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COC (Formerly CPC-H) study materials
COC (Formerly CPC-H) study resources

COC (Formerly CPC-H) practice questions

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Question 1Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

In ICD-10-CM, what is the function of the placeholder character X?

  1. It signals that a secondary external cause code must also be filed
  2. It marks codes that are exempt from principal diagnosis sequencing
  3. It indicates that the documented diagnosis is pending confirmation
  4. It maintains the code length when a character position is not applicable Correct answer.

Explanation

Some ICD-10-CM codes require a seventh character even though the code has only six meaningful characters. In those cases X fills the empty position so the code keeps its required length and the seventh character lands in the correct slot. The X carries no clinical meaning of its own.

Question 2Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Which CPT modifier indicates that a procedure was performed on both sides of the body during the same session?

  1. Modifier 79
  2. Modifier 51
  3. Modifier 50 Correct answer.
  4. Modifier 58

Explanation

Modifier 50 identifies a bilateral procedure performed on paired anatomic sites in a single operative session. It is reported once, with the bilateral modifier, rather than duplicating the code for each side. Payers may instead require the HCPCS Level II modifiers LT and RT.

Question 3Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

HCPCS Level II codes are primarily used to report which of the following?

  1. Inpatient hospital facility accommodation charges
  2. Physician office evaluation and management visits
  3. Surgical procedures with global surgical periods
  4. Supplies, drugs, and equipment not described in CPT Correct answer.

Explanation

The HCPCS Level II system covers items and services outside the CPT code set, such as drugs, biologicals, supplies, orthotics, and durable medical equipment. CPT continues to describe most professional services and procedures. The two systems are reported together on the same claim when both apply.

Question 4Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient was seen 18 months ago by a different physician in the same group practice. How is the patient classified for today's office visit?

  1. An established patient, but only when the same physician provides the care
  2. A new patient because the problem is unrelated
  3. A new patient because the specialty has changed
  4. An established patient, since the visit was within 3 years Correct answer.

Explanation

New versus established status depends on whether the patient has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years. Because the prior visit was 18 months ago, the patient is established. The specific issue addressed or the individual physician seen does not change the classification.

Question 5Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Which ICD-10-CM chapter contains the Z codes?

  1. Factors influencing health status and contact with health services Correct answer.
  2. Injury, poisoning, and other consequences of external causes
  3. Certain infectious and parasitic diseases
  4. Symptoms, signs, and abnormal clinical and laboratory findings

Explanation

Z codes appear in Chapter 21, Factors influencing health status and contact with health services. They cover encounters for reasons other than a current illness, such as screening, history of disease, and status codes. They are not reported in place of a definitive diagnosis when one exists.

Question 6Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A surgical procedure carries a global period of 010 days. What does this period include?

  1. Only the day the procedure is performed
  2. The day of the procedure plus the following 10 days Correct answer.
  3. Ten days before and ten days after the procedure
  4. The day before surgery through 90 days after surgery

Explanation

The three digits of a global period represent preoperative days, postoperative days, and the day of the service. A 010 period therefore covers the day of the procedure plus ten postoperative days. Related E/M services during that window are included in the surgical payment.

Question 7Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Modifier 25 is appended to report which of the following?

  1. A procedure carried out on both sides of the body during one session
  2. A repeat procedure performed by the same physician on the same day
  3. A service that the physician reduced or discontinued at the patient's request
  4. A separately identifiable E/M service on the same day as a procedure Correct answer.

Explanation

Modifier 25 tells the payer that a significant, separately identifiable evaluation and management service was provided on the same day as another service. The E/M service must be above and beyond the usual work of the procedure. The procedure code itself needs no modifier in this situation.

Question 8Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

In ICD-10-CM, what does the seventh character A represent?

