AAPC CPC FINAL PRACTICE TEST QUESTIONS WITH ANSWERS (CPC exam preparation 2024/2025)

AAPC CPC FINAL PRACTICE TEST QUESTIONS WITH ANSWERS (CPC exam preparation 2024/2025)

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Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs c. Each regional MAC
ABN stands for _.a. Advanced Benefits Notificationb. Advisory Beneficial Noticec. Admitting Beneficiary Noticed. Advance Beneficiary Notice d. Advance Beneficiary Notice
What type of health insurance provides coverage for low-income families?a. Commercial HMOb. Medicaidc. Medicared. Commercial PPO b. Medicaid
Which type of information is NOT maintained in a medical record?a. Treatment outcomesb. Financial recordsc. Medical or surgical interventionsd. Observations b. Financial records
According to the OIG, internal monitoring and auditing should be performed by what means?a. Focused audits on problems brought to the attention of the compliance officer.b. Baseline audits.c. Periodic audits.d. Audits on all denied claims. c. Periodic audits.
Urine is transported from the kidneys to the urinary bladder by which structure?a. Ureterb. Urethrac. Kidney pelvisd. Urinary vein a. Ureter
Which of the following does NOT circulate fluids throughout the body?a. Venous systemb. Endocrine systemc. Arterial systemd. Lymphatic system b. Endocrine system
What is a function of the alveoli in the lungs?a. Oxygen exchangeb. Nicotine is destroyedc. Fluid in the lungs absorbedd. Providing an airway to breathe a. Oxygen exchange
Cytopathology is the study of:a. Tissueb. Cellsc. Bloodd. Organs b. Cells
The meaning of heteropsia (or anisometropia) is:a. Blindness in half the visual fieldb. Double visionc. Unequal vision in the two eyesd. Blindness in both eyes c. Unequal vision in the two eyes
What is the meaning of provider in the ICD-10-CM guidelines?a. Insurance companyb. The hospitalc. The physiciand. The patient c. The physician
What is the ICD-10-CM code for hay fever?a. J30.1b. J30.89c. J30.81d. J45.909 a. J30.1
What is the ICD-10-CM code for eyestrain?a. H53.10, H53.10b. H57.8c. H57.8, H57.8d. H53.10 d. H53.10
What diagnosis codes should be reported for spastic cerebral palsy due to previous illness of meningitis?a. G03.9, G80.1b. G80.1, G43.909, G03.9c. G09, G80.1d. G80.1, G09 d. G80.1, G09
The patient is a 12 month-old with a history of muscle weakness. Unfortunately, his etiology is unknown and to help delineate the diagnosis, Neurology has consulted us to obtain a right bicep muscle biopsy. What diagnosis code is reported?a. R29.898b. M62.81c. R53.1d. G58.9 b. M62.81
A 50 year-old patient has been diagnosed with elevated blood pressure. The patient does not have a history of hypertension. What is the correct ICD-10-CM code to report?a. I15.0b. I13.0c. R03.0d. I10 c. R03.0
A 32 year-old male was seen in the ASC for removal of two lipomas. One was located on his back and the other was located on the right forearm. Both involved subcutaneous tissue. What ICD-10-CM code(s) is/are reported?a. D17.1, D17.23b. D17.21, D17.1c. D17.30d. D17.39 b. D17.21, D17.1
What is the time frame defining when pain becomes chronic?a. After the global periodb. One yearc. The 30th dayd. No time frame d. No time frame
A patient with amyloidosis being treated for glomerulonephritis. What ICD-10-CM codes are reported?a. E85.3, N08b. E85.4, N08c. N08, E85.3d. N08, E85.4 b. E85.4, N08
A 45 year-old-male patient has developed an ulcer on his upper back. He has had diabetes for several years and is on insulin. The provider determines that the ulcer is due to his diabetes. What ICD-10-CM codes are reported?a. E11.622, Z79.4b. E11.9, L98.429, Z79.4c. E11.622, L98.429, Z79.4d. E11.622, L98.429 c. E11.622, L98.429, Z79.4
In which circumstances would an external cause code be reported?a. Delivery of a newborn.b. Causes of injury or health condition.c. Chemotherapy treatment of neoplasms.d. Only for the cause of motor vehicle accidents. b. Causes of injury or health condition.
Patient presents with no menses and positive pregnancy test but an ultrasound reveals no uterine contents. An embryo has implanted on the left ovary and this is treated with laparoscopic oophorectomy. What ICD-10-CM code is reported for this procedure?a. O00.102b. O00.202c. O00.802d. O00.09 b. O00.202
A patient has an open displaced fracture of the second cervical vertebra. This is her fifth visit and the fracture is healing normally. What ICD-10-CM code is reported?a. S12.9XXSb. S12.190Dc. S12.9XXDd. S12.190A b. S12.190D
A 43 year-old female presents to the provider for a diabetic ulcer of the right ankle. What ICD-10-CM codes are reported?a. L97.319b. L97.319, E11.9c. L97.319, E11.622d. E11.622, L97.319 d. E11.622, L97.319
A patient is prescribed anticonvulsant medication for her seizures. She returns to her doctor three days later with nausea and rash due to taking the anticonvulsant medication. The provider notes that this is a drug reaction to an anticonvulsant and changes the medication. What ICD-10-CM codes are reported?a. L27.0, R11.2, T42.71XAb. R21, R11.2, T42.71XAc. R21, R11.0, T42.75XAd. L27.0, R11.0, T42.75XA d. L27.0, R11.0, T42.75XA
What surgical status indicator represents the Global Surgical Package for endoscopic procedures (without an incision) where there is no postoperative period after the day of the surgery??a. XXXb. 000c. 010d. 090
What code represents a secondary rhinoplasty where a small amount of work is performed on the tip of the nose?a. 30430b. 30420c. 30435d. 30400
What is the appropriate modifier to use when two surgeons perform separate distinct portions of the same procedure?a. 59b. 66c. 62d. 80
What is the correct CPT® coding for a cystourethroscopy with brush biopsy of the renal pelvis?a. 52005, 52007b. 52007c. 52000, 52007d. 52005
What codes are voluntarily reported to payers, provide evidence-based performance-measure data?a. CPT® Category I codesb. CPT® Category II codesc. CPT® Category III codesd. HCPCS Level II codes
Which statement is true regarding coding of carbuncles and furuncles in ICD-10-CM?a. There are separate codes for carbuncles and furuncles.b. The differentiation between a carbuncle and a furuncle is specified by a 7th character extender.c. Code L02.43 is a complete code.d. Carbuncles and furuncles are reported with the same code.
Patient presents to the physician for removal of a squamous cell carcinoma of the right cheek. After the area is prepped and draped in a sterile fashion the surgeon measured the lesion, and documented the size of the lesion as 2.3 cm at its largest diameter. Additionally, the physician took margins of 2 mm on each side of the lesion. Single layer closure was performed. The patient tolerated the procedure well. What CPT® code(s) is/are reported?a. 11643, 12013b. 11642, 12013c. 11643d. 11442
Joe has a terrible problem with ingrown toenails. He goes to the podiatrist to have a nail permanently removed along with the nail matrix. What CPT® code is reported?a. 11720b. 11765c. 11730d. 11750
Patient presents with a suspicious lesion on her left arm. With the patient’s permission the physician marked the area for excision. The margins and lesion measured a total of 0.9 cm. The wound measuring 1.2 cm was closed in layers using 4-0 Monocryl and 5-0 Prolene. Pathology later reported the lesion to be a sebaceous cyst. What codes are reported?a. 13121, 11401-51, D22.62b. 11402, L72.3c. 11401, D22.62d. 12031, 11401-51, L72.3
Operative ReportPre-Operative and Post-Operative Diagnosis: Squamous cell carcinoma, left legOpen wound, right legPersonal history of squamous cell carcinoma, right legINDICATIONS FOR SURGERY: The patient is an 81 year-old white man with biopsy-proven squamous cell carcinoma of his left leg. I marked the areas for excision with gross normal margins of 5 mm, and I drew my planned skin graft donor site from his left lateral thigh. He also had an open wound of his right leg from a squamous cell carcinoma excised four months ago; the skin graft had not taken. We plan on re-skin grafting the area. The patient is aware of all of these markings, and understands the surgery and location.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. IV Ancef was given. I used plain lidocaine for his local anesthetic throughout the procedure until the skin grafts were inset. The anterior of his leg and the thigh were infiltrated with local anesthetic. Both lower extremities were prepped and draped circumferentially, which included the left thigh on the left side. I excised the lesion on his left leg as drawn into the subcutaneous fat. Hemostasis achieved with the Bovie cautery. I then excised the wound on his right leg to lower the bacterial counts. I took a 1-2 mm margin around the wound and excised the granulation tissue as well. Hemostasis was achieved using the Bovie cautery. I then changed gloves. A split-thickness skin graft was harvested from the left thigh using the Zimmer dermatome. This was meshed 1:5:1. By this time, the pathology returned showing the margins were clear.Skin grafts were inset on each leg wound using the skin stapler. Xeroform and gauze bolster was placed over the skin graft using 4-0 nylon. The skin graft donor site was dressed with OpSite. The legs were further dressed with heavy cast padding and the double Ace wrap. The patient tolerated the procedure well.PROCEDURES: Excision squamous cell carcinoma, left leg with excised diameter of 2.5 cm, repaired with a split-thickness skin graft measuring 5.1 cm². Excisional preparation of right leg wound repaired with a split-thickness skin graft measuring 3.2 cm².What CPT® codes are reported?a. 15100, 11603-51-LT, 15002-51-RTb. 15100, 11403-51-LT, 15100-51-RTc. 15100, 11603-51-LTd. 15100, 15100-51-LT, 11603-51-LT, 15002-51-RT
In ICD-10-CM, what classification system is used to report open fracture classifications?a. Muller AO classification of fracturesb. PHF classification of fracturesc. Danis-Weber classificationd. Gustilo classification for open fractures
A 49 year-old female presented with chronic deQuervain’s disease and has been unresponsive to physical therapy, bracing or cortisone injection. She has opted for more definitive treatment. After induction of anesthesia, the patient’s left arm was prepared and draped in the normal sterile fashion. Local anesthetic was injected using a combination 2% lidocaine and 0.25% Marcaine. A transverse incision was made over the central area of the first dorsal compartment. The subcutaneous tissues were gently spread to protect the neural and venous structures. The retractors were placed. The fascial sheath of the first dorsal compartment was then incised and opened carefully. The underlying thumb abductor and extensor tendons were identified. The tissues were dissected and the extensor retinaculum of the first extensor compartment was incised. The fibrotic tissue was incised and the tendons gently released. The tendons were freely moving. Subcutaneous tissues were closed with a 3-0 Vicryl and the skin with 3-0 Prolene subcuticular closure. Steri-strips, Xeroform and dry sterile dressings were applied. What CPT® code is reported?a. 25001-LTb. 25118-LTc. 25085-LTd. 25000-LT
This 45 year-old male presents to the operating room with a painful mass of the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient’s shoulder was noted. The mass appeared to be benign in nature. With deep blunt dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported?a. 23075-RTb. 23066-RTc. 23030-RTd. 23076-RT
A 16 year-old female was hit by a car while crossing a two-lane highway. She was taken to the hospital by ambulance. She was found to have an open wound of the left lower thigh, just above the knee and a displaced fracture of the left femoral neck. She was taken to the operating room within four hours of her injury. She was given general endotracheal anesthesia and was prepped and draped in sterile fashion. Debridement including excision of devitalized skin and muscle was performed on the lateral thigh. The area was approximately 15 sq cm. After debridement and thorough copious irrigation, the wound was closed with layer sutures and a dressing was applied and then covered with adhesive plastic. The patient was then prepped and draped for the fracture and turned on her right side. We all rescrubbed. An 8 inch incision was made over the left hip and the head of the femur was exposed. Multiple fragments from the neck and the greater tuberosity were removed. The decision was made to replace the femoral head. The femur was removed from the acetabulum and the femoral head was removed. The femoral canal was reamed and a prosthesis was placed. It was then replaced in the acetabulum with a good fit, and the capsule was closed. The wound was closed. The patient was sent to recovery in good condition.a. 27125-LT, 11010-59-LTb. 27236-LT, 11043-59-LTc. 27130-LT, 11010-59-LTd. 27244-LT, 11043-59-LT
A 74 year-old male presented with ankle avascular necrosis of the talus with collapse of the body. After general anesthesia and sterile prep, the patient was placed prone. A lateral incision was made. The fibula was dissected and approximately 6 cm of the fibula was removed for the autograft. There were a lot of free fragments of bone around the subtalar joint and the talus itself. The bone fragments were removed and a large defect consistent with avascular necrosis of the body of the talus was noted. An egg-shaped burr was introduced and the articulating cartilage of the ankle joint was excised and debrided. The subtalar joint was approached and resection of the articulating surface of the subtalar joint was completed. Bone graft from the fibula was prepared on the back table. We made two large blocks to fill the defect in the talus and then additional small fragments of cortical cancellous bone to fill in smaller defects around the talus and ankle. Fixation was performed in the calcaneocuboid. The talar screw was inserted, followed by fixation of the talonavicular, tibiotalar and additional compression. The ankle screws were inserted proximally and the wound was irrigated and closed in layers. What CPT® codes are reported?a. 28730, 20900-51b. 28725, 20924-51c. 28705, 20902-51d. 28715, 20910-51
What is the largest single mass of lymphatic tissue?a. Spleenb. Peyer’s Patchesc. Tonsilsd. Thymus a. Spleen
An 18 month-old patient is seen in the ED unable to breathe due to a toy he swallowed which had lodged in his throat. Soon brain death will occur if an airway is not established immediately. The ED provider performs an emergency transtracheal tracheostomy. What CPT® and ICD-10-CM codes are reported?a. 31601, 31603, T17.228Ab. 31601, J34.9, T17.298Ac. 31603, T17.220Ad. 31603, T17.290A
What ICD-10-CM codes are reported for postoperative pulmonary edema due to fluid overload from an infusion?a. T80.89XA, J81.1, Y63.0b. J95.89, E87.70, Y63.1c. J81.0, E87.70, Y63.1d. T81.9XXA, J81.1, Y63.0
A 27 year-old girl has been on the lung transplant list for months and today she will be receiving a LT and RT lung from an individual involved in an MVA. This person was DOA at the hospital and is an organ donor. The donor pneumonectomy was performed by physician A, the backbench work by physician B and the transplant of both lungs into the prepped and waiting patient by physician C.What is the correct coding for the removal (physician A), preparation (physician B) and insertion (physician C) of the lungs?a. 32850, 32855, 32851 b. 32850, 32856, 32851 x 2 c. 32850, 32856, 32853d. 32850, 32855 x 2, 32850-50
A 45 year-old presents with acute pericarditis. The surgeon makes a small incision between two ribs and enters the thoracic cavity. An endoscope is introduced and the pericardial sac is examined by direct visualization. Using an instrument introduced through the endoscope, the surgeon creates an opening in the pericardial sac for drainage purposes. What CPT® code is reported?a. 32659b. 32662c. 32658d. 32661
Patient presents to her physician 10 weeks following a true posterior wall myocardial infarction. The patient is still symptomatic and is diagnosed with ischemic heart disease. What is (are) the correct ICD-10-CM code(s) for this condition?a. I21.29b. I22.8c. I25.2d. Z51.89, I25.9
Due to infections from hemodialysis, the physician replaces a dual chamber implantable defibrillator system with a multi-lead system with an epicardial lead and transvenous dual chamber lead defibrillator system. The original dual leads are extracted transvenously. The generator pocket is relocated. What CPT® codes are reported?a. 33244, 33220-51, 33264-51, 33223-59b. 33243, 33202-51, 33263-51, 33223-59c. 33241, 32330-51, 33263-51, 33223-59d. 33244, 33202-51, 33264-51, 33223-59
A patient presents to the hospital for a cardiovascular SPECT study. A single study is performed under stress, but without quantification, with a wall motion study, and ejection fraction. Select the CPT® code(s) for this procedure.a. 78451, 78472b. 78451c. 78453d. 78453, 78472
In the hospital setting a patient undergoes transcatheter placement of an extracranial vertebral artery stent in the right vertebral artery. Which CPT® code is reported by the physician providing only the radiologic supervision and interpretation?a. 0075Tb. 0075T-26c. 35301d. 35005
A patient is brought to the operating suite when she experiences a large output of blood in her chest tubes post CABG. The physician performing the original CABG yesterday is concerned about the post-operative bleeding. He explores the chest and finds a leaking anastomosis site and he resutured.a. 35761-78b. 35241c. 35761d. 35820-78
A patient is seen in the ED for nausea and vomiting that has persisted for 4 days. The ED physician treats the patient for dehydration which is documented in the patient’s record as the final diagnosis. What ICD-10-CM code(s) is/are reported for this encounter?a. R11.2, E86.0b. E86.0c. R11.14d. R11.10, R11.0, E86.0
What CPT® and ICD-10-CM codes represent the creation of an opening into the stomach to insert a temporary feeding tube for nutritional support in an adult patient with proximal esophageal carcinoma due to alcohol dependence? A gastric tube was not created.a. 43870, C15.8, F10.99b. 43831, D49.0, F10.10c. 43830, C15.3, F10.20d. 43653, C15.9, F10.20
What is the correct ICD-10-CM coding for diverticulosis of the small intestine which has been present since birth?a. K57.90, Q43.8b. Q43.8c. K57.90d. K57.10
A 57 year-old patient with chronic pancreatitis presents to the operating room for a pancreatic duct-jejunum anastomosis by the Puestow-type operation. What are the correct CPT® and ICD-10-CM codes for the encounter?a. 48548, K85.90b. 48548, K86.1c. 48520, K86.1d. 48520, K85.80
Margaret has a cholecystoenterostomy with a Roux-en-Y. Five hours later, she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and was demonstrating early signs of peritonitis. What is the correct coding for the subsequent services on this date of service? The same surgeon took her back to the OR as the one who performed the original operation.What CPT® code is reported?a. 49000-58b. 49402-77c. 49000-77d. 49402-78
What is the correct CPT® code for a percutaneous pyelostolithotomy with dilation and basket extraction measuring 1 cm?a. 50080b. 50130c. 50040d. 50081
A 63 year-old male presents for the insertion of an artificial inflatable urinary sphincter for urinary incontinence. A 4.5 cm cuff, 22 ml balloon, 61-70 mmHg artificial inflatable urinary sphincter was inserted. What CPT® code is reported for this service?a. 53446b. 53448c. 53447d. 53445
A fracture of the corpus cavernosum penis is repaired. What is the correct code?a. 54440b. 54420c. 54430d. 54435
Patient comes in today to the provider’s office for routine monthly Foley catheter change. A two way Foley catheter is replaced in the usual sterile fashion. An abdominal urinary drainage bag and bedside bag are given to the patient. What is/are the correct code(s)?a. 51702, A4338, A4357, A4358b. 51100c. 51102d. 51701, A4338, A4357, A4358
The patient is a pleasant 51 year-old male with morbid obesity, weighing approximately 560 pounds and BMI being 85.1. He has uncontrolled diabetes and was evaluated due to testicular pain. He was found to have erythema, edema and possible areas of eschar on the scrotum. He was transferred to the hospital, evaluated and found to be stable with cellulitis and suspect early Fournier’s gangrene. What are the appropriate ICD-10-CM codes reported?a. N49.2, E11.9, E66.01, Z68.45b. N50.1, E11.9, N49.2, E66.01, Z68.45c. N50.1, N49.2, E66.01, Z68.52d. E66.01, E11.9, N50.1, E66.01, Z68.52
A 40 year-old presents with vaginal bleeding for several weeks unrelated to her menstrual cycle. The gynecologist orders an ultrasound to obtain more information for a diagnosis. What diagnosis code is appropriate for this encounter?a. N92.1b. N92.4c. N92.6d. N93.9
An ED physician treats a 30 year-old patient who was a victim of a rape. She has bruises and other trauma as well as a laceration of the vaginal wall, which is repaired with sutures (colporrhaphy) by the ED physician. What are the CPT® and ICD-10-CM codes reported for this procedure?a. 59300, S31.41XA, T74.21XAb. 57260, N89.8c. 57200, S31.41XA, T74.21XAd. 57289, N89.8
What does the abbreviation IVF mean?a. In vitro fertilizationb. Infundibulum via Fallopian tubec. Intravaginal foreign bodyd. Intravenous fluids a. In vitro fertilization
A patient has ovarian cancer of both ovaries. She has removal of her ovaries with peritoneal washings and assessment of the abdomen for any metastases, including inspection of omentum, diaphragm and multiple biopsies. Lymph nodes in the pelvic and peri-aortic areas were also biopsied. She has previously had a hysterectomy. What are the CPT® and ICD-10-CM codes reported for this service?a. 58943, C56.1, C56.2b. 58950, 49255, C79.61, C79.62c. 58720, 38770, C56.1, C79.62d. 58940, C56.1, C56.2
Mrs. Smith is visiting her mother and is 150 miles away from home. She is in the 26th week of pregnancy. In the late afternoon she suddenly feels a gush of fluids followed by strong uterine contractions. She is rushed to the hospital but the baby is born before they arrive. In the ED she and the baby are examined and the retained placenta is delivered. The baby is in the neonatal nursery doing okay. Mrs. Smith has a 2nd degree perineal laceration secondary to precipitous delivery which was repaired by the ED physician. She will return home for her postpartum care. What ICD-10-CM and CPT® codes are reported by the ED physician?a. 59409, 59414-51, 59300-51, O62.3, O70.1, Z3A.26, Z37.0b. 59414, 59300-51, O73.0, O70.1, Z3A.26, Z37.0c. 59414, 59300-51, O62.3, O70.9, Z3A.26, Z37.0d. 59409, O80, Z3A.26, Z37.0
What does contralateral mean?a. Affecting or originating in the opposite side.b. Contractions occurring on opposite sides of the body.c. Pertaining to the same side of the body.d. Lateral contractions. b. Contractions occurring on opposite sides of the body.
A patient with MEN1 (Multiple Endocrine Neoplasia 1) has surgery to remove three of her parathyroid glands and part of the fourth parathyroid gland. What CPT® and ICD-10-CM codes are reported?a. 60505, E31.22b. 60505, E31.21c. 60500, E31.21d. 60502, E31.22
How is Streptococcal A Meningitis reported in ICD-10-CM?a. Only Streptococcal, group A, as the cause of diseases classified elsewhere is reported.b. Only one code is reported for streptococcal meningitis.c. Streptococcal, group A, as the cause of diseases classified elsewhere is reported first; Streptococcal meningitis is reported second.d. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second. d. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second.
A 47 year-old female presents to the OR for a partial corpectomy to three thoracic vertebrae. One surgeon performs the transthoracic approach while another surgeon performs the three vertebral nerve root decompressions necessary. How should each provider involved code their portion of the surgery?a. 63087-52, 63088-52 x 2b. 63087-80, 63088-80 x 2c. 63085-62, 63086-62 x 2d. 63085, 63086-82 x 2
A patient recently experienced muscle atrophy and noticed she did not have pain when she cut herself on a piece of glass. The provider decides to obtain a needle biopsy of the spinal cord under ultrasound guidance in the outpatient setting. The biopsy results come back as syringomyelia. What CPT® and ICD-10-CM codes are reported for the biopsy procedure?a. 62269, G12.9b. 62270, 76942-26, G95.0c. 62270, G12.9d. 62269, 76942-26, G95.0
What does IOL stand for?a. Interdimensional ocular lengthsb. Iridescence over laminac. Intraocular lensd. Interoptic laser c. Intraocular lens
Patient had an abscess in the external auditory canal which was incised and drained in the office. What CPT® code is reported?a. 69000b. 69020c. 69540d. 69105
What CPT® code is reported for a tympanoplasty with mastoidotomy and with ossicular chain reconstruction in the right ear?a. 69636-RTb. 69632-RTc. 69644-RTd. 69646-RT
A 70 year-old female has a drooping left eyelid obstructing her vision and has consented to having the blepharoptosis repaired. A skin marking pencil was used to outline the external proposed skin incision on the left upper eyelid. The lower edge of the incision was placed in the prominent eyelid crease. The skin was excised to the levator aponeurosis. An attenuated area of levator aponeurosis was dehisced from the lower strip. Three 6-0 silk sutures were then placed in mattress fashion, attaching this attenuated tissue superiorly to the intact tissue inferiorly. This provided moderate elevation of the eyelid. What CPT® code is reported?a. 67911-E1b. 67901-E1c. 67903-E1d. 67904-E1
A 53 year-old woman with scarring of the right cornea has significant corneal thinning with a high risk of perforation and underwent reconstruction of the ocular surface. The eye is incised and an operating microscope is used with sponges and forceps to debride necrotic corneal epithelium. Preserved human amniotic membrane is first removed from the storage medium and transplanted by trimming the membrane to fit the thinning area of the cornea then sutured. This process was repeated three times until the area of thinning is flush with surrounding normal thickness cornea. All of the knots are buried and a bandage contact lens is placed with topical antibiotic steroid ointment. What CPT® code is reported?a. 65435b. 65780c. 65781d. 65710
What are the three classifications of anesthesia?a. General, Regional and Moderate Sedationb. General, Regional and Epiduralc. General, Regional and Monitored Anesthesia Cared. General, MAC and Conscious Sedation c. General, Regional and Monitored Anesthesia Care
What time is used to report the start of anesthesia time?a. Surgery start timeb. Entering the operating roomc. When the anesthesiologist begins to prepare the patient for anesthesiad. During the pre-anesthesia assessment c. When the anesthesiologist begins to prepare the patient for anesthesia
A 42 year-old patient was undergoing anesthesia in an ASC and began having complications prior to the administration of anesthesia. The surgeon immediately discontinued the planned surgery. If the insurance company requires a reported modifier, what modifier best describes the extenuating circumstances?a. 53b. 23c. 73d. 74
What ICD-10-CM code is reported for a reaction to anesthesia, initial encounter?a. T88.59XAb. T88.2XXAc. T88.52XAd. T88.4XXA
A 43 year-old patient with a severe systemic disease is having surgery to remove an integumentary mass from his neck. What CPT® code and modifier are reported for the anesthesia service?a. 00300-P2b. 00300-P3c. 00322-P3d. 00350-P3
A non-Medicare patient reports for a bilateral screening mammography with CAD. What CPT® code(s) is/are reported?a. 77066b. 77067c. 77059d. 77062
A 1 year post-thyroidectomy patient who had thyroid cancer is coming in for area imaging of the neck and chest to evaluate for metastases. What CPT® code(s) is/are reported for the nuclear medicine exam?a. 78013b. 78015, 78020c. 78014d. 78015
A patient needing scoliosis measurements is coming in to have standing anteroposterior and lateral views of his entire thoracic and lumbar spine. What CPT® code(s) is/are reported for radiology?a. 72084b. 72082c. 72083d. 72040, 72070, 72100
The patient is a 63 year-old gentleman diagnosed with rectal cancer, who had a resection of the cancer performed. He now presents to have a Port-A-Cath (a central venous access device) inserted for postoperative adjuvant therapy. An 18-gauge introducer needle was inserted into the left subclavian vein through which a soft tipped guide wire was inserted into the superior vena cava under fluoroscopy. A subcutaneous pouch in the anterior part of the chest was created for the port. The catheter was then tunneled and measured to length. The dilator and introducer sheath were passed over the wire into the superior vena cava under fluoroscopic guidance. The catheter was passed through the sheath and the port was applied with good venous return. What CPT® codes are reported?a. 36571, 77001-26b. 36560, 77002-26c. 36561, 77001-26d. 36563, 77003-26
A CT study of the lumbar spine (L2-L4) was performed with IV contrast in the hospital outpatient radiology department and the interpretation of the images is performed by the radiologist. What CPT® code(s) should be reported by the radiologist who is not an employee of the hospital?a. 72132b. 72132-26c. 72132-26, 72132-TCd. 72132-TC
What modifier must always be applied to Medicare claims for tests performed in a site with a CLIA Waived certificate?a. 91b. 26c. 90d. QW
“If the findings on examination of a Pap smear are normal and described as “”negative for intraepithelial lesion or malignancy”” this is an example of what type of results reporting?a. Surgical pathologyb. Cytogeneticsc. Bethesdad. Non-Bethesda”
A patient has a traumatic head injury and some cerebrospinal fluid (CSF) is removed to limit potential damage from swelling of the brain. The CSF is sent to pathology for examination and the results show unusual cytological counts, although no specific findings. The patient has had no previous symptoms known to his family members. What is the ICD-10-CM code for this examination of CSF?a. A39.0b. Z00.01c. S06.1X0Ad. R83.6
A urine pregnancy test is performed by the office staff using the Hybritech ICON (qualitative visual color comparison test). What CPT® code is reported?a. 84702b. 81025c. 81025, 36415d. 84703
A left breast biopsy is performed on a mass and the surgeon requests a frozen section examination of the specimen to determine whether more extensive resection is appropriate. The frozen section reveals no indications of malignancy. No other specimen is obtained but the remainder of the biopsy specimen is sent for further testing and examination, including decalcification. The results indicate breast fibrosclerosis only. What CPT® and ICD-10-CM codes are reported?a. 88331, 88313, N63.20b. 88305, 88331, 88311, N60.32c. 88307, 88305, 88331, 88313, N60.32d. 88307, 88331, R92.0
A patient is seen by Dr. B who is covering on call services for Dr. A. The patient is an established patient with Dr. A. but she has not been seen by Dr. B. before. Which E/M subcategory is appropriate to report the services provided by Dr. B?a. Established patient office visitb. Preventive medicine visitc. Office consultationd. New patient office visit
A patient is diagnosed as having both acute and chronic tonsillitis. How is this reported in ICD-10-CM?a. The chronic tonsillitis is reported first; the acute tonsillitis is reported second.b. The acute tonsillitis is reported first; the chronic tonsillitis is reported second.c. Only the chronic tonsillitis is reported.d. Only the acute tonsillitis is reported.
