Test Bank for Comprehensive Health Insurance 3rd Edition by Vines

Test Bank for Comprehensive Health Insurance 3rd

Edition by Vines

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Comprehensive Health Insurance, 3e (Vines)
Chapter 6 Introduction to CPT and Place of Coding Services

6.1 Multiple Choice Questions

1) The Current Procedural Terminology (CPT®) is published by the:

A) World Health Organization (WHO).
B) Centers for Medicare and Medicaid Services (CMS).
C) American Medical Association (AMA).
D) National Center for Health Statistics.
Answer: C

2) The current CPT system uses codes with:

A) 3 digits.
B) 4 digits.
C) 5 digits.
D) 6 digits.
Answer: C

3) In what year did CMS require state Medicaid agencies to use CPT codes for reporting
outpatient hospital procedures as part of the Omnibus Budget Reconciliation Act?
A) 1977.
B) 1986.
C) 1992.
D) 2006.
Answer: B

4) The type of procedure codes that use a five-digit numeric code and descriptor are:
A) ICD-9-CM codes.
B) Category I CPT codes.
C) Category II CPT codes.
D) Category III CPT codes.
Answer: B

5) The temporary codes used for emerging technology, services, or procedures are:
A) Category I CPT codes.
B) Category II CPT codes.
C) Category III CPT codes.
D) ICD-10-CM codes.
Answer: C

6) The Health Insurance Portability and Accountability Act (HIPAA) supports the:
A) use of local codes.
B) increased use of temporary codes for emerging technology.
C) elimination of local, temporary codes.
D) increased use of nonstandard CPT codes.
Answer: C
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7) CPT Category II codes are used principally:
A) for providing more information about the diagnosis.
B) as temporary codes for emerging technology.
C) for performance measurement.
D) to describe the procedure performed by the physician.
Answer: C

8) What letter appears in the last field of CPT Category II codes to distinguish them from
Category I codes?
A) F
B) P
C) T
D) V
Answer: A

9) All of the following are sections of Category I CPT codes EXCEPT:

A) Evaluation and Management.
B) Surgery.
C) Medicine.
D) Emergency Room Services.
Answer: D

10) The first section of the CPT code book is:

A) Anesthesia.
B) Surgery.
C) Medicine.
D) Evaluation and Management .
Answer: D

11) The symbol • used with a CPT code indicates:

A) revised code.
B) new code.
C) new or revised text.
D) add-on code.
Answer: B

12) The symbol + used with a CPT code indicates:

A) revised code.
B) new code.
C) new or revised text.
D) add-on code.
Answer: D

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13) The ▲ symbol used with a CPT code indicates:
A) revised code.
B) new code.
C) new or revised text.
D) add-on code.
Answer: A

14) To report that the description of a service or procedure has been altered in some way, the
coder should use a:
A) Category II CPT code.
B) Category III CPT code.
C) modifier.
D) written explanation.
Answer: C

15) The modifier -32 is used to indicate:

A) mandated services (used when requested by the payer).
B) unrelated E/M service by the same physician during a postoperative period.
C) significant, separately identifiable E/M service by the same physician on the same day of the
procedure or other service.
D) reduced services.
Answer: A

16) The modifier -52 is used to indicate:

A) prolonged evaluation and management (E/M) service.
B) unrelated E/M service by the same physician during a postoperative period.
C) significant, separately identifiable E/M service by the same physician on the same day of the
procedure or other service.
D) reduced services.
Answer: D

17) The modifier -25 is used to indicate:

A) prolonged evaluation and management (E/M) service.
B) unrelated E/M service by the same physician during a postoperative period.
C) significant, separately identifiable E/M service by the same physician on the same day of the
procedure or other service.
D) reduced services.
Answer: C

18) The modifier -57 is used to indicate:

A) repeat procedure by the same physician.
B) unrelated evaluation and management (E/M) service by the same physician during a
postoperative period.
C) significant, separately identifiable E/M service by the same physician on the same day of the
procedure or other service.
D) a decision for surgery.
Answer: D
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19) If a physician began an initial gynecological exam on a patient but discontinued it due to the
patient's extreme discomfort, the modifier would be:
A) -25.
B) -32.
C) -52.
D) -57.
Answer: C

20) Evaluation and management (E/M) services can be performed in which of the following
locations?
A) physician offices only
B) physician offices and hospitals only
C) physician offices, hospitals, and nursing homes
D) physician offices, inpatient and outpatient facilities, and patients' homes
Answer: D

