AAPC Certified Professional Coder (CPC) — All Questions

A radiologist reads films taken at a hospital and dictates the report, but does not own the equipment. Which modifier reports only the physician's work?

• a.Modifier -26 (professional component)✓
• b.Modifier -TC (technical component)
• c.No modifier — the global service is reported
• d.Modifier -76 (repeat procedure)

Many radiology codes split into a professional component (the physician's supervision, interpretation, and written report — modifier -26) and a technical component (equipment, supplies, technologist — modifier -TC). When the physician only interprets, append -26; the facility bills -TC. Reporting the code with no modifier claims the global (both components), which would be incorrect here.

A CPT code describes a 'complete' ultrasound of the abdomen. What must the documentation support to use the complete study code rather than a limited study?

• a.Imaging of a single organ of interest
• b.Evaluation and documentation of all required elements for that complete exam (for the complete abdomen: liver, gallbladder, common bile duct, pancreas, spleen, kidneys, and the upper abdominal aorta and inferior vena cava)✓
• c.Only the kidneys, because they are the largest structures imaged
• d.Only the clinical indication for the study

'Complete' ultrasound codes require that every anatomic element listed in the CPT guidelines be examined and documented. If the study images fewer than all required structures, or targets a single organ/quadrant, it is a 'limited' study. Coding a complete exam without the full documented survey is an overcode.

In CPT radiology, when a code specifies 'with contrast,' contrast material must be administered by which route(s)?

• a.Orally or rectally only
• b.Intravascularly, intra-articularly, or intrathecally (oral or rectal contrast alone does NOT satisfy 'with contrast')✓
• c.Any route, including oral, so long as any contrast is used
• d.Topically on the skin surface

CPT defines 'with contrast' as contrast given intravascularly, intra-articularly, or intrathecally. Contrast given only by mouth or rectum is coded as 'without contrast.' A study that starts without contrast and then adds IV contrast is coded 'without contrast followed by with contrast.' Knowing the route prevents miscoding CT/MR studies.