed
on body tissue or fluid.
Medicine coding covers non-invasive and minimally invasive
procedures.
Use the stem/differentiating factor highlighting technique in each
section of your CPT manual. This will save time during a
certification examination.
Discover More: CPT Radiology, Pathology and Laboratory, and

Medicine Sections
Complete Quick Quizzes 20.1, 21.1, and 22.1 on Canvas. Then,

complete Practice Exercises 20.1 through 20.5 in Chapter 20,
Practice Exercises 21.1 through 21.5 in Chapter 21, and Practice
Exercises 22.1 through 22.5 in Chapter 22.
Discover More Answer Key:

Discover More: CPT Radiology, Pathology and Laboratory, and

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Medicine Sections
Check your codes for the Practice Exercises in Appendix B in your

textbook. The answers to the Abstracting Questions follow.
1. Altered mental status

2. The plural of sulcus, which is a furrow or groove on the surface of
the brain
1. Ultrasound
2. Right upper abdomen
3. 76700–76705
4. -26
1. Yes
2. No, 78452 includes myocardial perfusion imaging and ejection
fraction.
1. Radiology
2. Diagnostic ultrasound

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1. Congenital
2. Voiding
1. Pathology, surgical
2. Both
3. Level III
4. No
1. In ICD-10-CM, you're directed to "see Dysplasia, cervix."

2. Excessive uterine bleeding
3. Because the pathology report provided the most definitive
diagnoses
1. One. The placenta and umbilical cord were examined as one

specimen.
2. Specimen
3. Diagnosis
1. Intravertebral disc

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1. One
1. Placement of the catheter, injection, and imaging

2. Right femoral artery for left heart catheterization
3. Yes, modifier -26
4. Left ventriculography and coronary angiography
1. Duplex scan
1. A blood clot (thrombus) in a deep vein
1. It's a diagnostic ultrasound. The extremities are duplex scans.

2. Wouldn't be reported. There isn't a definitive finding, “consistent
with fatty infiltration” and “cirrhotic configuration,” documented
that would be reportable. More specific diagnostic studies would
be required, such as biopsy, to confirm liver disease.
1. Yes
2. Chronic, irreversible renal failure

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Lesson 2 Review
Self-Check
1. Which CPT code is used to assign Interpretation and report of fine
needle aspirate?
a. 88173
b. 88172
c. 88177
d. 88150
2. Which CPT code is used to assign incision and drainage of
complicated abscess?
a. 10061
b. 10121
c. 10080
d. 10060
3. A physician performed debridement of wounds with exposed
musculature. Wound 1 measures 12 × 5 × 3cm. Wound 2 measures
1.2 × 3 × 3 cm. Which CPT code(s) are assigned?
a. 11043, 11046 x 2
b. 11042, 11045 x 2
c. 11043
d. 11043, 11046
4. Mr. Jones presented for an outpatient procedure in which 20 skin

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tags were removed from the left side of his neck. What CPT code(s)
are assigned?
a. 11200, 11201
b. 11200 x 1
c. 11200, 11201 x 1
d. 11200
5. Complete matrixectomy performed of the lateral border of the left
great toe is assigned which CPT code?
a. 11750
b. 11762
c. 11721
d. 11765
6. Surgical procedure of the left lower extremity which involves
surgical transfer of the anterior tibial tendon is assigned which CPT
code?
a. 27691
b. 27658
c. 27680
d. 27690, 27691
7. What code(s) are assigned for bilateral arthrodesis of the sacroiliac
joint with removal of bone graft?
a. 27280, 50
b. 27284
c. 27280, Rt; 27280, LT
d. 27280 x 2
8. Multilayer compression dressing applied to the right ankle only as

Course Version: 1
treatment of a sprain requires which CPT code(s)?
a. 29581, 36475
b. 29581
c. 29582
d. 29582, 36475
9. What substance is used to light up structures for easier
visualization?
a. Radiation
b. Ultrasound
c. Contrast
d. Magnetic resonance imaging
10. Nasal sinus exploration with tissue removal requires which code?
a. 31276, 31296
b. 31296
c. 31276
d. 31255
11. Which CPT code is assigned for biopsy of left lung mass with
pleura?
a. 32607
b. 32609
c. 32608, 32440
d. 32609, 32671
12. Which code(s) are assigned for removal and replacement of
implantable defibrillator pulse generator and subcutaneous electrode?
a. 33272, 33241, 33270
b. 33272

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c. 33241, 33270
d. 33272, 33241
13. A patient recieves a coronary artery bypass with lower extremity
vein harvesting for 2 venous grafts. What CPT code(s) are assigned?
a. 33511, 35572
b. 33511-80, 35572
c. 33510, 35500
d. 35572
14. Repair of pseudoaneurysm in the iliac artery is assigned which
CPT code?
a. 35131
b. 35351
c. 35001
d. 35045
15. What CPT code is assigned for rigid esophagoscopy with guide
wire and dilation?
a. 43196, 43191
b. 43191, 43196
c. 43191
d. 43196
16. Which CPT code is assigned for Laproscopic partial nephrectomy?
a. 50545
b. 50543, 49320
c. 50545, 49320
d. 50543
17. Which CPT code is assigned for Therapeutic amniotic fluid

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reduction?
a. 59000
b. 59001, 76942
c. 59001
d. 59000, 76942
18. Which CPT code is assigned for Mechanical cataract removal with
intraocular prosthesis insertion?
a. 66984
b. 66984, 0308T
c. 66983, 0308T
d. 66985
19. Treatment for a patient experiencing a reaction to a specific event
or situation is called
a. crisis psychotherapy.
b. psychoanalysis.
c. psychotherapy.
d. psychiatriac evaluation.
Self-Check Answer Key
1. 88173
Explanation: Reference 2019 CPT, Alphabetical Index,
Aspiration, Aspirate Evaluation.
Reference: Section 2.1
2. 10061

