AAPC CPB

What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits?

A deductible is the amount a policyholder pays for health care services before the health insurance begins to pay.

Which type of insurance covers physicians and other healthcare professionals for liability as to claims arising from patient treatment?

Medical malpractice insurance is a type of liability insurance that covers physicians and other healthcare professionals for liability as to claims arising from patient treatment.

Which of the following does NOT fall under group policy insurance?

I. The premium is paid for by the employee.

II. The premium is paid for (or partially paid for) by an employer.

III. The employer selects the plan(s) to offer to employees.

IV. Physical exams and medical history questionnaires are a mandatory part of the application process.

V. Employee can make changes to the policy.

VI. The employee's spouse and children are not eligible for coverage.

I, IV, V, and VI, Group health insurance coverage is a type of health policy that is purchased by an employer and is offered to eligible employees of the company, and to eligible dependents of employees. With group health insurance, the employer selects the plan (or plans) to offer to employees. With an individual policy, you are the only one who can make changes to your policy and you are the only one who can cancel the coverage. You have full control over your own policy. Applicants for individual health insurance will need to complete a medical history questionnaire and have a physical exam when applying for coverage.

Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan. He received $25,000 from the health plan to provide services for the 175 enrollees on the health plan. The services provided by Dr. Wallace to the enrollees cost $23,000. Based on the information, what must be done?

Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan

What is the deadline for filing a Medicare claim?

One year from the date of service

A provider sees a patient who has TRICARE Select. The provider is not contracted with TRICARE but is certified by the regional TRICARE Managed Care Support Contractor (MCSC). The provider charges $200 for the office visit. TRICARE allows $160 and pays $140. How much can the provider bill the patient for?

. $60.00

What organization is responsible in evaluating the medical necessity, appropriateness, and efficiency of the use of healthcare services and procedures?

Utilization Review Organization

Medicaid providers are forbidden by law to:

Balance bill patients

Which statement is FALSE about Local Coverage Determinations (LCDs)?

CMS develops LCDs when there is no National Coverage Determination

When a minor procedure is performed on a Medicare patient, what is the global period and what time frame is covered?

10-day global period - the day of the procedure and 10 days following the procedure.

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Question 11

If add-on procedure code 11103 is performed twice during an office visit, how is it indicated on the CMS-1500 claim form?

Code 11103 is reported once with the number 2 in box 24G

Which set of documentation guidelines can be used for E/M services submitted to Medicare for a physician assistant (PA)?

Either 1995 or 1997 CMS documentation guidelines

Select the scenario that meets the incident-to requirements

Care is delivered to an established patient by the physician assistant as part of the physician's treatment plan while the physician is seeing another patient in the same office suite in a different room.

Medicare beneficiary is having a screening colonoscopy performed. How is the service reported to Medicare?

G0121

Which providers submit the CMS-1500 claim form?

I. Independent diagnostic testing facilities (IDTFs)

II. Emergency department physicians

III. Hospice organizations

IV. Ambulance companies submitting under their own Medicare number

V. Physicians in a group practice

VI. Ambulatory surgery centers

I, II, IV, V and VI

According to CPT® Radiology Guidelines, if a patient is given oral contrast for a CT scan of the abdomen which code is reported?

74150 Computed tomography, abdomen; without contrast material

Which of the following is NOT in the HIPAA Privacy Rule?

Implementing hardware, software, and/or procedural mechanisms to record and examine access and other activity in information systems that contains or use electronic PHI (e-PHI).

When a physician intentionally bills procedures to Medicaid that he did not perform he is in violation of which Act?

False Claims Act

Cardiologist Dr. W has been consistently reporting a higher E/M level than what is documented to cover the revenue being lost in his practice. Is this considered fraud or abuse and why?

Fraud; the provider intentionally over-coded to gain financially

What is a Qui tam relator?

A person who brings civil action for violation under the False Claims Act (FCA) for themselves and the US government

Dr. Wilson assigns all established Medicare patients E/M level 99215 regardless of the work performed during the visit. He considers all Medicare patients to be complicated patients and therefore, he should be paid at the highest rate possible. Is Dr. Wilson's actions considered fraud or abuse?

