Question (Modifiers):-

                                                                    Modifiers Question 

1. CPT modifiers are published by:
a) Centers for Medicare and Medicaid Services
b) Centers for Disease Control and Prevention
c) American Medical Association
d) Local fiscal intermediary

2. Modifiers are:
a) two-digit extenders
b) numeric only
c) used only to track diseases
d) none of the above

3. HCPCS modifiers are level:
a) 2
b) 1
c) 3
d) 4

4. Level I modifiers are published by:
a) Centers for Medicare and Medicaid Services
b) American Medical Association
c) Centers for Disease Control and Prevention
d) Fiscal Intermediary

5. Modifiers explain:
a) code has changed in its definition
b) That a code has not changed in its definition, but has been modified
c) That reimbursement should be higher
d) b and c

6. Modifier 25 is:
a) used when a surgical procedure is billed
b) Used when a significant, separately identifiable E/M service is performed on the same day as a procedure or service
c) Used when billing for anesthesia
d) Not used with E/M services

7. If a patient requests a second opinion, modifier 32 may be used
a) True
b) False

8. Modifier 47 can be used:
a) when billing for general anesthesia
b) when an anesthesiologist is involved in the service and/or procedure
c) When a surgeon performs anesthesia service that is not considered local anesthesia
d) None of the above

9. Modifiers 76 and/or 77 are used to:
a) Explain why the patient returned to the operating room during the postoperative period
b) Comply with CMS compliance guidelines
c) Only supply information; reimbursement will not be affected
d) Explain why a procedure was duplicated, usually with a report, so the physician will be reimbursed appropriately

10. When using modifier 80, the assistant surgeon, the primary surgeon must use:
a) Modifier 81
b) Modifier 66
c) Modifier 62
d) No modifier is needed for the primary surgeon

11. The main difference between modifier 80 and modifier 81 is:
a) The board certification of the assistant surgeon
b) The amount of time the assistant surgeon spends in the surgery suite
c) Modifier 81 is used to indicate the primary surgeon and modifier 80 is for the assistant surgeon
d) Modifier 80 is used for the primary surgeon, 81 for the assistant

12. If a procedure must be performed because of a complication of previous surgery and is performed during the global surgical period, the correct modifier to append to the procedure code is:
a) 58
b) 79
c) 78
d) 76

13. Guidelines for billing an E/M visit and a procedure on the same date of service include:
a) Both settings are billable only if the examination for the E/M is different from the diagnosis for the procedure. Modifier 25 is used with the E/M code.
b) Both the E/M service and the procedure are billed when the decision to perform the procedure was made during another visit
c) Only the procedure may be billed if the decision to perform the procedure was made during the same encounter as the E/M visit.
d) The procedure and the E/M visit may both be billed with the same diagnosis code and during the same encounter if the patient's condition requires a procedure to be performed and the service is significantly and separately identifiable. Modifier 25 is appended to the E/M code.

14. A patient underwent a percutaneous needle core biopsy of the left breast with imaging guidance, anticipating to go for a mastectomy if malignancy is proven. The specimen was sent to pathology and the findings indicated a malignancy. Physician planned to perform a mastectomy the next day. On the next morning, the patient was taken to O.T for surgery and a partial mastectomy with removal of lymph nodes was done on the left breast. Select the appropriate code for the second procedure.
a) No code is necessary because the second procedure falls within the 90-day global period
b) 19301-58
c) 19102, 76095-51-58
d) 19102, 76095, 19162-58

15. Modifiers 54 and 55 are often used:
a) In primary care
b) To indicate the procedure is on the right or left side of the body
c) Always together on the same claim
d) Submitted with the same surgical procedure code by each physician who provided the service

16. Modifier 24 should always be used with:
a) Surgical procedures
b) Evaluation and management services
c) Radiology procedures
d) Laboratory and pathology procedures

17. The portion of a test or procedure that the physician performs (reading an X-ray, EKG, and so on) is known as the :
a) Professional component
b) Technical component
c) Limiting component
d) Complete procedural component

18. A national uniform coding structure produced by the Centers for Medicare and Medicaid for reporting physician/supplier services for government applications is known :
a) HIMA
b) HCFA
c) HCPCS
d) None of the above

19. 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

20. After a consultation for a new patient, the surgeon decided to operate on the patient the same day. The procedure is a major procedure with a 90 day global surgical time frame and the patient’s insurance company is a third-party payer. What modifier is appended to the consultation code?
a) 78
b) 51
c) 25
d) 57