  1. Unspecified encounter type
  2. Sequelae of a healed injury
  3. Initial encounter for the condition Correct answer.
  4. Subsequent encounter for the same condition

Explanation

The seventh character A denotes the initial encounter, meaning the patient is receiving active treatment for the condition. It does not refer to the first visit ever recorded. Later visits for active treatment continue to use A until the patient moves into the healing or residual phase.

Question 9Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Two distinct procedures on different anatomic sites are performed in one session and are not normally bundled. Which modifier most specifically identifies the separate site for an NCCI edit?

  1. Modifier XS Correct answer.
  2. Modifier 59
  3. Modifier 76
  4. Modifier 51

Explanation

The X{EPSU} modifiers were created to give payers more specific information than modifier 59 provides. Modifier XS identifies a service performed on a separate organ or anatomic site. Modifier 59 remains available but is reserved for cases that no more specific modifier describes.

Question 10Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Which statement about CPT add-on codes is accurate?

  1. They may stand alone when no primary procedure is documented
  2. They require modifier 51 when reported with the primary service
  3. They are never reported alone and are exempt from modifier 51 Correct answer.
  4. They are always reported with modifier 50 for bilateral sites

Explanation

Add-on codes describe supplemental work that is always performed with a primary procedure, so they are never reported by themselves. The CPT Appendix on add-on codes exempts them from multiple-procedure reduction, meaning modifier 51 is not appended. They are also typically exempt from the bilateral modifier.

Question 11Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

In the outpatient setting, which condition should be reported as the first-listed diagnosis?

  1. The chronic condition treated for the longest duration
  2. The most severe condition documented anywhere in the patient record
  3. The diagnosis that carries the highest relative value
  4. The condition chiefly responsible for the services provided Correct answer.

Explanation

Outpatient coding follows the Uniform Hospital Discharge Data Set definition adapted for outpatient services, which sequences first the condition chiefly responsible for the encounter. Severity, chronicity, and reimbursement value do not drive sequencing. When a definitive diagnosis is not established, the presenting symptom may be first-listed.

Question 12Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient who quit smoking two years ago is seen for an unrelated condition. Which code reports the former tobacco use?

  1. Z87.891 Correct answer.
  2. F17.200
  3. Z72.0
  4. F17.210

Explanation

Z87.891 reports personal history of nicotine dependence, which describes a patient who formerly used tobacco and has quit. Current tobacco use is coded with Z72.0, and active dependence is coded from category F17. Documentation must clearly state the patient no longer uses the substance.

Question 13Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A radiologist interprets an MRI while hospital staff perform the scan and supply the equipment. Which modifier does the radiologist report?

  1. Modifier 52
  2. Modifier TC
  3. Modifier 22
  4. Modifier 26 Correct answer.

Explanation

Modifier 26 identifies the professional component, which covers the physician's interpretation and written report. The facility that owns the equipment and performs the study bills the technical component with modifier TC. When the same entity provides both, the code is submitted without either modifier.

Question 14Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

When coding a wound repair, what does the measurement recorded for code selection represent?

  1. The total length of all repaired wounds in the same group Correct answer.
  2. The size of the scar expected after healing
  3. The number of sutures or staples used
  4. The depth of the wound measured at its deepest point before closure

Explanation

Repair codes are selected by the length of the wound, in centimeters, with lengths of wounds in the same body group added together. The sum selects the code and is reported with an additional unit when the length exceeds the largest code. Depth, suture count, and expected scarring are not selection factors.

Question 15Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Under the current E/M guidelines for office and outpatient visits, medical decision making is determined by which three elements?

  1. History, examination, and medical decision making
  2. Number and complexity of problems, data reviewed, and risk Correct answer.
  3. Total time spent on the date of the encounter in every case
  4. The count of diagnoses and medications in the chart

Explanation

Medical decision making is scored across three elements: the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications, morbidity, or mortality. Two of the three must be met or exceeded to assign a level. Time may be used instead of MDM when counseling or coordination dominates the visit.

Question 16Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

How are units determined when reporting a HCPCS Level II J code for a drug?