Fraud; he is knowingly billing patients incorrectly to obtain higher payment

Dr. Jay is a gynecologist and has been reporting two codes for a total abdominal hysterectomy with removal of the ovaries and fallopian tubes (salpingo-oophorectomy), codes 58150 and 58720.

58150

JR had surgery on January 15, 20XX by Dr. Waters (a Medicare participating provider). The Medicare fee schedule for the surgery is $500. Four months later, JR and Dr. Waters each received a check from Medicare in the amount of $400. JR signed over his $400 to Dr. Waters. JR had previously paid the doctor $100 for the co-insurance. In total Dr. Waters has received $900 for the surgery provided on January 15, an overpayment of $400. What should Dr. Waters do?

Contact the MAC of the overpayment and provide a refund.

Which one is NOT a Nonphysician Practitioner (aka mid-level provider)?

Resident

Which Federal Law requires written acknowledgement of consumer billing disputes and investigation of billing errors by creditors?

Fair Credit Billing Act

Mr. Doyle had seen a non-participating provider for a hernia repair in outpatient surgery. His insurance company Telehealth provided a reimbursement check of $400 for the anesthesia services provided to him for the surgery. Mr. Doyle cashed the check and kept the money. Mr. Doyle receives the bill from the anesthesiologist, but he no longer has the money to pay it. The account becomes delinquent and is outsourced to a collection agency. The collection agency is unable to obtain any monies from Mr. Doyle. What is this is considered?

Bad debt

Relative Value Units (RVUs) are payment components consisting of:

Physician work; Practice Expense; Professional liability/malpractice insurance

Which of the following falls under the Prompt Payment Act?

Clean claims must be paid or denied within 30 days from the date of receipt by MACs

25 year-old is 32 weeks pregnant. She was admitted to the labor and delivery unit because she was having severe pre-eclampsia and needed to have an emergency cesarean section. Reduced payment was sent to the obstetrician by the payer with a remittance advice stating that preauthorization for the cesarean section was not obtained. What does the biller do?

Appeal the claim, explaining the reason for the emergency cesarean section

When a provider chooses not to participate in the Medicare program and does not accept assignment on claims, the maximum amount the provider can charge is _______ percent of the approved fee schedule amount for non-participating providers.

115

Mr. Allen is scheduled for an appointment with his physician for follow-up of his rheumatoid arthritis and hypertension. The physician is called away for a personal emergency just after Mr. Allen arrives for his appointment and the patient is seen by the physician assistant, who orders labs and refills the patient's prescriptions. Mr. Allen is scheduled to return in one month. How should this patient's visit should be billed?

Under the PA as the incident-to guidelines have not been met.

Jill presents to Dr. Calvert for collagen injections to her upper lip for cosmetic reasons. She is informed by the office staff that cosmetic surgery may not be a benefit of her insurance plan in which case she would be responsible for the charges. Jill requests the claim to be submitted to her insurance. The claim is submitted to her insurance for payment. Dr. Calvert's office receives a remittance advice stating that the injections are considered cosmetic and are not a covered service. What is the appropriate next step for resolution?

Move charges to patient responsibility and send the patient a statement.

The financial policy for Midtown Physicians Group states that when all means for collecting payments have been exhausted and payment has not been received within 120 days, the account is turned over to a collection agency. When generating an accounts receivable aging report, you see an outstanding claim for Mrs. Smith that has not received payment for 150 days. Mrs. Smith's account is considered to be:

delinquent

Which of the following is considered by CMS to be a source document when a provider and billing service file claims electronically?

I. Patient's registration form

II. Routing Slip

III. Superbill

IV. Encounter form

V. Charge slip

VI. Patient's insurance card

II-V

A hospital chargemaster does not include __________

Diagnosis codes (ICD-10-CM)

Mary is tasked to perform an audit on Dr. Pain's practice to verify charges are documented as reported. What are the key elements Mary needs for the audit process on 25 records to support what Dr. Pain is charging?

Medical record, encounter form, CMS-1500 claim form

Mr. Peabody is an established patient who was told by Dr. Woods to come back for an injection in his right knee if he was still getting pain due to arthritis. Mr. Peabody is in for just the injection. The physician only examines the knee (problem focused exam) before he gives the injection. Dr. Woods explains the risks associated with the procedure and the patient gives consent. The doctor prepped the knee with betadine and injects the right knee with 10 mg of Depo-Medrol. How is this visit reported?