21) The most-often reported evaluation and management (E/M) services are:
A) office and other outpatient services.
B) hospital (inpatient) services.
C) emergency room services.
D) consultations.
Answer: A

22) Most services for established patients and subsequent care include all the following
components EXCEPT:
A) expanded problem, focused history.
B) expanded problem, focused examination.
C) medical decision making of low complexity.
D) medical decision making of high complexity.
Answer: D

23) A new patient is considered one who has NOT received professional services from the
physician or another physician of the same specialty in the same group within the past:
A) 1 year.
B) 2 years.
C) 3 years.
D) 5 years.
Answer: C

24) The transfer of total care or a specific portion of care of a patient from one physician to
another is called a(n):
A) authorization.
B) consultation.
C) office visit.
D) referral.
Answer: D
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25) When a second physician examines a patient and renders an opinion, the service is referred
to as a:
A) consultation.
B) referral.
C) specialist visit.
D) wellness examination.
Answer: A

26) Components that define the level of evaluation and management (E/M) services include all
of the following EXCEPT:
A) the extent of the history documented.
B) the location of the procedure or service.
C) the complexity of the medical decision making documented.
D) time.
Answer: B

27) The three key components used to select the appropriate evaluation and management (E/M)
code include:
A) history, patient age, and time.
B) medical decision making, presenting problem, and counseling.
C) examination, chief complaint, and place of service.
D) history, examination, and medical decision making.
Answer: D

28) A statement, usually in the patient's words, describing the symptom, problem, condition, or
other factor that is the reason for the encounter is called the:
A) chief complaint.
B) primary diagnosis.
C) principal diagnosis.
D) reason for complaint.
Answer: A

29) A chronological description of the patient's illness from the first sign or symptom to the
present is the:
A) history of present illness.
B) past history.
C) family history.
D) social history.
Answer: A

30) Dimensions of a history of present illness (HPI) include all of the following EXCEPT:
A) location in the body where the chief complaint is occurring.
B) age-appropriate dietary status.
C) the situation that is associated with the pain or symptom.
D) how long the symptom or pain has been present and/or how long it lasts.
Answer: B
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31) Which of the following dimensions of a history of present illness (HPI) refers to actions
taken to make the pain or symptom change?
A) Associated signs and symptoms
B) Context
C) Modifying factors
D) Quality
Answer: C

32) A description of how long the symptom or pain has been present is referred to as the:
A) timing.
B) duration.
C) severity.
D) quality.
Answer: B

33) A social history would include which of the following?

A) prior major illnesses and injuries
B) current medications
C) the situation that is associated with the pain or symptom
D) marital status and/or living arrangements
Answer: D

34) Details about a patient's current employment or school history would be part of a:
A) history of present illness.
B) past history.
C) family history.
D) social history.
Answer: D

35) Details about the health status or cause of death of parents, siblings, and children would be
part of a:
A) history of present illness.
B) past history.
C) family history.
D) social history.
Answer: C

36) The four types of examinations used in determining the level of evaluation and management
(E/M) services are:
A) problem focused, expanded problem focused, detailed, and comprehensive.
B) problem focused, expanded problem focused, complete, and comprehensive.
C) problem focused, detailed, comprehensive, and complete.
D) expanded problem focused, detailed, expanded detailed, and comprehensive.
Answer: A

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37) An expanded problem focused history would include all of the following EXCEPT:
A) chief complaint.
B) brief history of present illness.
C) brief family history.
D) problem-pertinent review of systems.
Answer: C

38) If a history includes a review of the chief complaint (CC) and a brief history of present
illness (HPI) only, it is considered a(n):
A) problem-focused history.
B) expanded problem-focused history.
C) detailed history.
D) comprehensive history.
Answer: A

39) If an examination includes an extended exam of the affected body area(s) and other
symptomatic or related organ systems, it is considered a(n):
A) problem-focused exam.
B) expanded problem-focused exam.
C) detailed exam.
D) comprehensive exam.
Answer: C

40) In a coding a physical examination, all of the following organ systems are recognized
EXCEPT:
A) head, including the face.
B) eyes.
C) respiratory.
D) skin.
Answer: A