  1. One unit for each day of the therapy course
  2. The number of dosage units defined in the code descriptor Correct answer.
  3. One unit for each vial dispensed, regardless of strength
  4. One unit for every 10 mg of the drug given

Explanation

Each J code descriptor states the dosage amount that equals one billing unit, such as 10 mg or 1 mg. The total dose administered is divided by that amount to determine units, and units are rounded per the payer's instructions. Vial size and number of days do not define the unit.

Question 17Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Modifier 51 is used to indicate which of the following?

  1. A procedure discontinued before it was completed
  2. A procedure performed bilaterally in one session
  3. Multiple procedures performed in the same operative session Correct answer.
  4. A procedure repeated by the same physician in the postoperative period

Explanation

Modifier 51 shows that additional procedures were performed by the same physician during the same session and signals that multiple-procedure reduction may apply. It is appended to the secondary procedure, not the primary one. Add-on codes and codes designated as modifier 51 exempt are never reported with it.

Question 18Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

The outpatient record documents “probable pneumonia” after the physician's evaluation. How should the diagnosis be coded?

  1. With a symptom code only, and add the pneumonia code after the result is confirmed
  2. As pneumonia, since outpatient coding does not permit uncertain diagnoses Correct answer.
  3. Only after a confirmatory laboratory result has been filed
  4. As an unconfirmed diagnosis that is flagged for later review

Explanation

In the outpatient and physician office setting, a condition documented as probable, suspected, or rule out is coded as though it exists. The inpatient rule that allows an uncertain diagnosis to be coded as stated applies only to facility inpatient records. No flag or pending status is used in outpatient coding.

Question 19Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Anesthesia code selection combines which components?

  1. The number of postoperative visits the anesthesiologist makes
  2. The ASA physical status class as the sole determinant
  3. Base units, time units, and qualifying circumstances Correct answer.
  4. The surgical procedure's relative value alone

Explanation

Anesthesia payment is built from base units assigned to the procedure, time units based on minutes of anesthesia care, and qualifying circumstance codes when applicable. Physical status modifiers describe the patient's condition and may affect payment but do not replace the other components. Postoperative visit counts are not part of the formula.

Question 20Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A clinical laboratory test is repeated on the same day because the original specimen was unsatisfactory. Which modifier is reported on the repeat test?

  1. Modifier 91 Correct answer.
  2. Modifier 90
  3. Modifier 76
  4. Modifier 59

Explanation

Modifier 91 reports a repeat clinical diagnostic laboratory test performed on the same day to obtain a subsequent result. It is not used for tests repeated because of equipment failure or specimen problems when no result was reported from the first attempt. Modifier 76 applies to repeat procedures, not laboratory tests.

Question 21Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient receives a therapeutic antibiotic infusion, and hydration runs concurrently only to keep the line open. Which service is reported?

  1. Both services, with modifier 51 on the infusion
  2. Only the hydration is reported
  3. Both services, with modifier 59 on the hydration
  4. Only the therapeutic infusion is reported Correct answer.

Explanation

Hydration provided solely to facilitate administration of a drug is not separately reportable. When multiple infusions are given, the hierarchy starts with the primary service and hydration ranks lowest, so the therapeutic infusion is reported alone. Distinct-service modifiers do not make the hydration payable.

Question 22Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

How is sepsis caused by methicillin-resistant Staphylococcus aureus reported in ICD-10-CM?

  1. A41.02 Correct answer.
  2. A41.9 plus B95.62
  3. A41.9 plus R65.20
  4. A49.02

Explanation

A41.02 is a combination code that captures both sepsis and the causal organism, MRSA, in a single code. When a combination code fully describes the condition and organism, no separate code for the bacterium is added. Additional codes are used only for further specifics such as severe sepsis with organ dysfunction.

Question 23Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

For excision of a malignant skin lesion, code selection is based on which factors?