A provider visits Mr. Smith’s home monthly. Today, the provider performs a problem focused history, an expanded problem focused examination and a medical decision making of low complexity. What CPT® code is reported?a. Home visits are no longer reportable.b. 99348c. 99349d. 99347
An infant is born six weeks premature in rural Arizona and the pediatrician in attendance intubates the child and administers surfactant in the ET tube while waiting in the ER for the air ambulance. During the 45-minute wait, he continues to bag the critically ill patient on 100 percent oxygen while monitoring VS, ECG, pulse oximetry and temperature. The infant is in a warming unit and an umbilical vein line was placed for fluids and in case of emergent need for medications. How is this coded?a. 99471-25, 94610, 36510b. 99291c. 99471d. 99291-25, 31500, 36510, 94610
65 year-old was admitted in the hospital two days ago and is being examined today by his primary care physician, who has been seeing him since he has been admitted. Primary care physician is checking for any improvements or if the condition is worsening.CHIEF COMPLAINT: CHFINTERVAL HISTORY: CHF symptoms worsened since yesterday.Now has some resting dyspnea. HTN remains poorly controlled with systolic pressure running in the 160s. Also, I’m concerned about his CKD, which has worsened, most likely due to cardio-renal syndrome.REVIEW OF SYSTEMS: Positive for orthopnea and one episode of PND. Negative for flank pain, obstructive symptoms or documented exposure to nephrotoxins.PHYSICAL EXAMINATION:GENERAL: Mild respiratory distress at restVITAL SIGNS: BP 168/84, HR 58, temperature 98.1.LUNGS: Worsening bibasilar cracklesCARDIOVASCULAR: RRR, no MRGs.EXTREMITIES: Show worsening lower extremity edema.LABS: BUN 56, creatinine 2.1, K 5.2, HGB 12.IMPRESSION:1. Severe exacerbation of CHF2. Poorly controlled HTN3. Worsening ARF due to cardio-renal syndromePLAN:1. Increase BUMEX to 2 mg IV Q6.2. Give 500 mg IV DIURIL times one.3. Re-check usual labs in a.m.What E/M Category is used for this visit?a. Inpatient Consultation (99251-99255)b. Established Patient Office/Outpatient Visit (99211-99215)c. Subsequent Hospital Visit (99231-99233)d. Initial Hospital Visit (99221-99223)
A new patient with cystic fibrosis underwent evaluation of lung function, including percussion, vibration and cupping to the chest wall to facilitate his lung function. What CPT® code(s) is/are reported for this service?a. 94664b. 99201-25, 94668c. 94667d. 94662
A patient with hypertensive cardiovascular disease is admitted by his primary care provider. What is/are the correct ICD-10-CM code(s) for this encounter?a. I11.0b. I11.9c. I10, I25.10d. I11.9, I25.10
What ICD-10-CM code is reported when a flu vaccine is administered?a. J11.1b. Z28.3c. Z28.04d. Z23 d. Z23
A 5 year-old is brought in to see an allergist for generalized urticaria. The family just recently visited a family member that had a cat and dog. The mother wants to know if her son is allergic to cats and dogs. The child’s skin was scratched with two different allergens. The provider waited 15 minutes to check the results. There was a flare up reaction to the cat allergen, but there was no flare up to the dog allergen. The provider included the test interpretation and report in the record.a. 95004 x 2b. 95027 x 2c. 95024 x 2d. 95018 x 2
A 32 year-old ETOH dependent female is in a partial hospitalization program and has been seeing an addictive disease specialist (psychotherapist) in a chemical dependency program. Her employer is aware of her problem. She was referred to the group through their Employee Assistance Program. As long as she is in compliance they will support her efforts. Recently, she has arrived late at the meetings. The provider met with the patient and discussed the importance of her treatment, compliance with the program and avoidance of situations in which she may use alcohol. She denies contact with her previous associates and assures the provider she has had no alcohol intake since beginning the substance abuse treatment program. They will continue to reinforce her progress and successful sobriety. Time of the session was 45 minutes. What CPT® and ICD-10-CM codes are reported?a. 90832, F10.220b. 90832, F10.20c. 90834, F10.20d. 90834, F10.220

The minimum necessary rule is based on sound current practice that protected health information should NOT be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. What does this mean?a. Staff members are allowed to access any medical record without restrictionb. Providers should develop safeguards to prevent unauthorized access to protected health information.c. Practices should only provide minimum necessary information to patients.d. All of the above. b. Providers should develop safeguards to prevent unauthorized access to protected health information.
EHR stands for:a. Electronic health recordb. Extended health recordc. Electronic health responsed. Established health record a. Electronic health record
The AAPC offers over 500 local chapters across the country for the purpose ofa. Continuing education and networkingb. Membership duesc. Regulations and bylawsd. Financial management a. Continuing education and networking
What does the abbreviation MAC stand for?a. Medicaid Alert Contractorb. Medicare Advisory Contractorc. Medicare Administrative Contractord. Medicaid Administrative Contractor c. Medicare Administrative Contractor
The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are .a. Permanentb. Consistent and appropriatec. Frequentd. Swift and enforceable b. Consistent and appropriate Through which vessel is oxygenated blood returned to the heart from the lungs?a. Pulmonary veinb. Bronchial veinc. Pulmonary arteryd. Bronchial artery a. Pulmonary vein Muscle is attached to bone by what method?a. Tendons, ligaments, and directly to boneb. Tendons, aponeurosis, and directly to bonec. Ligaments, aponeurosis, and directly to boned. Tendons and cartilage b. Tendons, aponeurosis, and directly to bone Lacrimal glands are responsible for which of the following?a. Production of tearsb. Production of vitreousc. Production of mydriatic agentsd. Production of zonules a. Production of tears Melasma is defined as:a. Lines where the skin has been stretchedb. A discharge of mucus and bloodc. A dark vertical line appearing on the abdomend. Brownish pigmentation appearing on the face d. Brownish pigmentation appearing on the face A gonioscopy is an examination of what part of the eye:a. Anterior chamber of the eyeb. Lacrimal ductc. Interior surface of the eyed. Posterior segment a. Anterior chamber of the eye What type of code is assigned when the provider documents the reason for a patient seeking healthcare services that is not for an injury or disease?a. Non-specific codeb. External cause code (V00-Y99)c. Z code (Z00-Z99)d. ICD-10-PCS c. Z code (Z00-Z99) What is the ICD-10-CM code for hay fever? J30.1 What is the ICD-10-CM code for swine flu?a. J10.1b. A08.4c. J11.1d. J09.X2 d. J09.X2 What ICD-10-CM code(s) is/are reported for enlargement of the prostate with a symptom of urinary retention?a. N40.1b. N40.3, R33.8c. N40.0d. N40.1, R33.8 d. N40.1, R33.8 What diagnosis code(s) is/are reported for behavioral disturbances in a patient with early onset Alzheimer’s?a. G30.8, F02.81b. F02.81c. F02.81, G30.0d. G30.0, F02.81 d. G30.0, F02.81 What is the ICD-10-CM code for a patient with postoperative anemia due to acute blood loss during the surgery who needs a blood transfusion?a. D64.9b. D53.0c. D50.0d. D62 d. D62 A 54-year-old male goes to his primary care provider with dizziness. On physical exam his blood pressure is 200/130. After a complete work-up, including laboratory tests, the provider makes a diagnosis of end stage renal disease and hypertension. What are the appropriate diagnosis codes for this encounter?a. I12.0, N18.6b. I10, N18.6c. I10, N18.9d. I12.0 a. I12.0, N18.6 A 32-year-old male was seen in the ambulatory surgery center ASC for removal of two lipomas. One was located on his back and the other was located on the right forearm. Both involved subcutaneous tissue. What ICD-10-CM code(s) is/are reported?a. D17.30b. D17.39c. D17.1, D17.23d. D17.21, D17.1 d. D17.21, D17.1 A 33-year-old patient visits his primary care provider to discuss a lap band procedure for his morbid obesity. His caloric intake is in excess of 4,000 calories per day and his BMI is currently 45. What ICD-10-CM code(s) is/are reported?a. E66.01, Z68.42b. E66.3, Z68.45c. E66.01d. E66.01, Z68.45 a. E66.01, Z68.42 A 58-year-old patient sees the provider for confusion and loss of memory. The provider diagnoses the patient with early onset stages of Alzheimer’s disease with dementia. What ICD-10-CM codes are reported?a. F02.80, G30.0, F29, F41.3b. G30.0, F02.80c. F02.80, G30.0d. G30.0, F02.80, F29, R41.3 b. G30.0, F02.80 What would be considered an adverse effect?a. Shortness of breath when runningb. Rash developing when taking penicillinc. Hemorrhaging after a vaginal deliveryd. Wound infection after surgery b. Rash developing when taking penicillin What is a TRUE statement in reporting pressure ulcers?a. When a pressure ulcer is at on stage and progresses to the higher stage, report the lowest stage for that site.b. Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to another stage during the admission.c. When documentation does not provide the stage of the pressure ulcer, report the unstageable pressure ulcer code(L89.95).d. The site of the ulcer and the stage of the ulcer are reported with two separate codes. b. Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to another stage during the admission. A child has a splinter under the right middle fingernail. What ICD-10-CM code is reported?a. S61.222Ab. S61.227Ac. S61.242Ad. S60.452A d. S60.452A A 16-year-old male is brought to the ED by his mother. He was riding his bicycle in the park when he fell off the bike. The patient’s right arm is painful to touch, discolored, and swollen. The X-ray shows a closed fracture of the ulna. What ICD-10-CM codes are reported?a. S52.201A, V19.9XXA, Y92.830b. S52.201A, V18.4XXA, Y92.831c. S52.201A, V18.0XXA, Y92.830d. S52.209A, V18.4XXA, Y92.830 c. S52.201A, V18.0XXA, Y92.830 A 12-month-old receives the following vaccinations: Hepatitis B, Hib, Varicella, and Mumps-measles-rubella. What ICD-10-CM code(s) is/are reported for the vaccinations?a. B19.10, B01.9, B26.9, B05.9, B06.9, Z23b. Z23, B19.10, B01.9, B26.9, B05.9, B06.9c. Z23d. B19.10, B01.9, B26.9, B05.9, B06.9 c. Z23 The Table of Drugs in the HCPCS Level II book indicates various medication routes of administration. What abbreviation represents the route where a drug is introduced into the subdural space of the spinal cord?a. ITb. SCc. IMd. INH a. IT A patient is in the OR for an arthroscopy of the medial compartment of his left knee. A meniscectomy is performed. What is the correct code used to report for the anesthesia services?a. 01400b. 01402c. 29880-LTd. 29870-LT a. 01400 What is the correct CPT® code for a MRI performed on the brain first without contrast and then with contrast?a. 70554b. 70553c. 70552d. 70551 b. 70553 How are ambulance modifiers used?a. They identify the time elements of the ambulance service.b. They identify the mileage traveled during the encounter.c. They identify ambulance place of origin and destination.d. they identify emergency or non-emergency transport types. c. They identify ambulance place of origin and destination. What is the correct CPT® code for the wedge excision of a nail fold of an ingrown toenail? 11765 Rationale: In the CPT® Index, look for Excision/Nail Fold referring you to 11765. A patient is taken to surgery for removal of a squamous cell carcinoma of the right thigh. What is the correct diagnosis code for today’s procedure?a. C44.722b. C44.702c. D79.89d. C79.2 a. C44.722 In ICD-10-CM, what type of burn is considered corrosion? Burns due to chemicals Joe has a terrible problem with ingrown toenails. He goes to the podiatrist to have a nail permanently removed along with the nail matrix. What CPT® code is reported?a. 11720b. 11730c. 11750d. 11765 c. 11750 The patient is seen for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest area and was continued on the right and the lateral trochanteric and posterior aspect of the medial thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a compression garment was applied. What CPT® codes are reported?a. 15877, 15878-50-51b. 15877, 15879-50-51c. 15830, 15839-50-51, 15847d. 15830, 15832-50-51 b. 15877, 15879-50-51 The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a fragment of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, and we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it; the mass was removed. There was a granuloma capsule around this, containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal. He wanted me to, and so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene.What CPT® and ICD-10-CM codes are reported?a. 10121, L92.3, Z18.10, Z85.828b. 11010, M79.5, Z18.10, Z85.828c. 10121, M79.5, Z18.10, Z85.828d. 11010, S01.84XA, Z18.10, Z85.828 a. 10121, L92.3, Z18.10, Z85.828 In ICD-10-CM, what classification system is used to report open fracture classifications?a. Gustilo classification for open fracturesb. PHF classification of fracturesc. Danis-Weber classificationd. Muller AO classification of fractures a. Gustilo classification for open fractures A patient presented with a right ankle fracture. After induction of general anesthesia, the right leg was elevated and draped in the usual manner for surgery. A longitudinal incision was made parallel and posterior to the fibula. It was curved anteriorly to its distal end. The skin flap was developed and retracted anteriorly. The distal fibula fracture was then reduced and held with reduction forceps. A lag screw was inserted from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then applied to the lateral contours of the fibula with cortical and cancellous bone screws. Final radiographs showed restoration of the fibula. The wound was irrigated and closed with suture and staples on the skin. Sterile dressing was applied followed by a posterior splint. What CPT® code is reported?a. 27823-RTb. 27792-RTc. 27814-RTd. 27787-RT b. 27792-RT A 49-year-old female presented with chronic deQuervain’s disease and has been unresponsive to physical therapy, bracing or cortisone injection. She has opted for more definitive treatment. After induction of anesthesia, the patient’s left arm was prepared and draped in the normal sterile fashion. Local anesthetic was injected using a combination 2% lidocaine and 0.25% Marcaine. A transverse incision was made over the central area of the first dorsal compartment. The subcutaneous tissues were gently spread to protect the neural and venous structures. The retractors were placed. The fascial sheath of the first dorsal compartment was then incised and opened carefully. The underlying thumb abductor and extensor tendons were identified. The tissues were dissected and the extensor retinaculum of the first extensor compartment was incised. The fibrotic tissue was incised and the tendons gently released. The tendons were freely moving. Subcutaneous tissues were closed with a 3-0 Vicryl and the skin with 3-0 Prolene subcuticular closure. Steri-strips, Xeroform and dry sterile dressings were applied. What CPT® code is reported?a. 28085-LTb. 25001-LTc. 25118-LTd. 25000-LT d. 25000-LTRationale:The report states the extensor retinaculum of the first extensor compartment was incised. Look in CPT index for Incision/Wrist/Tendon Sheath 25000-25001. Code 25000 shows deQuervain’s disease in the description. Modifier LT is appended to inciate procedure isperformed on the left side. A 45-year-old presents to the operating room with a right index trigger finger and left shoulder bursitis. The left shoulder was injected with 1 cc of Xylocaine, 1 cc of Celestone and 1 cc of Marcaine. An approximately 1-inch incision was made over the A1 pulley in the distal transverse palmar crease. This incision was taken through skin and subcutaneous tissue. The A1 pulley was identified and released in its entirety. The wound was irrigated with antibiotic saline solution. The subcutaneous tissue was injected with Marcaine without epinephrine. The skin was closed with 4-0 Ethilon suture. Clean dressing was applied. What CPT® codes are reported?a. 20553-F6, 20610-51-LTb. 20552-F6, 20605-52-LTc. 26055-F6, 20610-76-LTd. 26055-F6, 20610-51-LT d. 26055-F6, 20610-51-LT A 3-year-old is brought into the ED crying. He cannot bend his left arm after his older brother twisted it. X-ray is performed and the ED physician diagnoses the patient has a dislocated nursemaid elbow. The ED physician reduces the elbow successfully. The patient is able to move his arm again. The patient is referred to an orthopedist for follow-up care. What CPT® and ICD-10-CM codes are reported? a. 24640-54-LT, S53.091A, W50.2XXAb. 24600-54-LT, S53.002A, W49.9XXAc. 24640-54-LT, S53.032A, W50.2XXAd.24565-54-LT, S53.194S, Y33.XXXA c. 24640-54-LT, S53.032A, W50.2XXA What CPT® code is reported for an emergency endotracheal intubation to save the patient’s life? 31500 Rationale: In the CPT® Index, look for Intubation/Endotracheal Tube. This directs you to code 31500, which is for an emergency endotracheal intubation. An 18-month-old patient is seen in the ED unable to breathe due to a toy he swallowed which had lodged in his throat. Soon brain death will occur if an airway is not established immediately. The ED provider performs an emergency transtracheal tracheostomy. What CPT® and ICD-10-CM codes are reported?a. 31603, T17.220Ab. 31603, T17.290Ac. 31601, J34.9, T17.298Ad. 31601, 31603, T17.228A b. 31603, T17.290A What ICD-10-CM code is reported for pyopneumothorax with fistula? J86.0 A patient with chronic pneumothoraces presents for chemopleurodesis. Under local anesthesia a small incision is made between the ribs. A catheter is inserted into the pleural space between the parietal and pleural viscera. Subsequently, 5g of sterile asbestos free talc was introduced into the pleural space via the catheter. What CPT® and ICD-10-CM codes are reported? a. 32560, J93.81 b. 32650, 32560, J93.11 c. 32650, J95.811 d. 32601, 32560, J95.811 a. 32560, J93.81Response Feedback:Rationale:Chemopleurodesis is represented by codes 32560-32562. In the CPT® Index look for Pleurodesis/Instillation of Agent. Code 32560 is appropriate for the described actions taken to instill the talc used to treat recurrent pneumothorax.Look in the ICD-10-CM Alphabetic Index for Pneumothorax NOS/chronic which directs you to code J93.81. Verification in the Tabular List confirms code selection. A 25-year-old male presents with a deviated nasal septum. The patient undergoes a nasal septum repair and submucous resection. Cartilage from the bony septum was detached and the nasoseptum was realigned and removed in a piecemeal fashion. Thereafter, 4-0 chronic was used to approximate mucous membranes. Next, submucous resection of the turbinates was handled in the usual fashion by removing the anterior third of the bony turbinate and lateral mucosa followed by bipolar cauterization. What CPT® codes are reported?a. 30450, 30999-51b. 30520, 30140-51c. 30420, 30140-51d. 30620, 30999-51 b. 30520, 30140-51 Which main coronary artery bifurcates into two smaller ones?a. Leftb. Rightc. Invertedd. Superficial a. Left In the cath lab a physician places a catheter in the aortic arch from a right femoral artery puncture to perform an angiography. Fluoroscopic imaging is performed by the physician. What CPT® code(s) is/are reported?a. 36222b. 36200, 75605-26c. 36215, 75605-26d. 36221 d. 36211Rationale:The aorta is the trunk of the system, so this is a non-selective catheterization. Look in CPT Index for Angiography/Cervicocerebral Arch. Only one code is reported for the catheterization and fluoroscopic imaging which is code 36221 Which statement is TRUE regarding codes for hypertension and heart disease in ICD-10-CM?A) Only one code is required to report hypertension and heart failure.B) Hypertension and heart disease have an assumed causal relationship.C) Hypertension and heart disease without a stated causal relationship must be coded separately.D) Hypertension with heart disease is always coded to heart failure. B) Hypertension and heart disease have an assumed causal relationship.Rationale: ICD-10-CM Coding Guidelines I.C.9.a states a causal relationship is presumed between hypertension and heart involvement. Only if the documentation specifically states they are unrelated, are they to be coded separately. ICD-10-CM guideline I.C.9.a.1 indicates two codes are required to report hypertension and heart failure. A patient presents for extremity venous study. Complete noninvasive physiologic studies of both lower extremities were performed. Which CPT® code is reported? 93970Rationale: Code 93970 reports a complete bilateral noninvasive physiologic study of extremity veins. This study is found in the CPT® Index by looking for Vascular Studies/Venous Studies/Extremity which directs you to 93970-93971. Modifier 50 is not appended because the term bilateral is included in the code description for 93970. When reporting an encounter for screening of malignant neoplasms of the intestinal tract, what does the 5th character indicate?A) History of malignancy in the intestinal tractB) Laterality of the intestinal tractC) Anatomic location being screened in the intestinal tractD) Screening codes for malignant neoplasms of the intestinal tract are only reported with four characters. C) Anatomic location being screened in the intestinal tract Bile empties into the duodenum through what structure?A) Pyloric sphincterB) Biliary arteryC) Common bile ductD) Common hepatic duct C) Common Bile Duct What ICD-10-CM code is reported for non-erosive duodenitis?a. K29.80b. K29.90c. K29.81d. K29.91 a. K29.80 A 57-year-old patient with chronic pancreatitis presents to the operating room for a pancreatic duct-jejunum anastomosis by the Puestow-type operation. What CPT® and ICD-10-CM codes are reported for the encounter?a. 48548, K85.90b. 48520, K86.1c. 48520, K85.80d. 48548, K86.1 d. 48548, K86.1 The urologist is called to the operating room to repair a kidney laceration status post MVA. The urologist examines the kidney and repairs a small 2 cm laceration of the kidney. What CPT® code is reported for this service?a. 50525b. 50520c. 50500d. 50526 c. 50500 Transurethral resection of bladder neck and nodular prostatic regrowth. What CPT® code is reported for this service?a. 55801b. 52630c. 52500d. 52640 b. 52630Rationale:CPT 52630 is reported for a transurethral resection of residual or regrowth of the prostatic tissue. In the the CPT index look for Transurethral Procedure/Prostate/Resection. CPT 52500 is a separate procedure and considered an integral part of the prostate resection. CPT 52640 is used for the transurethral resection of a postoperative bladder neck contracture. A 63-year-old male presents for the insertion of an artificial inflatable urinary sphincter for urinary incontinence. A 4.5 cm cuff, 22 ml balloon, 61-70 mmHg artificial inflatable urinary sphincter was inserted. What CPT® code is reported for this service? 53445Rationale: In the CPT® Index look for Insertion/Prosthesis/Urethral Sphincter. You’re directed to 53444-53445. Codes 53446-53448 are for the removal or removal/replacement of the inflatable sphincter. CPT® 53445 describes the insertion of an inflatable urethra/bladder neck sphincter, including placement of pump, reservoir and cuff. The patient has significant morbid obesity and her pannus has been retracted to help with dissection. The planned procedure is to place a catheter/tube to drain the bladder. It is apparent she has quite a bit of scarring from her previous surgeries and appears to have an old sinus tract just above the symphysis. A midline incision is made following her old scar from just above the symphysis for a length of about 4-6cm. The sinus tract was excised, as this was also in the midline, and carefully dissected down to the level of the fascia. It does not appear to be an actual hernia, as there are no ventral contents within it. Again, there is quite a bit of distortion from previous scarring because of the obesity, but staying in the midline, the fascia is incised just above the symphysis of a length of about 2cm. The fat and scar are incised above the fascia more superiorly and with palpation, mesh from a previous hernia repair is felt. This was not palpable prior to the incision because of her body habitus. The mesh was not exposed or entered, it comes down quite close to the symphysis and certainly is too close to place a suprapubic (SP) tube. There is concern the mesh may become infected with an SP tube tract right there. Therefore, decision to abort the procedure is made. What CPT® code and modifier are reported for this service?a. 51040-53b. 51040-52c. 51102-53d. 51050-52 a. 51040-53 What does the abbreviation VBAC mean? Vaginal Birth After Cesarean A patient is seen for three extra visits during the third trimester of her 30-week pregnancy because of her history of pre-eclampsia during her previous pregnancy which puts her at risk for a recurrence of the problem during this pregnancy. No problems develop. What diagnosis code(s) is/are reported for these three extra visits?a. O09.893, Z3A.30b. O14.03, Z3A.30c. Z34.83d. Z34.83, O09.893, Z3A.30 a. O09.893, Z3A.30 A pregnant patient presents to the ED with bleeding, cramping, and concerns of loss of tissue and material per vagina. On examination, the physician discovers an open cervical os with no products of conception seen. He tells the patient she has had an abortion. What type of abortion has she had?a. Missedb. Inducedc. Spontaneousd. None of the above c. Spontaneous Mrs. Smith is visiting her mother and is 150 miles away from home. She is in the 26th week of pregnancy. In the late afternoon she suddenly feels a gush of fluids followed by strong uterine contractions. She is rushed to the hospital but the baby is born before they arrive. In the ED she and the baby are examined and the retained placenta is delivered. The baby is in the neonatal nursery doing okay. Mrs. Smith has a 2nd degree perineal laceration secondary to precipitous delivery which was repaired by the ED physician. She will return home for her postpartum care. What ICD-10-CM and CPT® codes are reported by the ED physician?a. 59409, O80, Z3A.26, Z37.0b. 59409, 59414-51, 59300-51, O62.3, O70.1, Z3A.26, Z37.0c. 59414, 59300-51, O62.3, O70.9, Z3A.26, Z37.0d. 59414, 59300-51, O73.0, O70.1, Z3A.26, Z37.0 d. 59414, 59300-51, O73.0, O70.1, Z3A.26, Z37.0 Migraines are reported from what category in ICD-10-CM?a) F02b) G00c) G30d) G43 d) G43 A patient with a status post (after or following) lumbar puncture headache receives an epidural blood patch. The patient’s venous blood is injected into the lumbar epidural space; this blood forms a clot sealing the leak of CSF from the lumbar puncture. What CPT® and ICD-10-CM codes are reported?a. 62273, G97.1b. 62281, G44.1c. 62282, G97.1d. 62273, G44.1 a. 62273, G97.1 What ICD-10-CM code is used for spinal meningitis?a. G03.9b. A87.9c. G04.90d. A39.9 a. G03.9 A 47-year-old male presents with chronic back pain and lower left leg radiculitis. A laminectomy is performed on the inferior end of L5. The microscope is used to perform microdissection. There was a large extradural cystic structure on the right side underneath the nerve root as well as the left. The entire intraspinal lesion was evacuated. What CPT® code(s) is/are reported for this procedure?a. 63252, 69990b. 63267, 69990c. 63277d. 63272 b. 63267, 69990 What ICD-10-CM code is reported for mild nonproliferative diabetic retinopathy with macular edema?a. E11.3599b. E11.3399c. E11.3219d. E11.3199 c. E11.3219 The provider makes an incision in the patient’s left tympanic membrane in order to inflate eustachian tubes and aspirate fluid in a patient with acute eustachian salpingitis. The procedure is completed without anesthesia. What CPT® and ICD-10-CM codes are reported?a. 69421, H68.012b. 69420, H68.012c. 69421, H68.022d. 69420, H68.022 b. 69420, H68.012 A patient with a cyst like mass on his left external auditory canal was visualized under the microscope and a microcup forceps was used to obtain a biopsy of tissue along the posterior superior canal wall. What CPT® code is reported?a. 69105-LTb. 69140-RTc. 69145-LTd. 69100-RT a. 69105-LT A 26-year-old female with a one-year history of a left tympanic membrane perforation. She has extensive tympanosclerosis with a nonhealing perforation. Her options, including observation with water precautions or surgery, were discussed. The patient wished to proceed with surgery. With use of the operating microscope, the surgeon performs a left lateral graft tympanoplasty. What CPT® code is reported? 