CPCE MODIFIERS (WHOLE RATIONALE) 1: Patient is seen in the office because of complications with his diabetes and thyroid. The doctor ordered lab work and performed a detailed history and examination. The patient also had a skin tag that he asked the doctor to remove from his neck and was bothersome. What modifier would be used for this office visit? A) 25 B)59 cosa D)54 Option A. Question is modifier for office visit. All the other options are N/A for E&M visit. Hence options A. 2: Patient presented to the office one week ago (global days are 10 days) with a skin lesion on her scalp. It was excised at that time and sent to the pathologist. The pathology report came back as malignant and she is here today for a re-excision for complete removal of the lesion. What modifier would be used for todayae™s visit? A)24 B)25 c)58 D) None would be used Option C, Since the patient is undergoing related surgery within the global period of a previous surgery modifier 58 (planned, related procedure during the Post-Op period) is appropriate. Hence the option is C. 3: Patient came into the Urgent Care Facility for ankle swelling, discoloration and pain. Patient had a collision with another player at softball practice. A two-viewx-ray was taken by our x- ray technician and it confirmed a tri-malleolar ankle fracture. The ankle was manipulated, and a walking cast was applied. The patient is to return next week for a follow-up visit. The x-rays were sent to the radiologist (who is not part of the Urgent Care Facility) for reading. What modifier would be used for this Urgent Care Visit? A)TC B)26 c)s4 )58 Option A. Since the professional component of x-ray service is done by the radiologist outside the urgent care only technical component can be claimed by the urgent care facility. Hence the optionis A. 4: Fifteen days ago the patient went to the Emergency Room for a ruptured appendix. The patient is here in my office today for redness and inflammation of his arm from a tattoo that he received a month ago. He has not had any vomiting or diarrhoea. He has noticed some greenish colour fluid coming4: Fifteen days ago the patient went to the Emergency Room for a ruptured appendix. The patient is here in my office today for redness and inflammation of his arm from a tattoo that he received a month ago. He has not had any vomiting or diarrhoea. He has noticed some greenish colour fluid coming from the inflamed area. He thinks he has a fever but did not take his temperature. Exam reveals skin of his arm is red, swelling and warm to touch. | have prescribed an antibiotic and he is to keep the area dry and apply Neosporin 3 times per day. He did recently have his appendix removed but | do not believe it is related to his surgery. What modifier would the doctor use for this office vi A)24 8)25 sa D)79 Option A. Since the E&M Is not related to the previous surgery done this should be appended with Modifier 24. 5 : This patient is from Nebraska and is visiting Yellow Stone National Park. He falls while hiking and the injury requires an open surgical fracture of his left humerus (code 23615). Surgery is performed by Doctor A. The patient is released two days later from the hospital and then seen by his home town doctor (Doctor B) in Nebraska for a post-op care. How are services billed by each Doctor A and Doctor B? A) Doctor A 23615 for entire surgical package B) Doctor A-23615 - 54 Doctor B-23615 -55 C) Doctor A= 23615 - 62 Doctor B - 23615 -62 D) Doctor A - 23615 - 54 Doctor 8 - 23615 4€" 24 Option B. In this case, the surgical care has been done by Doctor A and Post-op care is done by Doctor B.,s0 option Bis appropriate. 6 : If the physician had to stop in the middle of a procedure because the patienta€™s blood pressure was dropping, and they could not stabilize it, which modifier would you use? A) 23. B)52 )53 D) None would be used Option C. In this case, the physician terminated the procedure in the middle because of the fall in patienta€™s BP. Hence this should be considered as. Discontinued procedure (53 Modifier). So, the Option is C. 7: Select the TRUE statement that defines per CPT why modifiers are reported? ‘A) Modifiers provides or indicates the procedure or service will be greatly increased in cost but not changed in its definition or code B) Modifier