  1. The site and the number of sutures placed
  2. The site and the size of the final healed scar
  3. The site and the microscopic depth of invasion
  4. The site and the largest diameter of the lesion plus margins Correct answer.

Explanation

Excision codes for malignant lesions are stratified by anatomic site and by the largest diameter of the lesion, measured with margins included as excised. The pathology report supplies the size for code selection. Depth of invasion and closure technique do not determine the excision code.

Question 24Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A CPT code pair carries an NCCI procedure-to-procedure edit with a modifier indicator of 1. What does this mean?

  1. The edit applies only to facility claims
  2. Modifier 51 may be used to override the edit
  3. An appropriate modifier may override the edit Correct answer.
  4. The edit can never be bypassed

Explanation

A modifier indicator of 1 means the edit is bypassable when documentation supports that the services are distinct and an appropriate modifier such as 59 or an X modifier is appended. An indicator of 0 means no modifier can override the edit. Modifier 51 does not function as an NCCI override.

Question 25Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient intentionally takes an overdose of a prescribed medication and is treated in the emergency department. How is this reported?

  1. Code underdosing of the drug using the documented intent
  2. Code the poisoning with intent plus the drug and external cause codes Correct answer.
  3. Code the reaction as an adverse effect of the drug with an external cause code
  4. Code only the drug toxicity code, with no external cause code

Explanation

Poisoning codes from categories T36-T50 require a seventh character identifying the intent, which here is intentional self-harm. The specific drug is identified within the poisoning code, and an external cause code from the X40-X49 range is added to describe the intent and circumstance. Adverse effect and underdosing codes describe different clinical situations.

Question 26Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

In ICD-10-CM, a six-character code that requires a seventh character uses which character in the sixth position?

  1. 0
  2. 9
  3. X Correct answer.
  4. Z

Explanation

ICD-10-CM uses the placeholder character X in the sixth position when a code requires a seventh character but has no sixth-character information. This preserves code length and keeps the seventh character in its correct position.

Question 27Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

For CPT E/M purposes, a patient is considered new when the patient has not received any professional services from the physician or another physician of the same specialty in the same group practice within what period?

  1. 7 years
  2. 3 years Correct answer.
  3. 5 years
  4. 1 year

Explanation

A new patient has not received any professional service from the physician or a same-specialty physician in the same group practice within three years. After that period, the patient may be considered new again.

Question 28Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Which HCPCS Level II code series is used to report durable medical equipment?

  1. J codes
  2. A codes
  3. V codes
  4. E codes Correct answer.

Explanation

HCPCS Level II E codes report durable medical equipment such as walkers, wheelchairs, and hospital beds. A codes cover supplies and ambulance services, J codes cover drugs, and V codes cover vision and hearing items.

Question 29Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Which modifier indicates that a procedure was performed on both sides of the body during the same operative session?

  1. Modifier 51
  2. Modifier 50 Correct answer.
  3. Modifier 59
  4. Modifier 22

Explanation

Modifier 50 identifies a bilateral procedure performed on both sides during the same operative session. It is used only for procedures that CPT allows to be reported bilaterally.

Question 30Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A procedure is discontinued before completion because the patient cannot tolerate the service. Which modifier is reported?

  1. Modifier 53 Correct answer.
  2. Modifier 59
  3. Modifier 58
  4. Modifier 52

Explanation

Modifier 53 reports a procedure that is discontinued before completion because of a patient condition or safety concern. It is not used when the physician elects to reduce the service, which is reported with modifier 52.

Question 31Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

In ICD-10-CM, the word "with" in a code descriptor is interpreted as which of the following?

  1. A presumed causal link Correct answer.
  2. An optional relationship
  3. A documented causal link
  4. A diabetes-only relationship

Explanation

In ICD-10-CM, "with" represents a default causal relationship that is presumed when the two conditions are listed together, unless the documentation states otherwise. The relationship does not need to be explicitly documented as causal.