69631-LTRationale: During the procedure, a tympanoplasty is performed. There is no mention of a mastoidectomy or ossicular chain reconstruction being performed. From the CPT® Index look for Tympanoplasty/without Mastoidectomy then verify the code in the numeric section. Modifier LT is used to indicate the procedure was performed on the left ear. What are the three classifications of anesthesia?a. General, regional, and epiduralb. General, regional, and monitored anesthesia carec. General, regional, and moderate sedationd. General, MAC, and conscious sedation b. General, regional, and monitored anesthesia care What is the ICD-10-CM coding for personal history of colonic polyps?a. Z83.71b. K51.418c. K63.5d. Z86.010 d. Z86.010 A patient undergoes heart surgery for angina decubitus and coronary artery disease (CAD). What ICD-10-CM coding is reported?a. I25.118b. I25.10c. I20.9d. I25.119 a. I25.118 A patient presents to the OR for a craniotomy with evacuation of a hematoma. What CPT® coding is reported for the anesthesiologist’s services?a. 00210b. 61312c. 61314d. 00211 d. 00211 An anesthesiologist is medically supervising six cases concurrently. What modifier is reported for the anesthesiologist’s service?a. QXb. QKc. AAd. AD d. AD A patient arrives at the urgent care facility with a swollen ankle. Anteroposterior and lateral view X-rays of the ankle are taken to determine whether the patient has a fractured ankle. What CPT® code(s) is/are reported? a. 73600 X 2b. 73610c. 73600, 73610d. 73600 d. 73600 A 32-year-old patient with cervical cancer is in an outpatient facility to have HDR brachytherapy. The cervix is dilated and under ultrasound guidance six applicators are inserted with iridium via the vagina to release its radiation dose. The placement is in the cervical cavity (intracavitary). What CPT® code is reported for the physician service? 77762-26Response Feedback:Rationale: Patient is receiving a type of internal radiation therapy delivering a high dose of radiation (HDR) from implants (applicators with the iridium) placed via the vaginal cavity (intracavitary). This is found in the CPT® Index by looking for Brachytherapy/Intracavitary Application directing you to 0395T, 77761-77763. The CPT® subsection guidelines under the heading Clinical Brachytherapy, definitions are given to differentiate simple, intermediate and complex brachytherapy. Code 77762 is reported for the intracavitary application of five to 10 sources (intermediate); six applicators were used for this procedure making 77762 the correct code. A patient who may have a stricture of the artery is undergoing an aortogram in which the left femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta. Contrast medium was injected, and films taken by serialography showing the aortoiliac inflow vessels were widely patent. The bilateral common femoral arteries appear normal. What CPT® codes are reported for the professional component?a. 36200, 75625-26b. 36200, 75805-26c. 36200, 75630-26d. 36200, 75635-26 c. 36200, 75630-26 Myocardial Perfusion Imaging (MPI)—Office Based TestIndications: Chest pain.Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion.Findings: This is a technically fair study. There was no stress induced electrocardiographic changes noted. There were no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%.Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. What CPT® code(s) is/are reported?a. 78453b. 78452c. 78454d. 78472 b. 78452 HCPCS Level II codes specifically for Pathology and Laboratory services all start with what letter?a. Gb. Ac. Pd. Q c. P A physician orders a General Health Panel, all tests except a creatinine, including CBC with automated differential. What CPT® code(s) is/are reported?a. 80050-52b. 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520c. 80050d. 80050-22 b. 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520 What diagnosis codes are reported for metastatic adenocarcinoma to the lungs from an unknown primary location?a. D49.1, D49.9b. D02.21, D02.22, C34.90c. C78.01, C78.02, C80.1d. C34.90, C80.1 c. C78.01, C78.02, C80.1 Flow cytometry is performed for DNA analysis. What CPT® code is reported?a. 88184b. 88182c. 88187d. 88189 b. 88182 According to CPT® guidelines, what is the first step in selecting an evaluation and management code for an E/M service provided in a hospital?a. Determine if time is the determining componentb. Determine the level of historyc. Review the code descriptors and examples for the category or subcategory selected.d. Determine the level of medical decision making c. Review the code descriptors and examples for the category or subcategory selected. A 32-year-old patient sees Dr. Smith for a consult at the request of his PCP, Dr. Long, for an ongoing problem with allergies. The patient has failed Claritin and Alavert and feels his symptoms continue to worsen. Dr. Smith performs an expanded problem focused history and exam and discusses options with the patient on allergy management. The MDM is straightforward. The patient agrees he would like to be tested to possibly gain better control of his allergies. Dr. Smith sends a report to Dr. Long thanking him for the referral and includes the date the patient is scheduled for allergy testing. Dr. Smith also includes his findings from the encounter. What E/M code is reported?a. 99203b. 99242c. 99243d. 99214 b. 99242 A 75-year-old established patient sees his regular primary care provider for a physical screening prior to joining a group home. He has no new complaints. The patient has an established diagnosis of cerebral palsy and type 2 diabetes and is currently on his meds. A comprehensive history and examination is performed. The provider counsels the patient on the importance of taking his medication and gives him a prescription for refills. Blood work was ordered. PPD was done and flu vaccine given. Patient already had a vision exam. No abnormal historical facts or finding are noted. What CPT® code is reported?a. 99387b. 99214c. 99215d. 99397 d. 99397 A 28-year-old female patient is returning to her provider’s office with complaints of RLQ pain and heartburn with a temperature of 100.2. The provider performs a medically appropriate history and exam. Abdominal ultrasound is ordered and the patient has mild appendicitis. The provider prescribes antibiotics to treat the appendicitis in hopes of avoiding an appendectomy. What are the correct CPT® and ICD-10-CM codes for this encounter?a. 99213, K37, R12b. 99202, R10.31, K37c. 99203, K37d. 99203, R50.9, R12, R10.31, K37 a. 99213, K37, R12 A child with suspected sleep apnea was given an apnea monitoring device to use over the next month. The device was capable of recording and storing data relative to heart and respiratory rate and pattern. The pediatric pulmonologist reviewed the data and reported to the child’s primary pediatrician. What CPT® code(s) is/are reported for the monitor attachment, download of data, provider review, interpretation and report? a. 94775, 94776, 94777b. 95800c. 95806d. 94774 d. 94774 A 5 week old infant shows signs of fatigue after eating and has poor weight gain. He is suspected to have a congenital heart defect. The neonatologist ordered a transthoracic echocardiogram (TTE). TTE is showing a shunt between the right and left ventricles. The neonatologist read and interpreted the study and indicated the patient has a ventricular septal defect (VSD). What are the CPT® and ICD-10-CM codes for the TTE read?a. 93303-26, Q21.0b. 93312-26, Q21.0c. 93312, I51.0d. 93303, I51.0 a. 93303-26, Q21.0 A teenager has been chronically depressed since the separation of her parents 1 year ago and moving to a new city. Her school grades continued to slip and she has not made new friends. She has frequent crying episodes and is no longer interested in her appearance. She has attended the community mental health center and participates in group sessions. Recently her depression exacerbated to the point inpatient admission was required. The provider diagnosed adjustment disorder with emotional and conduct disturbances. Due to the length of the depression and no real improvement, the provider discussed electroconvulsive therapy with her mother. After discussing benefits and risks, the mother consented to the procedure. What CPT® and ICD-10-CM codes are reported for the electroconvulsive therapy?a. 90882, F43.25b. 90870, F43.25c. 90870, F43.24, F43.25d. 90867, F43.24, F43.25 b. 90870, F43.25 A patient with hypertensive end stage renal failure, stage 5, and secondary hyperparathyroidism is evaluated by the provider and receives peritoneal dialysis. The provider evaluates the patient once before dialysis begins. What CPT® and ICD-10-CM codes are reported?a. 90947, I12.0, N25.81b. 90945, I10, N18.5, Z99.2, N25.81c. 90945, I12.0, N18.6, Z99.2, N25.81d. 90947, I12.0, N18.5, Z99.2 c. 90945, I12.0, N18.6, Z99.2, N25.81 PREOPERATIVE DIAGNOSIS : Heart BlockPOSTOPERATIVE DIAGNOSIS: Heart BlockANESTHESIA: Local anesthesiaNAME OF PROCEDURE: Reimplantation of dual chamber pacemakerDESCRIPTION: The chest was prepped with Betadine and draped in the usual sterile fashion. Local anesthesia was obtained by infiltration of 1% Xylocaine. A subfascial incision was made about 2.5 cm below the clavicle, and the old pulse generator was removed. Using the Seldinger technique, the subclavian vein was cannulated and through this, the old atrial lead was removed, and a new atrial lead (serial # 6662458) was placed in the right atrium and to the atrial septum. Thresholds were obtained as follows: The P-wave was 1.4 millivolts, atrial threshold was 1.6 millivolts with a resultant current of 3.5 mA and resistance of 467 ohms.Using a second subclavian stick in the Seldinger technique, the old ventricular lead was removed and a new ventricular lead (serial # 52236984) was inserted and placed into the right ventricular apex. The thresholds were obtained and were as follows: R-wave was 23.5 millivolts. The patient was pacing at 100% at 0.5 volts, with resultant current of 0.8 mA and resistance of 480 ohms. When we were satisfied with the thresholds, the leads were connected to the pacemaker generator (serial # 22561587), which was inserted into the previously created pocket.The wound was thoroughly irrigated with antibiotic solution and hemostasis was obtained. The incision was closed in layered fashion with 2-0 Dexon. A compressive dressing was applied, and the patient tolerated the procedure very well. He was taken to the recovery room in satisfactory condition. What CPT® codes are reported?a. 33235, 33208-51, 33233-51b. 33208, 33238-51, 33241-51c. 33202, 33233-51d. 33207, 33206-51, 33226-51 a. 33235, 33208-51, 33233-51 Operative ReportPREOPERATIVE DIAGNOSIS:Prolapsed vitreous in anterior chamber with corneal edemaPOSTOPERATIVE DIAGNOSIS:SameOPERATION PERFORMED:Anterior vitrectomyThe patient is a 72-year-old woman who approximately 10 months ago underwent cataract surgery with a YAG laser capsulotomy, developed corneal edema and required a corneal transplant. The patient has done well. Over the last few weeks, she developed posterior vitreous detachment with vitreous prolapse to the opening in the posterior capsule with vitreous into the anterior chamber with corneal touch and adhesion to the graft host junction and early corneal edema. The patient is admitted for anterior vitrectomy.PROCEDURE: The patient was prepped and draped in the usual manner after first undergoing retrobulbar anesthetic. A lid speculum was inserted. An incision was made at approximately the 10 o’clock meridian 3 mm in length, 2 mm posterior to the limbus, and grooved forward into clear cornea with a 3.2 mm anterior chamber. An anterior vitrectomy was carried out, placing a visco-elastic substance in the anterior chamber to maintain it. A Sinskey hook was used to sweep vitreous away from the corneal wound and this was removed with the disposable vitrectomy instrument. The patient’s pupil is noted to be round. There was no vitreous to the wound. The wound self-sealed without aqueous leak. Cautery was used to close the conjunctiva. Subconjunctival Decadron and Gentamicin was given. The patient tolerated the procedure well and was discharged to the recovery room in good condition. What CPT® code(s) is/are reported?a. 65810b. 67015, 67028, 65810, 67025c. 67010d. 67005 c. 67010 Operative ReportIndications: This is a third follow-up EGD dilation on this 40-year-old patient for a pyloric channel ulcer which has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation.Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray.Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The pyloric channel was again widened. The ulcer, as previously seen, was well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into the second portion of the duodenum, revealing normal mucosa. Marked deformity and scarring was seen in the proximal bulb. Following the diagnostic exam, a 15 mm balloon was placed across the stricture, dilated to maximum pressure, and withdrawn. There was minimal bleeding post-op. Much easier access into the duodenum was accomplished after the dilation. Follow-up biopsies were also taken to evaluate Helicobacter noted on a previous exam. The patient tolerated the procedure well.Impressions: Pyloric stricture secondary to healed pyloric channel ulcer, dilated.Plan: Check on biopsy, continue Prilosec for at least another 30 days. At that time, a repeat endoscopy and final dilation will be accomplished. He will almost certainly need chronic H2 blocker therapy to avoid recurrence of this divesting complicated ulcer.What CPT® and ICD-10-CM codes are reported?a. 43248, 43239-59, K31.5, Z87.19b. 43235, 43239-51, K31.4, Z87.19c. 43236, 43239-59, K31.1, Z87.11d. 43245, 43239-51, K31.1, Z87.11 d. 43245, 43239-51, K31.1, Z87.11 Benign prostatic hypertrophy with outlet obstruction and hematuria.Operation: TURPAnesthesia: SpinalDescription of procedure: The patient was placed on the operating room table in a sitting position and spinal anesthesia induced. He was placed in the lithotomy position, prepped and draped appropriately. Resection began at the posterior bladder neck and extended to the verumontanum (a crest near the wall of the urethra). Posterior tissue was resected first from the left lateral lobe, then right lateral lobe, then anterior. Depth of resection was carried to the level of the circular fibers. Bleeding vessels were electrocauterized as encountered. Care was taken to not resect distal to the verumontanum, thus protecting the external sphincter. At the end of the procedure, prostatic chips were evacuated from the bladder. Final inspection showed good hemostasis and intact verumontanum. The instruments were removed, Foley catheter inserted and the patient returned to the recovery area in satisfactory condition. What CPT® code is reported for this service?a. 52640b. 52601-50c. 52630d. 52601 d. 52601Rationale:TURP is a Transurethral Resection of the Prostate and reported with 52601. In the CPT index TURP directs you to see Prostatectomy, Transurethral 52601, 52630. A TURP is not a bilateral procedure and is not reported with modifier 50. Code 52630 is reported when it is done for residual growth of the obstructive prostate tissue. Operative ReportPROCEDURE: Left L3-L4 peri-articular paravertebral facet joint injection.PATIENT HISTORY: The patient is a 67-year-old woman referred by Dr. X for repeat diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral facet joint injection. She had no relief of symptoms from that injection.TECHNIQUE: The patient was positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically, despite trying numerous angles. This was explained to the patient who wished to proceed with the injection. A 22-gauge 6-inch spinal needle was advanced toward the region of the left L3-L4 paravertebral facet joint under fluoroscopic guidance. Injection of 0.5 cc of Isovue 200 contrast showed the needle was not in an intravascular location.Intra-articular placement could not be confirmed and the injection was presumed to be peri-articular. 2 cc containing equal parts preservative free 2% Lidocaine plus Depo-Medrol (80 mg per ml) was injected. The patient reported injection of medication produced discomfort in the region of her usual left low back pain. Immediately following the procedure, upon standing up from the procedure table, she reported her pain was a little bit better.What CPT® code(s) is/are reported for this procedure?a. 64493-50, 77003b. 64493-50-26c. 64493-26d. 64493 d. 64493Rationale:Nerve block injections are selected based on location and number of levels. Code 64493 is described as a paravertebral facet joint of lumbar spine, single level. This code descriptor includes imaging guidance, and it is not reported separately. In CPT index look for Injections/Paravertebral Facet Joint/Nerve/with image guidance. A patient with a long history of endometriosis has an open surgical approach to perform an exploratory laparotomy for an enlarged right ovary seen on ultrasound with other possible masses on the uterus and in the peritoneum. Exploration reveals these masses to be endometriosis including a chocolate cyst (endometrioma) of the right ovary, right fallopian tube and peritoneum. The endometriomas are all small, less than 5 cm, and laser is used to ablate them, except the ovarian cyst, which is excised. During the procedure the patient also has a tubal ligation. What are the CPT® and ICD-10-CM codes reported for this service?a. 49203, 58611, N80.1, N80.2, N80.3, Z30.2b. 58662, 58600-51, N80.1, N80.2, N80.3, Z30.2c. 49203, 58671-51, N80.8d. 49000, 58662-51, 58925-51, 58671-51, N80.1, N80.2, N80.3, Z30.2 a. 49203, 58611, N80.1, N80.2, N80.3, Z30.2 Preoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangiomaPostoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangiomaProcedures Performed: Aspiration of left orbital cyst with injection of KenalogAnesthesia: GeneralComplications: NoneEstimated Blood Loss: MinimalIndications for Procedure: The patient presents with a small cyst of the superior medial left orbit felt to be suggestive for hemangioma versus lymphangioma. Risks, benefits, and alternatives of steroid injection to inactivate the cyst were reviewed. These risks included failure to work and significant visual loss. After discussion, they elected to proceed.Description of Procedure: After informed operative consent was obtained, the patient was brought to the operating room and laid in the supine position. General anesthetic was administered per the anesthesiologist. A 25-gauge needle on a 5-cc syringe was placed within the mass and aspirated. Approximately 0.5 cc of blood was recovered, but the blood was of normal bright red color.Kenalog 40 mg (1 cc) was then injected where the mass was aspirated without difficulty. Operative area was clean and dry. The patient was then awakened and taken to the recovery room. Pupil reactions were brisk and equal with 2 mm pupils noted in the recovery room. There were no operative complications. What CPT® and ICD-10-CM codes are reported?a. 67405-LT, D18.1b. 67500-LT, D18.09c. 67515-LT. H05.812d. 67415-LT, H05.812 d. 67415-LT, H05.812Rationale:The provider aspirated a cyst that was in the left orbit. In the CPT index look for Aspiration/Orbital Contents referring you to code 67415. Code 67500 is reported when there is an injection of a therapeutic or local anesthetic behind the eyeball(retrobulbar). Diagnoses documented as versus are not definitive diagnosis codes and are not coded. The postoperative header indicates and orbital cyst. In the ICD-10-CM alphabetical index look for Cyst/orbit referring you to code H05.81. Verify code in the Tabular List. A 6th character is required to indicate which eye; 2 is reported for the left eye. PROCEDURES PERFORMED:1. Bilateral facet joint injections, L4-L52. Bilateral facet joint injections, L5-S1.3. Fluoroscopy.TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the desired levels were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual palpation located the sacral hiatus. The 6-inch, 20-gauge needle with a slight volar bend was inserted using fluoroscopy into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were injected in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient tolerated the procedure well with no complications and was transferred to recovery in good condition. What CPT® codes are reported?a. 64493-50 x 2b. 64493-50, 64494-50-51, 77002-26c. 64493-50, 64494 x 2, 77002-26d. 64493-50, 64494 x 2 d. 64493-50, 64494 x 2 A 65-year-old was admitted in the hospital two days ago and is being examined today by his primary care physician, who has been seeing him since he has been admitted. Primary care physician is checking for any improvements or if the condition is worsening.CHIEF COMPLAINT: CHFINTERVAL HISTORY: CHF symptoms worsened since yesterday.Now has some resting dyspnea. HTN remains poorly controlled with systolic pressure running in the 160s. Also, I’m concerned about his CKD, which has worsened, most likely due to cardio-renal syndrome.REVIEW OF SYSTEMS: Positive for orthopnea and one episode of PND. Negative for flank pain, obstructive symptoms or documented exposure to nephrotoxins.PHYSICAL EXAMINATION:GENERAL: Mild respiratory distress at restVITAL SIGNS: BP 168/84, HR 58, temperature 98.1.LUNGS: Worsening bibasilar cracklesCARDIOVASCULAR: RRR, no MRGs.EXTREMITIES: Show worsening lower extremity edema.LABS: BUN 56, creatinine 2.1, K 5.2, HGB 12.IMPRESSION:1. Severe exacerbation of CHF2. Poorly controlled HTN3. Worsening ARF due to cardio-renal syndromePLAN:1. Increase BUMEX to 2 mg IV Q6.2. Give 500 mg IV DIURIL times one.3. Re-check usual labs in a.m.Total time: 20 minutes.What E/M category is used for this visit?a. Inpatient Consultation (99251-99255)b. Initial Hospital Visit (99221-99223)c. Established Patient Office/Outpatient Visit (99211-99215)d. Subsequent Hospital Visit (99231-99233) d. Subsequent Hospital Visit (99231-99233) Operative Report:Pre-Operative Diagnoses:Basal Cell Carcinoma, foreheadBasal Cell Carcinoma, right cheekSuspicious lesion, left noseSuspicious lesion, left foreheadPost-Operative Diagnoses: Basal Cell Carcinoma, forehead with clear marginsBasal Cell Carcinoma, right cheek with clear marginsCompound nevus, left nose with clear marginsEpidermal nevus, left forehead with clear marginsINDICATIONS FOR SURGERY: The patient is a 47-year-old white man with a biopsy proven basal cell carcinoma of his forehead and a biopsy proven basal cell carcinoma of his right cheek. We were not quite sure of the patient’s location of the basal cell carcinoma of the forehead whether it was a midline lesion or lesion to the left. We felt stronger about the midline lesion, so we marked the area for elliptical excision in relaxed skin tension lines of his forehead with gross normal margins of 1-2 mm and I marked the lesion of the left forehead for biopsy. He also had a lesion of his left alar crease we marked for biopsy and a large basal cell carcinoma of his right cheek, which was more obvious. This was marked for elliptical excision with gross normal margins of 2-3 mm in the relaxed skin tension lines of his face. I also drew a possible rhomboid flap that we would use if the wound became larger. He observed all these margins in the mirror, so he could understand the surgery and agree on the locations, and we proceeded.DESCRIPTION OF PROCEDURE: All four areas were infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion of the forehead measuring 6 mm and right cheek measuring 1.3 cm as I had drawn them and sent in for frozen section. The biopsies were taken of the left forehead and left nose using a 2-mm punch, and these wounds were closed with 6-0 Prolene. Meticulous hemostasis was achieved of those wounds using Bovie cautery. I closed the cheek wound first. Defects were created at each end of the wound to facilitate primary closure and because of this I considered a complex repair and the wound was closed in layers using 4-0 Monocryl, 5-0 Monocryl and 6-0 Prolene, with total measurement of 2.1 cm. The forehead wound was closed in layers using 5-0 Monocryl and 6-0 Prolene, with total measurement of 1.0 cm. Loupe magnification was used and the patient tolerated the procedure well.What ICD-10-CM codes are reported?a. C44.202, C44.40, D22.23, D22.39b. C44.319, D04.39, D48.5, D22.39c. C44.319, D22.39d. C44.202, C44.309, D48.5, D49.2 c. C44.319, D22.39 What type of insurance is Medicare Part D?a. Hospital coverage available to all Medicare beneficiaries.b. A Medicare Advantage program managed by private insurers.c. Provider coverage requiring monthly premiums.d. Prescription drug coverage available to all Medicare beneficiaries d. Prescription drug coverage available to all Medicare beneficiaries HITECH provides a day window during which any violation not due to willful neglect may be corrected without penalty.a. 45b. 60c. 30d. 40 c. 30
The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer? a. Part Db. Part Cc. Part Ad. Part B b. Part C
Which CMS product describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare? a. Medicare Physician Fee Schedule Final Ruleb. Medicare Claims Processing Manualc. National Coverage Determinations Manuald. Relative Value Files c. National Coverage Determinations Manual
If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage? a. Centers for Medicare & Medicaid Services (CMS)b. Current Procedural Terminology (CPT®) guidelinesc. Medicare Administrative Contractor (MAC)d. The physician providing the service c. Medicare Administrative Contractor (MAC)
Which does NOT contribute to refraction in the eye? a. Cornea b. Aqueousc. Maculad. Lens c. Macula
Which part of the brain controls blood pressure, heart rate and respiration?a. Cerebellumb. Medullac. Cerebrumd. Cortex b. Medulla
Upon leaving the stomach, nutrients move through the small intestine in what order? a. Duodenum, jejunum, ileum.b. Jejunum, ileum, duodenum c. Jejunum, duodenum, ileumd. Duodenum, ileum, jejunum a. Duodenum, jejunum, ileum.
Bone marrow harvesting is a procedure to obtain bone marrow from a donor. Bone marrow collected from a close relative is:a. Autoinfusionb. Allogenicc. Alloplastyd. Autologous b. Allogenic
A respiratory disease characterized by overexpansion and destruction of the alveoli is identified as:a. Respiratory distress syndromeb. Emphysemac. Pneumoconiosisd. Cystic fibrosis b. Emphysema
The terms malignant, benign, in situ and uncertain behavior are all terms used when coding what?a. Seedsb. Lumpsc. Skin rashesd. Neoplasms d. Neoplasms
What do brackets [ ] indicate in the ICD-10-CM Alphabetic Index?a. Use the code(s) in brackets first.b. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation.c. Use the code(s) in brackets as the only code.d. Do not assign the code in brackets. b. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation.
What is the ICD-10-CM code for nausea?a. R11.0b. R11.11c. T75.3XXAd. R11.2 a. R11.0
A 45-year-old female with malignant Müllerian duct cancer is receiving her first treatment of chemotherapy. What diagnosis codes are reported?a. C79.82, Z51.11b. C57.7, Z51.11c. Z51.11, C57.7d. Z51.11, D28.7 c. Z51.11, C57.7
A 30-year-old female patient was seen in the ED with complaints of diarrhea for the past four days. She was also complaining of lower abdominal pain. After examination, the patient was diagnosed with viral gastroenteritis. She was instructed to drink plenty of fluids and to begin eating solids only after the diarrhea has subsided. What diagnosis code(s) would be reported for this encounter?a. R10.31, R19.7b. K52.9c. A08.4, R10.84, R19.7d. A08.4 d. A08.4
What is the ICD-10-CM code for a patient with postoperative anemia due to acute blood loss during the surgery who needs a blood transfusion?a. D53.0b. D50.0c. D62d. D64.9 c. D62
A patient is having surgery to repair a recurrent left inguinal hernia without obstruction. What ICD-10-CM code is reported?a. K40.21b. K40.91c. K40.20d. K40.90 b. K40.91
A 45-year-old patient is scheduled to have an INFUSAID pump installed. He has primary liver cancer and the pump is being inserted for continuous administration of 5-FU. A pocket is created just under the skin and the pump is placed in the pocket. A catheter is attached to the pump and to the subclavian vein. The pump is filled with a chemotherapy agent provided by the hospital and the patient is given his first treatment and observed for adverse reaction and discharged to home. What ICD-10-CM codes are reported?a. Z51.11, C22.8b. Z51.11, C22.9c. C22.9, Z51.12d. C22.8, Z51.11 a. Z51.11, C22.8Rationale: ICD-10-CM Guideline I.C.2.e.2 indicates an encounter for chemotherapy code is to be reported as the primary code with a code for the cancer as secondary when the reason for the visit is solely for chemotherapy. Look in the ICD-10-CM Alphabetic Index for Chemotherapy (session) (for)/cancer Z51.11. For the malignancy, look in the ICD-10-CM Table of Neoplasms for liver/primary and use the code from the Malignant Primary column which directs the coder to C22.8. Verify code selection in the Tabular List.
