22 CPT & HCPCS Coding Practice Questions & Answers

1. 1. A clinic reports several four-character codes ending in the letter F in addition to its regular procedure codes. Which statement correctly describes CPT Category II codes?

   • A.Permanent codes that replace the Category I code whenever a quality measure is documented
   • B.Optional supplemental tracking codes for performance measurement that never replace a Category I code✓ Answer
   • C.Temporary codes for emerging technology that must be reported in place of an unlisted code
   • D.Mandatory quality codes that a payer requires on a claim before any procedure is paid

   Category II codes are supplemental tracking codes used to measure performance; reporting them is optional and they are never reported instead of a Category I code, which remains required for the service itself.

   Source: AMA CPT Professional Edition, Category II Codes guidelinesReport a problem with this question

2. 2. A surgeon performs an emerging technology procedure for which a Category III code exists. How must the service be reported under CPT guidelines?

   • A.Report the Category III code, which takes precedence over an unlisted Category I code✓ Answer
   • B.Report the Category III code and an unlisted code so the payer can select the correct one
   • C.Report the unlisted Category I code, since Category III codes are optional tracking codes
   • D.Report the closest Category I code that approximates the work actually performed

   When a Category III code describes the service, CPT requires it to be used instead of an unlisted Category I code; unlisted codes are reported only when no Category I or Category III code applies.

   Source: AMA CPT Professional Edition, Category III Codes guidelinesReport a problem with this question

3. 3. A provider reports an unlisted procedure code on a claim. Under CPT guidelines, what must accompany that code?

   • A.Modifier 22 appended to show that the work performed was substantially greater
   • B.A signed notice showing the patient accepted financial responsibility for it
   • C.A Category II code identifying the quality measure that the service satisfied
   • D.A special report describing the nature, extent and necessity of the service✓ Answer

   CPT requires a special report with unlisted and other unusual services, describing the nature, extent and need for the procedure along with the time, effort and equipment involved, because the unlisted code itself conveys no specific description to the payer.

   Source: AMA CPT Professional Edition, Introduction — Special ReportReport a problem with this question

4. 4. A CPT code entry is preceded by a plus symbol. Which statement about reporting that code is correct?

   • A.It may stand alone on the claim when the primary service was done earlier
   • B.It requires modifier 51 whenever a second, unrelated procedure is billed that session
   • C.It is reported together with a primary procedure and is exempt from modifier 51✓ Answer
   • D.It is a resequenced code printed out of numeric order within its own section

   The plus symbol marks an add-on code, which describes additional work performed with a primary procedure; it is never reported by itself and it is exempt from modifier 51 because the multiple-procedure reduction does not apply to it.

   Source: AMA CPT Professional Edition, Introduction — Add-on Codes; Appendix DReport a problem with this question

5. 5. A CPT descriptor ends with the parenthetical phrase 'separate procedure'. What does that designation oblige the coder to do?

   • A.Report it with the larger procedure, adding modifier 59 to the comprehensive code
   • B.Report it whenever a second surgeon does that part through another incision
   • C.Report it only when it is performed independently, and not as part of a larger procedure✓ Answer
   • D.Report it with modifier 51, since it is always a second procedure in the session

   The separate-procedure designation means the service is considered an integral component of a more comprehensive procedure and is bundled into it; it is reportable only when carried out independently or when it is unrelated to the other services performed.

   Source: AMA CPT Professional Edition, Surgery Guidelines — Separate ProcedureReport a problem with this question

6. 6. How does HCPCS Level II differ structurally from CPT Category I?

   • A.CMS maintains it, codes are one letter plus four digits, and updates come quarterly✓ Answer
   • B.CMS maintains it, codes are five digits, and the update follows the January CPT cycle
   • C.A joint AMA and CMS panel maintains it, with two alphanumeric updates each year
   • D.The AMA maintains it, codes are five digits, and updates are issued every quarter

   HCPCS Level II is the national code set maintained by CMS, formatted as a single letter A through V followed by four digits and updated quarterly, whereas CPT Category I is a five-digit numeric set maintained by the AMA and updated once a year in January.