Question 32Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A procedure is partially reduced at the physician's discretion without terminating the service. Which modifier reports this?

  1. Modifier 52 Correct answer.
  2. Modifier 58
  3. Modifier 53
  4. Modifier 22

Explanation

Modifier 52 reports a service that is partially reduced or eliminated at the physician's discretion. It is not used when a procedure is terminated because of patient safety, which is modifier 53.

Question 33Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient with no signs or symptoms undergoes a screening colonoscopy. Which type of code is reported as the first-listed diagnosis?

  1. A symptom code
  2. An external cause code
  3. A screening Z code Correct answer.
  4. A history code

Explanation

Screening services for patients without signs or symptoms are reported with a Z code from the screening category, such as Z12.11 for colon cancer screening. Symptom codes are not used because no symptom is present.

Question 34Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

During the postoperative global period, a patient returns to the same physician for an E/M service unrelated to the surgery. Which modifier is appended to the E/M code?

  1. Modifier 24 Correct answer.
  2. Modifier 79
  3. Modifier 25
  4. Modifier 57

Explanation

Modifier 24 reports an unrelated E/M service provided during a postoperative global period by the same physician. It distinguishes the visit from the surgical follow-up included in the global package.

Question 35Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A physician performs an E/M service and decides during that encounter to perform surgery the following day. Which modifier is appended to the E/M code?

  1. Modifier 78
  2. Modifier 24
  3. Modifier 57 Correct answer.
  4. Modifier 58

Explanation

Modifier 57 reports the E/M service that results in the initial decision to perform surgery. It is used when the decision occurs on the day before or the day of the procedure, depending on payer rules.

Question 36Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient undergoes a related procedure during the postoperative period that was planned in advance as a staged procedure. Which modifier is reported?

  1. Modifier 79
  2. Modifier 58 Correct answer.
  3. Modifier 76
  4. Modifier 78

Explanation

Modifier 58 identifies a staged or related procedure performed during the postoperative period when the procedure was planned before the original surgery. It is not used for an unplanned return to the operating room, which is modifier 78.

Question 37Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient is returned to the operating room during the global period for a related procedure to treat a complication. Which modifier is used?

  1. Modifier 58
  2. Modifier 78 Correct answer.
  3. Modifier 76
  4. Modifier 79

Explanation

Modifier 78 reports an unplanned return to the operating room for a related procedure during the postoperative period. The procedure is related to the original surgery and is typically performed for a complication.

Question 38Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

An unrelated procedure is performed by the same physician during the postoperative period of an earlier procedure. Which modifier is reported?

  1. Modifier 24
  2. Modifier 78
  3. Modifier 79 Correct answer.
  4. Modifier 58

Explanation

Modifier 79 identifies a procedure that is unrelated to the original procedure and is performed during its postoperative period by the same physician. It is not used for related procedures or for E/M services.

Question 39Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A procedure is repeated by the same physician on the same day because the first attempt did not provide an adequate result. Which modifier is reported?

  1. Modifier 77
  2. Modifier 76 Correct answer.
  3. Modifier 79
  4. Modifier 78

Explanation

Modifier 76 reports a repeat procedure or service by the same physician on the same day. It explains why the same CPT code appears more than once on the claim.

Question 40Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

When an office E/M visit is selected based on time, which time is used?

  1. Total time on the encounter date Correct answer.
  2. The time spent only by ancillary staff
  3. The face-to-face time only with the patient
  4. The record-review time before the visit

Explanation

Under current E/M guidelines, time includes the total time on the date of the encounter for the physician's or qualified health care professional's services, including both face-to-face and non-face-to-face work. It is not limited to the face-to-face portion.

Question 41Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

What does an Excludes1 note in ICD-10-CM indicate?

  1. May be reported together
  2. Is optional for reporting
  3. Cannot be reported together Correct answer.
  4. Applies only to inpatient claims

Explanation

An Excludes1 note means that the excluded code and the code being reviewed cannot be reported together because they represent mutually exclusive conditions. An Excludes2 note, by contrast, allows both codes when both conditions are present.