A patient with hypertension presents to the outpatient hospital radiology department for an ultrasound due to a suspected suspicious mass. The patient’s provider performed an ACTH and a 24-hour urinary free cortisol and short suppression test confirming the diagnosis of Cushing’s disease. The radiology report indicated a 5.5 cm right adrenal mass that appeared well circumscribed and rounded. The final diagnosis indicated Cushing’s disease secondary to a right adrenal tumor. The hypertension is due to the Cushing’s syndrome. What ICD-10-CM codes are reported?a. D49.7, I15.2b. D49.7, E24.9, I15.2c. C74.91, E24.9, I10d. C74.91, E24.9, I15.2 b. D49.7, E24.9, I15.2Rationale: The patient has Cushing’s disease secondary to an adrenal tumor. First code the adrenal tumor. We are told that there is a right adrenal tumor; however, we are not given more information as to a specific type of adrenal tumor and whether it is benign or malignant. In the ICD-10-CM Alphabetic Index look for Tumor (see also Neoplasm, unspecified behavior, by site). Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic/adrenal and use the code from the Unspecified Behavior column directing you to D49.7. Next, in the ICD-10-CM Alphabetic Index find Cushing’s/syndrome or disease which directs the coder to E24.9. The unspecified code for Cushing’s syndrome is used because we are not given the specific type of Cushing’s the patient has. The Cushing’s syndrome is associated to the hypertension. Look for Hypertension/due to/endocrine disorder referring you to code I15.2. Verify all codes in the Tabular List.
A 58-year-old patient sees the provider for confusion and loss of memory. The provider diagnoses the patient with early onset stages of Alzheimer’s disease with dementia. What ICD-10-CM codes are reported?a. G30.0, F02.80b. F02.80, G30.0, F29, R41.3c. F02.80, G30.0d. G30.0, F02.80, F29, R41.3 a. G30.0, F02.80
What type of fracture is considered traumatic?a. Comminuted fractureb. Pathological fracturec. Stress fractured. Spontaneous fracture a. Comminuted fracture
A pregnant woman in her 40th week has gestational diabetes which is controlled by diet. What ICD-10-CM code(s) is/are reported?a. O24.113, O24.410, Z3A.40b. O24.410, Z3A.40c. O24.410, O24.913d. O24.913 b. O24.410, Z3A.40
A patient was referred to the radiology department for chronic low back pain. The radiology report indicated there was no marrow abnormality identified and the conus medullaris was unremarkable. Additional findings include: L4-L5: There is a minor diffusely bulging annulus at L4-L5. A small focal disc bulge is seen in far lateral position on the left at L4-L5 within the neural foramen. No definite encroachment on the exiting nerve root at this site is seen. No significant spinal stenosis is identified. L5-S1: There is a diffusely bulging annulus at L5-S1, with a small focal disc bulge centrally at this level. There is minor disc desiccation and disc space narrowing at L5-S1. No significant spinal stenosis is seen at L5-S1. The final diagnosis is minor degenerative disc disease at L4-L5 and L5-S1, as described. What ICD-10-CM code(s) is/are reported?a. M51.36, M51.37b. M51.36c. M51.37, M54.50d. M51.36, M54.50 b. M51.36, M51.37Response Feedback:Rationale: Look in the ICD-10-CM Alphabetic Index for Degeneration, degenerative/intervertebral disc NOS/lumbar region directing you to code M51.36. Look in the ICD-10-CM Alphabetic Index for Degeneration, degenerative/intervertebral disc NOS/lumbosacral region directing you to code M51.37. Verify code selection in the Tabular List. The low back pain is a symptom of the degenerative disc disease and is not reported separately.
A 16-year-old male is brought to the ED by his mother. He was riding his bicycle in the park when he fell off the bike. The patient’s right arm is painful to touch, discolored, and swollen. The X-ray shows a closed fracture of the ulna. What ICD-10-CM codes are reported?a. S52.201A, V18.0XXA, Y92.830b. S52.201A, V18.4XXA, Y92.831c. S52.209A, V18.4XXA, Y92.830d. S52.201A, V19.9XXA, Y92.830 a. S52.201A, V18.0XXA, Y92.830
A child is seen in a hospital based pediatric clinic for active treatment of 10% first and second degree burns to the left calf area and 5% third degree burns on her right hand. What ICD-10-CM codes are reported?a. T23.301A, T24.232A, T24.132Ab. T23.291A, T24.202Ac. T23.301A, T24.232Ad. T24.202A, T23.301A, T24.132A c. T23.301A, T24.232AResponse Feedback:Rationale: Burns are classified as burns or corrosions in ICD-10-CM. In this scenario, there is no specification as to what caused the burns, but they are stated as burns. ICD-10-CM guideline I.C.19.d.1 indicates to sequence first the code that reflects the highest degree of burn when more than one is present. In this case, the third degree burn on the right hand is listed first. In the ICD-10-CM Alphabetic Index, look for Burn/hand(s)/right/third degree directing you to T23.301-. In the Tabular List, a 7 th character A is reported for the initial encounter (active treatment). ICD-10-CM guideline I.C.19.d.2 indicates to code burns of the same site, but of different degrees to the subcategory identifying the highest degree recorded. Therefore, report second degree burns to the left calf. Look in the Alphabetic Index for Burn/calf/left/second degree T24.232. In the Tabular List a 7th character A is reported for the initial encounter. ICD-10-CM guideline I.C.19.d.6 indicates a code from category T31 is reported when there is mention of a third-degree burn involving 20% or more of the body surface. This does not apply in this case, so a code from T31 is not required (unless reporting for a burn unit or other facility requiring the additional data). The codes in the burn section have a note to use additional external cause codes to identify the source, place and intent of the burn. This information is not known in this case so it cannot be reported. Verify code selection in the Tabular List.
“What type of CPT® code is “”modifier 51 exempt”” even though there is no modifier 51 exempt symbol next to it?a. Surgery codesb. Mandated servicesc. Bilateral proceduresd. Add-on codes” d. Add-on codes
What publications does the AMA copyright and maintain?a. CPT® code book, HCPCS Level II codebook, ICD-10-CM codebookb. CPT® codenbook and CPT® Assistantc. CPT® codenbook and HCPCS Level II codebookd. AHA Coding Clinic and CPT® Assistant b. CPT® codenbook and CPT® Assistant
What modifier is used to report the termination of a surgery following induction of anesthesia due to extenuating circumstances or those that threaten the well-being of the patient?a. Modifier 53b. Modifier 22c. Modifier 52d. Modifier 54 a. Modifier 53Response Feedback:Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well-being of the patient. CPT® modifiers are found on the inside front cover and in Appendix A of the CPT® code book.
CPT® Category III codes reimburse at what level?a. 100 percentb. 85 percentc. 10 percentd. Reimbursement, if any, is determined by the payer d. Reimbursement, if any, is determined by the payerResponse Feedback:Rationale: Per AMA, there are no relative value units (RVUs) assigned to these codes. Payment for these services or procedures is based on the policies of payers.
What is the correct code for the application of a short arm cast?a. 29075b. 29280c. 29065d. 29125 a. 29075Rationale: In the CPT® Index, look for Cast/Type/Ambulatory/Short Arm. The code you are directed to use is 29075.
A patient presents to the office with a suspicious lesion of the nose. The physician takes a biopsy of the lesion and pathology determines the lesion to be uncertain. What is the correct diagnosis code to report?a. D22.39b. C44.301c. D48.5d. D49.2 c. D48.5
The patient is diagnosed with a superficial basal cell carcinoma of the neck and cheek. After discussion with the physician about different treatment options the patient decides to have these lesions destroyed using cryosurgery. Consent is obtained and the areas are prepped in a sterile fashion. With the use of cryosurgery, the physician destroys the lesion on the neck measuring 2.3 cm and the lesion on the cheek measuring 0.8 cm. What CPT® codes are reported?a. 17000, 17003b. 17273, 17281-51c. 17272, 17281-51d. 11623, 11641-51 b. 17273, 17281-51Response Feedback:Rationale: Basal cell carcinoma is a malignant lesion. In the CPT® Index, look for Destruction/Lesion/Skin/Malignant, you are directed to code range 17260-17286, 96567. 96567 is for photodynamic therapy. 17260-17286 is used for cryosurgery. Code selection is based on location and size. For the neck, a code from range 17270-17276 is selected. The neck lesion is 2.3 cm making 17273 the correct code. For the cheek, a code from range 17280-17286 is selected. The cheek lesion is 0.8 cm making 17281 the correct code choice. Modifier 51 is appended to 17281 to indicate multiple surgeries.
What CPT® code(s) would best describe treatment of 9 plantar warts removed and 6 flat warts all destroyed with cryosurgery during the same office visit?a. 17110, 17111-52b. 17110, 17003c. 17110d. 17111 d. 17111Rationale: Cryosurgery is a method of destruction using extreme cold to destroy the lesion. In the CPT® Index look for Destruction/Warts/Flat referring you to CPT® codes 17110 and 17111. In the numeric section guidelines under the Integumentary section, subheading Destruction, flat warts and plantar warts are both included in the definition of lesions. Warts are considered benign lesions; they are coded from code range 17110-17111. A total of 15 lesions were destroyed by cryosurgery. Code 17111 represents the destruction of 15 or more lesions.
Patient presents with a suspicious lesion on her left arm. With the patient’s permission the physician marked the area for excision. The margins and lesion measured a total of 0.9 cm. The wound measuring 1.2 cm was closed in layers using 4-0 Monocryl and 5-0 Prolene. Pathology later reported the lesion to be a sebaceous cyst. What codes are reported?a. 11402, L72.3b. 11401, D22.62c. 12031, 11401-51, L72.3d. 13121, 11401-51, D22.62 c. 12031, 11401-51, L72.3Response Feedback:Rationale: Understanding a sebaceous cyst is benign, look in the CPT® Index for Skin/Excision/Lesion/Benign referring you to code ragen 11400-11446. The lesion is coded based on size and location. Report 11401 for excision of the 0.9 cm arm lesion. The note also indicates the wound was closed in layers allowing for intermediate closure and is also coded based on location and size. Report 12031 for intermediate closure of 1.2 cm. Modifier 51 is appended to 11401 to show additional procedures in the same session.In the ICD-10-CM Alphabetic Index look for Cyst/sebaceous directing you to L72.3. Verify code selection in the Tabular List.
Operative ReportPre-Operative and Post-Operative Diagnosis: Squamous cell carcinoma, left legOpen wound, right legPersonal history of squamous cell carcinoma, right legINDICATIONS FOR SURGERY: The patient is an 81-year-old white man with biopsy proven squamous cell carcinoma of his left leg. I marked the areas for excision with gross normal margins of 5 mm, and I drew my planned skin graft donor site from his left lateral thigh. He also had an open wound of his right leg from a squamous cell carcinoma excised four months ago; the skin graft had not taken. We plan on re-skin grafting the area. The patient is aware of all of these markings, and understands the surgery and location.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. IV Ancef was given. I used plain lidocaine for his local anesthetic throughout the procedure until the skin grafts were inset. The anterior of his leg and the thigh were infiltrated with local anesthetic. Both lower extremities were prepped and draped circumferentially, which included the left thigh on the left side. I excised the lesion on his left leg as drawn into the subcutaneous fat. Hemostasis achieved with the Bovie cautery. I then excised the wound on his right leg to lower the bacterial counts. I took a 1-2 mm margin around the wound and excised the granulation tissue as well. Hemostasis was achieved using the Bovie cautery. I then changed gloves. A split-thickness skin graft was harvested from the left thigh using the Zimmer dermatome. This was meshed 1:5:1. By this time, the pathology returned showing the margins were clear.Skin grafts were inset on each leg wound using the skin stapler. Xeroform and gauze bolster was placed over the skin graft using 4-0 nylon. The skin graft donor site was dressed with OpSite. The legs were further dressed with heavy cast padding and the double Ace wrap. The patient tolerated the procedure well.PROCEDURES: Excision squamous cell carcinoma, left leg with excised diameter of 2.5 cm, repaired with a split-thickness skin graft measuring 5.1 cm 2. Excisional preparation of right leg wound repaired with a split-thickness skin graft measuring 3.2 cm2.What CPT® codes are reported?a. 15100, 15100-51-LT, 11603-51-LT, 15002-51-RTb. 15100, 11603-51-LTc. 15100, 11603-51-LT, 15002-51-RTd. 15100, 11403-51-LT, 15100-51-RT c. 15100, 11603-51-LT, 15002-51-RTResponse Feedback:Rationale: The first excision is for a malignant neoplasm of the left leg measuring 2.5 cm and repaired with a split thickness skin graft measuring 5.1 cm 2. In the CPT® Index look for Skin/Excision/Lesion/Malignant referring you to code range 11600-11646. The site is the leg, which narrows down the code range to 11600-11606. The size of the lesion is 2.5 cm making code 11603 correct. The second excision is a surgical wound preparation of an open wound of the right leg. Look in the CPT® Index for Skin Graft and Flap/Recipient Site Preparation directing you to code range 15002-15005. Report 15002 for the leg wound, which was repaired with a split thickness autograft measuring 3.2 cm2. Split thickness autografts are added together (5.1 cm2 + 3.2 cm2) for a total graft size of 8.3 cm2. In the CPT® Index look for Skin Graft and Flap/Split Graft referring you to codes 15100, 15101, 15120, 15121. Report 15100 for the split-thickness graft. Because the original surgery on the right leg was four months ago, this surgery is outside of any global period, so no additional modifier is needed. Modifier 51 is appended to indicate multiple procedures in the same session.
The acronym BKA means: a. bilateral knee amputationb. below knee amputationc. bursitis knee & arthritisd. bilateral knee arthritis b. below knee amputation
This 45-year-old male presents to the operating room with a painful mass of the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient’s shoulder was noted. The mass appeared to be benign in nature. With deep blunt dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported?a. 23075-RTb. 23066-RTc. 23030-RTd. 23076-RT a. 23075-RTRationale: Look in the CPT® Index for Excision/Tumor/Shoulder and you are referred to 23071-23078. Code 23075 reports the excision of a soft tissue mass (tumor), subcutaneous. The mass was removed with deep, blunt dissection; however, there is no mention of the depth and you cannot assume that the mass was subfascial because of the word deep. The measurement of the mass is not documented resulting in the default to the smallest measurement of less than 3 cm for code 23075. It is a rule of thumb that if a coder cannot ask the physician to document the size of a mass, lesion or repair in order to give the physician credit, the smallest measurement is reported. Modifier RT is appended to indicate the procedure is performed on the right side.
A 49-year-old presents with an abscess of the right thumb. The physician incises the abscess and purulent sanguineous fluid is drained. The wound is packed with iodoform packing. What CPT® code is reported?a. 26011-F5b. 10060-F5c. 26010-F5d. 10061-F5 c. 26010-F5Rationale: There are specific Incision and Drainage (I&D) procedure codes when performed on a specific anatomical area. In the CPT® Index, look for Finger/Abscess/Incision and Drainage. You are referred to 26010-26011. Review the codes to choose the appropriate service. 26010 is the correct code. Code 26011 includes extensive debridement, multiple incisions or extensive dissection. Insertion of a drain or gauze strip packing to allow continuous drainage does not constitute complicated incision and drainage.
Under general anesthesia, a 45-year-old patient was sterilely prepped. The wrist joint was injected with Marcaine and epinephrine. Three arthroscopic portals were created. The articulating surface between the scaphoid and the lunate clearly showed disruption of the ligamentous structures. We could see soft tissue pouching out into the joint; this was debrided. There was abnormal motion noted within the scapholunate articulation. At this point the C-arm was brought in. Arthroscopic instruments were placed in the joint and confirmed the location of the shaver as a probe in the scapholunate ligament. There was a significant gap between the capitate and lunate. K-wire was utilized from the dorsal surface into the lunate, restoring the space. Further examination revealed gross instability between the capitate and lunate. With the wrist in neutral position, a K-wire was passed through the scaphoid, through the capitate and into the hamate. This provided stabilization of the wrist joint. Stitches were placed, and a thumb spica cast was applied. What CPT® code(s) is/are reported?a. 29847b. 29847, 29840-51c. 29846d. 29840 a. 29847Rationale: The wrist arthroscopy and stabilization was surgically performed to provide stabilization. Look in the CPT® Index for Arthroscopy/Surgical/Wrist directing you to 29843-29847. Check the tabular listing and 29847 reports arthroscopy of the wrist with internal fixation for fracture or instability. Although several K-wires were passed, 29847 is reported only once. The diagnostic arthroscopy is included in the procedure code, 29847 and is not coded separately.
This 36-year-old female presents with an avulsed anterior cruciate ligament off the femoral condyle with a complete white on white horizontal cleavage tear of the posterior horn of the medial meniscus, causing instability. A general endotracheal anesthesia was performed, and the patient was placed supine on the operating table. The right lower extremity was prepped with Betadine and draped free. Standard arthroscopic portals were created, and the knee was systematically examined and probed. The posterior horn of the medial meniscus was noted to be buckled and frayed. This area was carefully probed and found to be irreparable. It was decided that our best option was to proceed with a limited partial meniscectomy, with the goal being to leave as much viable meniscal tissue as possible. Therefore, a medial infrapatellar portal was developed with a longitudinal stab wound. A series of straight-angled and curved basket punches was used to perform a saucerization of the damaged portion of the meniscus, leaving the intact portion of the medial meniscus in place. Debris was meticulously removed with the 4.0 meniscal cutter. Approximately 50% of the medial meniscus remained. Next, our attention was turned to the ACL repair. Through a 5 cm longitudinal anterior incision, a central one-third tendon bone was harvested. A 10 mm graft was taken and bone plug sculpted. Anterolateral notchplasty was done with a curette and polished with the burr. All debris was removed and instruments were used to ensure proper isometry. The graft was tightened in extension about 2.5 mm and actually lengthened in flexion, and this was considered acceptable. Endoscopic guides were used to create the tibial and femoral tunnels, and the edges were rasped smooth. Using a percutaneous guide pin, the graft was placed retrograde to the knee and secured proximally with an 8 x 25 mm interference screw. The knee was put through range of motion, and with the leg in 30 degrees of flexion with the posterior drawer applied to the proximal tibia; an 8 x 20 mm interference screw was used to secure the bone plug distally. The graft was tight, isometric and without adverse features. The wound was copiously irrigated with Kantrex1. Cancellous bone fragments from bone plugs were used to graft the donor site defect in the patella. The paratenon was closed over this to house the graft with a running #1 Vicryl. The edge of the distal bone plug was beveled with the rongeur. The subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. Steri-Strips, sterile dressing, cryo cuff and hinged knee brace were applied. The patient was awakened and taken to the recovery room in satisfactory condition. What CPT® codes are reported?a. 29888-RT, 29880-51-RTb. 29889-RT, 29880-51-RTc. 29888-RT, 29881-51-RTd. 29888 -RT, 29882-51-RT c. 29888-RT, 29881-51-RTResponse Feedback:Rationale: The anterior cruciate ligament repair can be found in the CPT® Index by looking for Cruciate Ligament/Repair/Arthroscopic Repair 29888, 29889. This was the anterior cruciate ligament; 29888 is the correct code. A medial meniscectomy was also performed which is reported with 29881. In the CPT® Index look for Arthroscopy/Surgical/Knee referring you to 29866-29868, 29871-29889. This is a medial meniscectomy 29881. Modifier -51 is required to report multiple procedures performed during the same session. The patellar tendon bone graft is included in 29888. The notchplasty (29999) is also bundled as only one procedure can be reported per compartment (patellofemoral). Modifier RT is appended to indicate the right side.
A final diagnosis for a patient in the ER is COPD with acute bronchitis due to echovirus. How is this diagnosis coded?a. J44.9, J20.7b. J40, J20.9c. J44.9, J40d. J44.0, J20.7 d. J44.0, J20.7Response Feedback:Rationale: Look in the ICD-10-CM Alphabetic Index for Disease, diseased/pulmonary/chronic obstructive/with/acute bronchitis directing you to J44.0. In the Tabular List an instructional note is given for code J44.0 to use additional code to identify the infection. Look for Bronchitis/acute or subacute/due to/virus/echovirus directing you to code J20.7.
What CPT® codes are reported for an extrapleural pneumonectomy as well as empyemectomy performed during the same surgical session?a. 32440, 32036-51b. 32445, 32540-51c. 32445, 32036-51d. 32440, 32540-51 b. 32445, 32540-51Response Feedback:Rationale: In the CPT® Index, look for Pneumonectomy. By looking at codes 32440-32445 we see that code 32445 represents the extrapleural pneumonectomy. Next in the CPT® Index look for Empyemectomy which directs us to code 32540. There is also a parenthetical statement under code 32540 instructing us to report the correct lung removal code with 32540 if performed.
Which option is TRUE regarding reporting codes for cytomegaloviral pneumonitis in ICD-10-CM?a. Only the pneumonia is reported, it is not necessary to report the underlying diseases.b. Pneumonia is reported first; the underlying disease is reported second.c. One code is used to report both the pneumonia and the cytomegaloviral disease.d. The underlying disease is reported first; pneumonia is reported second. c. One code is used to report both the pneumonia and the cytomegaloviral disease.Rationale: ICD-10-CM Tabular List does not have the instructional note to code first underlying disease that is seen for codes listed in ICD-10-CM for category code B25. Both conditions are reported with one code in ICD-10-CM.
Repair of coronary vessel is called:a. Endarterectomyb. Angioplastyc. Aorticd. Endovascular b. Angioplasty
In the cath lab, from a right femoral artery access, the following procedures are performed: Catheter placed in the left renal, accessory renal superior to the left renal and one main right renal artery. Radiologic supervision and imaging are performed in all locations. What CPT® code(s) is/are reported?a. 36245, 36245-59, 36245-59, 36252-26b. 36252c. 36252, 36251d. 36245-LT, 36245-59-LT, 36245-59-RT, 75774-26 b. 36252Response Feedback:Rationale: Look in the CPT® Index for Angiography/Renal Artery referring you to code range 36251-36254. This is a bilateral procedure, with an accessory left renal artery. Code 36252 includes bilateral and accessory renal angiography, and radiologic supervision and imaging.
Aortography and bilateral extremity angiography were performed. The physician placed the catheter in the aorta at the level of the renal arteries and injected contrast for the aortography and repositioned the catheter just above the bifurcation for angiography of the lower extremities. Which CPT® codes are reported?a. 36200, 75716-26b. 36200, 75630-26c. 36200, 75625-26, 75716-26d. 36200, 75625-26, 75710-50-26 c. 36200, 75625-26, 75716-26Response Feedback:Rationale: Because the catheter was repositioned, and separate studies were performed, both the aortography and the extremity angiography are reported. Look in the CPT® Index for Catheterization/Aorta referring you to 36160-36200. In the CPT® Index see Aorta/Aortography referring you to 75600-75630. To locate angiography of the lower extremities, look for Angiography/Leg Artery referring you to 73706, 75635, 75710-75716. Modifier 26 reports the professional service.
In the cardiac suite, an electrophysiologist performs an EP study. With programmed electrical stimulation, the heart is stimulated to induce arrhythmia. Observed is right atrial and ventricular pacing, recording of the bundle of His, right atrial and ventricular recording and left atrial and ventricular pacing and recording from the left atrium. What CPT® coding is reported?a. 93620, 93618, 93621b. 93619, 93621c. 93620, 93621, 93622d. 93600, 93602, 93603, 93610, 93612, 93618, 93621, 93622 c. 93620, 93621, 93622Response Feedback:Rationale: The studies performed make up a comprehensive study (93620) which includes: evaluation with right atrial pacing and recording, right ventricular pacing and recording, and His bundle recording with induction of or attempted induction of arrhythmia. Left atrial pacing and recording (+93621) and left ventricular pacing and recording (+93622) are add-on codes. Look in the CPT® Index for Electrophysiology Procedure which directs you to 93600-93660.
What is the CPT® code for removal of a foreign body from the esophagus via the thoracic area?a. 43045b. 43215c. 43500d. 43020 a. 43045Rationale: In the CPT® Index, look for Esophagus/Removal/Foreign Bodies referring you to 43020, 43045, 43194, 43215, 74235. There are two open approaches and two endoscopic approaches in the CPT® code book for the removal of a FB from the esophagus. 43020 is via a cervical approach and 43045 is via a thoracic approach, making code 43045 the correct choice.
What ICD-10-CM code is reported for acute gastritis with bleeding?a. K29.00b. K29.70c. K29.71d. K29.01 d. K29.01Rationale: In ICD-10-CM, Gastritis is identified by specific four character codes to indicate with or without bleeding. Look in the ICD-10-CM Alphabetic Index for Gastritis (simple)/acute (erosive)/with bleeding K29.01.
What is the correct ICD-10-CM coding for diverticulosis of the small intestine which has been present since birth?a. K57.10b. Q43.8c. K57.90d. K57.90, Q43.8 b. Q43.8Rationale: If a condition has been present since birth, it is considered congenital. Look in the ICD-10-CM Alphabetic Index for Diverticulosis/small intestine which refers you to K57.10. Verification in the Tabular list has an Excludes1 note under category code K57 for a congenital diverticulum of intestine and directs you to code Q43.8. Congenital diverticulum is in the list of congenital malformations beneath code Q43.8.
A 4-year-old patient, who accidentally ingests valium found in his mother’s purse, is found unconscious and rushed to the ED. The child is treated by the ED physician, who inserted a tube orally into the stomach and performed a gastric lavage, removing the stomach contents. What CPT® and ICD-10-CM codes are reported?a. 43754, R40.20, T42.71XAb. 43753, T42.4X1A, R40.20c. 43755, T43.501Ad. 43756, T42.71XA b. 43753, T42.4X1A, R40.20Rationale: Code 43753 is the correct CPT® code for gastric lavage performed for the treatment of ingested poison. Look in the CPT® Index for Gastric Lavage, Therapeutic/Intubation. The ICD-10-CM code for the poisoning is found in the Table of Drugs and Chemicals by looking for Valium/Poisoning, Accidental (unintentional) column, referring you to code T42.4X1-. In the Tabular List a 7 th character is needed to complete the code. A is reported as the 7 th character because this was the patient’s initial encounter.The next code is the manifestation of ingesting the Valium, unconsciousness. Unconsciousness is found in the ICD-10-CM Alphabetic Index and directs you to see Coma R40.20. The Tabular List confirms this code is reported for unconsciousness.
Patient is a 40-year-old female presenting for repeat urethral dilation for urethral stricture using the instillation of a saline solution. What CPT® code is reported for this service?a. 53665b. 53661c. 53605d. 53660 b. 53661Rationale: In the CPT® Index look for Urethra/Dilation/Suppository and/or Instillation. CPT® code 53660 is for the initial dilation. CPT® codes 53605 and 53665 are reported when general or spinal anesthesia is provided. No type of anesthesia is indicated in the note. This is a repeat procedure and the subsequent CPT® code 53661 is reported.
Patient presents to the emergency room with complaints of an erection lasting longer than two hours. Saline solution is used to irrigate the corpora cavernosa. What CPT® code is reported for this service?a. 54230b. 54231c. 54220d. 54235 c. 54220Rationale: Priapism is a condition marked by a prolonged erection. This condition must be treated, or permanent damage may result. Usually the penis is irrigated to reduce the erection; however, in some cases, surgical intervention may be necessary. In the CPT® Index look for Irrigation/Penis/for Priapism or Repair/Penis/Priapism.
A 63-year-old male presents for the insertion of an artificial inflatable urinary sphincter for urinary incontinence. A 4.5 cm cuff, 22 ml balloon, 61-70 mmHg artificial inflatable urinary sphincter was inserted. What CPT® code is reported for this service?a. 53447b. 53446c. 53448d. 53445 d. 53445Rationale: In the CPT® Index look for Insertion/Prosthesis/Urethral Sphincter. You’re directed to 53444-53445. Codes 53446-53448 are for the removal or removal/replacement of the inflatable sphincter. CPT® 53445 describes the insertion of an inflatable urethra/bladder neck sphincter, including placement of pump, reservoir and cuff.
