Coding Guidelines/Modifiers
Coding Guidelines and Modifiers
Guidelines are systematically developed by appropriate groups to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances. A modifier is a code that provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code
Key Notes
1.Modifiers are useful in eliminating the wrong options
2.Check for the beginning page of each chapter and ICD guidelines.
3.Use of right modifiers in right place is necessary.
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Coding Guidelines/Modifiers
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Question 1 |
What is NOT included in CPT® surgical package?
A | Typical postoperative follow-up care |
B | One related Evaluation and Management service on the same date of the procedure |
C | Returning to the operating room the next day for a complication resulting from the
initial procedure |
D | Evaluating the patient in the post-anesthesia recovery area |
Question 1 Explanation:
The CPT® surgical package definition is in the Sugery Guidelines found in the
CPT® codebook (right after the Anesthesia section of codes). Multiple choice C is the correct answer,
because modifier 78 is reported on a procedure code to indicate a patient's return to the OR for a
complication (unplanned return) that has occurred during the postoperative period of the initial
procedure.
Question 2 |
Modifier 91 is used:
A | When there are testing problems with either the specimen or equipment |
B | To obtain subsequent (multiple) readings of a test on the same day and is medically
necessary |
C | When specimens are lost or not sent to the laboratory appropriately |
D | To obtain subsequent (multiple) readings of a test on the same day for the patient’s peace
of mind |
Question 2 Explanation:
Modifier 91 should only append when repeat lab done for medical necessary
based on physician orders.
Question 3 |
Which place of service code should be reported on the physician’s claim for a surgical
procedure performed in an ASC?
A | 21 |
B | 22 |
C | 24 |
D | 11 |
Question 3 Explanation:
Place of service for ASC is 24,you can find in the starting pages of CPT with
Tabular list.
Question 4 |
A patient returning within the global surgical time frame for a mole excision presents to
the physician’s office for Evaluation of headache. Which modifier should be attached?
A | 24 |
B | 25 |
C | 78 |
D | 79 |
Question 4 Explanation:
Patient came for unrealted E/M service with in global period of mole
excision,where you to code with modifier 24.
Question 5 |
If the patient undergoes an appendectomy on June 8th then a cholecystectomy is
performed on august 16th by the same surgeon what modifier would be placed on the
cholecystectomy code with in the post operative period?
A | 76 |
B | 77 |
C | 78 |
D | 79 |
Question 5 Explanation:
Patient came to O.R with in the global period for different surgery,where you have
to append modifier 79
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