   Source: CMS HCPCS Level II coding overview; AMA CPT IntroductionReport a problem with this question

7. 7. A coder has only the CPT Professional edition at hand and needs the definition of a national (HCPCS Level II) modifier. Which CPT appendix contains it?

   • A.Appendix D, which lists every add-on code reported with a primary procedure
   • B.Appendix N, which lists resequenced codes printed out of numeric order
   • C.Appendix E, which lists the codes that are exempt from modifier 51 reporting
   • D.Appendix A, which lists CPT modifiers together with commonly used national modifiers✓ Answer

   Appendix A is the modifier appendix: it carries the CPT modifiers, the anesthesia physical status modifiers, the modifiers approved for ambulatory surgery center and hospital outpatient use, and the commonly used HCPCS Level II national modifiers.

   Source: AMA CPT Professional Edition, Appendix A — ModifiersReport a problem with this question

8. 8. On the same day as a minor procedure carrying a zero-day global period, the physician also performs a significant, separately identifiable evaluation and management service. Which modifier belongs on the E/M code?

   • A.Modifier 57, because an E/M on the day of any procedure is a decision for surgery
   • B.Modifier 51, because two separate services were furnished during the same session
   • C.Modifier 25, because the E/M went beyond the usual work of that minor procedure✓ Answer
   • D.Modifier 59, because the E/M is a distinct service at a separate patient encounter

   Modifier 25 identifies a significant, separately identifiable E/M service furnished by the same provider on the day of a minor (0- or 10-day global) procedure; the record must show work beyond the usual preoperative and postoperative care already bundled into that procedure.

   Source: AMA CPT Professional Edition, Appendix A — Modifier 25Report a problem with this question

9. 9. An internist examines a patient the day before a procedure that carries a 90-day global period and documents that this visit is when surgery was decided upon. Which modifier applies to the E/M service?

   • A.Modifier 22, because the preoperative work performed was substantially greater
   • B.Modifier 24, because the E/M falls within the surgical global period already
   • C.Modifier 25, because the E/M is separately identifiable from the procedure
   • D.Modifier 57, the decision-for-surgery modifier used with a major procedure✓ Answer

   Modifier 57 marks the E/M service at which the decision for a major (90-day global) procedure was made, when that visit occurs on the day of or the day before surgery; modifier 25 is the counterpart used with minor procedures.

   Source: AMA CPT Professional Edition, Appendix A — Modifier 57Report a problem with this question

10. 10. Ten days after a diagnostic biopsy, the same surgeon performs the definitive excision that was planned at the time of the biopsy. Which modifier describes the second procedure?

    • A.Modifier 76, a repeat of the identical procedure by the same physician
    • B.Modifier 58, a staged or planned procedure, which starts a new global period✓ Answer
    • C.Modifier 79, an unrelated procedure done in the postoperative period
    • D.Modifier 78, an unplanned return to the procedure room for a complication

    Modifier 58 applies when the later procedure was planned or anticipated at the time of the first, is more extensive than the first, or is therapy following a diagnostic procedure; unlike modifier 78, it begins a new global period.

    Source: AMA CPT Professional Edition, Appendix A — Modifier 58Report a problem with this question

11. 11. Two days after a major operation the patient bleeds, and the same surgeon returns her to the operating room to control the hemorrhage. Which modifier applies, and what happens to the global period?

    • A.Modifier 78; the original global period continues and no new one begins✓ Answer
    • B.Modifier 79; the bleeding is unrelated, so a fresh global period begins
    • C.Modifier 76; the operation is a repeat, so the global period is extended
    • D.Modifier 58; the return was a planned stage, so a new global period starts

    Modifier 78 reports an unplanned return to the operating or procedure room by the same physician for a related problem during the global period; because it treats a complication of the original surgery, the original global period simply continues and is not restarted.

    Source: AMA CPT Professional Edition, Appendix A — Modifier 78Report a problem with this question

12. 12. In a hospital outpatient surgical suite the patient is prepped and taken to the procedure room, and the case is cancelled before anesthesia is administered. Which modifier does the facility report?