20610, J1020

Patient presents to her physician 10 weeks following a true posterior wall myocardial infarction. The patient is still exhibiting symptoms of chronic ischemic heart disease. The physician reviews the current medications to confirm the patient is compliant and discusses a heart-healthy diet and exercise. What is the correct ICD-10-CM code for this condition?

I25.9

10-year-old girl is scheduled for her yearly physical exam with her pediatrician .At the time of her visit, the patient complains of watery eyes, scratchy throat, and stuffy nose for the past two days. The physician first performs a complete physical. Then he also evaluates and treats the patient for a URI supported with separate documentation of an expanded problem focused exam and low medical decision making. What CPT® code(s) is/are reported for this visit?

99393, 99213-25

The patient is admitted for radiation therapy for metastatic bone cancer, unknown primary. What ICD-10-CM codes should be reported?

Z51.0, C79.51, C80.1

60-year-old woman is seeking help to quit smoking. She makes an appointment to see Dr. Lung for an initial visit. The patient has a constant cough due to smoking and some shortness of breath. No night sweats, weight loss, night fever, CP, headache, or dizziness. She has tried patches and nicotine gum, which has not helped. Patient has been smoking for 40 years and smokes 2 packs per day. She has a family history of emphysema. A limited three system exam was performed. Dr. Lung discussed in detail the pros and cons of medications used to quit smoking. Counseling and education was done face to face for 20 minutes on smoking cessation of the 30 minute visit. Prescriptions for Chantix and Tetracycline were given. The patient to follow up in 1 month. A chest X-ray and cardiac work up was ordered. Select the appropriate CPT® code(s) for this visit:

99407

A 14-year-old male patient fell while skateboarding. He went to the emergency department at the local hospital. The diagnosis was a fracture of the upper right arm. The ICD-10-CM codes reported were S42.301A, V00.131A, and Y93.51.Is this correct?

Yes; the ICD-10-CM codes reported are correct

Obstetrician A recommends a new type of cancer treatment for patient who has ovarian cancer. Before the patient's private insurance company approves the treatment, the insurer mandates Obstetrician B (in a different practice) to conduct a physical examination of the patient. What modifier should obstetrician B append to the E/M consultation code?

Modifier 32

Which managed care plan has the patient receiving care from participating providers (network provider) and the providers are only paid for services provided?

EPO is a managed care plan in which enrollees must receive their care from doctors and hospitals within the EPO network, but cannot go outside of the network for care. If an enrollee goes to a provider or hospital outside of the network the enrollee will have to pay the medical bills out of pocket. A network provider for EPO plans is reimbursed on fee-for-service basis.

Which TRICARE plan is similar to an HMO plan?

TRICARE Prime is one of the three healthcare options that is similar to an HMO plan as the patient is assigned a PCP and the treatment goes through the PCP.

Which of the services are covered by Medicare Part A?

I. Skilled Nursing Facility Care

II. Ambulatory Surgery

III. Durable Medical Equipment

IV. Hospice Care

V. Home Health Services

VI. Long Term Care

VII. Outpatient prescription drugs

I, IV, V.. Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services.

Which is a TRUE statement regarding Workers' Compensation?

There is no co-payment for workers' compensation cases. A worker (employee) cannot be given a bill for co-pay or anything else because it is the insurance policy of the employer, and not the workers' personal policy, that pays the bill. The filing deadline for a first report of injury form is determined by state law. All providers must accept the compensation payment as payment in full. There is no deductible in workers' compensation.

Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the charge for the office visit. As a courtesy, the physician's staff submits a claim to Bob's insurance company. If the service is covered by the insurance company, Bob can expect to be reimbursed for the office visit. This is which type of insurance model?

Fee-for-service (traditional coverage) Blue Cross/Blue Shield fee-for-service (traditional coverage) plan is selected by individuals who do not have the access to a group plan, and for small business employers. The plan has two types of coverage, basic coverage and major medical benefits.

Which of the following benefits are NOT covered by all Medigap policies?