provides or indicates Evaluation and Management codes only have been altered but not changed in its definition or code. ) Modifier provides or indicates procedure codes only have been altered but not changed in its definition or code D) Modifier provides or indicates the service or procedure has been altered but not changed in its definition or code aPei Option D. Modifiers only indicates any alternation done on the service / procedures. So, the option Is D. 8 : This Medicare patient is having laboratory work that Medicare will not reimburse the patient because the diagnosis does not support the test being ordered. The patient was informed Medicare will not pay, the patient signed the ABN and wanted the procedure performed. What modifier would be added to the laboratory code? A)S2 B)90 cj92 D)GA Option D. GA modifier is defined as, 4€ceWaiver of liability statement on file.€ Since the patient is informed in prior about the non-payment status by medicare and the patient has signed the ABN, modifier GA Is appropriate for the case. 9 : Per guidelines of proctosigmeidoscopy, sigmoidoscopy or colonoscopy which guideline is TRUE and correct? ‘A) Colonoscopy is the examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon B) Report flexible sigmoidoscopy (45378-45398) for endoscopic examination during. which the endoscope is not advanced beyond the splenic flexure C) Ifa therapeutic colonoscopy such as a 45380 is performed and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy code with modifier 52 D) When bleeding occurs because of an endoscopic procedure, control of bleeding is not reported separately during the same operative session. Option D. A is the definition of a sigmoidoscopy, B 4€“ codes 45378-45398 are for a colonoscopy and not a sigmoidoscopy, C 4€" Code 45380 is not a therapeutic code for a colonoscopy. 10 : Nurse is preparing the patient for his colonoscopy. Patient informs the nurse he has taken all steps necessary for his prep. The doctor performs the colonoscopy but after advancing the scope past the splenic flexure the physician must stop the procedure because the patient did not fully cleanse the large intestine and he is unable to continue the procedure. What modifier would be attached to the procedure? A)52 B)53 o)58 D)76 Option B, Since the provider discontinues at the middle of the procedure because of poor prep, Modifier 53 is appropriate. 11: Modifiers -73 and -74 are most appropriate in: A) Inpatient Hospital only B) Home Health. C) Outpatient Hospital and Ambulatory Surgery Centres (ASC) D) Emergency Room services. Option C. Both the modifiers are applicable only in ASCA€™s. 12 : What is the correct order of the following three mod =55 -56 1s:54,El 12: What is the correct order of the following three modifier: -55, -56 ‘A) Surgery care only, Post-Op, Pre-op B) Pre-op, Surgery, Post-op ©) Pre-op, Post-op, Surgery D) Decision for surgery, Pre-op, Post-op Option A. 13 : Distinct Procedural Services, modifier _____ is: A) 59, Only used on surgical procedure codes. B) 59, Only used to specify separate incision on an existing site C) 59, Only used surgeons are involved. D) None of the Above: Option D. 14: Modifier -62, is used ‘A) Two surgeons, two are primary B) Surgical team, one primary and one assistant surgeon ©) Repeat procedure by same physician, same procedure billed D) Assistant surgeon, assistant is available for the entire operation. Option A. Modifier 62 is appended for 2 surgeons, if both involved in a surgery as primary surgeon. 15: The reason you used modifiers -76, -77 is to: A) Explain why the patient returned to the operating room during the post-operative period. B) Comply with CMS compliance guidelines ©) Only to supply information, reimbursement will not be affected. D) Explain why a procedure was duplicated, usually with a report, so you will be reimbursed appropriately Option D. Both the modifiers are used to explain the reason for the procedure duplication. 