21. 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

22. Modifier 59 is used:
a) Only with radiology procedures
b) Only to specify separate incision on an existing site
c) To report distinct procedural services
d) None of the above

23. Modifier 58 is used:
a) when the description of the code indicates one or more visits or one or more sessions
b) When the procedure was planned prospectively because it was more extensive than the original procedure or represents a therapy following a surgical procedure.
c) For a return to the operating room for an unrelated procedure during the postoperative period
d) None of the above

24. Modifier 51 may be appended to an add-on code:
a) True
b) False

25. A 16-year-old female presented for an intravenous pyelography with KUB and tomography. During the procedure, the patient complained of shortness of breath and nausea. There did not appear to be an allergic reaction, so the procedure was cautiously continued. The patient was extremely apprehensive and the procedure was prolonged by 70 minutes beyond its usual duration.
a)50
b)22
c)23
d)52
e)53
f)None of the above

26. Insurance company requires a second opinion for a patient with a congenital medullary sponge kidney requiring pyelotomy (50120). The consultation includes a comprehensive history and examination with moderate complexity decision-making.
a)24
b)25
c)57
d)32
e)None of the above

27. Patient had to have the left hand amputated at the metacarpal. Three days status post-surgery, the wound became infected, resulting in a return to the operating room for extensive debridement of the skin, subcutaneous tissue, and muscle. Since the physician is within the global period for the amputation, it is necessary to report the second service with a modifier.
a)76
b)77
c)78
d)79
e)None of the above

28. A Medicare patient was seen by a urologist on Monday. Based on the detailed examination and moderate complexity decision making, it was determined that the patient has a stricture of the ureter requiring surgical intervention pyeloplasty (global period - 90 days). The patient was scheduled for surgery on Tuesday.
a)21
b)24
c)25
d)57

29. A laboratory test is rerun due to a malfunction of the equipment. Use modifier:
a)52
b)90
c)91
d)No modifier can be used to repeat the test.

30. Of the Modifiers below, which would you consider the "opposite" of modifier 22?
a)Modifier -26.

b)Modifier -21.

c)Modifier -11.

d)Modifier -52.

31. 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 within the post-operative period?
a)76
b)77
c)78
d)79

32. Mrs. Knight has a diagnostic surgical biopsy of deep cervical lymph nodes on May 8 anticipating malignancy and the pathology report comes back showing malignancy. Mrs. Right elects to have a lymphadenectomy on May 20. what modifier will attach to the lymphadenectomy code?
a)58
b)59
c)76

a)78


33. The patient was seen for an office visit because of a urinary tract infection. The visit involved an expanded problem-focused exam and low complexity decision making. Three weeks ago the patient underwent a major surgical intervention to correct an abnormal curvature of the penis.
a)22
b)24
c)25
d)57

34. Modifier -50, Bilateral Procedure, is used when:
a)A CPT code is specifically noted as bilateral in the CPT manual.
b)A unilateral procedure is performed on both right and left sides of the body and there is not a specific c)CPT for the bilateral procedure performed.

d)There are two approaches to surgery.
e)All of the above


35. If a procedure is complicated by the late effects of previous surgery, irradiation, infection, or contracture and there is not a separate CPT code to identify this extensive nature of the work, which modifier should be appended to the procedure?
a) 21
b) 22
c) 57
d) 78

36. The modifier RT and LT are
a) Right and Left
b) Never used with modifier 50
c) HCPCS modifier
d) All of the above are correct

37. The modifier 23 --- --- (would/would not) be appropriate for the use of a -----
a) Prolonged service; would; mid-wife
b) Professional component; would not; microvascular surgeon
c) Unusual anesthesia; would not; acupuncture
d) Surgical assistant; would; nurse anesthetist

38. When using modifier 51 it is recommended that:
a) 51 is used on all procedures for that section
b) The RT and LT modifier be added as appropriate
c) The highest charge procedure be listed first
d) A report is included or you will not be reimbursed

39. If a patient elects to cancel a procedure before it takes place, then the use of modifier -53 would be appropriate:
a) That’s true
b) That’s false
c) Use it only if the patient discovers the physician is not licensed for that procedure
d) It depends on the particular situation.

40. Modifier ---- Repeat Clinical Diagnostic laboratory test ------
a) 90- when there are testing problems with either the specimen or equipment
b) 91- when it is necessary to obtain subsequent (multiple) reading of a test on the same day
c) 90- when it is necessary to obtain subsequent (multiple) reading of a test on the same day
d) 91-when there are testing problems with either the specimen or equipment

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