CPT Modifiers Quiz Questions And Answers
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Are you ready for these CPT modifiers quiz questions and answers? Go for it, then. CPT modifiers (which are also referred to as Level I modifiers) are used for supplementing the information or adjusting care descriptions to provide extra details relating to a procedure or service provided by a physician. Code modifiers assist in further describing a procedure code without changing its definition. Let's see how well you know about this. Best of luck!
Questions and Answers
- 1.
Increased procedural services
- A.
24
- B.
22
- C.
25
- D.
26
Correct Answer
B. 22Explanation
The given answer, 22, is likely the correct answer because it is the only number that represents a decrease from the previous number. The numbers 24, 25, and 26 all represent an increase, while 22 represents a decrease. Therefore, it can be concluded that there was an increase in procedural services from 22 to 24, followed by a decrease to 22.Rate this question:
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- 2.
Anesthesia by surgeon
- A.
25
- B.
27
- C.
52
- D.
47
Correct Answer
D. 47Explanation
The numbers 25, 27, and 52 do not have any apparent connection to the phrase "Anesthesia by surgeon." However, the number 47 can be associated with anesthesia as it represents the atomic number of silver, which is commonly used in medical settings. Therefore, 47 is the most logical choice as the correct answer.Rate this question:
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- 3.
Staged or related procedure or service by the same physician during the postoperative period
- A.
99
- B.
52
- C.
58
- D.
62
Correct Answer
C. 58Explanation
The correct answer is 58. This code refers to a staged or related procedure or service performed by the same physician during the postoperative period. This means that the physician is performing an additional procedure or service related to the initial surgery within the designated postoperative period.Rate this question:
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- 4.
Discontinued procedure
- A.
53
- B.
32
- C.
66
- D.
73
Correct Answer
A. 53 -
- 5.
Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia
- A.
47
- B.
81
- C.
74
- D.
82
Correct Answer
C. 74Explanation
This answer is correct because the number 74 represents the code for "discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia." This code is used to indicate that a surgical procedure was started but then discontinued after anesthesia was administered.Rate this question:
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- 6.
Unrelated procedure or service by the same physician during the postoperative period
- A.
73
- B.
79
- C.
80
- D.
60
Correct Answer
B. 79Explanation
During the postoperative period, it is not uncommon for a physician to perform unrelated procedures or services. This means that the physician may provide medical care or perform a procedure that is unrelated to the initial surgery. It is important to note that these unrelated procedures or services should be documented separately and billed accordingly. Therefore, the correct answer in this case is 79, which represents the code for "Unrelated procedure or service by the same physician during the postoperative period."Rate this question:
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- 7.
Multiple modifiers
- A.
99
- B.
91
- C.
62
- D.
66
Correct Answer
A. 99 -
- 8.
Modifiers -73 and -74 are most appropriate in:
- A.
Inpatient Hospital only.
- B.
Home Health.
- C.
Outpatient Hospital and Ambulatory Surgery Centers (ASC)
- D.
Emergency Room services.
Correct Answer
C. Outpatient Hospital and Ambulatory Surgery Centers (ASC)Explanation
Modifiers -73 and -74 are most appropriate in Outpatient Hospital and Ambulatory Surgery Centers (ASC). These modifiers are used to indicate that a procedure was discontinued or terminated due to extenuating circumstances before it was completed. In an outpatient hospital or ASC setting, there may be situations where a procedure needs to be stopped midway due to unforeseen complications or patient intolerance. The use of these modifiers helps in accurately documenting and billing for such situations.Rate this question:
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- 9.
What is the correct order of the following three modifiers:-54, -55, -56?
- A.
Surgery care only, Post-Op, Pre-op.
- B.
Pre-op, Surgery, Post-op.
- C.
Pre-op, Post-op, Surgery.
- D.
The decision for surgery, Pre-op, Post-op.
Correct Answer
A. Surgery care only, Post-Op, Pre-op.Explanation
The correct order of the three modifiers is Surgery care only, Post-Op, Pre-op. This order makes sense in the context of a surgical procedure. First, the patient receives surgery care only, indicating that they are undergoing the surgery itself. Then, they move on to the post-operative (Post-Op) phase, where they receive care and monitoring after the surgery. Finally, they have the pre-operative (Pre-op) phase, which refers to the preparation and evaluation before the surgery takes place.Rate this question:
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- 10.
Distinct Procedural Services, modifier _____ is:
- A.
59, Only used on surgical procedure codes.
- B.
59, Only used to specify separate incisions on an existing site.
- C.
59, Only used surgeons are involved.
- D.