16 : When using modifier -80, assistant surgeon, the primary surgeon must use modifier: A) Modifier -81 B) Modifier -66 ) Modifier -62 D) No modifier is necessary for the primary surgeon. Option D. 17: The main difference between modifier -80 and modifier -81 is: ‘A) The board certification of the assistant surgeon, 8) Amount of time the assistant surgeon spends in the OR. C)-81is used to indicate the primary surgeon and -80 is for the assistant ) -80 is used for the primary surgeon, -81 for the assistant. Option B. 18 : Billing mistakes because the appropriate outside reference lab modifier was not used, could‘A) Be corrected if modifier -91 is used. B) Cause confusion but will not affect reimbursement ) Trigger a Medicare audit for Medicare patients D) Easily be corrected using modifier -92. Option C. 19 : Modifier __ Test __. , Repeat Clinical Diagnostic Laboratory A) -90, is used when there are testing problems with either the specimen or equipment B)-91, is used only when it is necessary to obtain subsequent (multiple) reading of a test on the same day C)-90, is used only the itis necessary to obtain subsequent (multiple) reading of a test on the same day D)-91, is used when there are testing problems with equipment Option B. jer the specimen or 20: Evaluation and Management services were performed on an established patient in which the decision to perform a major surgery scheduled for the following morning was made. The patient was counselled for 15 minutes regarding treatment options, risks, and projected outcome. Which of the following modifiers would be appended to the service performed? A) 56 B)52 )50 D)57 Option D. since the decision for the surgery has been taken on the E&M visit, it has to be claimed with modifier 57 (Decision for Surgery) 21: When a patient is in a postoperative period and returns to the operating room for an unrelated procedure by the same physician, which of the following modifiers would you attach to the procedure being performed? A)S9 B24 078 D)79 Option D. 22 : When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding which of the following modifiers? A)54 B) 66 O59 b)62 Option D. 23: Which modifier indicates diagnostic mammogram converted from screening mammogram on the same day? Eiena ee) on 23: Which modifier indicates diagnostic mammogram converted from screening mammogram on the same day? AGG 8) 58 7% D)GH Option D. 24: Anaesthesia-related modifiers include: A)23.47 8) 58,59 ©)32,34 0) 90,91 Option A. 25: The modifier -RT and -LT are: ‘A) Right and Left B) Never used with MOD-50 C)HCPCS modifiers D) All the above is correct. Option D. 26 : Which group of modifiers below, are most likely NOT to be recognized by insurance carriers? ‘A) MOD25, MODS11 and MOD82. 8) MOD-63, MOD-53, MOD-54, MOD-55, MOD-56 C) MOD-26, MOD-50 and MOD-62 D) Insurance companies are required by the AMA to recognize all valid CPT modifiers Option B. 27: Modifiers -54 and -55 most likely would be used. ‘A) Together, on the same claim. B) In primary care. ©) By two different physicians, on separate claims D) To indicate whether the operation was on the left or right side of the body. Option. 28: You can / cannot use modifiers on HCPCS codes A) Youcan B) You cannot C) You could before 2004 but no longer D) You can but for local codes only Option A. 29 : The modifier -23, ‘appropriate for the use of a _ _ (would / would not) be ‘A) Prolonged services; would; mid-wife. B) Professional Component: would not; micro vascular surgeon. C) Unusual anesthesia, would not; acupuncture D) Surgical assistant; would; nurse anaesthetistOption C. Unusual Anesthesia is not appropriate with Acupuncture service. 30 : Under which of the following circumstances should coders report modifier -63? © A) When a physician performs a procedure on an infant weighing 3.5 kg > B) When a physician decides to perform surgery during an evaluation and ‘management encounter ) C) hen two surgeons work together to perform distinct parts of a surgery © D) When a surgical assistant is present during a procedure Option A. 31: What modifier should coders report when a physician elects to terminate a surgical or diagnostic procedure due to extenuating circumstances? Oa)s1. ) 52. 1c) 53. O07 Option c. 32 : What modifier should coders report when there is an unusual circumstance that requires a physician to use general anesthesia for a procedure that, under normal circumstances, requires only local anesthesia or none? Oay22 ) 23 a7 ©p)50 Option B. 33 : Services mandated by an external agency not the responsibility of NHP WE ARE WITH YOU EVERY STEP GET TRAINED EASILY. GET STARTED NOW