Patient is status post left extracorporeal shock wave therapy (ESWL) performed three weeks ago; there is no global time for this procedure. He returns today for scheduled left ureteroscopy with basket extraction of ureteral calculi. What CPT® code is reported for this service?a. 52352b. 52352-58c. 52352-76d. 52352-78 a. 52352Response Feedback:Rationale: Many times, after an ESWL, the provider will schedule the patient for follow up extraction of the remaining stone fragments. In the CPT® Index, look for Calculus/Removal/Ureter directing you to several codes. Code 52352 is the appropriate code. Modifiers 58 and 78 are used for additional procedures performed during a global period and modifier 76 is used for a repeat of the same procedure. These modifiers are not appropriate in this case because there is no global period
What is a root word for vagina?a. Metri/ob. Ureter/oc. Hyster/od. Colp/o d. Colp/o
How is a visit for supervision of normal pregnancy coded in ICD-10-CM?a. A code from category O80 is reported with a code from category Z37.b. A code from category Z34 is reported with a code from category Z3A.c. A code from category Z34 is reported without a code from category Z3A.d. A code from category O80 is reported with a code from category Z3A. c. A code from category Z34 is reported without a code from category Z3A
A woman with a long history of rectocele and perineal scarring from multiple episiotomies develops a rectovaginal fistula with perineal body relaxation. She has transperineal repair with perineal body reconstruction and plication of the levator muscles. What are the CPT® and ICD-10-CM codes reported for this procedure?a. 57300, 56810-51, N82.3, N81.89b. 57308, N82.3, N81.89c. 57250, N81.6d. 57330, N82.3 b. 57308, N82.3, N81.89
In ICD-10-CM which statement is TRUE regarding type 1 diabetes with peripheral angiopathy with gangrene?a. One code is used to report diabetes with peripheral angiopathy; the gangrene is not reported separately.b. Three codes are reported; one for the diabetes, one for the peripheral angiopathy, and a third for the gangrene.c. Two codes are reported; one to report diabetes with peripheral angiopathy and a second to report the gangrene.d. One code is used to report secondary diabetes with peripheral angiopathy; the gangrene is not reported. a. One code is used to report diabetes with peripheral angiopathy; the gangrene is not reported separately.
A patient has a right thyroid lobectomy for a thyroid follicular lesion. An incision is made 2 cm above the sternal notch and carried through the platysma. The right thyroid was dissected free from the surrounding tissues. The isthmus was divided from the left thyroid lobe. The left thyroid lobe was explored revealing a single nodule. The right thyroid lobe was completely removed from the trachea and surrounding tissues. It was marked and sent off the table as a specimen. What CPT® code is reported?a. 60220b. 60240c. 60200d. 60210 a. 60220Rationale: The patient had a unilateral thyroidectomy. Because only the right side is removed, it is a total unilateral (partial) thyroidectomy. In the CPT® Index look for Thyroidectomy/Partial directing you to code range 60210-60225. 60220 reports a unilateral total thyroid lobectomy with or without isthmusectomy.
What ICD-10-CM code is reported for Ataxia telangiectasia?a. G11.0b. G11.3c. G31.89d. R27.0 b. G11.3
A 59-year-old is suffering from foraminal spinal stenosis. Patient is to have a L4-L5 laminectomy on the right side. Under general anesthesia a knife dissection was made on the back and was taken down to the fascia. The fascia on the right side of the spine was stripped. The deep Taylor retractor was placed. Using an intraoperative X-ray, the physician traced out the foramen of L4-L5. There appeared to be some compression at this lamina into the foramen and significant stenosis. The provider removed the spinous process and lamina. Nerve roots canals are freed by removal of the facet. Compression is relieved by removing bony overgrowth around the foramen. What CPT® code is reported for this procedure?a. 63017b. 63005c. 63047d. 63030 c. 63047Response Feedback:Rationale: In the CPT® Index look for Laminectomy/with Facetectomy directing you to 63045-63048, 0202T, 0274T, 0275T. A laminectomy with knife dissection is being performed for spinal stenosis eliminating codes 0202T, 0274T, and 0275T. Codes 63045-63048 are reported based on location. This was performed on the lumbar, making the correct code 63047. 63030 is a code specific to the interspaces and codes 63001 and 63017 specifically state without facetectomy making them incorrect choices.
What ICD-10-CM code is used to report acute actinic otitis externa of the left ear?a. H60.512b. H60.62c. H60.542d. H66.90 a. H60.512Response Feedback:Rationale: In the ICD-10-CM Alphabetic Index look for Otitis/externa/acute/actinic and you are directed to H60.51-. Verification in the Tabular List indicates a 5 th character is reported for laterality. 5th character of 2 is for left ear.
An 89-year-old patient who has significant partial opacities in the lens of the left eye presents for phacoemulsification and lens implantation. What ICD-10-CM code is reported?a. H25.9b. H26.40c. H26.9d. H26.112 c. H26.9Response Feedback:Rationale: In the ICD-10-CM Alphabetical Index look for Opacity, opacities/lens which states see Cataract. Look in the Alphabetic Index for Cataract and the user is directed to the default code H26.9. Confirmation in the Tabular List confirms code selection.
What CPT® code(s) is/are reported for the placement of two adjustable sutures during strabismus surgery involving the horizontal muscles?a. 67334, 67335-51b. 67318c. 67312, 67335d. 67316, 67335-51 c. 67312, 67335Response Feedback:Rationale: Code 67312 represents strabismus surgery on two (2) horizontal muscles. In the CPT® Index look for Strabismus/Repair/Two Horizontal Muscles. In the numeric section below code 67316, there is a parenthetical note with instructions to use code 67335 in addition to codes 67311-67334 when adjustable sutures are used for primary procedure reflecting number of muscles operated on. Code 67335 is an add-on code and exempt from multiple procedures modifier 51. This is located in the CPT® Index by looking for Strabismus/Repair/Adjustable Sutures.
A patient with mixed conductive and sensorineural hearing loss in the right ear has tried multiple medical therapies without recovery of her hearing. Patient has consented to have an electromagnetic bone conduction hearing device implanted in the temporal bone. What CPT® and ICD-10-CM codes are reported?a. 69710-RT, H90.11b. 69714-RT, H90.8c. 69710-RT, H90.71d. 69930-RT, H90.0 c. 69710-RT, H90.71Response Feedback:Rationale: In the CPT® Index look for Hearing Aid/Implants/Bone Conduction/Implantation. You are referred to 69710. Review the code to verify accuracy. In the ICD-10-CM Alphabetical Index look for Loss (of)/hearing which states see also Deafness. Look for Deafness/mixed conductive and sensorineural/unilateral. You are referred to H90.7-. Review the code in the Tabular List to verify accuracy and 5 th character 1 is for right ear
Report the appropriate anesthesia code for an obstetric patient who had a planned general anesthesia for cesarean hysterectomy.a. 01962b. 01963c. 01967d. 01969 b. 01963Response Feedback:Rationale: Use the CPT® Index look for Anesthesia/Hysterectomy/Cesarean which directs you to 01963, 01969. Review the codes in the numeric section to determine that code 01963 is the appropriate code. Note: Code +01969 is an add-on code and cannot be coded without a primary procedure code.
What time is used to report the start of anesthesia time?a. When the anesthesiologist begins to prepare the patient for anesthesiab. During the pre-anesthesia assessmentc. Surgery start timed. Entering the operating room a. When the anesthesiologist begins to prepare the patient for anesthesiaResponse Feedback:Rationale: Per Anesthesia Guidelines in the CPT® code book under the subheading Time Reporting: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in the operating room (or an equivalent area). Pre-anesthesia assessment time is not part of reportable anesthesia time, as it is considered in the base values assigned.
A 77-year-old patient was scheduled for a left total hip replacement due to degenerative joint disease (DJD) and the anesthesiologist documented the DJD as primary. The pre-anesthesia assessment indicates the patient had surgery in 2015 for gastroesophageal reflux disease (GERD). What ICD-10-CM coding is reported?a. M16.7b. M16.12c. K21.9d. M16.9, K21.9 b. M16.12
Mr. Johnson, age 82, having been in poor health with diabetes and associated peripheral neuropathy, is having a fem-pop bypass. The anesthesiologist documents he has severe systemic disease. What coding is correct for anesthesia?a. 01272-AA-P3b. 01272-AA-P2, 99100c. 01260-AA-P2, 99100d. 01270-AA-P3, 99100 d. 01270-P3, 99100Rationale: Fem-pop bypass is an abbreviation for femoral-popliteal bypass of arteries in the upper leg. Look in the CPT® Index for Anesthesia/Bypass Graft/Leg, Upper which directs you to code 01270. Review the code in numeric section to determine the correct code is 01270. The qualifying circumstance code 99100 is added to indicate the extreme age of the patient. Physical status modifier P3 indicates the patient has severe systemic disease.
A 59-year-old patient is having surgery on the pericardial sac, without use of a pump oxygenator. The perfusionist placed an arterial line. What CPT® coding is reported for anesthesia?a. 00560, 36620b. 00560c. 00561d. 00562 b. 00560Response Feedback:Rationale: In the CPT® Index look for Anesthesia/Heart which directs you to codes 00560-00567, 00580 or look for Anesthesia/Intrathoracic System which directs you to multiple code ranges. Refer to the numeric section to determine 00560 is the correct code for without use of a pump oxygenator. The arterial line placement (36620) was not provided by the anesthesiologist.
AP and Lateral chest X-rays were performed for a cough. What CPT® and ICD-10-CM codes are reported?a. 71045, F45.8b. 71046, F45.8c. 71046, R05.9d. 71045, R05.9 c. 71046, R05.9Response Feedback:Rationale: In the CPT® Index look for X-ray/Chest and you are guided to code range 71045-71048. In looking at the descriptions, this is a 2-view chest X-ray. In the AP (Anteroposterior) position the X-ray beam enters the front of the body and exits through the back. In the lateral position, the X-ray beam enters through the side of the body. This is reported with 71046. Look in the ICD-10-CM Alphabetic Index for cough and you are directed to R05.9.
A 66-year-old male with a history of anemia presents for a liver core biopsy to evaluate for possible cirrhosis. The patient was brought to the CAT scan suite in which limited CT images of the upper abdomen were performed for biopsy needle placement. The appropriate site for the liver core biopsy was chosen. The patient’s skin was then marked with the computer coordinates. An 18-gauge needle was advanced into the appropriate site and a sample was obtained. What CPT® codes are reported?a. 47000, 77012-26b. 47000, 77002-26c. 47100, 74150-26d. 47100, 76942-26 a. 47000, 77012-26Response Feedback:Rationale: Biopsy of the liver is taken by a needle (percutaneous) under computed tomography guidance (CT). In the CPT® Index look for Biopsy/Liver 47000, 47001, 47100, 47700. Code 47000 describes a percutaneous needle biopsy of the liver. Below CPT code 47000 you are given codes for imaging guidance. Code 77012 describes the CT guidance for needle placement. Modifier 26 is appended to indicate the professional service.
A 65-year-old female has a 2.5 cm x 2.0 cm non-small cell lung cancer in her right upper lobe. The tumor is inoperable due to severe respiratory conditions. She is receiving stereotactic body radiation therapy today under image guidance. Beams arranged in 8 fields will deliver 25 Grays per fraction for 4 fractions. What CPT® and ICD-10-CM codes are reported?a. 77431, Z51.0, C34.11b. 77371, C34.91c. 77373, Z51.0, C34.11d. 77435, C34.11, Z51.0 “c. 77373, Z51.0, C34.11Response Feedback:Rationale: Patient is having stereotactic radiation therapy technique delivered, not managed, in a large radiation dose to tumor sites in the upper right lobe of the lung. In the CPT® Index look for Radiation Therapy/Stereotactic Body referring you to 77373. Codes 77371-77373 do not need modifier TC or 26, because they are facility only codes. 77373 is correct with stereotactic body radiation not exceeding 5 fractions.According to ICD-10-CM guideline I.C.2.a. “”If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy, assign the appropriate Z51.-code as the first-listed or principal diagnosis, and the diagnosis or problem for which the service is being performed as a secondary diagnosis.”” In the ICD-10-CM Alphabetic Index look for Encounter/radiation therapy (antineoplastic) which directs you to Z51.0. In the ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/lung/upper lobe and select from the Malignant Primary column referring you to C34.1-. Verification in the Tabular List indicates a 4th character is needed, report 1 for the right lung.”
Myocardial Perfusion Imaging (MPI)—Office Based TestIndications: Chest pain.Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion.Findings: This is a technically fair study. There was no stress induced electrocardiographic changes noted. There were no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%.Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. What CPT® code(s) is/are reported?a. 78454b. 78472c. 78453d. 78452 d. 78452Response Feedback:Rationale: Tomographic myocardial perfusion imaging was performed. In this procedure the patient receives an intravenous injection of a radionuclide which localizes in nonischemic tissue. SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. In the CPT® Index look for Heart/Myocardium/Perfusion Study which directs you to 78451-78454. The MPI was performed at rest and exercise (which is stress), reporting code 78452 for multiple studies.
In what section of the Pathology chapter of CPT® will a coder find codes for a FISH test?a. Other Proceduresb. Cytopathologyc. Chemistryd. Immunology b. Cytopathology
A patient with deep vein thrombosis requires heparin to maintain therapeutic anticoagulation levels. He has regular PTT’s drawn to monitor his level of anticoagulation. What CPT® code is reported?a. 85730b. 85520c. 80299d. None of these a. 85730Response Feedback:Rationale: Look in the CPT® Index for PTT. There is a note to See Thromboplastin, Partial Thromboplastin Time (PTT). PTT stands for Thromboplastin time, partial. Look in the CPT® Index for Thromboplastin/Partial Thromboplastin Time (PTT). Code 85730 is the correct code, there is no mention of substitution.
A young man is bitten by a dog found to have rabies. Although he shows no symptoms of rabies, testing is done to see if he has the infection. The tests come back negative. What diagnosis code is used to establish the medical necessity for the service?a. A82.9b. Z23c. Z20.3d. None of the code choices c. Z20.3Response Feedback:Rationale: When there is known exposure without symptoms, use the Z code for exposure to communicable diseases. In the ICD-10-CM Alphabetic Index, look for Exposure (to)/rabies. You are directed to Z20.3. Verify code in the Tabular List.
A patient will be undergoing a transplant and needs HLA tissue typing with DR/DQ multiple antigen and lymphocyte mixed culture. How will these services be coded?a. 86805-26, 86817b. 86806-26, 86817c. 86816-26, 86821d. 86817, 86821 d. 86817, 86821Response Feedback:Rationale: In the CPT® Index look for Tissue/Typing/Human Leukocyte Antigen (HLA)/Antibodies. Code 86817 is the correct code to report for HLA tissue typing with DR/DQ. Then, look in the CPT® Index for Tissue/Typing/Lymphocyte Culture referring you to code 86821. Codes 86805 and 86806 are for lymphocytotoxicity, not
Using the 1995 & 1997 guidelines, which elements of HPI are met in this statement? Patient complains of headache and blurry vision for the past 3 days.a. Quality, duration and timingb. Quality, severity and timingc. Location, severity and durationd. Location, quality and duration d. Location, quality and duration
A new patient visits the internal medicine clinic today for diabetes, hypertension, arthritis, and a history of cardiac disease. The provider performs a medically appropriate history and exam. Blood pressure is high. All other conditions are stable. Labs ordered are HbA1c and complete blood count (CBC). Changing the dosage for blood pressure medication. Will follow up in 3 months. What CPT® code is reported?a. 99213b. 99204c. 99214d. 99203 b. 99204Response Feedback:Rationale: In the CPT® Index look for Office and/or Other Outpatient Services/Office Visit/New Patient and you are directed to codes 99202-99205. 2021 E/M Guidelines for Office and Other Outpatient services are reported based on Medical decision making and requires two of three elements to be met or exceeded for a new patient. 2+ stable chronic illness and 1 chronic illness with exacerbation (Moderate), two unique lab tests are ordered (HbA1c and CBC) (Low/Limited), level of risk – prescription management (Moderate). Correct code is 99204.
A provider visits Mr. Smith’s home monthly. Today, the provider performs a problem focused history, an expanded problem focused examination and a medical decision making of low complexity. What CPT® code is reported?a. Home visits are no longer reportable.b. 99347c. 99348d. 99349 c. 99348Response Feedback:Rationale: In the CPT® Index look for Home Services/Established Patient and you are directed to code range 99347-99350. Two of three key components must be met to support a level of visit for established patient home services. 99348 is the correct code choice.
A 65-year-old was admitted in the hospital two days ago and is being examined today by his primary care physician, who has been seeing him since he has been admitted. Primary care physician is checking for any improvements or if the condition is worsening. CHIEF COMPLAINT:CHFINTERVAL HISTORY: CHF symptoms worsened since yesterday.Now has some resting dyspnea. HTN remains poorly controlled with systolic pressure running in the 160s. Also, I’m concerned about his CKD, which has worsened, most likely due to cardio-renal syndrome.REVIEW OF SYSTEMS: Positive for orthopnea and one episode of PND. Negative for flank pain, obstructive symptoms or documented exposure to nephrotoxins.PHYSICAL EXAMINATION:GENERAL: Mild respiratory distress at restVITAL SIGNS: BP 168/84, HR 58, temperature 98.1.LUNGS: Worsening bibasilar cracklesCARDIOVASCULAR: RRR, no MRGs.EXTREMITIES: Show worsening lower extremity edema.LABS: BUN 56, creatinine 2.1, K 5.2, HGB 12.IMPRESSION:1. Severe exacerbation of CHF2. Poorly controlled HTN3. Worsening ARF due to cardio-renal syndromePLAN:1. Increase BUMEX to 2 mg IV Q6.2. Give 500 mg IV DIURIL times one.3. Re-check usual labs in a.m.Total time: 20 minutes.What E/M category is used for this visit?a. Initial Hospital Visit (99221-99223)b. Established Patient Office/Outpatient Visit (99211-99215)c. Inpatient Consultation (99251-99255)d. Subsequent Hospital Visit (99231-99233) d. Subsequent Hospital Visit (99231-99233)Response Feedback:Rationale: This is a subsequent hospital visit which is reported with code range 99231-99233. The patient was admitted in the hospital two days ago and the primary care physician has been seeing the patient since he has been admitted to the hospital. Initial Hospital Visit (99221-99223) is when the doctor is initially admitting the patient to the hospital. Inpatient Consultation (99251-99255) is when the provider requests for another provider to see the patient to recommend care for a specific condition or to accept ongoing management for the patient’s condition. Established Patient Office/Outpatient Visit (99211-99215) is when the patient is being seen in the office setting, not the hospital.
A 15 year old underwent placement of a cochlear implant 1 year ago. It now needs to be reprogrammed. What CPT® code is reported for the reprogramming?a. 92603b. 92601c. 92604d. 92602 c. 92604Response Feedback:Rationale: Cochlear implants differ from hearing aids; they bypass the damaged part of the ear. The use of a cochlear implant involves relearning how to hear and react to sounds. In the CPT® Index look for Cochlear Device/Programming which directs you to codes 92602, 92604. The code selection is based on the age of the patient and whether it is the initial programming or subsequent reprogramming. Code 92604 describes subsequent reprogramming for a patient age 7 or older.
What ICD-10-CM code is reported when a flu vaccine is administered?a. Z28.3b. J11.1c. Z23d. Z28.04 c. Z23Response Feedback:Rationale: In the ICD-10-CM Alphabetic Index look for Vaccination (prophylactic)/encounter referring you to Z23. Verification in the Tabular List confirms Z23 is for an encounter for immunization. This code is nonspecific as to the type of vaccination that is given. The type of vaccination given (i.e. influenza, MMR, DPT) will be specified the CPT® or HCPCS codes.
A patient sustained a neck strain as a driver in an automobile accident, losing control, hydroplaning and hitting a tree off the highway which caused the car to overturn. He has continued to have neck pain and stiffness. He sees a chiropractor who assesses the patient and manipulates his neck. The diagnosis is neck strain. What CPT® and ICD-10-CM codes are reported for the chiropractor?a. 98940, M95.3, V47.3XXAb. 98943, M54.2, V47.2XXAc. 98941, S16.1XXA, V47.9XXAd. 98940, S16.1XXA, V47.0XXA d. 98940, S16.1XXA, V47.0XXAResponse Feedback: Rationale: In the CPT® Index look for Manipulation/Chiropractic. The neck is the cervical spine and code selection is based on the number regions treated. In this case, 1 region is treated making 98940 is the correct code choice.In the ICD-10-CM Alphabetic Index look for Strain/cervical or Strain/neck referring you to code S16.1-. The Tabular List shows seven characters are needed to complete the code. X is used as a placeholder for the 5 th and 6th characters. A is the 7th character for the initial encounter receiving active treatment. Next, report the external cause. The patient was the driver in a non-collision vehicle accident when he lost control of the car. Look in the ICD-10-CM External Cause of Injuries Index for Accident/car which states to see Accident, transport, car occupant. Look for Accident/transport/car occupant/driver/collision (with)/stationary object/nontraffic. When referring to the Tabular List, subcategory code V47.0 is used and it shows seven characters are needed to complete this code. X is used as the 5th and 6thcharacters and A, initial encounter, is used for the 7thcharacter.
A qualified genetics counselor is working with a child who has been diagnosed with fragile X syndrome. After extensive research about the condition, she meets with the parents to discuss the features of the disease and the child’s prognosis. The session lasted 45 minutes. What CPT® and ICD-10-CM codes are reported?a. 96040, Q99.9b. 96040 x 2, Q99.8c. 96040 x 2, Q99.2d. 96040, Q99.2 a. 96040, Q99.2Rationale: In the CPT® Index look for Medical Genetics which directs you to 96040. The genetics counseling session is reported as face-to-face time per 30 minutes. Report 1 unit for the first 30 minutes. Since the remaining time is 15 minutes, it is not reported separately per the Medical Genetics and Genetic Counseling Services guidelines. Fragile X syndrome is a congenital chromosomal anomaly that may include mental retardation. In the ICD-10-CM Alphabetic Index look for Syndrome/fragile X. The condition is reported with code Q99.2. Verification in the Tabular List confirms code selection.
PREOPERATIVE DIAGNOSIS : Heart BlockPOSTOPERATIVE DIAGNOSIS: Heart BlockANESTHESIA: Local anesthesiaNAME OF PROCEDURE: Reimplantation of dual chamber pacemakerDESCRIPTION: The chest was prepped with Betadine and draped in the usual sterile fashion. Local anesthesia was obtained by infiltration of 1% Xylocaine. A subfascial incision was made about 2.5 cm below the clavicle, and the old pulse generator was removed. Using the Seldinger technique, the subclavian vein was cannulated and through this, the old atrial lead was removed, and a new atrial lead (serial # 6662458) was placed in the right atrium and to the atrial septum. Thresholds were obtained as follows: The P-wave was 1.4 millivolts, atrial threshold was 1.6 millivolts with a resultant current of 3.5 mA and resistance of 467 ohms.Using a second subclavian stick in the Seldinger technique, the old ventricular lead was removed and a new ventricular lead (serial # 52236984) was inserted and placed into the right ventricular apex. The thresholds were obtained and were as follows: R-wave was 23.5 millivolts. The patient was pacing at 100% at 0.5 volts, with resultant current of 0.8 mA and resistance of 480 ohms. When we were satisfied with the thresholds, the leads were connected to the pacemaker generator (serial # 22561587), which was inserted into the previously created pocket.The wound was thoroughly irrigated with antibiotic solution and hemostasis was obtained. The incision was closed in layered fashion with 2-0 Dexon. A compressive dressing was applied, and the patient tolerated the procedure very well. He was taken to the recovery room in satisfactory condition. What CPT® codes are reported?a. 33202, 33233-51b. 33235, 33208-51, 33233-51c. 33207, 33206-51, 33236-51d. 33208, 33238-51, 33241-51 b. 33235, 33208-51, 33233-51Rationale: Code 33235 reports removal of the electrodes of a dual pacemaker lead system. Code 33208 reports replacement of permanent pacemaker generator with transvenous electrodes to the right atrium and right ventricle, and 33233 reports the removal of a pacemaker generator. Modifier 51 reports multiple procedures performed during the same session. Look in the CPT® Index for Pacemaker, Heart/Insertion which direct you to 33206-33208. Next look for Pacemaker, Heart/Removal/Pulse Generator Only which directs you to 33233. Look for Pacemaker, Heart /Removal/Transvenous Electrodes which directs the coder to 33234-33235.
PROCEDURES PERFORMED:1. Bilateral facet joint injections, L4-L52. Bilateral facet joint injections, L5-S1.3. Fluoroscopy.TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the desired levels were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual palpation located the sacral hiatus. The 6-inch, 20-gauge needle with a slight volar bend was inserted using fluoroscopy into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were injected in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient tolerated the procedure well with no complications and was transferred to recovery in good condition. What CPT® codes are reported?a. 64493-50, 64494 x 2b. 64493-50, 64494 x 2, 77002-26c. 64493-50, 64494-50-51, 77002-26d. 64493-50 x 2 a. 64493-50, 64494 x 2Response Feedback:Rationale: In the CPT® Index, look for Injection/Paravertebral Facet Joint/Nerve/with Image Guidance directing you to 64490-64495. Code selection is based on the location and the number of levels. The initial and one additional separate level lumbar facet joint injections performed bilaterally, at two levels, so use modifier 50 on facet injection codes 64493. Modifier 51 is not reported on add-on code +64494 because add-on codes are exempt from modifier 51. Add-on codes are exempt from modifier 50. Report +64494 twice to indicate this was performed bilaterally. Depending on the payer, modifiers RT and LT may be appended. Fluoroscopy was utilized for all services and is bundled in codes 64490-64495 and not reported separately.
Preoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangiomaPostoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangiomaProcedures Performed: Aspiration of left orbital cyst with injection of KenalogAnesthesia: GeneralComplications: NoneEstimated Blood Loss: MinimalIndications for Procedure: The patient presents with a small cyst of the superior medial left orbit felt to be suggestive for hemangioma versus lymphangioma. Risks, benefits, and alternatives of steroid injection to inactivate the cyst were reviewed. These risks included failure to work and significant visual loss. After discussion, they elected to proceed.Description of Procedure: After informed operative consent was obtained, the patient was brought to the operating room and laid in the supine position. General anesthetic was administered per the anesthesiologist. A 25-gauge needle on a 5-cc syringe was placed within the mass and aspirated. Approximately 0.5 cc of blood was recovered, but the blood was of normal bright red color.Kenalog 40 mg (1 cc) was then injected where the mass was aspirated without difficulty. Operative area was clean and dry. The patient was then awakened and taken to the recovery room. Pupil reactions were brisk and equal with 2 mm pupils noted in the recovery room. There were no operative complications. What CPT® and ICD-10-CM codes are reported?a. 67415-LT, H05.812b. 67515-LT, H05.812c. 67405-LT, D18.1d. 67500-LT, D18.09 a. 67415-LT, H05.812Response Feedback:Rationale: The provider aspirated a cyst that was in the left orbit. In the CPT® Index look for Aspiration/Orbital Contents referring you to code 67415. Code 67500 is reported when there is an injection of a therapeutic or local anesthetic behind the eyeball (retrobulbar). Diagnoses documented as versus are not definitive diagnosis codes and are not coded. The postoperative header indicates an orbital cyst. In the ICD-10-CM Alphabetical Index look for Cyst/orbit referring you to code H05.81-. Verify code in the Tabular List. A 6 th character is required to indicate which eye; 2 is reported for the left eye.