Question 42Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

When a laboratory panel is ordered and all of the panel's tests are performed, how is the service reported?

  1. With the panel code plus each test code
  2. With the single panel code Correct answer.
  3. With a modifier 59 on each test
  4. With each test code separately

Explanation

A panel is reported with one panel code when all of its listed tests are performed. Individual test codes are not reported separately for the components of the panel.

Question 43Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Two surgeons from different specialties each perform a distinct portion of the same surgical procedure. Which modifier does each surgeon report?

  1. Modifier 66
  2. Modifier 62 Correct answer.
  3. Modifier 80
  4. Modifier 51

Explanation

Modifier 62 identifies co-surgery, in which two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon reports the same procedure code with modifier 62.

Question 44Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient with hypertension and chronic kidney disease is seen. How are these conditions reported?

  1. A combination code plus a CKD stage code Correct answer.
  2. Only the CKD stage code
  3. Only the hypertension code
  4. Separate hypertension and CKD codes without a combination code

Explanation

ICD-10-CM provides a combination code for hypertension with chronic kidney disease, such as I12.-, and an additional code is reported for the stage of CKD. The combination code captures the causal relationship between the conditions.

Question 45Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A team of surgeons performs a complex procedure, with each surgeon handling a defined part of the operation. Which modifier is reported?

  1. Modifier 82
  2. Modifier 62
  3. Modifier 66 Correct answer.
  4. Modifier 80

Explanation

Modifier 66 identifies team surgery, in which multiple surgeons with different expertise perform a procedure as a team. It differs from co-surgery, where two surgeons act as primary surgeons.

Question 46Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

An NCCI procedure-to-procedure edit has a modifier indicator of 0. What does this mean?

  1. No modifier can bypass the edit Correct answer.
  2. The edit applies only to Medicare
  3. A modifier 59 can bypass the edit
  4. The edit is advisory only

Explanation

A modifier indicator of 0 means the edit cannot be bypassed with any modifier; the two codes cannot be reported together. Indicator 1 means a permitted modifier may bypass the edit if documentation supports it.

Question 47Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A patient is seen for the late effect of a healed ankle fracture that occurred two years ago. Which seventh character is used on the injury code?

  1. S Correct answer.
  2. G
  3. D
  4. A

Explanation

The seventh character S identifies a sequela, which is a late effect of a healed injury. Character D is used for a subsequent encounter for routine healing, and character A is the initial encounter.

Question 48Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A screening colonoscopy is performed, and a polyp is found and removed during the same procedure. How should the encounter be coded?

  1. Polyp code first, then the screening code
  2. Polyp code only Correct answer.
  3. Screening code only
  4. Screening code first, then the polyp code

Explanation

When a screening test reveals a condition, the condition is coded rather than the screening code. Because a polyp was found and removed, the encounter is diagnostic rather than screening.

Question 49Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

Two procedures are performed on the same day during separate encounters. Which modifier most specifically identifies the separate encounter?

  1. Modifier XS
  2. Modifier 51
  3. Modifier XE Correct answer.
  4. Modifier 59

Explanation

Modifier XE is a specific subset of modifier 59 that identifies a separate encounter on the same day. The X{EPSU} modifiers provide more precise reasons for distinct procedural services.

Question 50Core outpatient coding knowledge (ICD-10-CM, CPT®, HCPCS Level II)

A physician assistant assists a surgeon during an operation. Which modifier is reported for the assistant's services?

  1. Modifier 82
  2. Modifier 81
  3. Modifier AS Correct answer.
  4. Modifier 80

Explanation

Modifier AS reports assistant-at-surgery services performed by a physician assistant, nurse practitioner, or clinical nurse specialist. Modifier 80 is used when a physician serves as the assistant surgeon.