Course Version: 1
Explanation: Reference 2019 CPT, Alphabetical Index, Incision
and Drainage, Abscess, Skin.
3. 11043, 11046 x 2
Debridement, Skin, Subcutaneous Tissue.
4. 11200, 11201
Explanation: Reference 2019 CPT, Alphabetical Index, Skin,
Tags, Removal.
5. 11750
Explanation: Reference 2019 CPT, Alphabetical Index, Nails,
Excision.
6. 27691
Explanation: Reference 2019 CPT, Alphabetical Index, Tendon,
Transfer, Leg, Lower.
7. 27280, 50

Course Version: 1
Arthrodesis, Sacroiliac Joint, Open.
8. 29581
Strapping, Ankle, Compression.
9. Contrast
Explanation: Contrast is used in imaging to increase the contrast
of fluids or structures within the body.
10. 31276
Explanation: Reference 2019 CPT, Alphabetical Index, Sinus,
Endoscopy, Surgical.
11. 32609
Explanation: Reference 2019 CPT, Alphabetical Index, Biopsy,
Pleura, Thoracoscopic.
12. 33272, 33241, 33270

Implantable Defibrillator, Removal, Electrodes, Pulse Generator;

Course Version: 1
Implantable Defibrillator, Insertion, System.
13. 33511, 35572

Explanation: Reference 2019 CPT, Alphabetical Index, Bypass
Graft, Coronary, Femoral-Popliteal.
14. 35131
Explanation: Reference 2019 CPT, Alphabetical Index, Aneurysm
Repair, Iliac Artery.
15. 43196
Esophagoscopy, Transoral, Insertion Guide Wire.
16. 50543
Nephrectomy, Partial, Laparoscopic.
17. 59001
Amniocentesis, Therapeutic, Amniotic fluid reduction.

Course Version: 1
18. 66984
Explanation: Reference 2019 CPT, Alphabetical Index, Cataract,
Extraction/Removal, Extracapsular.
19. crisis psychotherapy.

Explanation: Crisis psychotherapy is an urgent assessment and
history of a patient experiencing a reaction to a specific event.
Reference 2019 CPT, Alphabetical Index, Psychotherapy, for
Crisis.
Flash Cards
1. Term: Bundled Procedures
Definition: Services included in surgical procedures that should not
be coded separately
2. Term: Global Package

Definition: Necessary services provided preoperative, intraoperative,
and postoperative
3. Term: Services Not Included Within the Global Package

Definition: Initial evaluation, unrelated evaluations or procedures,

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diagnositc tests, postop complications, necessary more extensive
procedures, critial care not related to surgery
4. Term: Proximal
Definition: Near the point of attachment
5. Term: Modifier -26

Definition: Appended for physician interpretation and report of a
radiological exam
6. Term: Modifier TC
Definition: Applied to pathology and laboratory codes if a test is
performed within an office and sent out for interpretation
7. Term: Modifier 52
Definition: Do not append this modifier with panel CPT codes
8. Term: CPT Code 80550

Definition: Limited consultations not including review of the patient's
medical records
9. Term: Modifier 91
Definition: Modifier appended if laboratory tests are repeated on the
same day
10. Term: Medical Genetics and Genetic Counseling Services

Course Version: 1
Definition: Codes based on time. Should be reported in 30-minute
intervals

Course Version: 1

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HCPCS Coding and

You'll begin this lesson by

2.1 Identify when and

Integumentary System (10040–19499)

Copyright Penn Foster, Inc. 2019 Page 1

Important Guidelines to Understand

Copyright Penn Foster, Inc. 2019 Page 2

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Preparing for the Certification Exam

Reading lengthy documentation and choosing accurate codes under

Breaking down each section and understanding the differentiating

Use the debridement subheading in Chapter 19 of your textbook as an

11004—external genitalia and perineum

Copyright Penn Foster, Inc. 2019 Page 4

Pay attention to the guidance under each code. Understanding the

Consider another example: 11042-11047 Debridement code set stems

11042—subcutaneous tissue (up to 20 square centimeters)

Understanding Modifiers and Surgical Procedures

Before appending a modifier to surgical procedures, carefully review

Copyright Penn Foster, Inc. 2019 Page 5

Key Points and Links

CPT Code Global Reporting (www.cms.gov/medicare/medicare-f

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Discover More: CPT Surgery Section

Complete Quick Quiz 19.1 on Canvas. Then, complete Practice

Discover More Answer Key:

Check your codes for the Practice Exercises in Appendix B in your

Practice Exercise 19.1

Practice Exercise 19.2

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Practice Exercise 19.4

Practice Exercise 19.5

Practice Exercise 19.6

Practice Exercise 19.7

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Practice Exercise 19.8

1. Carpometacarpal joint or wrist

Practice Exercise 19.9

Practice Exercise 19.10

Practice Exercise 19.11

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Practice Exercise 19.12

Practice Exercise 19.13

Copyright Penn Foster, Inc. 2019 Page 10

1. Left anterior oblique projection

Practice Exercise 19.15

1. superficial femoral artery; Third order

Practice Exercise 19.16

1. Kidney, ureter, and bladder

Practice Exercise 19.17

Practice Exercise 19.18

1. Exploratory laparotomy, cystotomy repair, adhesiolysis

Copyright Penn Foster, Inc. 2019 Page 11

1. Small intestine (small bowel)

Practice Exercise 19.20

Practice Exercise 19.21

Practice Exercise 19.22

Copyright Penn Foster, Inc. 2019 Page 12

1. Extent of the procedure

Practice Exercise 19.24

1. If the service includes postpartum care

Practice Exercise 19.25

Practice Exercise 19.26