I. Part A co-insurance and hospital costs

II. Skilled nursing facility care co-insurance

III. Parts A & B deductible

IV. Part B excess charges

V. Foreign travel exchange

II, III, IV, V Medigap is required to cover Part A coinsurance and hospital costs. The remaining items are only covered by some of the Medigap policies.

____________ is incorporated by CMS into the NCCI program to limit the number of times a service or procedure can be reported by a physician on the same date of service to a patient.

Medically Unlikely Edits (MUE)Medically unlikely edits (MUE), which are units of service edits, was implemented by CMS into the NCCI program to limit the number of times a service or procedure can be reported by a physician on the same date of service to an individual patient. CMS developed the MUE program to reduce the error rate for Part B coding and to control improper payments.

In the CPT® codebook, which of the following codes may be used for reporting synchronous telemedicine services when appended by modifier 95?

99253has the star symbol next to it. The star symbol identifies codes that can be used for reporting synchronous telemedicine services when appended by modifier 95 (see Appendix P).

Which service is NOT included in the global package for surgical procedures?

Treatment for postoperative complication that requires a return trip to the OR is not included in the global package. An example of this is when someone has a postoperative complication of an infected seroma a couple days after surgery and needs to return to the OR for incision and drainage of the seroma. Modifier 78 is appended to the surgical procedure code to indicate this

A biller notices there is a large amount of Medigap claims where Medicare has paid the claim but Medicaid has not processed or paid the claim. After research, the biller discovers the IDs for the Medigap coverage is not formatted correctly on the CMS 1500 claim form. Which of the following format is correct for the Medigap insurer ID in Item 9a?

When a patient has Medigap in addition to Medicare, item 9a is completed with the Medigap insurer's policy and/or group number preceded by MEDIGAP, MG, or MGAP.

When item 18 on a CMS-1500 claim form has dates of service for inpatient care, what is entered in item 32?

Name and address of the facility that provided the service

According to CPT® subsection guidelines for Excision-Malignant Lesions, when there is a removal of a 3 cm malignant lesion on the arm and the defect area is repaired with an intermediate layer closure, how is it reported?

11603, 12032-51

On the UB-04 claim form the type of bill (TOB) is reported with four digits. Which digit classifies the type of care provided?

Digit 3 in TOB classifies the type of care provided (example, Inpatient [Medicare Part A], Outpatient). Digit 1 (the leading zero) is ignored by CMS. Digit 2 identifies the type of facility (example, Hospital, Skilled Nursing). Digit 4 is the sequence of this bill for this particular episode of care (example, Late Charge only, Interim-first claim).

The CPT® or HCPCS Level II code reported on a UB-04 is translated to what type of code by Medicare to reimburse for outpatient facility services?

In the case of Medicare reimbursement for outpatient services, CPT® or HCPCS Level II codes assigned to charges will be translated into APC groups. Each APC will generate a predetermined payment amount, which is multiplied by the number of units of the charge.

Which of the following are common identifiers for protected health information (PHI) which can be used to identify an individual?

I. Birth Date

II. Past mental health condition

III. Driving records

IV. Mailing Address

V. Medical record number

I, II, IV, V

Which of the following service type providers is required to accept assignment on Medicare claims?

I. Clinical diagnostic laboratory services

II. Specialized radiology services

III. Services provided to Medicare/Medicaid patients

IV. Simplified billing roster for influenza virus vaccine and pneumococcal vaccine

V. Physical therapy services

I, III, and IV

Medicare requires the following types of providers to accept assignment on Medicare claims: clinical diagnostic laboratory services, physician services to individuals dually entitled to Medicare and Medicaid, participating physician/supplier services, services of physician assistants, nurse practitioners, clinical nurse specialist, nurse midwives, certified registered nurse anesthetists, clinical psychologists, and clinical social workers, ambulatory surgical center services for covered ASC procedures, home dialysis supplies and equipment paid under Method II, ambulance services, drugs and biologicals, simplified billing roster for influenza virus vaccine and pneumococcal vaccine.

A Medicare patient comes in for a consultation from the orthopedist. The patient was referred by her primary care provider due to right hip pain. The orthopedist documents a detailed history and an expanded problem focused exam. An X-Ray of the hip is ordered. The medical decision making was moderately complex. The orthopedist provides a report back to the primary care provider with recommendations for physical therapy and potential hip replacement. What codes are reported by the

99202, M25.551

Which of the following scenarios is the best example of fraud?