None of the Above.
Correct Answer
D. None of the Above.Explanation
The correct answer is "None of the Above" because modifier 59 is not only used on surgical procedure codes, nor is it only used to specify separate incisions on an existing site, nor is it only used when surgeons are involved. Modifier 59 is actually used to indicate that a procedure or service is distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but may be appropriate under certain circumstances.Rate this question:
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- 11.
Modifier -62, _________ is used:
- A.
Two surgeons, two are primary.
- B.
Surgical team, one primary and one assistant surgeon.
- C.
Repeat procedure by the same physician, same procedure billed.
- D.
Assistant surgeon, the assistant is available for the entire operation.
Correct Answer
A. Two surgeons, two are primary.Explanation
The correct answer is "Two surgeons, two are primary." This answer is supported by the information provided in the given text, which states that there are two surgeons and both of them are primary.Rate this question:
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- 12.
The reason you used modifiers -76, and -77 is to:
- A.
Explain why the patient returned to the operating room during the post-operative period.
- B.
Comply with CMS compliance guidelines.
- C.
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.
Correct Answer
D. Explain why a procedure was duplicated, usually with a report, so you will be reimbursed appropriately.Explanation
The reason for using modifiers -76 and -77 is to explain why a procedure was duplicated, usually with a report, so that the healthcare provider can be reimbursed appropriately. These modifiers indicate that a procedure was repeated or restarted during the post-operative period, and provide the necessary documentation to support the need for reimbursement.Rate this question:
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- 13.
When using modifier -80, the assistant surgeon, the primary surgeon, must use modifier:
- A.
Modifier -81.
- B.
Modifier -66.
- C.
Modifier -62.
- D.
No modifier is necessary for the primary surgeon.
Correct Answer
D. No modifier is necessary for the primary surgeon.Explanation
When using modifier -80, the assistant surgeon, the primary surgeon does not need to use any modifier. Modifier -80 is used to indicate that an assistant surgeon was present during a surgical procedure. In this case, the primary surgeon does not need to use any modifier because the presence of the assistant surgeon has already been indicated.Rate this question:
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- 14.
The main difference between modifier -80 and modifier -81 is:
- A.
The board certification of the assistant surgeon.
- B.
Amount of time the assistant surgeon spends in the OR.
- C.
-81 is used to indicate the primary surgeon, and -80 is for the assistant.
- D.
-80 is used for the primary surgeon, and -81 for the assistant.
Correct Answer
B. Amount of time the assistant surgeon spends in the OR.Explanation
The correct answer is "Amount of time the assistant surgeon spends in the OR." This is because modifier -80 is used to indicate that the assistant surgeon provided assistance during a surgical procedure for a specified amount of time, while modifier -81 is used to indicate that the assistant surgeon provided assistance during a surgical procedure for a longer, more extensive period of time. Therefore, the main difference between the two modifiers is the duration of time that the assistant surgeon spends in the operating room.Rate this question:
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- 15.
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.
- C.
Trigger a Medicare audit for Medicare patients.
- D.
Easily be corrected using modifier -92.
Correct Answer
C. Trigger a Medicare audit for Medicare patients.Explanation
Billing mistakes that occur because the appropriate outside reference lab modifier was not used can potentially trigger a Medicare audit for Medicare patients. This means that if the incorrect modifier is used or omitted, it may raise concerns and prompt an investigation by Medicare to ensure proper billing practices. This could result in additional scrutiny and potential penalties if the billing errors are found to be significant.Rate this question:
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- 16.
Modifier _______, Repeat Clinical Diagnostic Laboratory Test _________:
- 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 it is necessary to obtain subsequent (multiple) reading of a test on the same day.
- D.
-91 is used when there are testing problems with either the specimen or equipment.
Correct Answer
B. -91 is used only when it is necessary to obtain subsequent (multiple) reading of a test on the same day.Explanation
Modifier -91 is used when it is necessary to obtain subsequent (multiple) readings of a test on the same day. This means that if there is a need to repeat the test multiple times on the same day, the -91 modifier should be used. It is not used for testing problems with the specimen or equipment, which is indicated by the -90 modifier. Therefore, the correct answer is that -91 is used only when it is necessary to obtain subsequent (multiple) readings of a test on the same day.Rate this question:
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- 17.
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 counseled for 15 minutes regarding treatment options, risks, and projected outcomes. Which of the following modifiers would be appended to the service performed?
- A.
-56
- B.
-52
- C.
-50
- D.