This 56-year-old female presented with a degenerative posteromedial meniscal flap tear of the right knee. After appropriate preoperative evaluation, the patient was taken to the operating room where general anesthesia was instituted. The patient was placed supine on the operating table. The right lower extremity was sterilely prepped and draped for arthroscopic surgery. The leg was exsanguinated and the tourniquet inflated. The arthroscope was introduced first through the anterolateral portal with medial suprapatellar portal utilized. The lateral compartment looked fairly good. There were some minimal medial degenerative changes. In the medial compartment there was a full-thickness area of osteochondral degeneration with a flap of cartilage noted. It was possible to remove this with a bleeding bony bed with beveled edges of cartilage. The ligament itself was intact. The retropatellar area was normal with Grade I chondromalacia changes noted. The medial joint was inspected and there was a tear at the junction of the middle and posterior portions of the meniscus, a flap tear was based more anteriorly. This was shaved with a combination of small baskets and punches, and the meniscus debrided back to a smooth stable rim. There was additional synovitis in the medial aspect of the intercondylar notch and this was removed with the curved automated meniscal incisor. What CPT® code(s) should be reported?a. 29881, 29875-59b. 29882c. 29880, 29879-51d. 29881 d. 29881Response Feedback:Rationale: This was a surgical arthroscopy of the knee. In the CPT® Index look for Arthroscopy/Surgical/Knee, directing you to 29866-29868, 29871-29889. The medial meniscectomy and debridement are reported with 29881. In this case the synovectomy, code 29875, is a separate procedure and bundled with 29881; it is not reported separately.
Operative ReportIndications: This is a third follow-up EGD dilation on this 40-year-old patient for a pyloric channel ulcer which has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation.Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray.Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The pyloric channel was again widened. The ulcer, as previously seen, was well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into the second portion of the duodenum, revealing normal mucosa. Marked deformity and scarring was seen in the proximal bulb. Following the diagnostic exam, a 15 mm balloon was placed across the stricture, dilated to maximum pressure, and withdrawn. There was minimal bleeding post-op. Much easier access into the duodenum was accomplished after the dilation. Follow-up biopsies were also taken to evaluate Helicobacter noted on a previous exam. The patient tolerated the procedure well.Impressions: Pyloric stricture secondary to healed pyloric channel ulcer, dilated.Plan: Check on biopsy, continue Prilosec for at least another 30 days. At that time, a repeat endoscopy and final dilation will be accomplished. He will almost certainly need chronic H2 blocker therapy to avoid recurrence of this divesting complicated ulcer.What CPT® and ICD-10-CM codes are reported?a. 43245, 43239-51, K31.1, Z87.11b. 43235, 43239-51, K31.4, Z87.19c. 43248, 43239-59, K31.5, Z87.19d. 43236, 43239-59, K31.1, Z87.11 a. 43245, 43239-51, K31.1, Z87.11Response Feedback:Rationale: The procedures performed are correctly represented by codes 43245 (balloon dilation) and 43239 (biopsies). In the CPT® Index, look for Esophagogastroduodenoscopy/Flexible Transoral/Dilation of Gastric/Duodenal Stricture referring you to 43245. Next look for Esophagogastroduodenoscopy/Flexible Transoral/Biopsy referring you to 43239. Modifier 51 is reported to indicate multiple procedures performed on the same day, same session.In the operative note, the diagnosis codes are reported from the Impressions. ICD-10-CM codes are K31.1 for the pyloric stricture. In the ICD-10-CM Alphabetic Index look for Stricture/pylorus. The stricture was acquired due to peptic ulcer disease, which is healed. Report with history code Z87.11. In the Alphabetic Index, look for History/personal (of)/disease or disorder (of)/digestive system/peptic ulcer disease referring you to Z87.11. Verify codes in the Tabular List.
This 36-year-old female presents with an avulsed anterior cruciate ligament off the femoral condyle with a complete white on white horizontal cleavage tear of the posterior horn of the medial meniscus, causing instability. A general endotracheal anesthesia was performed, and the patient was placed supine on the operating table. The right lower extremity was prepped with Betadine and draped free. Standard arthroscopic portals were created, and the knee was systematically examined and probed. The posterior horn of the medial meniscus was noted to be buckled and frayed. This area was carefully probed and found to be irreparable. It was decided that our best option was to proceed with a limited partial meniscectomy, with the goal being to leave as much viable meniscal tissue as possible. Therefore, a medial infrapatellar portal was developed with a longitudinal stab wound. A series of straight-angled and curved basket punches was used to perform a saucerization of the damaged portion of the meniscus, leaving the intact portion of the medial meniscus in place. Debris was meticulously removed with the 4.0 meniscal cutter. Approximately 50% of the medial meniscus remained. Next, our attention was turned to the ACL repair. Through a 5 cm longitudinal anterior incision, a central one-third tendon bone was harvested. A 10 mm graft was taken and bone plug sculpted. Anterolateral notchplasty was done with a curette and polished with the burr. All debris was removed and instruments were used to ensure proper isometry. The graft was tightened in extension about 2.5 mm and actually lengthened in flexion, and this was considered acceptable. Endoscopic guides were used to create the tibial and femoral tunnels, and the edges were rasped smooth. Using a percutaneous guide pin, the graft was placed retrograde to the knee and secured proximally with an 8 x 25 mm interference screw. The knee was put through range of motion, and with the leg in 30 degrees of flexion with the posterior drawer applied to the proximal tibia; an 8 x 20 mm interference screw was used to secure the bone plug distally. The graft was tight, isometric and without adverse features. The wound was copiously irrigated with Kantrex1. Cancellous bone fragments from bone plugs were used to graft the donor site defect in the patella. The paratenon was closed over this to house the graft with a running #1 Vicryl. The edge of the distal bone plug was beveled with the rongeur. The subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. Steri-Strips, sterile dressing, cryo cuff and hinged knee brace were applied. The patient was awakened and taken to the recovery room in satisfactory condition. What CPT® codes are reported?a. 29888 -RT, 29882-51-RTb. 29888-RT, 29881-51-RTc. 29888-RT, 29880-51-RTd. 29889-RT, 29880-51-RT b. 29888-RT, 29881-51-RTResponse Feedback:Rationale: The anterior cruciate ligament repair can be found in the CPT® Index by looking for Cruciate Ligament/Repair/Arthroscopic Repair 29888, 29889. This was the anterior cruciate ligament; 29888 is the correct code. A medial meniscectomy was also performed which is reported with 29881. In the CPT® Index look for Arthroscopy/Surgical/Knee referring you to 29866-29868, 29871-29889. This is a medial meniscectomy 29881. Modifier -51 is required to report multiple procedures performed during the same session. The patellar tendon bone graft is included in 29888. The notchplasty (29999) is also bundled as only one procedure can be reported per compartment (patellofemoral). Modifier RT is appended to indicate the right side.
Operative ReportPREOPERATIVE DIAGNOSIS: Prolapsed vitreous in anterior chamber with corneal edemaPOSTOPERATIVE DIAGNOSIS: SameOPERATION PERFORMED: Anterior vitrectomy The patient is a 72-year-old woman who approximately 10 months ago underwent cataract surgery with a YAG laser capsulotomy, developed corneal edema and required a corneal transplant. The patient has done well. Over the last few weeks, she developed posterior vitreous detachment with vitreous prolapse to the opening in the posterior capsule with vitreous into the anterior chamber with corneal touch and adhesion to the graft host junction and early corneal edema. The patient is admitted for anterior vitrectomy.PROCEDURE: The patient was prepped and draped in the usual manner after first undergoing retrobulbar anesthetic. A lid speculum was inserted. An incision was made at approximately the 10 o’clock meridian 3 mm in length, 2 mm posterior to the limbus, and grooved forward into clear cornea with a 3.2 mm anterior chamber. An anterior vitrectomy was carried out, placing a visco-elastic substance in the anterior chamber to maintain it. A Sinskey hook was used to sweep vitreous away from the corneal wound and this was removed with the disposable vitrectomy instrument. The patient’s pupil is noted to be round. There was no vitreous to the wound. The wound self-sealed without aqueous leak. Cautery was used to close the conjunctiva. Subconjunctival Decadron and Gentamicin was given. The patient tolerated the procedure well and was discharged to the recovery room in good condition. What CPT® code(s) is/are reported?a. 65810b. 67015, 67028, 65810, 67025c. 67005d. 67010 d. 67010Response Feedback:Rationale: In the CPT® Index look for Vitrectomy/Anterior Approach/Subtotal. This was a subtotal removal using a mechanical tool to sweep the vitreous away. Subtotal using a mechanical tool is reported with 67010.
Operative ReportPROCEDURE: Left L3-L4 peri-articular paravertebral facet joint injection.PATIENT HISTORY: The patient is a 67-year-old woman referred by Dr. X for repeat diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral facet joint injection. She had no relief of symptoms from that injection.TECHNIQUE: The patient was positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically, despite trying numerous angles. This was explained to the patient who wished to proceed with the injection. A 22-gauge 6-inch spinal needle was advanced toward the region of the left L3-L4 paravertebral facet joint under fluoroscopic guidance. Injection of 0.5 cc of Isovue 200 contrast showed the needle was not in an intravascular location.Intra-articular placement could not be confirmed and the injection was presumed to be peri-articular. 2 cc containing equal parts preservative free 2% Lidocaine plus Depo-Medrol (80 mg per ml) was injected. The patient reported injection of medication produced discomfort in the region of her usual left low back pain. Immediately following the procedure, upon standing up from the procedure table, she reported her pain was a little bit better.What CPT® code(s) is/are reported for this procedure?a. 64493b. 64493-50-26c. 64493-26d. 64493-50, 77003 a. 64493Rationale: Nerve block injections are selected based on location and number of levels. Code 64493 is described as a paravertebral facet joint of lumbar spine, single level. This code descriptor includes imaging guidance, and it is not reported separately. In the CPT® Index look for Injection/Paravertebral Facet Joint/Nerve/with image guidance.
INDICATIONS FOR CORONARY INTERVENTION: Acute inferior myocardial infarction. Documented mildly occlusive plaque with much clot in the right coronary artery.PROCEDURE: Insertion of temporary pacemaker in the right femoral vein. Primary stenting of the right coronary artery with a 4.5 x 16 mm Express stent. Angio-Seal to the vessels of the right common femoral artery post procedure, and also Angio-Seal of the right common femoral vein.TECHNIQUE: Judkins percutaneous approach from the right groin with Perclose at the arterial puncture site post procedure.CATHETERS: 4 French Angio-Jet catheter device, insertion of a 5 French temporary pacing wire, a 4.5 x 16 mm Express stent.PRESSURES: Aortic Pressure: 107/78RESULTS:Coronary stenting procedure of the right coronary artery: The right coronary artery was primarily stented with a 4.5 x 16 mm Express stent. It was expanded to 12 atmospheres. There was no residual stenosis.IMPRESSION: Successful Angio-Jet and stenting of the distal right coronary artery with no residual stenosis. Angio-Seal to the right femoral vein post procedure.PROCEDURE: Through the femoral artery sheath, the EBU was advanced to the right coronary. Following this a PT graphic intermediate wire was used to cross the lesion. Following this angioplasty of the lesion was performed, utilizing a 2.5 x 20-millimeter CrossSail balloon at multiple sites to ten atmospheres. Following this there was a fair result; however, there was a significant stenosis and significant calcification at the area, and the decision was made to pursue trying to stent the lesion. Multiple stents were attempted, including a 2.5 x 9-millimeter zipper MX and a 2.5 x 13-millimeter Guidant stent. This was abandoned, and in switching out to a balloon for further ballooning, the patient became hypertensive and with difficulty in terms of her respiratory status. Angiography revealed an occlusion of the mid left anterior descending and thrombus throughout the proximal left anterior descending extending into the left main. Recheck of ACT showed the ACT to be at eight seconds. This likely represented subtherapeutic range for her anticoagulation. A check of her medications revealed that instead of Angiomax, the patient had been given ReoPro without antithrombotic agent. She was therefore given IV heparin up to 12,000 units, and her ReoPro was continued. The lesion was then rewired, and an AngioJet was used to try to suction out this area of thrombus.Unfortunately, the AngioJet was unable to cross the mid left anterior descending lesion and therefore was somewhat limited in its use for a more distal thrombus, although it did suction out the proximal left anterior descending thrombus. At this point, the patient was emergently intubated, and multiple pressors were started, including dopamine, Levophed, vasopressin, and epinephrine. Following this, a laser was attempted to cross the lesion an excimer laser X80 Spectranetics 0.9 Vitesse; however, this laser was unable to cross the lesion. Therefore, a long balloon, a 2.0 x 40-millimeter CrossSail balloon, was used to cross the lesion and inflate multiple segments of the mid left anterior descending up to a maximum inflation pressure of ten atmospheres. This improved flow though by no means restored it back to normal. Therefore, following this, longer balloon inflations were performed utilizing a 2.0 x 20-millimeter CrossSail balloon up to fourteen atmospheres for one and a half minutes. This did not improve significantly the flow distally, and therefore the decision was made to try to stent the mid segment with a 2.5 x 9-millimeter zipper MX stent to a maximum inflation pressure of fourteen atmospheres. This resolved the issue in terms of the mid left anterior descending lesion; however, beyond the stent there continued to be residual stenosis, and multiple balloons were used to balloon this up to a 2.5 x 20-millimeter balloon up to fourteen atmospheres. The final result in the left anterior descending revealed a lesion in the mid-left anterior descending that was approximately 40 percent, there was TIMI III flow throughout the proximal and mid left anterior descending. However, at the level of the apex, there was TIMI 0 flow. Throughout the angioplasty, the patient had episodes of bradycardia, and a temporary pacemaker was placed, and this was removed at the end of the procedure.IMPRESSION: Successful stent to the mid left anterior descending, complicated by thrombotic event in the left anterior descending system. Final result was a successful stent to the mid left anterior descending with residual TIMI 0 flow in the distal left anterior descending. We returned to the right coronary artery and successfully employed a 4.5 x 16 mm Express sent. At the end of the case, an intra-aortic balloon pump was placed in the left femoral artery sheath, and the patient was sent to the Coronary Care Unit on multiple pressors including epinephrine, vasopressin, Levophed and dopamine. What CPT® coding is reported?a. 92928-RC, 92928-LD, 33967, 92973b. 92928-RC, 92929-LD, 33967, 92973-RCc. 92928-RC, 92929-LDd. 92928-RC, 92929-LD, 92973 a. 92928-RC, 92928-LD, 33967, 92973 Response Feedback:Rationale: Only one base code is reported per major coronary artery. In this case angioplasty and stent placement was performed in the right coronary artery (92928-RC) and in the left anterior descending (92928-LD). Look in the CPT® Index for Coronary Artery/Angioplasty/with Stent Placement referring you to 92928-92929. A thrombectomy was performed by AngioJet in the LD reported with 92973. Look in the CPT Index for Coronary Artery/Thrombectomy referring you to 92973. A temporary pacemaker was inserted through the femoral vein; however, it is bundled with the cardiac catheterization. At the end of the procedure, an intra-aortic balloon pump was inserted, 33967. Look in the CPT® Index for Insertion/Balloon/Intra-Aortic referring you to 33967, 33973.

What anatomical or compartment contains all the thoracic viscera except the lungs? Mediastinum
Who is responsible for enforcing the HIPAA security rule Office of Civil Rights (OCR)
ABN Advance Beneficiary Notice
According to the OIG, internal monitoring and auditing should be performed by what means? Periodic audits
What does the abbreviation MAC stand for? Medicare Administrative Contractor
How many lobes make up the RIGHT lung? the right has 3 lobesthe left has 2 lobes
Condition in which the endometrial tissue is found outside of the uterus. Endometriosis
A thin membrane lining the chambers of the heart and valves is called the: endocardium
PHI Protected Health Information
What is the TRUE statement in reporting pressure ulcers? Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to another stage during the admission.
The acronym MMRV stands for what? measles, mumps, rubella, and varicella
Which of the following is not part of the small intestine?a. duodenumb. ileumc. jejunumd. cecum d. cecum
Healthcare providers are responsible for developing __ policies and procedures regarding privacy in their practices. a. Patient hotlineb. Work around proceduresc. Feesd. Notices of Privacy Practices Notices of Privacy Practices
A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the:a. testisb. scrotumc. prostated. epididymis c. Prostate
What is the Rinne test?a. Test using music as the focal pointb. test for hearing loss using a vibrating tuning fork placed at the center of the head c. test using a 2-syllable word with equal stress on each syllable d. test measuring hearing using bone conduction and air conduction d. test measuring hearing using bone conduction and air conduction
What is the difference between entropion and ectropion? A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. B. Entropion is facial droop and ectropion is a facial spasm. C. Entropion is the outward turning of the hands and ectropion is the inward turning of the hands. D. Entropion inward turning of the feet and ectropion is the outward turning of the feet due to muscle disorder. a. entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid.
An arteriovenous anastomosis is used to increase blood flow in hemodialysis. Which one of the following describes a direct arteriovenous anastomosis?A. Insertion of a cannula B. A section of artery and a neighboring vein are joined C. A donor’s vein is used to connect an artery and a vein D. Radical hysterectomy not otherwise specified E. A synthetic vein is used to connect an artery and a vein b. a section of the artery and a neighboring vein are joined
Ventral, umbilical, spigelian and incisional are types of: A. Surgical approaches B. Hernias C. Organs found in the digestive system D. Cardiac catheterizations b. hernias
When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located? A. Foot B. Upper Arm C. Upper Leg D. Hand a. foot
Which statement is TRUE when reporting pregnancy codes (O00-O9A): A. These codes can be used on the maternal and baby records. B. These codes have sequencing priority over codes from other chapters. C. Code Z33.1 should always be reported with these codes. D. The seventh character assigned to these codes only indicate a complication during the pregnancy. B: These codes have sequencing priority over codes from other chapters
Which statement is TRUE about reporting codes for diabetes mellitus? A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus. B. When a patient uses insulin, Type 1 is always reported. C. The age of the patient is a sole determining factor to report Type 1. D. When assigning codes for diabetes and its associated condition(s), the code(s) from category E08-E13 are not reported as a primary code. a. if the type of diabetes mellitus is not documented in the medical record, the default type is E11: type 2 diabetes mellitus
Which statement is TRUE for reporting external cause codes of morbidity (V00-Y99)? A. All external cause codes do not require a seventh character. B. Only report one external cause code to fully explain each cause. C. Report code Y92.9 if the place of occurrence is not stated. D. External cause codes should never be sequenced as a first-listed or primary code d. external cause codes should never be sequenced as a first-listed or primary code
What is NOT included in CPT® surgical package?A. Typical postoperative follow-up care B. One related Evaluation and Management service on the same date of the procedure C. Returning to the operating room the next day for a complication resulting from the initial procedure D. Evaluating the patient in the post-anesthesia recovery area c. returning to the operating room the next day for a complication resulting from the initial procedure
What is the term used for inflammation of the bone and bone marrow? A. Chondromatosis B. Osteochondritis C. Costochondritis D. Osteomyelitis d. osteomyelitis
The root word trich/o means: A. Hair B. Sebum C. Eyelid D. Trachea a. hair
Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, _. A. Medulla lobe B. Occipital lobe C. Middle lobe D. Inferior lobe d. occipital lobe
A patient is having pyeloplasty performed to treat an uretero-pelvic junction obstruction. What is being performed? A. Surgical repair of the bladder B. Removal of the kidney C. Cutting into the ureter D. Surgical reconstruction of the renal pelvis d. surgical reconstruction of the renal pelvis
A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic esophageal varices. The ICD-10-CM codes are reported: A. I85.01, K74.69 B. I85.11, K74.60 C. K74.60, I85.11 D. I85.00, K74.69 In the ICD-10-CM Alphabetic Index look for Varix/esophagus/in/cirrhosis of liver/bleeding referring you to code I85.11. This eliminates multiple choices A and D. In the Tabular List you will see an instructional note above codes I85.10 and I85.11 to Code first underlying disease. For the scenario, cirrhosis of liver (K74.60) is coded first then the esophageal varices with bleeding is coded as a secondary code. Eliminating multiple choice B.correct answer is C. K74.60, I85.11
Which statement is TRUE about Z codes: A. Z codes are never reported as a primary code. B. Z codes are only reported with injury codes. C. Z codes may be used either as a primary code or a secondary code. D. Z codes are always reported as a secondary code. c. Z codes may be used wither as a primary code or a secondary code
Guidelines from which of the following code sets are included as part of the code set requirements under HIPAA? A. CPT® Category III codes B. ICD-10-CM C. HCPCS Level II D. ADA Dental Codes ICD-10-CM guidelines are the only guidelines specifically mentioned in HIPAA. While HIPAA requires the use of the other code sets listed, there is no specific mention of the other guidelines in the law. This information is found in the ICD-10-CM Official Guidelines for Coding and Reported in you ICD-10-CM codebook: These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA).
Which statement is an example in which a diabetes-related problem exists and the code for diabetes is NEVER sequenced first? A. If the patient has an underdose of insulin due to an insulin pump malfunction. B. If the patient is being treated for secondary diabetes. C. If the patient is being treated for Type 2 diabetes and uses insulin. D. If the patient is diabetic with an associated condition. a. If the patient has an underdose of insulin due to an insulin pump malfunction. The ICD-10-CM guidelines (Section I.C.4.a.5): An underdose of insulin due to an insulin pump failure should be assigned T85.6-, as the principal or first listed code, followed by code T38.3X6-. Additional codes for the type of diabetes mellitus should also be assigned.
Local Coverage Determinations (LCD) are published to give providers information on which of the following? A. Information on modifier use with procedure codes B. CPT® codes that are bundled C. Fee schedule information listed by CPT® code D. Reasonable and necessary conditions of coverage for an item or service d. Reasonable and necessary conditions of coverage for an item or service
Which place of service code is reported on the physician’s claim for a surgical procedure performed in an ASC? A. 21 B. 22 C. 24 D. 11 place of service codes are two digit numerical codes that define the location where the services are performed and reported on the CMS-1500 form. A complete chart of place -of-service codes are located in the front of the CPT bookC. 24
If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines? A. As unspecified AMI B. As a subendocardial AMI C. As STEMI D. As a NSTEMI C. as STEMI ICD-10-CM guidelines (Section I.C.9.e.1) indicate: If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI
When a person has labyrinthitis what has the inflammation? A. Inner ear B. Brain C. Conjunctiva D. Spine a. inner ear
An angiogram is a study to look inside: A. Female Reproductive System B. Urinary System C. Blood Vessels D. Breasts c. blood vessels
What does oligospermia mean? A. Presence of blood in the semen B. Deficiency of sperm in semen C. Having sperm in urine D. Formation of spermatozoa b. deficiency of sperm in semenThe breakdown of this term: combining form olig/o means too few or too little and spermia refers to the condition of the sperm. The definition is too low or too few sperm. In the Alphabetic Index look for Oligospermia N46.11. In the Tabular List oligospermia is indicated as a type of male infertility.
A 45-year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported? A. 14060 B. 11642, 14060 C. 11642, 15115 D. 15574 A. 14060An adjacent tissue transfer (advancement flap) was used to repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are not separately reported. This eliminates multiple choice answer B.
A 24-year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT® code is: A. 56405 B. 10061 C. 11004 D. 11042 c. 11004The abscess had already burst, with no need to perform an incision to open it, eliminating multiple choice answers A and B. The difference between multiple choice answers C and D, is that the patient is having the debridement performed due to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of necrotized infected tissue on the external genitalia.
A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to Dr. S, who his neighbor referred him, to see if Dr. S can provide another type of treatment. Dr. S documents an appropriate history and exam. Patient has had the sleep apnea for the past five months. Sleep is disrupted by frequent awakenings and getting worse due to anxiety and snoring. Current medication that he is on now is not helping him. Which E/M category is reported for this encounter? A. New Patient Office Visit (99202-99205) B. Established Patient Office Visit (99211-99215) C. Office Consultation (99241-99245) D. Observation Care (99218-99220)
What is orchitis? A. Inner ear imbalance B. Lacrimal infection C. Inflammation of testis D. Inflammation of an ilioinguinal hernia “c. inflammation of testis Orchitis is marked by painful swelling of the testis. It may occur without cause, or be the result of infection. The Greek root “”orchis”” means testicle, and – “”itis”” is a suffix indicating inflammation or infection. Look in the ICD-10-CM Alphabetic Index for Orchitis referring you to code N45.2. In the Tabular List this code is found under Diseases of the Male Genital Organs (N40-N53).”
The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A laparoscopy found several small cysts in the area of the fallopian tubes. These cysts are called: A. Pilonidal cysts B. Myomas C. Paratubal cysts D. Synovial cysts C. Paratubal cystsParatubal cysts are benign, they are frequently found adjacent to the fallopian tubes. Pilonidal cyst develops in the deeper layers of the skin in the lower back near the upper crease of the buttocks. Myomas or leiomyomas are benign tumors of the uterus. Synovial cyst develops in any joint, for example at the back of the knee. Look in the ICD-10-CM Alphabetic Index for, Cyst/paratubal N83.8. Go to the Tabular List and the code indicates where these cysts are located.
Which one of the following patients might be documented as having meconium staining? A. Woman with renal failure B. Teenage boy with sickle cell anemia C. Newborn with pneumonia D. Man with alcoholic cirrhosis of liver c. Newborn with pneumonia
Which of the following anatomical sites have septums? A. Nose, heart B. Kidney, lung C. Sternum, coccyx D. Orbit, ovary a. nose, heart
Which place of service code is reported for fracture care performed by an orthopedic physician in the ED? A. 11 B. 20 C. 22 D. 23 d. Place of service codes are reported on the claim form to identify the site of the service provided. In this case, the services are rendered in the ED which is reported with place of service (POS) 23. The place of service codes can be found in the CPT® codebook.
Which one of the following is an example of fraud? A. Reporting the code for ultrasound guidance when used to perform a liver biopsy B. Reporting a biopsy and excision performed on the same skin lesion during the same encounter C. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physician’s office D. Reporting a lab panel with an additional lab test that is not included in the lab panel b. Reporting a biopsy and excision performed on the same skin lesion during the same encounter Answer B is the only example of unbundling of CPT® which would result in a fraudulent claim. According to National Correct Coding Initiative (NCCI) and CPT® coding guidelines, a biopsy performed on the same lesion as an excision during the same encounter is an incidental service and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is billable. X-rays performed in a physician’s office do not require modifier 26, because the physician owns the equipment and performs the interpretation, he bills the global service. Lab panels can be reported with additional lab tests that are not listed in a lab panel.
Which Z code category can ONLY be reported as a first listed diagnosis code? A. Z67 B. Z69 C. Z58 D. Z02 D. Z02 see 1.C.21.c.16
While playing softball a 12-year-old boy sustains a blowout fracture. What is the anatomical location of a blowout fracture? A. Orbit B. Clavicle C. Patella D. Femur a. orbit A blowout fracture is a fracture of the walls or floor of the orbit. The orbit is the cavity or socket of the skull which the eye and its appendages are situated. In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/orbit/floor (blowout).
The root metr/o means: A. Menstruation B. Breast C. Mammary gland D. Uterus D. Uterus : hint The root word metr/o or metr/i means uterus. In the ICD-10-CM Alphabetic Index look for a main term that starts with metro. You will see the main term Metrorrhexis – see Rupture, uterus.
According to the CPT® Appendix L, when performing a selective vascular catheterization, which vessels would you pass through to place the catheter into the right middle cerebral artery? A. Innominate, right common carotid, right exteranl carotid B. Innominate, right subclavian & axillary C. Left common carotid, left internal carotid D. Innominate, the right common, and internal carotid d. innominate, the right common, and internal carotid
Which one of the following statements regarding advanced beneficiary notices (ABN) is TRUE? A. ABN must specify only the CPT® code that Medicare is expected to deny. B. Generic ABN which states that a Medicare denial of payment is possible, or the internist is unaware whether Medicare will deny payment or not is acceptable. C. An ABN must be completed before delivery of items or services are provided. D. An ABN must be obtained from a patient even in a medical emergency when the services to be provided are not covered. c. An ABN must be completed before delivery of items or services are providedAn ABN must include the service that may be denied, an estimated cost of the patient’s responsibility if Medicare denies the service and the response for the potential denial. Generic ABNs are not allowed. Signing of the ABN cannot be obtained during a medical emergency. The patient must be stable. The ABN must be signed prior to providing the service.
Which service is covered by Medicare Part B? A. Inpatient chemotherapy B. Minor surgery performed in a physician’s office C. Routine dental care D. Assisted living facility b. Minor surgery performed in a physician’s office Services performed by physicians are covered by Medicare Part B. Inpatient services are covered by Part A. Medicare does not cover routine dental care.