Submitting a claim for services prior to the physician performing the scheduled service.

A medical practice assesses a finance charge for patient balances past 90 days. This practice has failed to disclose to patients the percentage rate that will be charged on past due balances. This is a violation of which federal law?

Truth in Lending Act, The Truth in Lending Act requires lenders to follow standardized procedures and methods to make the cost and terms of credit known to their consumers. The False Claims Act protects the Government from being overcharged or sold substandard goods or services. The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a Federal health care program. The Criminal Health Care Fraud Statute prohibits knowingly and willfully executing, or attempting to execute, a scheme such as defrauding any health care benefit program.

A large group practice has implemented an electronic medical record system. They are setting up security groups and want to be sure access is correctly established to comply with HIPAA's minimum necessary requirements. Which of the following positions would generally not need to have access to the clinical notes of a patient's medical record?

Receptionist

payments may be denied by the payer because:

I. The service is not medically necessary.

II. The claim was coded incorrectly.

III. The conditions of the payment policy were not met.

IV. The patient's insurance was terminated following the service.

V. The provider is credentialed with multiple insurance plans.

VI. The incorrect place of service was submitted.

VII. The NPI for the provider is incorrect.

VIII. More than one modifier was appended to a procedure code.

. I, II, III, VI, VII, Multiple choice B is correct.

-The service is not medically necessary (I).

-The claim was coded incorrectly (II).

-The conditions of the payment policy were not met (III).

-The incorrect place of service was submitted (VI).

-The NPI for the provider is incorrect (VII).

Hospitals billing for inpatient services are based on which of the following reimbursement?

Medicare Severity-Diagnosis Related Groups (MS-DRG), The MS-DRGs enable CMS to provide reimbursement to hospitals billing for inpatient services based on severity of illness and the consumption of resources.

External cause codes report the circumstances surrounding an injury or illness. Which statement is TRUE regarding external cause codes?

Payer policy may dictate how external cause codes are reported.

External cause codes are reported for the length of the illness or injury. Payer policy may dictate how external cause codes are reported.

A "reasonable" charge in UCR is:

A fee which meets the criteria of usual and customary charges or (after appropriate peer review) is justified because of the special circumstances of a case

A 35-year-old female member of an HMO decides to go to an out-of-network specialty clinic for evaluation and surgery because she heard that this clinic provides superior services. The clinic submits claims totaling $15,000 for all services provided to this member. The insurance would typically have paid $10,000 for an in-network provider for the same services. This insurance would most likely pay as follows:

Pay nothing as this provider was out-of-network

At the end of each day, daily deposits should be balanced. Which of the following items should the daily deposits be balanced against?

I. Charges

II. Personal payment receipts

III. Mail receipts

IV. Co-pays due

II and III

A 48-year-old female awakens in the middle of the night with severe abdominal pain and excessive vomiting. She calls for an ambulance, which takes her to the closest hospital. She had a ruptured appendix and underwent an emergency appendectomy. Neither the hospital nor physician was in the payer network for her HMO. In this situation, the payer will most likely pay the following:

Both the hospital and physician claims for the emergency services

Ms. Sally's provider does not accept the Medicare approved amount as full payment. Instead Ms. Sally has to pay her provider the limiting charge. The provider files a claim to Medicare. Medicare sends payment to the patient. This is what type of claim?

Unassigned

For claims assigned a "pending status" by the payer, the provider should:

. Contact the insurance carrier to determine what additional information is needed and provide it to the insurance carrier.

Ms. Robinson is seen by Dr. Judy on 4/13/17. The claim is sent to Medicare for payment on 4/12/18. Which of the following statements is correct?

Medicare will pay the claim for the services provided based on the timely filing statute

Mr. Wilson was putting up a fence at his friend's house. In the process of nailing the fence to the posts, a nail was pushed through his thumb. His friend has homeowner's liability insurance and the patient has commercial coverage through his employer. Which of the following is correct?

File the homeowner's liability as the primary payer and the commercial carrier as the secondary carrier if the primary denies the claim.