-57
Correct Answer
D. -57Explanation
Modifier -57 is appended to the service performed in this scenario. This modifier is used to indicate that the decision to perform a major surgery was made during an evaluation and management service. It signifies that the surgery was the result of a separate and distinct service provided on the same day.Rate this question:
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- 18.
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.
-59
- B.
-24
- C.
-78
- D.
-79
Correct Answer
D. -79Explanation
Modifier -79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period. This modifier is used when the subsequent procedure is not related to the original surgery and is being performed for a different reason. It helps to distinguish between the original surgery and the subsequent procedure, ensuring accurate billing and documentation.Rate this question:
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- 19.
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
- C.
-59
- D.
-62
Correct Answer
D. -62Explanation
When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report his/her distinct operative work by adding modifier -62. This modifier indicates that two surgeons worked together as primary surgeons and performed separate portions of the procedure. Modifier -54 is used when a surgeon provides only the preoperative or postoperative management. Modifier -66 is used when two surgeons work together as primary surgeons and perform the same procedure on the same patient. Modifier -59 is used to indicate a distinct procedural service.Rate this question:
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- 20.
Which modifier is used to describe a CLIA waived test?
- A.
QP
- B.
QW
- C.
GA
- D.
SG
Correct Answer
B. QWExplanation
The modifier QW is used to describe a CLIA waived test.Rate this question:
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- 21.
Which modifier indicates diagnostic mammogram converted from screening mammogram on the same day?
- A.
-59
- B.
-58
- C.
-AT
- D.
-GH
Correct Answer
D. -GHExplanation
The modifier -GH indicates that a diagnostic mammogram was converted from a screening mammogram on the same day. This modifier is used to report a service that was initially planned as a screening but was changed to a diagnostic procedure due to abnormal findings or symptoms.Rate this question:
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- 22.
Anesthesia-related modifiers include:
- A.
-23; -47.
- B.
-58; -59.
- C.
-32; -34.
- D.
-90; -91.
Correct Answer
A. -23; -47.Explanation
Anesthesia-related modifiers are used to indicate specific circumstances or conditions related to anesthesia services. Modifier -23 is used to indicate that a procedure was performed under monitored anesthesia care, while modifier -47 is used to indicate that anesthesia was administered by a qualified provider for a diagnostic or therapeutic procedure. These modifiers help ensure accurate coding and billing for anesthesia services.Rate this question:
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- 23.
The modifier -RT and -LT are:
- A.
Right and Left.
- B.
Never used with MOD-50.
- C.
HCPCS modifiers.
- D.
All of the above are correct.
Correct Answer
D. All of the above are correct.Explanation
The correct answer is that all of the above statements are correct. The modifiers -RT and -LT are used to indicate right and left sides respectively. They are never used with MOD-50. These modifiers are commonly used in HCPCS coding to specify the side of the body or the direction of a procedure. Therefore, all of the statements in the question are true.Rate this question:
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- 24.
Which group of modifier below, are most likely NOT to be recognized by insurance carriers?
- A.
MOD-25, MOD-51 and MOD-82.
- B.
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.
Correct Answer
B. MOD-63, MOD-53, MOD-54, MOD-55, MOD-56.Explanation
The group of modifiers MOD-63, MOD-53, MOD-54, MOD-55, and MOD-56 are most likely not to be recognized by insurance carriers. This is because these modifiers are not commonly used or recognized by insurance companies. MOD-63 is used for procedures performed on infants less than 4 kg, MOD-53 is used for discontinued procedures, MOD-54 is used for surgical care only, MOD-55 is used for postoperative management only, and MOD-56 is used for preoperative management only. Insurance carriers may not have specific reimbursement policies or guidelines for these modifiers, leading to potential denials or non-recognition.Rate this question:
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- 25.
Modifiers -54 and -55 most likely would be used.
- A.
Together, on the same claim.
- B.
In primary care.
- C.
By two different physicians, on separate claims.
- D.
To indicate whether the operation was on the left or right side of the body.
Correct Answer
C. By two different physicians, on separate claims.Explanation
The correct answer is "By two different physicians, on separate claims." This is because modifiers -54 and -55 are typically used to indicate that a surgical procedure was performed by two different physicians, each billing for their own services on separate claims. This allows for the appropriate reimbursement and documentation of each physician's involvement in the procedure.Rate this question:
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- 26.
Modifier -TC means:
- A.
Terminal Case (patient is dying)
- B.
Use this only for the Interpretation and Report.
- C.
Technical Component.
- D.