    • A.Modifier 53, which the facility must use for any discontinued procedure
    • B.Modifier 74, because the patient had already been taken to the procedure room
    • C.Modifier 73, the facility modifier for a case stopped before anesthesia✓ Answer
    • D.Modifier 52, because the service the facility furnished was reduced

    Modifiers 73 and 74 are facility-only modifiers for ambulatory surgery centers and hospital outpatient departments: 73 applies when the case is discontinued after the patient is prepared and taken to the room but before anesthesia is given, and 74 applies once anesthesia has been administered or the procedure has begun.

    Source: AMA CPT Professional Edition, Appendix A — Modifiers 73 and 74Report a problem with this question

13. 13. A physician starts a procedure and, after anesthesia has been induced, terminates it because the patient becomes unstable. On the professional claim, which modifier reports this?

    • A.Modifier 73, for a case stopped before anesthesia was administered
    • B.Modifier 53, for a procedure discontinued after it began, on a physician claim✓ Answer
    • C.Modifier 52, for a service the physician reduced at his own discretion
    • D.Modifier 74, which the physician reports once anesthesia is given

    Modifier 53 is the physician's discontinued-procedure modifier, used when a started procedure is terminated because of extenuating circumstances or a threat to the patient's wellbeing; modifier 52 covers a service deliberately reduced, and 73 and 74 are reported only by facilities.

    Source: AMA CPT Professional Edition, Appendix A — Modifier 53Report a problem with this question

14. 14. During one session a surgeon performs the same procedure on the right knee and the left knee. Under CMS reporting rules, how is this reported?

    • A.Two lines with modifier 51 on the second, since two procedures were done
    • B.Two lines with modifier 59, since each knee is a distinct anatomic site
    • C.One line with modifier 22, since the work performed was substantially increased
    • D.One line with modifier 50 and one unit of service for the bilateral work✓ Answer

    Modifier 50 identifies the same procedure performed on both sides of the body at the same session; CMS instructs that it be reported on a single line with one unit of service, and payment is 150 percent of the fee schedule amount. Modifier 51 applies to different procedures, not to a bilateral pair.

    Source: AMA CPT Appendix A — Modifier 50; CMS Medicare Claims Processing Manual, bilateral surgery policyReport a problem with this question

15. 15. A radiologist who does not own the equipment interprets an imaging study performed at a hospital and dictates the written report. Which modifier reports the radiologist's work?

    • A.Modifier 26, identifying the professional component of the service✓ Answer
    • B.Modifier 90, because another facility actually performed the imaging
    • C.No modifier, because the global service already includes both components
    • D.Modifier TC, identifying the technical component of the service

    Modifier 26 reports the professional component only, meaning the physician's interpretation and written report, while HCPCS modifier TC reports the equipment, supplies and technician work. The unmodified code represents the global service, correct only when one provider furnishes both parts.

    Source: AMA CPT Appendix A — Modifier 26; CMS professional and technical component policyReport a problem with this question

16. 16. An NCCI edit pair may be bypassed, and the two services were performed on separate anatomic structures. Which reporting choice best follows CMS guidance?

    • A.Use modifier XS, the site-specific modifier CMS prefers over the broader modifier 59✓ Answer
    • B.Use modifier 59 first, because the X modifiers apply only to laboratory services
    • C.Use no modifier, since separate anatomic sites never trigger an edit bypass
    • D.Use modifier 51, because more than one procedure was performed that session

    CMS created the X{EPSU} subset as more specific alternatives to modifier 59, which is the modifier of last resort; XS identifies a service performed on a separate organ or structure, so it is the better choice when anatomy is what makes the two services distinct.

    Source: CMS MLN, Proper Use of Modifier 59 and the X{EPSU} modifiersReport a problem with this question

17. 17. An NCCI procedure-to-procedure edit pair carries a modifier indicator of 0. What does that indicator tell the coder?

    • A.The edit may be bypassed with a modifier when documentation supports it
    • B.The edit no longer applies, so both codes may be reported without a modifier
    • C.The edit can never be bypassed; no modifier will allow both codes to pay✓ Answer
    • D.The edit applies to facility claims only and not to professional claims

    In the NCCI procedure-to-procedure tables the modifier indicator governs whether an edit can be overridden: 0 means no NCCI-associated modifier may be used and only the Column One code is payable, 1 means the edit may be bypassed with an appropriate modifier and supporting documentation placed on the Column Two code, and 9 means the edit is not applicable.