What resources could a biller use to determine whether a procedure is bundled with another procedure according to Medicare?

I Star icon

II. CPT® section guidelines

III. Parenthetical instructions in the CPT® codebook

IV. NCCI edits

II, III, and IV

Which statement is TRUE regarding appeals?

An appeal should be written if a claim is denied by the payer in error.

A patient has a major surgery on her hip on January 3. Two weeks later, the same patient is seen by the provider for migraines. How would the office visit be reported?

Modifier 24 is appended to the office visit to indicate it is unrelated to the surgical procedure.

A Medicare patient has bilateral open treatment of iliac wing fracture patterns that do not disrupt the pelvic ring. How is this service reported?

G0412, Because the patient is a Medicare patient, Medicare requires the HCPCS Level II code be reported rather than the CPT® code when a code exists in both for the same service. According to the HCPCS Level II code, G0412, the code is only reported once whether it is unilateral or bilateral so modifier 50 is not appended.

A 12-month-old established patient is coming in to see the pediatrician for an annual physical exam. The physician decides to administer the Hib-HepB vaccine intramuscularly. Counseling was provided by the physician to the mother about each vaccine. What codes are reported for this encounter?

99392-25, 90460, 90461, 90748

Patient had an open cholecystectomy three weeks ago. During the postoperative period the patient comes in to see his doctor (who performed the cholecystectomy) for a sore throat and productive cough. The physician performs a problem focused history, expanded problem focused exam, and medical decision of low complexity. The patient has an upper respiratory infection. How is this reported?

99213-24

A 54-year-old male presents to his family physician with dizziness. During the physical exam his blood pressure is 200/130. After a complete work-up, including laboratory tests, the physician makes a diagnosis of stage V kidney disease due to malignant hypertension. What is the appropriate diagnosis code(s) for this encounter?

I12.0, N18.5, Two diagnosis codes are reported for this scenario. In the ICD-10-CM Alphabetic Index locate Hypertension/kidney/with/stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) and you're directed to I12.0. The Tabular List confirms this is the correct code. There is a use additional code note below code I12.0 to identify the stage of chronic kidney disease (N18.5, N18.6). In the Tabular List code N18.5 identifies Chronic kidney disease, stage 5.

A 54-year-old patient is brought to the ED by ambulance suffering from acute respiratory failure. The physician documents critical care services and also performs an endotracheal intubation. Physician services were provided for a total of 142 minutes. What are the correct CPT® codes to report?

99291, 99292 x 3, 31500, Critical care codes are located in the Evaluation and Management section in the CPT® code book. In the CPT® code book the subsection guidelines for Critical Care Services is above code 99291. The guidelines has a table that shows how codes 99291 and add-on code 99292 are reported according to the time documented. For a total critical care time of 142 minutes you will report 99291 once and add-on-code 99292 three times. The guidelines also indicate what additional procedures are not reported with critical care codes. In the scenario an endotracheal intubation was performed, it is not listed as a procedure that is included in the critical care codes, so it can be reported separately. Modifier 51 is not reported with E/M codes, add-on codes, and procedures that have the forbidden symbol in front of the code (the forbidden symbol is in front of code 31500).

A patient undergoes a craniotomy to evacuate a hematoma. The anesthesiologist prepared the patient in the OR starting the anesthesia at 0300. Surgery started at 0320 and ended at 0505. The anesthesiologist stopped the anesthesia at 0515 and the patient was placed under postoperative supervision.

The total anesthesia time the anesthesiologist should report on the claim form is:

2 hours and 15 minutes (135 minutes)

Due to an extreme infection, the patient required an injection of amphotericin B of 50 mg. How should this be reported to the insurance company?

J0285,

In the HCPCS Level II codebook look for the appendix that has the TABLE OF DRUGS. In that table look for the drug Amphotericin B referring you to code J0285. The code description for code J0285 indicates this is for Injection, amphotericin B, 50 mg, so it is reported once.

The claims reviewer has received records indicating that a surgery was performed on the left anterior descending coronary artery. What modifier would be appropriate to describe the anatomical location?

In the HCPCS Level II code book, look a listing of modifiers, different publishers will place the modifiers in different places. Locate modifier LD which is the correct modifier to indicate left anterior descending coronary artery.