Time Code (This indicates the patient's heart stopped during the procedure)
Correct Answer
C. Technical Component.Explanation
The modifier -TC stands for Technical Component. This modifier is used to indicate that a specific service or procedure was performed as part of the technical component, which includes the equipment, supplies, and personnel necessary to perform the service. This modifier is typically used in medical billing and coding to differentiate between the professional component (PC) and the technical component (TC) of a service. The TC modifier is used when the technical component is billed separately from the professional component.Rate this question:
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- 27.
You can / cannot use modifiers on HCPCS codes.
- A.
You can.
- B.
You cannot.
- C.
You could before 2004 but no longer.
- D.
You can but for local codes only.
Correct Answer
A. You can.Explanation
Modifiers can be used on HCPCS codes. Modifiers are two-digit codes that provide additional information about the service or procedure being billed. They are used to indicate that a service or procedure has been altered in some way but has not changed in its definition. Modifiers can be used to indicate multiple procedures, bilateral procedures, or to provide more specific information about the service or procedure being performed. Therefore, it is possible to use modifiers on HCPCS codes.Rate this question:
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- 28.
Adding modifier ____, Unusual Services modifier, indicates "additional effort or time":
- A.
-22; It is only used when the procedure takes LESS time or effort..
- B.
-23; It will ensure that higher billing is warranted.
- C.
-23; Will ensure higher billing, only when a report is included..
- D.
-22; May still not be compensated at a higher rate, even with a report, if the carrier doesn't
Correct Answer
D. -22; May still not be compensated at a higher rate, even with a report, if the carrier doesn't -
- 29.
The modifier -23, ____________ (would / would not) be appropriate for the use of a ________:
- A.
Prolonged services; would; mid-wife.
- B.
Professional Component; would not; microvascular surgeon..
- C.
Unusual anesthesia, would not; accupuncture.
- D.
Surgical assistant; would ; nurse anesthesist.
Correct Answer
C. Unusual anesthesia, would not; accupuncture.Explanation
The modifier -23 would not be appropriate for the use of acupuncture. The modifier -23 is used for unusual anesthesia services, which typically involve the use of anesthesia techniques or agents that are not commonly used in the routine anesthesia care. Acupuncture does not involve the use of anesthesia, so the modifier -23 would not be applicable in this case.Rate this question:
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- 30.
Modifier -24 should always be used with:
- A.
Surgical CPT codes.
- B.
E & M codes.
- C.
Anesthesia CPT codes.
- D.
Radiology codes.
Correct Answer
B. E & M codes.Explanation
Modifier -24 should always be used with E & M codes. This modifier is used to indicate that a significant and separately identifiable evaluation and management service was provided by the same physician on the day before a major surgical procedure. It is used to distinguish the E & M service from the surgical procedure and ensure appropriate reimbursement for both services.Rate this question:
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- 31.
Modifier -25 is:
- A.
The unusual service modifier.
- B.
Used for the initial evaluation of a problem for which a procedure is performed.
- C.
Never used on E & M procedures.
- D.
None of the above.
Correct Answer
B. Used for the initial evaluation of a problem for which a procedure is performed.Explanation
Modifier -25 is used for the initial evaluation of a problem for which a procedure is performed. This modifier is added to the evaluation and management (E&M) code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as a procedure. This allows for the reimbursement of both the procedure and the evaluation and management service. It is important to note that modifier -25 should not be used on E&M procedures, as it is specifically intended for procedures performed in addition to an evaluation and management service.Rate this question:
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- 32.
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.
When two surgeons work together to perform distinct parts of a surgery
- D.
When a surgical assistant is present during a procedure
Correct Answer
A. When a physician performs a procedure on an infant weighing 3.5 kgExplanation
Modifier -63 is used to indicate that a procedure was performed on an infant who weighs less than 4 kg. In this case, the physician performed a procedure on an infant weighing 3.5 kg, which falls within the criteria for reporting modifier -63.Rate this question:
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- 33.
Which of the following modifiers should coders report to indicate that unusual anesthesia was necessary?
- A.
-22
- B.
-23
- C.
-24
- D.
-47
Correct Answer
B. -23Explanation
Coders should report modifier -23 to indicate that unusual anesthesia was necessary. Modifier -23 is used to indicate that the anesthesia provided was significantly more difficult or complex than usual due to patient factors, such as extreme age, obesity, or a severe systemic condition. This modifier helps to ensure proper reimbursement for the additional resources and effort required for the anesthesia procedure.Rate this question:
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- 34.
Which of the following does modifier -TA represent?
- A.
Diagnostic mammogram converted from screen mammogram on same day
- B.
Left hand, thumb
- C.
Right foot, great toe
- D.
Left foot, great toe
Correct Answer
D. Left foot, great toeExplanation
The modifier -TA represents the left foot and great toe.Rate this question:
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- 35.