    Source: CMS National Correct Coding Initiative Policy Manual, PTP modifier indicatorsReport a problem with this question

18. 18. Under the current CPT evaluation and management guidelines, what determines the level of an office or outpatient visit?

    • A.The documented levels of history, examination and medical decision making together
    • B.Medical decision making, or the total time spent on the date of the encounter✓ Answer
    • C.The extent of examination documented and the number of systems reviewed
    • D.Two of the three key components, one of which must be the level of history

    Since the 2021 revision of the office and outpatient codes and the 2023 revision of the remaining categories, level selection rests on medical decision making or on total time on the date of the encounter; a medically appropriate history and examination are still documented but no longer drive the level.

    Source: AMA CPT Professional Edition, E/M Guidelines — Levels of E/M ServiceReport a problem with this question

19. 19. A coder is selecting a visit level using medical decision making. How many of the three MDM elements must be met or exceeded for that level?

    • A.Two of the three elements must be met or exceeded to reach that level✓ Answer
    • B.All three elements must be met or exceeded before the level is reached
    • C.Two of three, but the risk element must always be one of the two counted
    • D.One element is enough, provided the element met is the risk element

    The MDM table sets three elements — number and complexity of problems addressed, amount and complexity of data reviewed and analyzed, and risk of complications from patient management — and two of the three must be met or exceeded for a level; no particular element is mandatory among the two.

    Source: AMA CPT Professional Edition, E/M Guidelines — Medical Decision Making tableReport a problem with this question

20. 20. A patient seen two years ago by a cardiologist in a group practice now presents to an endocrinologist in that same group. How is this encounter classified?

    • A.An established patient, because the visit falls inside three years
    • B.A new patient, because more than one year has passed since that visit
    • C.An established patient, because the group practice is the same entity
    • D.A new patient, because the specialty and subspecialty are not the same one✓ Answer

    A patient is established only if a face-to-face professional service was received within three years from that provider, or from another provider of the exact same specialty and subspecialty in the same group; a different specialty within the same group makes the patient new.

    Source: AMA CPT Professional Edition, E/M Guidelines — New and Established PatientReport a problem with this question

21. 21. On the date of an office visit a physician reviews prior test results, counsels the patient, documents the note, and drives between two clinic sites. Which of these is excluded from total time?

    • A.The travel between the two clinic sites, which is never countable✓ Answer
    • B.The counseling, unless it took more than half of the visit time
    • C.The review of prior results, since that belongs to the test's code
    • D.The documentation of the note, since clerical work is not counted

    Total time on the date of the encounter includes face-to-face and non-face-to-face work the physician personally performs that day, such as reviewing results, counseling and documenting; travel and general teaching are expressly excluded, as is time spent on a separately reported service.

    Source: AMA CPT Professional Edition, E/M Guidelines — TimeReport a problem with this question

22. 22. Documentation shows hypertension unchanged since the last visit but still above the patient's treatment goal. How does this problem count in medical decision making?

    • A.The illness counts as a stable chronic illness, because it is unchanged
    • B.The illness counts as two chronic problems, controlled and uncontrolled
    • C.The illness counts as chronic but not stable, because the goal is unmet✓ Answer
    • D.The illness counts as a stable chronic illness, because therapy continued

    CPT defines stability for a chronic illness against the patient's treatment goal rather than against the previous visit, so a patient who is not at goal is not stable even when the findings are unchanged; the problem therefore carries more weight in the problems column than a stable chronic illness would.

    Source: AMA CPT Professional Edition, E/M Guidelines — definition of stable chronic illnessReport a problem with this question

Practice questions based on the AHIMA Certified Coding Associate (CCA) Exam Content Outline, the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, and the AHIMA Standards of Ethical Coding. This site is not affiliated with or endorsed by AHIMA. Code sets and their official guidelines are revised every year, so no question here keys a specific code value — always assign codes from the current code books, encoder and official guidelines in effect for the date of service, never from a practice test. Confirm current eligibility and exam requirements with AHIMA before you test. About the CCA credential →