41) Medical decision making (MDM) is measured by all of the following components EXCEPT
the:
A) cost associated with the recommended procedure.
B) risk of significant complications.
C) number of medical records or tests that must be analyzed.
D) number of possible diagnoses that must be considered.
Answer: A

42) If a patient presented with a condition that resulted in minimal management options, the
medical decision making (MDM) would be considered:
A) straightforward.
B) low complexity.
C) moderate complexity.
D) high complexity.
Answer: A

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43) When a provider has a discussion with a patient or family member regarding test results,
instructions, or follow-up care, this service is documented as:
A) consultation.
B) counseling.
C) referral.
D) treatment.
Answer: B

44) A presenting problem for which the risk of morbidity without treatment is low and full
recovery is expected would be considered:
A) minimal in nature.
B) self-limited in nature.
C) low severity in nature.
D) moderate severity in nature.
Answer: C

45) In order to consider time as a factor in evaluation and management (E/M) coding, counseling
must constitute more than:
A) 25% of the visit.
B) 30% of the visit.
C) 50% of the visit.
D) 75% of the visit.
Answer: C

46) To code an evaluation and management (E/M) service properly for a new patient, which of
the following elements must be documented?
A) history and examination
B) history and medical decision making
C) examination only
D) history, examination, and medical decision making
Answer: D

47) Counseling with a patient or family can be considered in coding an evaluation and
management (E/M) service if it pertains to:
A) results of diagnostic testing.
B) prognosis.
C) risks and benefits of treatment options.
D) all of the above.
Answer: D

48) The review of systems (ROS) is considered part of:

A) history of the patient.
B) examination of the patient.
C) medical decision making.
D) none of the above.
Answer: A

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49) In the case of a presenting problem that may NOT require the presence of a physician, if
service is provided under the physician's supervision, it is considered:
A) minimal in nature.
B) self-limited in nature.
C) low severity in nature.
D) moderate severity in nature.
Answer: A

50) Types of medical decision making (MDM) include: (Select all that apply)
A) straightforward.
B) low complexity.
C) moderate complexity.
D) all of the above.
Answer: D

6.2 True/False Questions

1) CPT codes are used to determine the amount of reimbursement the provider will receive.
Answer: TRUE

2) CPT codes describe the main reason for the encounter or visit.
Answer: FALSE

3) The Current Procedural Terminology (CPT) was first published by the American Medical
Association (AMA) in 1966.
Answer: TRUE

4) In 1983, CPT nomenclature was adopted which mandate that The Centers for Medicare and
Medicaid Services (CMS) use CPT codes to report services for Medicare Part B.
Answer: TRUE

5) An inpatient is defined as a patient who has been admitted to the hospital and is expected to
stay 48 hours or more.
Answer: FALSE

6) Category I CPT codes are used to describe a procedure or service.

Answer: TRUE

7) Category III CPT codes are intended to facilitate data collection by coding certain services
that contribute to positive health outcomes.
Answer: FALSE

8) The modifier -32 is used to identify a mandated service; it is used when the service is
requested by the payer.
Answer: TRUE

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9) For evaluation and management (E/M) services, the place of service is important in
determining the correct code.
Answer: TRUE

10) Services that include a physical examination according to age, and appropriate
immunizations and laboratory procedures, are called critical care.
Answer: FALSE

11) No distinction is made between new and established patients in coding for emergency room
care.
Answer: TRUE

12) An established patient is defined as one who has received professional service from the
physician or another physician of the same specialty in the same group within the last 5 years.
Answer: FALSE

13) A physician providing a consultation must document his or her opinion in the medical record
and render the opinion in writing to the requesting physician.
Answer: TRUE

14) E/M codes are used to report a significant portion of physician services.
Answer: TRUE

15) A description of other things that happen when the symptom or pain occurs is referred to as a
"modifying factor."
Answer: FALSE

16) A review of a patient's past experiences with illnesses, injuries, and treatments is called a
social history.
Answer: FALSE

17) A comprehensive exam would include a general multisystem exam or a complete exam of a
single organ system.
Answer: TRUE

18) The risk of significant complications, morbidity, and/or mortality is a factor in determining
the level of medical decision making (MDM).
Answer: TRUE

19) When time is reported using CPT codes, it documents the exact amount of time a physician
spends with a patient.
Answer: FALSE

20) When an evaluation and management (E/M) code is assigned, the patient's medical record
must contain the clinical data to support it.
Answer: TRUE