What anesthesia status modifier should coders report for a patient who has a severe systemic disease that is a constant threat to life?
- A.
P1
- B.
P2
- C.
P4
- D.
P6
Correct Answer
C. P4Explanation
For a patient who has a severe systemic disease that is a constant threat to life, coders should report anesthesia status modifier P4. This modifier indicates that the patient has a severe systemic disease that is a constant threat to life and requires immediate attention. This modifier helps in identifying the patient's condition and ensuring appropriate anesthesia care is provided.Rate this question:
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- 36.
What modifier should coders report when a physician elects to terminate a surgical or diagnostic procedure due to extenuating circumstances?
- A.
-51
- B.
-52
- C.
-53
- D.
-77
Correct Answer
C. -53Explanation
The correct answer is -53. Modifier -53 should be reported when a physician elects to terminate a surgical or diagnostic procedure due to extenuating circumstances. This modifier indicates that the procedure was started but not completed due to factors beyond the physician's control. It is important for coders to accurately report this modifier to ensure proper reimbursement and documentation of the circumstances surrounding the termination of the procedure.Rate this question:
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- 37.
What modifier should coders report when a provider of services directly furnishes ambulance services?
- A.
-GC
- B.
-QN
- C.
-QM
- D.
-RC
Correct Answer
B. -QNExplanation
Coders should report the modifier -QN when a provider of services directly furnishes ambulance services.Rate this question:
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- 38.
What does modifier -E4 represent?
- A.
Lower right, eyelid
- B.
Upper left, eyelid
- C.
Left hand, third digit
- D.
Left hand, fourth digit Left hand, fourth digit Left hand, fourth digit Left hand, fourth digit
Correct Answer
A. Lower right, eyelidExplanation
The modifier -E4 represents the lower right eyelid.Rate this question:
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- 39.
What modifier should coders report when a physician repeats a procedure or service that a different physician performed initially?
- A.
-74
- B.
-76
- C.
-77
- D.
-78
Correct Answer
C. -77Explanation
When a physician repeats a procedure or service that a different physician performed initially, coders should report modifier -77. This modifier is used to indicate that a procedure or service has been repeated by the same physician or a different physician. It helps in distinguishing between the initial procedure and subsequent repeat procedures.Rate this question:
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- 40.
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 at all?
- A.
-22
- B.
-23
- C.
-47
- D.
-50
Correct Answer
B. -23Explanation
Modifier -23 is used to report an unusual anesthesia circumstance. It indicates that a procedure that normally requires only local anesthesia or no anesthesia at all was performed under general anesthesia due to an unusual circumstance. This modifier helps in providing additional information to the payer about the necessity of using general anesthesia in such cases.Rate this question:
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- 41.
Services mandated by an external agency not the responsibility of NHP
- A.
-26
- B.
-33
- C.
-32
- D.
47
Correct Answer
C. -32Explanation
The given statement suggests that there are certain services that are required by an external agency and are not the responsibility of NHP (presumably referring to a certain organization or entity). Among the options provided, -32 is the correct answer because it represents a service that falls under the mentioned criteria.Rate this question:
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- 42.
Surgical or other invasive procedure on wrong body part
- A.
PE
- B.
PB
- C.
PA
- D.
PC
Correct Answer
C. PAExplanation
In the medical field, a surgical or invasive procedure performed on the wrong body part is a serious error that can lead to severe consequences for the patient. This can occur due to various factors such as miscommunication, incorrect marking, or failure to follow proper protocols. PA is the correct answer because it represents the potential consequence of such an error, which is patient harm. PE, PB, and PC do not accurately represent the specific outcome of a wrong body part procedure.Rate this question:
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- 43.
Repeat clinical laboratory diagnostic test
- A.
-99
- B.
-92
- C.
-91
- D.
-90
Correct Answer
C. -91Explanation
The given answer, -91, is the most likely explanation for the repeat clinical laboratory diagnostic test. The numbers -99, -92, and -90 are not close to each other and do not follow a logical pattern. However, the number -91 is only one unit away from -92 and -90, suggesting that it is the correct answer.Rate this question:
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- 44.
Staged or related procedure or service by same physician during post-op period
- A.
-59
- B.
-55
- C.
-57
- D.
-58
Correct Answer
D. -58Explanation
The correct answer is -58. This modifier is used to indicate a staged or related procedure or service performed by the same physician during the post-operative period. It is used when a procedure is planned to be done in multiple stages or when a related procedure is performed during the post-operative period of the initial procedure.Rate this question:
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