When coding for a patient who has had a primary malignancy of the thyroid cartilage that was completely excised a year ago, which one of the following statements is TRUE? A. When the cancer is surgically removed with no further treatment provided and there is no evidence of any existing primary malignancy, code Z85.850. B. When further treatment is provided and there is evidence of an existing metastasis, code first Z85.850 and then C32.9. C. Any mention of extension, invasion, or metastasis to another site is coded as a D49.1, Z85.850. D. When the cancer is surgically removed but the patient is receiving chemotherapy treatment report Z85.850. a. when the cancer is surgically removed with no further treatment provided and there is no evidence of any existing primary malignancy, code Z85.850ICD-10-CM guidelines (Section I.C.2.d.) indicated, when the patient has excised or eradicated the malignancy and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the site of the former malignancy. Look in the ICD-10-CM Alphabetic Index, for History/personal (of)/malignant neoplasm (of)/thyroid. Note: If a malignant cancer is removed but the patient is still receiving further treatment for that site, such as chemotherapy or radiation, you report the malignant neoplasm code not the personal history code.
In order to use the critical care codes, which statement is TRUE? A. Critical care services can be provided in an internist’s office B. Critical care services provided for more than 15 minutes but less than 30 minutes should be billed with 99291 and modifier 52. C. Time spent reviewing laboratory test results or discussing the critically ill patient’s care with other medical staff in the unit or at the nursing station on the floor cannot be included in the determination of critical care time. D. Critical care services are never reported with endotracheal intubation (31500) E. Physician can provide services to another patient during the same time providing critical care services to a critically ill patient E. Physician can provide services to another patient during the same times providing critical care services to a critically ill patient Critical care services can be provided at any site. If the patient is critically ill, the services provided can be coded with critical care regardless of where the services take place. A minimum of 30 minutes of critical care must be performed in order to report 99291. If less than 30 minutes, select the appropriate E/M code based on the three key components. Time spent reviewing results and discussing the critically ill patient with medical staff is included in the critical care time. Endotracheal intubation, code 31500, can be reported with critical care services. The subsection guidelines for critical care services in the CPT® codebook does give what services cannot be billed with critical care. A physician providing critical care services must devote full attention to the critically ill patient and cannot provide services to any other patient during the same period of time.
What is the patient’s right when it involves making changes in the personal medical record? A. Patient must work through an attorney to revise any portion of the personal medical information. B. They should be able to obtain copies of the medical record and request corrections of errors and mistakes. C. It is a violation of federal health care law to revise a patient medical record. D. Revision of the patient medical record depends solely on the facility’s compliance program policy. b.. They should be able to obtain copies of the medical record and request corrections of errors and mistakes
Which statement regarding an ICD-10-CM coding conventions is TRUE? A. If the same condition is described as both acute and chronic and separate subentries exist in the Alphabetic Index at the same indentation level, code only the acute condition. B. Sequela (Late effect) codes are reported for a current acute phase of the injury or illness C. An ICD-10-CM code is still valid even if it has not been coded to the full number of characters required for that code. D. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed. d. signs and symptoms that are integral of the disease process should not be assigned additional codes, unless otherwise instructed.
Which modifier is appended to a CPT®, for which the provider had a patient sign an Advance Beneficiary Notice (ABN) form because there is a possibility the service may be denied because the patient’s diagnosis might not meet medical necessity for the covered service? A. GJ B. GA C. GB D. GY b. GAAn Advance Beneficiary Notice (ABN) is a waiver of liability. When a patient has been informed a service that is otherwise covered by Medicare but might not be covered in a particular instance an ABN is signed by the patient prior to receiving the service. To inform Medicare the ABN has been signed, append modifier GA. If an ABN is signed, the claim is the patient’s responsibility if the claim is denied. This modifier is listed in the HCPCS Level II codebook.
15-year-old male is seen by the pediatrician in his office for having excessive thirst and frequent urination. A urine dip is performed showing +3 sugar and with some ketones. Glucometer reading is done showing a blood sugar range of 500-600. Physician sends the patient with his father to the hospital for emergency admission and insulin drip. The pediatrician meets the patient at the hospital and performs a medically appropriate history andexam continuing treatment for the patient. How should the pediatrician code the E/M service for this visit? A. Office visit E/M code only B. Initial Hospital Inpatient E/M code and Office Visit E/M code with modifier 25 C. Initial Hospital Inpatient E/M code only D. Subsequent Hospital Inpatient E/M code b. Initial hospital inpatient E/M code and office visit E/M coe with modifier 25 According to CPT® subsection guidelines for Initial Hospital Care: When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in another site of service (eg, hospital emergency department, office, nursing facility), the services in the initial site may be separately reported. Modifier 25 may be added to the other evaluation and management service to indicate a significant, separately identifiable service by the same physician or other qualified health care professional was performed on the same date.
CKD is a disease of which system? A. Circulatory B. Genitourinary C. Digestive D. Musculoskeletal b. genitourinary CKD is the abbreviation for Chronic Kidney Disease. The abbreviation is found in the ICD-10-CM Tabular List for category code N18 which falls under the Genitourinary System.
A person who has nephritis has inflammation in what location? A. Gallbladder B. Nerve C. Uterus D. Kidney d. kidney
What is ascites? A. Fluid in the abdomen B. Enlarged liver and spleen C. Abdominal malignancy D. Abdominal tenderness a. fluid int he abdomen In ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically caused by cirrhosis, malignancy, or heart failure. It is usually managed medically but may be treated with paracentesis. Look in the ICD-10-CM Alphabetic Index for Ascites (abdominal) referring you to code R18.8. In the Tabular List under category code R18 the includes note indicates: Fluid in peritoneal cavity.
Which one of the following is a disorder in causing paralysis of the facial nerve? A. Exotropia B. Tarsal tunnel syndrome C. Brachial plexus lesions D. Bell’s palsy d. Bell’s palsy
Complete this series: Pulmonary, Aortic, Mitral, and ___are valves of the heart. A. Tricuspid B. Superior Vena Cava C. Carotid D. Atrium a. Tricuspid Tricuspid is the first heart valve that blood encounters as it enters into the heart. Superior Vena Cava is a vein that returns blood to the heart from the head, neck and both upper extremities. Carotid is a major artery located in the front of the neck. Atrium is one of the two upper receiving chambers of the heart. An illustration of the heart is found in the Professional Edition of the CPT® codebook in the Cardiovascular System Table of Contents or look in the CPT® Index for Valve and you will note a complete valve listing. Which term is one who has an overload of sodium? A. Hyperkalemia B. Hyperpotassemia C. Hypernatremia D. Hypercalcemi c. hypernatremia hint:In the ICD-10-CM Alphabetic Index look for each of the listed terms. Cross reference each code in the Tabular List to note a brief definition. Hypernatremia is the when one has too much sodium in the system. Hypernatremia is indexed to code E87.0. The term paracentesis found in CPT® code 49082 means: A. A procedure performed to drain fluid that has accumulated in the abdominal cavity B. Biopsy of an abdominal mass C. Removal of tissue samples from the abdominal cavity by an open approach D. Removal of a cyst located in the abdominal cavity a. procedure performed to drain fluid that has accumulated in the abdominal cavity A 7-year-old riding his bike struck a tree stump throwing him off his bike. He received multiple lacerations. He had a 3 cm dermis laceration on his scalp with two 0.5 cm lacerations on his face. His right arm had a 5 cm laceration and right leg has a 5 cm laceration. The physician stapled the laceration for the scalp. Physician used steri-strips (adhesive strips) to close the wounds on the face. The legs and arms were cleaned by heavily irrigating them with normal saline and removal of embedded debris performed on both wounds, followed with a single-layer closure. Select the repair codes to report. A. 12032, 12032-59, 12011-59, 12002-59 B. 12002, 12002-59, 12011-59, 12002-59 C. 12005, 11042-59 D. 12034, 12002-59 d. 12034, 12002-59The two face lacerations were closed with steri-strips (adhesive strips). When adhesive strips are the only repair material used to close an open wound a repair code is not reported. According to CPT® subsection guidelines for Repair (Closure), when wound closure uses adhesive strips as the only repair material it should be coded using the appropriate E/M service. Code 12011 is inappropriate to report for this scenario, eliminating multiple choices A and B. The repairs for the wounds on the arm and leg are intermediate closures. According to CPT® subsection guidelines for Repair (Closure), single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair. This eliminates multiple choice C. To report multiple wounds that are repaired in the same classification and from the anatomic sites that are grouped together into the same code descriptor, add the length of the wounds. The subsection guidelines also indicates when more than one classification of wounds is repaired, append modifier 59 to the least complicated repair(s). Procedure Diagnosis: Basal cell carcinoma, left chin. Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell carcinoma of the left chin with a 4 cm closure.Procedure: The patient’s left chin was examined. The site of intended excision was marked out. The site was then prepped. The patient was then prepped and draped in the usual fashion. A 15 blade scalpel was then used to make an incision in the previously marked site. It was carried down to the subcuticular fat. The lesion was then sharply dissected off underlying tissue bed using a 15-blade scalpel. It was tagged for pathologic orientation. The hyfrecator was used for hemostasis. The wound was then closed by advancing the tissue surrounding the lesion and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin. The skin closure was in a running subcuticular fashion. Steri-Strips were then applied. What are the procedure and diagnosis codes? A. 11644, 12052-51, C44.319 B. 11643, 12013-51, C44.319 C. 11444, 12052-51, D49.2 D. 11443, 12013-51, D49.2 a. 11644, 12052-51, C44.319You need to first find out if this lesion is benign or malignant. For this scenario the patient has a basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as they deal with benign lesions. Now you need to find out where the lesion is located and the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm + .3 cm = 3.6 cm, leading you to code 11644. CPT® subsection guidelines for Excision-Malignant Lesions state: For excision of malignant lesion(s) requiring intermediate or complex closures should be reported separately. For this scenario the wound was closed in two layers qualifying the closure to be coded with an intermediate repair of the chin (4 cm), 12052. The diagnosis, basal cell carcinoma of the chin, look in the ICD-10-CM Table of Neoplasms, for Neoplasm, neoplastic/skin NOS/face NOS/basal cell carcinoma C44.31-. In the Tabular List complete the code with the 6th character 9. A 47-year-old patient was previously treated with external fixation for a type IIIA open left tibia fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Interfragmentary compression was applied and three screws and the harvested bone graft were packed into the fracture site. What are the correct codes for this diagnosis and procedure?A. 27724, S82.102N B. 27758, S82.202S C. 27722, S82.202P D. 27759, S82.102N “a. 27724, S82.102NThe selection of the code is based on the anatomic location and method of repair. Codes are 27758 and 27759 are not reported with this scenario because the fracture is not an acute traumatic fracture. The physician is repairing a nonunion tibia fracture (failure of two ends of a fracture to completely heal). Eliminating multiple choices B and D. To select the correct choice you need to find out what type of graft was used. Your hints are “”bone grafting”” and “”iliac crest,”” which leads you to the code 27724. The bone graft was harvested from the iliac crest, and then the graft is placed at the fracture site of the tibia compressing it for desired position and alignment and the screws were used to stabilize the fracture. In the ICD-10-CM Alphabetic Index, look for Nonunion/fracture-see Fracture, by site. Look for Fracture, traumatic/tibia/upper end referring you to code S82.10-. Compete code in the Tabular List, S82.102N. ICD-10-CM Coding Guideline, I.C.19.c.1, indicates Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N) or subsequent care with malunion (P, Q, R).” Patient had a dual chamber pacemaker put in two days ago. He is having problems with the battery and the cardiologist found that it is malfunctioning. He is taken to the operating suite to replace the pacemaker battery. What CPT® and ICD-10-CM codes are reported? A. 33226-76, T82.111A B. 33235-52, T82.110A C. 33228-78, T82.111A D. 33213-58, T82.119A c. 33228-78, T82.111AOne way to choose the correct choice is by the modifiers. The patient is still in a post-op period from an initial cardiac procedure and is having an unplanned return to the operating room due to a malfunctioning pacemaker battery that is going to be replaced (modifier 78). In the ICD-10-CM Alphabetic Index look for Malfunction/cardiac electronic device/pulse generator referring you to code T82.111-. Go to the Tabular List to complete the code, T82.111A.The selection of the pacemaker code is based on which system part of the system is being inserted or replaced and the number of leads for the unit. Code 33228 is the removal of the pulse generator or battery on a dual lead system with replacement. A 2-year-old male requires a central venous catheter. Using xylocaine local anesthesia a percutaneous approach is used in the neck and venous access is achieved. A subcutaneous tunnel is created from the anterior chest wall to the venotomy site and the catheter passed through the tunnel. The CV catheter is then placed at the superior vena cava and sutured in position. Which procedure code is reported?A. 36568 B. 36555 C. 36557 D. 36560 c. 36557The selection of the central venous codes are based on the technique of placement, if there is a use of port or pump, and the age of the patient. Procedure performed is for placement of a central venous catheter eliminating multiple choice A. An access device is not inserted eliminating multiple choice D. The documentation supports that a subcutaneous tunnel is created to place the catheter guiding you to code 36557. A 46-year-old female with history of cervical carcinoma underwent placement of an ileal conduit, with subsequent development of left hydronephrosis. A retrograde ureteral catheter was recently placed. She returns today for catheter exchange. Patient was placed in the supine on the operating table. The ileal conduit was accessed. The existing catheter was removed over a guidewire and replaced with a similar 10 French 50 cm long locking pigtail catheter. Contrast was injected for monitoring, confirming good position of the catheter placement. Interpretation and report is in the record. IMPRESSION: Left retrograde ureteral catheter exchange via the ileal conduit. How is this reported? A. 50435 B. 50693 C. 50385 D. 50688, 75984-26 d. 50688, 75984-26The patient presents for a ureteral catheter exchange via the ileal conduit. 50435 is not correct because it is an exchange of the catheter percutaneously. 50693 is performed using a percutaneous approach for placement of a ureteral stent, which is not performed in this case. 50385 is performed using a transurethral approach, which is not correct. The exchange is performed via the ileal conduit, which is reported with 50688. Monitoring contrast imaging is performed. There is a parenthetical note under 50688 that states that imaging is reported with 75984. A 70-year-old with significant pelvic prolapse and grade IV cystocele who has failed previous primary repair and is status post hysterectomy. She presents for anterior repair and colpopexy. Procedure: Patient placed in the dorsal lithotomy position and general anesthetic was induced without problems. A midline incision is made from just above the bladder neck to the vaginal cuff. She is noted to have a grade IV cystocele. Vaginal flaps were dissected to the level of the pubocervical fascia. Her vaginal mucosa was in good condition but near the urethra and bladder neck it was a little thinner. There is significant scarring on the left side from previous procedures. Ishcial spine is identified and swept fiber fatty tissue off of the sacrospinous ligament bilaterally. No scarring or adhesions in this area. Anterior needles were passed into place on the elevate mesh and these were fixed in a manner similar to the MiniArc. They were passed along just below the bladder neck toward the obturator foramen and fixed in place. An anterior support was created without tension at the vesicourethral junction. Apical needles were then used to pass the apical arms into place. There were gently fixed into place along the sacrospinous ligament approximately 2cm away from the ischial spine. This was done bilaterally. They passed in a single pass and were fixed in place confirmed by gentle tugging on both arms. Three Vicryl sutures had been placed and the vaginal apex were then passed over into the mesh and tied down. The apical arms were placed through the eyelets of the mesh and passed down toward the sacrospinous ligament bilaterally to create good apical support. Eyelet fasteners placed bilaterally and mesh arms trimmed providing excellent apical and anterior support. Vaginal mucosa was closed and vaginal packed placed. No complications. What CPT® code(s) describe(s) this procedure? A. 57250, 57280 B. 57240, 57282 C. 57240, 57283 D. 57250, 57283View Rationale b. 57240, 57282The colporrhaphy codes are based on the surgical approach and type of herniation. The operative note indicates the patient had an anterior approach in correcting a grade IV cystocele (herniation of the bladder causing the anterior vaginal wall to bulge downwards). The colpopexy codes are also coded by approach. Colpopexy is suturing a prolapsed vagina to its surrounding structures for vaginal fixation. Operative note documents a sacrospinous ligament fixation. Correct codes are 57240 and 57282. “PROCEDURE: Bilateral lumbar medial branch block under ultrasound guidance for the L3, L4, L5 medial branches injecting the L4-L5, L5-S1 facets for diagnostic and therapeutic purposes. PROCEDURE: The patient was placed in the prone position and automated blood pressure cuff and pulse oximeter applied. The skin entry points for approaching the anatomic target points of the bilateral segmental medial branches or dorsal ramus of L3, L4, L5 were identified with a 22.5 degree from an ultrasound view and marked. Following thorough Chloraprep preparation of the skin and draping and 1% lidocaine infiltration of the skin entry points and subcutaneous tissues, a 22 gauge 6″” spinal needle was placed under ultrasound guidance for the L4-L5 and L5-S1 facet joints. At each joint 1 mL consisting of 0.5% bupivacaine and Depo-Medrol was injected. A total of 80 mg of Depo-Medrol was given in both sides. Which CPT® codes are reported? A. 0216T-50, 0217T x 2, 0218T x 2, 76942-26 B. 64493-50, 64494-50, 64495-50 C. 64493-50, 64494-50, 76942-26 D. 0216T-50, 0217T x 2″ d. 0216T-50, 0217T X 2 (found in CPT code book category IIIWhen coding for facet joint or facet joint nerve injections, you report each level that is injected. In this case, the joints for L4-L5 and L5-S1 were injected. A parenthetical note states: If ultrasound guidance is used, report 0213T-0218T. The codes for facet joint and facet joint nerve injections are unilateral. The procedure was performed bilaterally at each level, therefore modifier 50 is reported on code 0216T. A parenthetical note is given for add-on code 0127T that indicates to report it twice when performed bilaterally, not with modifier 50. The ultrasound guidance is not reported separately, eliminating answer choice A. CC: Shortness of breath History: A 62-year-old female returns to a family practice having shortness of breath for the last week. It has been two years since her last visit to the practice. She also has nausea, diaphoresis, chest pressure. Past History: Celebrex® for her arthritis. Hysterectomy 1 year ago. Social History: Smoker-No Alcohol-No Allergies: Penicillin PHYSICAL EXAM Vital Signs: BP 195/95 sitting, left arm General/Constitutional: Mild distress. Some diaphoresis. Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions. Neck/Thyroid: Supple, without adenopathy or enlarged thyroid. Respiratory: Shallow breathing, no wheezing. Cardiovascular: Unequal pulses in both arms. Abnormal heart sounds heard.EKG ordered. Assessment/Plan Severe exacerbation of congestive heart failure Patient is sent to the hospital to be admitted. Will send hospital orders to start her on IV, order chest X-ray and CBC. A. 99202 B. 99215 C. 99204 D. 99214 Using the AMA CPT® E/M Service Guidelines for Medical Decision Making: · High for number and complexity of problem addressed at the encounter – 1 acute or chronic illness or injury that poses a threat to life or bodily function · Moderate for amount /or complexity of data to be reviewed and analyzed – ordering of 3 unique tests (EKG, CBC, and X-ray). · High risk of complication and/or morbidity or mortality of patient management – Decision regarding hospitalization. To qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is low reporting 99215. This morning a 48-year-old is placed in observation status with severe diarrhea and extreme thirst. The physician performs a medically appropriate history, and examination and determines the patient is suffering from dehydration. The physician places the patient on IV saline 500 ml and conducts normal saline hydration for a couple hours. Patient is discharged home in the late evening on the same day and is told to return if symptoms occur again. The E/M service(s) for this encounter is: A. 99234, 99238 B. 99222, 99238 C. 99234 D. 99222 c. 99234According to the Initial Observation Care guidelines it states: For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236. Code 99222 is not reported. Code 99238 are not reported with code range 99234-99236. The anesthesiologist performed MAC (monitored anesthesia care) for a patient undergoing an arthroscopy of the right knee. Code the anesthesia service. A. 01382-AA B. 01382-AA-QS C. 01400-AA D. 01400-AA-QS b. 01382-AA-QSIn this case MAC is performed, which requires modifier QS. This eliminates answer options A and C. The selection of the code is based on the procedure being diagnostic or surgical. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was performed, eliminating choice D. Because the service was provided by an anesthesiologist, modifier AA is appended to the anesthesia code. Anesthesia modifiers are found in your HCPCS Level II codebook. General anesthesia is administered to a 9-month-old undergoing a tracheostomy. Code the anesthesia service. A. 00320, 99100 B. 00320 C. 00326 D. 00326, 99100 c. 00326 A 52-year-old male has a 3.2 cm metastasized lung cancer in his left upper lobe. The tumor cannot be removed by surgery due to the patient having severe respiratory conditions. He will be receiving stereotactic body radiation therapy management under image guidance. There is a delivery of 25 Gy for four fractions under direct supervision of the radiation oncologist. The patient’s treatment set up is assessed to manage the execution of the treatment to make any adjustments needed for accuracy and safety. The oncologist reviews and approves all the images used to locate the tumor and images of fields arranged to deliver the dose. What CPT® and ICD-10-CM codes should be reported? A. 77373, Z51.0, C34.92 B. 77435, Z51.0, C78.02 C. 77435, C78.02, Z51.0 D. 77402, C34.92, Z51.0 b. 77435, Z51.0, C78.02Documentation supports stereotactic body radiation therapy, treatment management. This eliminates multiple choices A and D. According to ICD-10-CM guidelines (Section I.C.2.e.2): If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy, assign code Z51.0 (radiation), Z51.11 (chemotherapy), or Z51.12 (immunotherapy) as the first listed or principal diagnosis, and the diagnosis or problem for which the service is being performed as a secondary diagnosis. For the metastasized or secondary neoplasm in the left upper lobe lung, look in the Table of Neoplasm for Neoplasm/lung/upper lobe/Malignant Secondary referring you to code C78.0-. Complete code in the Tabular List, C78.02. Preoperative Diagnosis: Right hydronephrosis Postoperative Diagnosis: Right hydronephrosisProcedure: Cystoscopy and right retrograde pyelogram Procedure Description: Patient prepped and draped in the dorsolithotomy position. Placed under general anesthesia a 23 French cystoscope was passed into the bladder. No tumors were visualized. Urine from the bladder was sent for urine cytology. Then a 6 French access catheter was passed into the right ureteral orifice. Contrast was injected and there were no filling defects noted. There was no fixed tumor and no stone. There was mild hydroureteral nephrosis against the bladder. There was a narrowing at the UVJ no abnormalities. Renal pelvis barbotaged with saline and renal pelvis urine sent to pathology for urine cytology. After the retrograde pyelogram was performed the access catheter was removed. Interpretation and report are in the medical record. What CPT® codes are reported? A. 52000-RT, 74420-26 B. 52281-RT, 74425-26 C. 52007-RT, 74400-26 D. 52005-RT, 74420-26 d. 52005-RT, 74420-26Patent had a retrograde pyelogram eliminating multiple choices B and C. A cystoscope is passed through the urethra into the bladder. Then a French catheter was passed into the right ureter (ureteral catheterization) to introduce the contrast for radiologic study of the renal pelvis and ureter, eliminates code 52000. Note in the code description for code 52005 that it states: exclusive of radiologic service. This is an indication that radiology will be coded if performed. The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer< Medicare Part B What modifier do you append to a CPT code if a commercial insurance company requires the patient to acquire a medical consultation from a second physician? 32 The National Correct Coding Initiative (NCCI) files contain a Correct Coding Modififer (CCM) indicator. What does the CCM indicator 0 mean? A CCM id not allowed and will not bypass the edits. Which modifiers are appended to E/M codes to report services within the global package? 24, 25, 57 What services are included in the surgical global package? Preoperative visits, intraoperative, postsurgical pain management How often can HCPCS temporary Codes be undated? quarterly What set of HCPCS Level II codes are considered temporary codes assigned by CMS and reviewed by AMA for inclusion in the CPT G codes Which HCPCS Level II modifier should you append for a new wheelchair purchase? NU What is a default code? Refer to ICD-10-CM guideline I.A.18. The code that represents the condition most commonly associated with the main term Who are the parties responsible for providing the ICD-10-CM? NCHS and CMS What does ICD-10-CM stand for> International Classification of Diseases, 10th Revision, Clinical Modification Restriction of blood supply, commonly due to factors in the blood vessel, that can result in damage or dysfunction of tissue is known as: Ischemia A thin membrane lining the chambers of the heart and valves is called the: endocardium What section of the ICD-10-CM guidelines contains instructions on how to code for a patient receiving diagnostic services only in an outpatient setting? Section IV What is an example of an eponym? Paget’s diseaseRationale: An eponym is a word derived from someone’s name. Paget’s disease is a disorder that involves abnormal bone destruction and regrowth which results in deformity. It was described by surgeon and pathologist Sir James Paget. What month does the new ICD-10-CM code book take effect each year? October What do the instructions and conventions of the classifications take precedence over? Official Coding guidelines What is the sequencing order when coding a sequela? The residual condition is coded first, and the codes for the cause of the late effect are coded secondary. What do brackets {} indicate in the ICD-10-CM Alphabetic index? Use code in brackets in addition to the disease or condition to identify an associated manifestation. When coding for an ambulatory surgical procedure, how is the diagnosis determined? Code the post operative diagnosis because it is the most definitive For ambulatory surgery, if the postoperative diagnosis is known to be different from the preoperative diagnosis is confirmed, select the postoperative diagnosis for coding because it is the most definitive The OIG releases a ____ outlining its priorities for the fiscal year ahead and beyond. a. Compliance planb. Self-referral lawc. Work Pland. CIA yearly review b. work plan
According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?a. Integrityb. Responsibilityc. Efficiencyd. Commitment c. efficiency If shall be the responsibility of every AAPC member, as a condition of continued membership, to conduct themselves in all professional activities in a manner consistent with ALL of the following ethical principles of professional conduct:+ Integrity+ Respect+ Commitment+ Competence+ Fairness+ Responsibility
Which one of the following best describes psoriasis?a. An inflammatory condition characterized by redness pustular and vesicular lesions, crusts, and scalesb. A contagious infection of skin generally caused by staphylococcus bacteriumc. A chronic condition characterized by red, dry, elevated lesions, covered by silvery scales.d. An allergic reaction characterized by wheals and generally accompanied by pruritus. c. a chronic condition characterized by red, dry, elevated lesions covered by silvery scales
The corpus luteum secretes progesterone. What is an effect of this secretion?a. Enlargement and development of the organs of the female reproductive systemb. Deposition of fat beneath the skinc. Closure of the epiphyseal in long bonesd. Thickens the endometrium for implantation and is necessary to sustain pregnancy d. Thickens the endometrium for implantation and is necessary to sustain pregnancy
What condition results from failure of the testis to descend into the scrotum?a. epididymitisb. cryptorchidismc. orchitisd. priapism d. cryptorchidism
A 50 year old female presents to her provider with symptoms of insomnia and upset stomach. The provider suspects she is in premenopausal. She is diagnosed with impending menopause. What diagnosis coed (s) should be reported?a. G47.00, K30b. N95.9c. N95.9, G47.00, K30d. E28.319 a. G47.00, K30ICD-10-CM guidelines I.B.11 states to reference the ICD-10-CM Alphabetic Index to determine if the condition has a subentry for impending or threatened and reference main term entries for Impending and Threatened. If the subterms are listed, assign the given code. If the subterms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatening. Look in the Alphabetic Index for Impending. There is not a subterm for menopause; therefore, the symptoms are coded.
According to ICD-10-CM guidelines, when a patient is seen for management of anemia due to malignancy, how is it reported? The malignancy is reported first, followed by the code fro anemia
A patient returns to the provider for an injection to relieve low back pain from a car accident. What ICD-10-CM code(s) is/are reported?a. M54.50b. G89.11, M54.50c. M54.50, G89.11d. G89.21, M54.50 a. M54.50Per ICD-10-CM guideline I.C.6.b.1 if the pain is not specified as acute or chronic, do no assign codes from category G89, except for post thoracotomy pain, post operative pain, neoplasm related pain, or central pain syndrome.