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6.3 Short Answer Questions

1) The set of temporary codes used for emerging technology, services, and procedures is known
as ________ CPT.
Answer: Category III

2) The two-digit code placed after the main CPT code to indicate that the description of the
service or procedure has been altered is a(n) ________.
Answer: modifier

3) A patient who has received professional services from the physician or a physician in the same
group within the past 3 years is referred to as a(n) ________ patient.
Answer: established

4) The transfer of the total care or a portion of care of a patient from one physician to another is
a(n) ________.
Answer: referral

5) A concise statement, usually stated in the patient's words, describing the symptom, problem,
or condition is called the ________.
Answer: chief complaint

6) An inventory of the body obtained when the physician asks the patient a series of questions to
identify signs of illness and/or symptoms the patient may be experiencing is called a(n)
________.
Answer: review of systems

7) A review of the patient's prior experience with illnesses, injuries, and treatments is the
________.
Answer: past history

8) A history that involves the chief complaint (CC) and a brief history of present illness (HPI) is
a(n) ________ history.
Answer: problem focused

9) A description of the level of symptoms or pain or their ranking on a scale is the level of
________.
Answer: severity

10) A discussion with the patient and/or a family member to address risk-factor reduction is
considered ________.
Answer: counseling

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6.4 Matching Questions

Match the following:

A) timing
B) location
C) severity
D) social history
E) modifying factors
F) past history
G) associated signs and symptoms
H) duration
I) context

1) Description of the body area in which the chief complaint (CC) is occurring

2) Description of other things that happen when the symptom or pain occurs

3) The situation that is associated with the pain or symptom

4) A review of the patient's past experiences with illnesses, injuries, and treatments

5) Description used for the specific character of a symptom or pain = quality

6) Age-appropriate review of past and current activities

7) Description of how long a symptom or pain lasts when it occurs

8) Description of when a symptom or pain occurs

9) Description of actions taken to make pain or a symptom change

Answers: 1) B 2) G 3) I 4) F 5) C 6) D 7) H 8) A 9) E

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6.5 Essay Questions

1) What does the acronym CPT stand for?

Answer: Current Procedural Terminology.

2) What are the categories of CPT codes?

Answer: There are three categories of CPT codes. Category I codes describe a procedure or
service rendered. Category II codes are optional codes for tracking purposes. Category III codes
are used for new and emerging technology.

3) Name the first six sections of the CPT code book.

Answer: The first six sections of the CPT code book are Evaluation and Management;
Anesthesia; Surgery; Radiology; Pathology and Laboratory; and Medicine.

4) What is the purpose of guidelines at the beginning of each section of the CPT code book?
Answer: Guidelines provide information that is necessary to appropriately interpret and
accurately report procedures and services found in that section.

5) What are modifiers?

Answer: Modifiers are two-digit codes appended to a main code to indicate that the description
of the service or procedure has been altered in some way.

6) Explain the meaning of "observation status" in regard to a patient in the hospital.

Answer: "Observation status" applies to a patient who is in the hospital to be observed to
determine if he or she should be admitted, transferred to another facility, or sent home.

7) What is the difference between a new and an established patient?

Answer: A new patient is one who has NOT received any professional services from the
physician, or another physician of the same specialty who belongs to the same group practice,
within the past 3 years. An established patient has received services under these conditions.

8) List the three key components used to determine the level of evaluation and management
(E/M) service.
Answer: The three key components are the extent of the patient's history obtained, the extent of
the examination documented, and the complexity of the medical decision making.

9) What are the four components of a patient history?

Answer: The four components are chief complaint (CC); history of present illness (HPI); review
of systems (ROS); and past, family, and social history (PFSH).

10) What factors are considered in determining the level of medical decision making?
Answer: The factors are number of possible diagnoses and/or the number of management
options that must be considered; the amount and/or complexity of medical records, diagnostic
tests, and/or other information that must be obtained, reviewed, and analyzed; and the risk of
significant complications, morbidity, and/or mortality, as well as comorbidities, associated with
the patient's presenting problem.

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Test Bank for Comprehensive Health Insurance 3rd Edition by Vines

11) Explain what the initial preventive E/M codes are used to report.
Answer: The initial preventive E/M codes are used to report the preventive medicine evaluation
and management of infants, children, adolescents, and adults, which include
counseling/anticipatory guidance/risk factor reduction interventions which are provided at the
time of the initial or periodic comprehensive preventive medicine examination.

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