review for AAPC CPC exam 2023

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

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 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

Which of the following anatomical sites have septums? A. Nose, heart B. Kidney, lung C. Sternum, coccyx D. Orbit, ovary

a. nose, heart

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).

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

Which modifiers are appended to E/M codes to report services within the global package?

24, 25, 57

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.

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. 14060 An 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.

ABN

Advance Beneficiary Notice

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

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 cysts Paratubal 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.

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 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 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.

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

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.

Condition in which the endometrial tissue is found outside of the uterus.

Endometriosis

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).

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

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

What anatomical or compartment contains all the thoracic viscera except the lungs?

Mediastinum

What does the abbreviation MAC stand for?

Medicare Administrative Contractor

The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer<

Medicare Part B

Who are the parties responsible for providing the ICD-10-CM?

NCHS and CMS

Which HCPCS Level II modifier should you append for a new wheelchair purchase?

NU

Healthcare providers are responsible for developing ______________ policies and procedures regarding privacy in their practices. a. Patient hotline b. Work around procedures c. Fees d. Notices of Privacy Practices

Notices of Privacy Practices

What month does the new ICD-10-CM code book take effect each year?

October

Who is responsible for enforcing the HIPAA security rule

Office of Civil Rights (OCR)

What do the instructions and conventions of the classifications take precedence over?

Official Coding guidelines

What is an example of an eponym?

Paget's disease Rationale: 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.

According to the OIG, internal monitoring and auditing should be performed by what means?

Periodic audits

What services are included in the surgical global package?

Preoperative visits, intraoperative, postsurgical pain management

PHI

Protected Health Information

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 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

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.

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.

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, C44.319 You 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, S82.102N The 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).

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.

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.

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.

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.

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

The root word trich/o means: A. Hair B. Sebum C. Eyelid D. Trachea

a. hair

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

When a person has labyrinthitis what has the inflammation? A. Inner ear B. Brain C. Conjunctiva D. Spine

a. inner ear

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 Z85.850 ICD-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.

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-QS In 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.

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, 57283 View Rationale

b. 57240, 57282 The 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.

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

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, C78.02 Documentation 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.

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. GA An 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.

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.

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.

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

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 semen The 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.

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.

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

The OIG releases a __________ outlining its priorities for the fiscal year ahead and beyond. a. Compliance plan b. Self-referral law c. Work Plan d. CIA yearly review

b. work plan

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 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. 11004 The 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.

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, T82.111A One 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. 36557 The 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.

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. 99234 According 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.

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 provided An 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 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

A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the: a. testis b. scrotum c. prostate d. epididymis

c. Prostate

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

An angiogram is a study to look inside: A. Female Reproductive System B. Urinary System C. Blood Vessels D. Breasts

c. blood vessels

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.

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).

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

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.

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 III When 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.

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, 12002-59 The 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).

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, 75984-26 The 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.

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, 74420-26 Patent 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.

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 of the following is not part of the small intestine? a. duodenum b. ileum c. jejunum d. cecum

d. cecum

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

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

A person who has nephritis has inflammation in what location? A. Gallbladder B. Nerve C. Uterus D. Kidney

d. kidney

Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________. A. Medulla lobe B. Occipital lobe C. Middle lobe D. Inferior lobe

d. occipital lobe

What is the term used for inflammation of the bone and bone marrow? A. Chondromatosis B. Osteochondritis C. Costochondritis D. Osteomyelitis

d. osteomyelitis

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.

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

What is the Rinne test? a. Test using music as the focal point b. 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

A thin membrane lining the chambers of the heart and valves is called the:

endocardium

The acronym MMRV stands for what?

measles, mumps, rubella, and varicella

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 book C. 24

How often can HCPCS temporary Codes be undated?

quarterly

How many lobes make up the RIGHT lung?

the right has 3 lobes the left has 2 lobes