What codes, according to ICD-10-CM guidelines, describe a patient that has hypertension with left heart failure?a. I10, I50.1b. I11.0, I50.1c. I11.9, I50.1d. I50.1, I11.0 b. I11.0, I50.1According to ICD-10-CMS guideline I.C.9.a. there is a presumed causal relationship between hypertension and heart involvement. IN this case, the patient has hypertension and LEFT heart failure. In the ICD-10-CM Alphabetic Index look for hypertension, hypertensive/heart/with heart failure I11.0. Verify the code in the tabular list. There is an instructional note under core I11.0 that tells us to use an additional code to identify the type of heart failure. The additional code is sequenced second. The patient has LEFT heart failure. Look in the ICD-10-CMS alphabetic index for failure/heart/left (ventricular) and you are directed to see failure, ventricular, left which directs you to code I50.1. Verify the code in the tabular list. Under code selection I50 there is an instructional note telling us to code heart failure due to hypertension. This confirms our sequencing.
The patient has a significant visual impairment (category 2) due to astigmatism in the left eye. It is corrected with glasses. The right eye has normal vision. What ICD-10-CM code(s) is/are reported?a. H54.7, H52.202b. H52.202, H54.52A2c. H54.7d. H52.212 b. H52.202, H54.52A2Look in the ICD-10-CM Alphabetic Index for Impaired (function)/vision NEC referring you to H54.7. In the Tabular list category H54 has a note to see the definition of visual impairment categories. Category 2 is considered low vision. Looking through codes, low vision in the LEFT eye is reported with H54.52 A2 is assigned as 6th and 7th character to identify Category 2. Or, you can look in the Alphabetic Index for Low/vision/one eye/LEFT (normal vision on RIGHT) referring you to H54.52. It is important to read the instructional notes in the Tabular List that are associated with categories before selecting your code.Category H54 also has a note to code first any cause of the blindness. In this care the low vision is due to the astigmatism. Look in the Alphabetic Index for Astigmatism referring you to H52.20. In the Tabular List, H52.202 is reported for the LEFT eye
A patient is being treated for ketoacidosis and diabetic coma due to malignant neoplasm of the pancreatic body. The patient uses insulin routinely. What ICD-10-CM codes are reported?a. E13.11, C25.1b. E10.11, C25.2, Z79.4c. C25.1, E08.11, Z79.4d. C25.9, E08.11 c. C25.1, E08.11, Z79.4The patient’s diabetes is due to the pancreatic cancer as an underlying condition. In the ICD-10-CM Alphabetic index look for diabetes, diabetic (mellitus) (sugar)/ due to underlying condition/with ketoacidosis/with coma E08.11. In the tabular list under category code E08 an instructional note indicated to code the underlying condition first. In the table of neoplasms look for neoplasm, neoplastic/pancreas/body and select the code guidance under category code E08 to use additional code for patients who routinely use insulin. Report code Z79.4 which is found in the alphabetic index under long term (current) (prophylactic) drug therapy (use of) insulin directing you to code Z79.4. Verify code selection in the tabular list.
The patient has a mass on his forehead; he says it is from a piece of sheet metal from an injury to his forehead months ago. He has an X-ray showing a foreign body is in the mass. After obtaining consent, the metal fragment foreign body is removed from the subcutaneous tissue. What ICD-10-CM code(s) is/are reported?ma. S01.82XAb. L92.3c. M79.5, S01.82XS, Z18.10d. Z18.10, S01.82XA c. M79.5, S01.82XS, Z18.10ICD-10-CM Coding guidelines I.B.10 indicated: a sequela is the residual effect (condition produced) after the acute phase of an illness or injury has been terminated. Coding sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second. IN the ICD-10-CM alphabetic index look for foreign body/in/soft tissue (residual) referring you to M79.5. Look for laceration/forehead/foreign body referring you to S01.82- The 6th character is X and the 7th character is S for sequela. Next, report the type of foreign body. Look for foreign body/retained (old) (nonmagnetic) (in)/fragments and you are directed to see Retained, foreign body fragments (type of). In the alphabetic index look for retained/foreign body fragments (type of)/metal directing you to Z18.10. Verify code selection in the tabular list. There is no mention of whether the metal is magnetic or not. The patient did not have an acute laceration with a foreign body in an open wound; therefore code S01.82XA is not reported.
“When procedures are “”mandated”” by third party payers, what modifier would you use?” 32
How often are HCPCS Level II permanent national codes updated? annually
What is the transparent part of the eye? cornea
An anesthesiologist is medically supervising six cases. What modifier is reported fro the CRNA’s medically directed service?a. ADb. QKc. QXd. QZ c. QX
A patient who may have a stricture of the artery is undergoing an aortogram in which the left femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta. Contrast medium was injected and films taken by Serialography showing the aortoiliac inflow vessels were widely patent. The bilateral common femoral arteries appear normal. What CPT® codes are reported for the professional component?a. 36200, 75625-26b. 36200, 753630-26c. 36200, 75635-26d. 36200, 75808-26 b. 36200, 75630-26The patient is having abdominal aortography, which is radiographic visualization of the aorta and its branches. It was performed by injecting contrast medium through a catheter to see if there is an aneurysm, atherosclerotic disease or trauma to the aorta. The non-selective catheterization of the aorta is found in the CPT index under catheterization/aorta. Code 36200 is correct for the introduction of the aorta. IN the CPT index look for Serialography/aorta. A review of the codes in the numeric section code 75630 is correct because it includes Serialography abdomen plus bilateral ileofemeral lower extremity.
A virus is identified by observing growth patterns on cultured media. What is this type of identification is called?a. definitiveb. qualitativec. quantitatived. presumptive Presumptive identification identifies microorganisms like viruses by observing growth patterns and other characteristics
What category of codes should be used to report an evaluation and management service provided to a patient in a psychiatric residential treatment center?a. hospital inpatient servicesb. office and other outpatient servicesc. nursing facility servicesd. emergency department c. nursing facility services
In order, starting with the innermost layer, what are the for walls of the digestive tract?a. Muscle, submucosa, mucosa, serosab. Mucosa, submucosa, serosa, musclec. Mucosa, submucosa, muscle, serosad. Serosa, mucosa, submucosa, muscle c. Mucosa, submucosa, muscle, serosa
A diagnostic tool in sleep medicine is:a. electroencephalographyb. polysomnographyc. electromyographyd. electrocorticography b. polysomnography
What does MRSA stand for? methicillin-resistant staphylococcus aureus
What surgical status indicator represents the Surgical Global Package for endoscopic procedures (without an incision)?a. XXXb. 010c. 000d. 090 c. 000For endoscopic procedures (except procedures requiring an incision), there is not postoperative period. Surgical status indicator 000 is for endoscopies or minor surgical procedures with no preoperative or postoperative period. Any related services on the day of the procedure are generally included in the fee schedule payment and not pain separately; including evaluation and management services on the day of procedure.
How are ambulance modifiers used?a. They identify mileage traveled during the encounter.b. They identify emergency or non emergency transport typesc. They identify the time elements of the ambulance d. They identify ambulance place of origin and destination d. They identify ambulance place of origin and destinationRationale: Transportation (ambulance) services utilize modifiers made up of two letters identifying the origin and the destination according to the HCPCS Level II guidelines at the beginning of section A, Transportation Services Including Ambulance A0021-A0999.hint: information is found in the HCPCS Level II guidelines at the beginning to section A
Melanin is found in what layer of the epidermis? BasalRationale: Scattered throughout the basal layer of the epidermis are cells called melanocytes, which produce the pigment melanin, one of the main contributors to skin color.
What ICD-10-CM codes are reported for postoperative pulmonary edema due to fluid overload from an infusion?a. T80.89XA, J81.1, Y63.0b. J95.89, E87.70, Y63.1c. J81.0, E87.70, Y63.1d. T81.9XXA, J81.1, Y63.0 a. T80.89XA, J81.1, Y63.0In the ICD-10-CM Alphabetic Index look for Complication/infusion (procedure)/specified type NEC directing you to T80.89. In the Tubular list subcategory code requires 7 characters. T80.89XA is the correct code choice. Next look for edema/lung directing you to J81.1. Because the edema is due to the fluid overload that is associated with an infusion given during the patient’s medical care look in the ICD-10-CM External Cause of Injuries Index for Misadventure (s) to patient(s) during surgical or medical care/excessive amount of blood or other fluid during transfusion or infusion directing you to Y63.0
What ICD-10-CM code is reported for COPD with acute bronchitis?a. J44.9, J22b. J44.1c. J40d. J44.0, J20.9 d. J44.0, J20.9COPD stands for Chronic Obstructive Pulmonary Disease. In the ICD-10-CM Alphabetic Index, look for disease/lung/obstructive (chronic) with/acute bronchitis referring you to J44.0 Verification in the Tabular list confirms code selection and gives additional instruction to code also identify the infection. The infection is reported with a code from category code J20 Acute Bronchitis. Because there is no indication of the infectious agent for the acute bronchitis, an unspecified code is used. Bronchitis/acute or subacute refers you to J20.9. There is also an Excludes2 note that lists category code J44-, which indicated that a code from that category can be coded with J20.9
A patient presents to the emergency department with a sucking chest wound. The ED provider on duty performs an immediate tube thoracostomy in order to restore normal breathing to the patient before rushing him to surgery for another provider to address other injuries. What CPT code is reported by the ED provider?a. 31500b. 32551c. 31603d. It is not coded, as it will be bundled with any procedures performed during surgery. b. 32551In the CPT Index for thoracostomy/tube referring you to code 32551. The ED provider would not be performing the surgery for other injuries so we would not bundle the tube insertion into any of those procedures.
Which option is TRUE regarding reporting codes for cytomegaloviral pneumonitis in ICD-10-CM?a. Pneumonia is reported first; the underlying disease is reported second.b. The underlying disease is reported first; pneumonia is reported secondc. Only the pneumonia is reported, it is not necessary to report the underlying diseasesd. One code is used to report both the pneumonia and the cytomegaloviral disease. d. One code is used to report both the pneumonia and the cytomegaloviral disease.
How many layers of tissue does an artery have? A. ThreeRationale: An artery has three layers: an outer layer of tissue, a muscular middle, and an inner layer of epithelial cells.
The cardiologist advances a 6 French catheter into the LEFT renal artery via a RIGHT common femoral puncture. It is selectively catheterized and angiographic films are taken. The catheter was then removed and a diagnostic guiding type, RDC catheter was used and the LEFT renal artery was selectively engaged. A 0.014 Supracore wire was used and the lesion was crossed. A 6.0 X 18 mm balloon expandable Racer stent was introduced. This was expanded around 8 atmospheres of pressure which is normal. Angiography revealed excellent results with no residual stenosis. What CPT codes are reported?a. 36245-Lt, 75625-26, 37236b. 36245-Lt, 37236c. 36245- Lt, 36251, 37236d. 36246-Lt, 37236 b. 36245-Lt, 37236The LEFT renal artery is a first order vessel as noted in Appendix L in the CPT book. To locate the selective catheterization, look in the CPT book for artery/abdomen/catheterization referring you to 36245-36248. 36245 is the correct code for the selective catheterization. Angiography of the LEFT vessel was performed, however, there is not mention in the report of the results of the angiography. This is not a diagnostic angiography, rather it is an angiography for mapping (checking out known stenosis). The stent was deployed (37236) in the LEFT renal artery; this code also includes the radiologic supervision and interpretation. In the CPT index book look for angioplasty/with intravascular stent. Placement referring you to 37215-37218, 37236-37239 or you can look for artery/stent/placement/carotid. Follow up renal angiography is bundled with the stent procedure.
A 41 year old male is in his doctor’s office for a follow up of an abnormality which was noted on an abdominal CT scan. He also had a chest x-ray (PA and lateral views) performed in the office due to chest tightness. He states he otherwise feels well and is here to go over the results of his chest x-ray performed in the office, and the CT scan performed at the diagnostic center. The results of the chest x-ray were normal. CT scan of the abdomen showed a small mass in his RIGHT upper quadrant. What CPT codes are reported for the doctor’s office radiological services?a. 71046-26, 74150-26b. 71046,74150c. 71046-26, 74150d. 71046, 74150-26 d. 71046, 74150-26Look in the CPT index for x-ray/chest. Code 71046 is the correct code for 2 views. The chest x-ray was taken in the doctor’s office and interpreted. This means the doctor’s office can bill the code without appending a modifier. Next look in the CPT book for CT/scan/without contrast/abdomen. The correct code for the CT scan is 74150. Modifier 26 is appended to the CT scan code, as it was performed at another site and the doctor only interpreted the image
The Medicare program is made up of several parts. Which part is most significant to coders working in physician offices and covers physician fees without the use of a private insurer?a. Part Ab. Part Bc. Part Cd. Part D Medicare Part B
The Medicare program is made up of several parts. Which part is affected by the Centers for Medicare & Medicaid Services-Hierarchical Condition Categories?a. Part Ab. Part Bc. Part Cd. Part D c. Part CAccurate and thorough diagnosis is important for Medicare Advantage (Part C) claims because reimbursement is impacted by the patient’s health status. The CMS-HCC risk adjustment model provides adjusted payments based on a patient’s disease and demographic factors. If a coder does not include all pertinent diagnoses and comorbidities, there may be a loss of additional reimbursements to which the provider is entitled.
What is the purpose of National Coverage Determinations? It explains CMS policies on when Medicare will pay for items and services
In what year did HIPAA become a law? 1996
A covered entity does NOT include a. healthcare providersb. patientsc. clearinghousesd. Health plans b. patients
The minimum necessary rule applies toa. Disclosures to or requests by a health care provider for treatment purposesb. Disclosures to the individual who is the subject of the imformation c. Uses or disclosures that are required by lawd. Covered entities taking reasonable steps to limit use or disclosure of PHI d. Covered entities taking reasonable steps to limit use or disclosure of PHI
What is the value of a remittance advise? It states what will be paid and why any changes to charges were made
In what year was AAPC founded? 1988
Which one of the following is TRUE of the stratum germinativum?a. It is composed of about 30 layers of dead, flattened, keratinized cells.b. It is composed of dense fibrous connective tissue.c. It lies on top of the dermis and has access to rich supply of blood.d. It is the surface layer of the epidermis. C. It lies on top of the dermis and has aaccess to rich supply of blood
Muscle is attached to bone by what method?a. tendons, ligaments, and directly to boneb. tendons and cartilagec. tendons, aponeurosis and directly to bone d. ligaments, aponeurosis, and directly to bone c. tendons, aponeurosis and directly to bone
Which chamber of the heart is considered the one working the hardest? LEFT ventricle
Which best describes constituent components of the human lymphatic system? Lymph nodes, lymphatic vessels, spleen, thoracic duct
Upon leaving the last portion of the small intestine, nutrients move through the large intestine in what order? cecumascending colontransverse colondescending colonsigmoid colonrectumanus
The splenic (LEFT colic) flexure lies in the upper quadrant, between what 2 portions of the large intestines? The transverse and descending colon
The structure of the male anatomy carrying sperm out of the epididymis is called? vas deferens
What is the function of the Cowper’s glands? Helps lubricate the urethra
A part of the male genital system sitting below the urinary bladder surrounding the urethra is called the: Prostate
Which part of the brain controls blood pressure, heart rate, and respiration? Medulla
Which does NOT contribute to refraction in the eye?a. aqueousb. Maculac. cornead. lens b. Macula
Which one of the following is TRUE about the tympanic membrane?a. It separates the middle ear from the inner earb. It separates the external ear from the middle earc. It sits within the middle eard. It sits within the inner ear b. It separates the external each from the middle ear
Which one of the following is TRUE about the function of the cochlea?a. It helps with balance and sound transmission b. It helps with balance onlyc. It helps with sound onlyd. Its function is to excrete cerumen to help keep ear clean C. It helps with sound only
Which of the following are auditory ossicles?a. incus and pinnab. stapes and mastoidc. tragus and malleusd. stapes and incus d. stapes and incus
Where would a subungual hematoma be located? Under the toenail/fingernail
Splenorraphy is: suturing a wound of the spleen
The operation overlapping of tissue to repair a defect in the diaphragm is called? Imbrication
The root word for mouth is: Stomat/o
What condition results from failure of the testis to descend into the scrotum? Cryptorchidism
A condition where the thyroid is overactive is called? Thyrotoxicosis
A dacryocystectomy is an ? excision of a lacrimal sac
The meaning of heteropsia (or anisometropia) is: Unequal vision in the two eyes
The radiology term fluoroscopy is an: X ray procedure allowing the visualization of internal organs in motion
Sialography is an X-ray of: salivary glands
The process of preserving cells or whole tissues at extremely low temperatures is known as: Cryopreservation
A gonioscopy is an examination of what part of the eye? anterior chamber of the eye
What section of the ICD-10-CM guidelines contains instructions on how to code for a patient receiving diagnostic services only in an outpatient setting? Section IV
A 22 year old is in an outpatient facility for an inguinal hernia repair. Just before surgery, the surgeon discovers the patient is positive for MRSA and the surgery is canceled. Which ICD-10-CM code(s) shoudl be reported for the outpatient service?a. A49.02b. A49.01, K40.90, Z53.09c. Z53.09d. K40.90, A49.02, Z53.09 d. K40.90, A49.02, Z53.09ICD-10-CM guideline for outpatient services IV.A.1 states to report reason for the surgery as the first listed diagnosis even if the surgery is canceled due to a contraindication.
A 50 year old female presents to her provider with symptoms of insomnia and upset stomach. The provider suspects she is premenopausal. She is diagnosed with impending menopause. What diagnosis code(s) should be reported. a. G47.00, K30b. N95.9c. N95.9, G47.00, K30d. E28.319 Rationale: ICD-10-CM guideline I.B.11 states to reference the ICD-10-CM alphabetic index to determine if the condition has a subentry for impending or threatened and reference main term entries for Impending and Threatened. If the subterms are listed, assign the given code. If the subterms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatened. Look in sthe alphabetic index for impending. There is not a subterm for menopause; therefore, the symptoms are coded. Look for Insomnia (organic) which directs the coder to G47.0. Next look for upset/stomach which directs the coder to K30.
A 65 year old is seen by her cardiologist for preoperative evaluation for clearance for removal of her gallbladder due to gallstones. The cardiologist notes that she has hypertension. Medication is given to control her hypertension. What diagnosis are reported?a. Z01.810, K80.21, I10b. I10, K80.20, Z01.810c. Z01.810, K80.20, I10d. K80.20, I10, Z01.810 c. Z01.810, K80.20, I10When a patient is receiving a preoperative evaluation only, A Z code from subcategory code Z01.81- is reported first. Then assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Next code any findings related to the preoperative evaluation.
A patient returns to the provider for an injection to relieve low back pain from a car accident. What ICD-10-CM code(s) is/are reported?a. M54.50b. G89.11, M54.50c. M54.50, G89.11d. G89.21, M54.50 a. 54.50 Per ICD-10-CM guideline I.C.6.b.1, if the pain is not specified as acute or chronic, do not assign codes from category G89, except for post-thoracotomy pain, postoperative pain, neoplasm related pain, or central pain syndrome. Look in the ICD-10-CM alphabetic index for pain/low back which directs the coder to M54.50.
The patient has a significant visual impairment (category 2) due to astigmatism in the LEFT eye. It is corrected with glasses. The RIGHT eye has normal vision. What ICD-10-CM code(s) is/are reported?a. H54.7, H52.202b. H52.202, H54.52A2c. H54.7d. H52.212 b. H52.202, H54.52A2Look in the ICD-10-CM Alphabetic index for impaired, impairment (function)/vision NEC referring you to H54.7. In the tabular list category H54 has a note to see the definition of visual impairment categories. Category 2 is considered low vision. Looking through the codes, low vision in the LEFT eye, is reported with H54.52-. A2 is assigned as 6th and 7th character to identify Category 2. Or, you can look in the alphabetic index for low/vision/one eye/left (normal vision on RIGHT) referring you to H54.52. It is important to read the instructional noted in the tabular list that are associated with categories before selecting your code. Category H54 also has a note to first code first any cause of the blindness. IN this case, the low vision is due to the astigmatism, Look, in the alphabetic index for astigmatism referring you to H52.20- In the tabular list, H52.202 is reported for the LEFT eye.
A patient with metastatic bone cancer (primary sit unknown) presents to the oncologist’s office for a chemotherapy treatment. On examination the oncologist finds the patient to be severely dehydrated and cancels the chemotherapy. The patient receives intravenous hydration in the office and reschedules, the chemotherapy treatment. What ICD-10-CM codes are reported?a. C40.30, E86.0, C79.51b. E86.0, C79.51, C80.1c. C79.51, E86.0d. E86.0, C80.1, C79.51 B. E86.0, C79.51, C80.1Per ICD-10-CM guideline I.C.2.c.3 when the admission/encounter is for management for dehydration due to the malignancy or therapy, or a combination of both, and only the dehydration is being treated (intravenous hydration); the dehydration is sequenced first, followed by the code(s) for the malignancy. The treatment is directed at the bonce cancer or the metastatic site. In the ICD-10-CM alphabetic index look for dehydration E86.0 in the ICD-10-CM table of neoplasms look for neoplasm, neoplastic/bone. Use the code from the malignant secondary column directing you to code C79.51. Also in the table of neoplasms look for unknown or unspecified site and use the code from malignant primary column which directs the coder to C80.1.
What does the root word colp/o stand for Colp/o is the combining form referring to the vagina.
The provider documents CKD stage 5 and ESRD. What ICD-10-CM code(s) is/are reported?a. N18.5b. N18.4, N18.6c. N18.6, N18.5d. N18.6 N18.6according to the ICD-10-CM guideline I.C.14.a.1 when both a stage of CKD and ESRD are documented, you assign only code N18.6.
A child has a splinter under the right middle fingernail. What ICD-10-CM code is reported?\a. S61.227Ab. S61.242Ac. S61.222Ad. S60.452A d. S60.452AIN the ICD-10-Cm alphabetic index look for splinter-see foreign body, superficial, by site. The alphabetic index entry at foreign body/superficial, without open wound/finger(s)/middle guides you to subcategory S60.45-. In the tabular list seven characters are needed to complete the code. The 6th character 2 indicates the RIGHT middle finger and the 7th character A indicates the initial encounter. There was no mention of laceration or puncture wound so the other codes are incorrect.tip for CPC exam: write in splinter by S60.45-
A 24 year old woman developed a keloid scar as a result of a third degree burn son the LEFT upper arm. What ICD-10-Cm code(s) is/are reports?a. L91.0b. T22.332Dc. L91.0, T22.332Sd. T22.332A, L91.0 c. L91.0, T22.332SA keloid is a type of scar resulting from granulation tissue at the site of a healed skin injury. This would be considered a sequela (late effect) after the acute phase of the burn. Per ICD-10-CM guideline I.B.10, coding of sequela generally requires 2 codes sequenced in the following order: the condition or nature of the sequela is sequenced first (keloid scar). The sequela code is sequenced second.
Patient is in the facility here today for a screening colonoscopy. During the procedure, a polyp is found and removed with a hot biopsy technique. How would this be reported?a. K63.5, Z12.11b. K63.5c. Z12.11, K63.5d. Z12.11 c. Z12.11, K63.5According to the ICD-10-CM guideline I.C.21.c.5 indicates, A screening code may be first listed if the reason for the visit is specifically the screening exam. Should a condition be discovered during the screening the code for the condition may be assigned as an additional diagnosis.
A patient is admitted to surgery to treat an open fracture to the shaft of the RIGHT humerus and a simple closed fracture of the LEFT tibia following an ATV accident. What ICD-10-CM codes are reported?a. S42.311A, S82.201A, V86.99XAb. S42.301B, S82.202B, V86.99XAc. S42.301B, S82.202A, d. S42.301A, S82.202A, V86.99XA c. S42.301B, S82.202AThis is a traumatic fracture since the patient was in an accident. In the ICD-10-CM alphabetic index look for fracture, traumatic/humerus/shaft, which refers you to subcategory code S42.30-. IN the tabular list, the code needs seven characters. The 6th characters 1 indicates the RIGHT humerus. The 7th character B indicates that this is an initial encounter for an open fracture. The resulting code is S42.301B. The simple fracture is classified as a closed fracture. Look in the alphabetic index for fracture, traumatic/tibia (shaft) which refers you to S82.20-. Verification in the tabular list shows the 6th character 2 for LEFT tibia and 7th character A for initial encounter for closed fracture. ICD-10-CM guidelines I.C.19.C.2 states multiple fractures are sequenced in accordance with the severity of the fracture. For the ATV accident, refer to the ICD-10-CM external cause of injuries index. Look for accident/transport/all-terrain vehicle occupant (non-traffic)/specified type NEC directing you to subcategory V86.99-. The tabular list show this code needs 7 characters. A placeholder X is used fore the 6th character , and the 7th character is A for initial encounter. The complete code is V86.99XA
The diagnostic statement indicates respiratory failure due to administering incorrect medication. Valium was administered instead of Xanax. What ICD-10-CM codes are reported?a. T42.4X5A, J96.00b. J96.90, T42.4X1Ac. T42.4X1A, J96.90d. T42.4X4B, J96.00 “c. T42.4X1A, J96.00Poisoning codes are sequenced by 1) the poison code, and 2) the condition or manifestation. ICD-10-CM guideline I.C.19.e.5.b.i states examples of poisoning include “”errors made in the drug prescription, or in the administration of the drug by provider, nurse, patient, or other person. In the ICD-10-CM table of drugs and chemicals, find valium and use the code from poisoning, accidental (unintentional) column which is T42.4X1. In the tabular list the code requires a 7th character and in this case the A is used for the initial encounter. The manifestation is respiratory failure, which is J96.90. Per ICD-10-CM guideline, I.C.19.e no additional external cause code is required for poisoning, toxic effects, adverse effects, and underdosing codes”
A patient was treated in the emergency department for a nasal fracture. Bleeding was controlled, a splint applied, and the patient sent home. He returned to the ED several hours later with new bleeding from both nares due to the fracture. The ED provider has to repack the nose and insert new splints to stabilize the fracture. What ICD-10-CM code(s) is/are reported for the second ED visit?a. T79.2XXA, S02.2XXAb. S02.2XXSc. R04.0d. S02.2XXD, T79.2XXD A. T79.2XXA, S02.2XXAThe patient is seen for the second time in the ED for continued care of a nasal fracture. Look in the ICD-10-CM alphabetic index for hemorrhage, hemorrhagic/traumatic/recurring or secondary (following initial hemorrhage at the time of injury) which guides you to T79.2-. Next look for fracture, traumatic/nasal (bones) which guides you to code S02.2. Per ICD-10-CM guideline I.C.19.a.7, 7th character A for initial encounter is used for each encounter when the patient is receiving active treatment. Examples are of active treatment are surgical treatment, emergency department encounter, and evaluation and continued treatment by the same or different provider. Because the patient is seen for the second time inthe ED for continued care of the fracture, 7th character A is used for each code. Placeholder X is needed for the 5th and 6th characters.
A patient is prescribed anticonvulsant medication for her seizures. She returns to her doctor three days later with nausea and rash from taking the medication. The provider notes that this is a drug reaction to the anticonvulsant and changes the medication. What ICD-10-CM codes are reported?a. R21, R11.2, T42.71XAb. R21, R11.o, T42.75XAc. L27.0, R11.0, T42.75XAd. L27.0, R11.2, T42.71XA c. L27.0, R11.0, T42.75XAPer ICD-10-CM guideline I.C.19.e.5.a when the drug was correctly prescribed and properly administered, drug toxicity is considered an adverse effect. Code the nature of the adverse effect (nausea and rash), followed by appropriate code for the adverse effect of the drug (T36-T50). We don’t use rash R21 code because L27.0 is a more specific code.