Chapter 5

Mr. Bowen is having a pre-employment physical (screening). His doctor ordered the following serum blood tests: CBC, automated, comprehensive metabolic panel and a thyroid stimulating hormone (TSH) assay. Code the services for these labs.

80050

A provider orders a lipid panel. According to the practice standards, this includes a complete blood count (85027), total cholesterol (82465), HDL cholesterol (83718), and triglycerides (84478). What is reported on the claim form?

80061, 85027

The patient is a 58 year-old white male, one month status post pneumonectomy. He had a post pneumonectomy empyema treated with a tunneled cuffed pleural catheter which has been draining the cavity for one month with clear drainage. He has had no evidence of a block or pleural fistula. Therefore, a planned return to surgery results in the removal of the catheter. The correct CPT® code is:

32552-58

A patient presents for epicardial lead placement via median sternotomy to the right atrium and right ventricle. A dual pacemaker generator is then inserted subcutaneously. The patient has bundle branch block and sinoatrial node dysfunction. What CPT® code(s) are reported?

33202, 33213-51

An AP and lateral chest films were performed on a patient with X-ray equipment owned by his physician in the office to rule out right pleural effusion. The physician interprets the chest films and documents the finding in the patient's chart. The physician bills 71046 for the X-ray. Is this billed correctly? If not, what is billed?

Yes, the physician reports the code correctly

Claim is sent for biopsy of soft tissue of flank with code 21920. Is this code correct? If not, what code is reported?

Yes, this is correct

A 2 year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedure code(s) to report for the ER physician?

99291-25, 36555, 31500

A provider is making rounds in the Nursing Home. She visits an established patient to check on her pneumonia and UTI. She performs an expanded problem focused interval history, an expanded problem focused exam, and moderate decision making. What E/M code is reported?

99308

A 43-year-old established patient is seen for his annual preventative exam by the family physician. A comprehensive history, comprehensive exam, and medical decision making of low complexity is performed. What E/M code is reported?

99396

Claim is denied for a hernia repair for a 4-year-old male billed with 49585. Is this code correct? If not, what is the reason for the denial?

CPT® code 49585 is used for greater than age 5

Agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid and State Children's Health Insurance Programs (CHIP).

Centers for Medicare & Medicaid Services (CMS)—

A code set copyrighted and maintained by the American Medical Association (AMA).

Current Procedural Terminology (CPT®)

What guidance is found under CPT® code 64492?

Do not report 64492 more than once per day

Surgeries classified as minor have a global surgical period that includes the preoperative service the day of surgery, the surgery, and any related follow-up visits with/by the physician 0-10 days after the surgery.

Minor Surgery

A commercial insurance claim was filed and denied using 99213 with M25.519 for DOS 9/12. The patient had an arthroscopy of the left knee on 8/16 (90 day global surgery) that is unrelated to the visit on 9/12. What error is identified for the claim for DOS 9/12?

Modifier 24 is appended to identify this as not related to the surgery

What does the icon indicate for procedure code 20974?

Modifier 51 cannot be used with procedure code 20974.

Used by professional billers to determine codes considered by CMS to be bundled codes for procedures and services deemed necessary to accomplish a major procedure. This is to promote correct coding methodologies and to control improper assignment of codes that results in inappropriate reimbursement

National Correct Coding Initiative (NCCI)

The patient is 15 weeks pregnant with twins and is coming back to her obstetrician to have a transabdominal ultrasound performed to reassess anatomic abnormalities of both fetuses that were previously demonstrated in the last ultrasound a week ago. The physician bills 76816, 76816-51. Is this correctly billed? If not, how is the ultrasound billed?

No, it is billed 76816, 76816-59

A 10 month-old child is taken to the operating room for removal of a laryngeal mass. What is the appropriate anesthesia code(s)?

00326

Anesthesia procedures 00830 (4 base units) and 00832 (6 base units) are both performed. How are these reported on the claim form?

00832 with the time units for both procedures

What is the CPT® code for anesthesia performed for surgical arthroscopy on theankle?

01464

A patient sees his primary care doctor for calluses on his feet. The provider uses a scalpel to pare down six calluses (benign hyperkeratotic lesions) on his feet. How is this reported?

11057

What CPT® code(s) is/are reported for removal of two skin tags?

11200

What is the CPT® code for excision of a 3.2 cm benign lesion of the trunk?

11404

What is the CPT® code for trimming of nondystrophic nails?

11719

Claim for excision of squamous cell carcinoma from the posterior aspect of the neck, 3 cm in diameter, including margins of resection with a W-plasty to close surgical defect, less than 10 sq cm. Which code(s) is(are) correct?

14040

A claim is reviewed for MOHS surgery on the foot that was performed in 1 stage with 6 tissue blocks. The claim was reported with 17311, 17312-51, 17312-51. Is this correct? If not, what codes are used?

17311, 17315

Which reporting option below is correct use of the modifier 50?

19318-50

Which option shows the correct way to report procedure code 22515?

22514, 22515

22 year-old has developed an abscess on his left index finger. An incision was made over the abscess and pus and blood are drained. The wound was irrigated with sterile saline and gauzed. What CPT® code is reported for this procedure?

26010

A 67 year-old female has CAD, atrial fibrillation, claudication and several chronic conditions that have been marginally controlled with medication. The doctor decided that the benefits outweigh the risks for her having a single vessel cardiopulmonary bypass using an arterial graft. Her medication Heparin had been stopped for several days. She was admitted in the hospital a day before the surgery. In the operating room, general anesthesia was administered. After the chest is opened the patient begins to hemorrhage and drops in blood pressure. The decision is made to stop the procedure and close the chest. How is this service coded?

33533-53

A 56 year-old patient who has been admitted requires a tunneled CV catheter insertion. The physician uses ultrasound guidance to perform the insertion. The physician documented vessel patency and that permanent recordings are in the patient's record. What CPT® codes are reported for the physician's services?

36558, 76937-26

What is the CPT® code for a tonsillectomy for a 5 year-old?

42825

A 62-year-old woman presents for sigmoidoscopy. The physician inserts a flexible scope into the patient's rectum and determines the rectum to be clear of polyps. The scope is advanced to the sigmoid colon and a total of 3 polyps are found. Using a snare technique, the polyps are removed. The flexible scope is withdrawn. The pathology report later indicates the polyps are benign. The claim was billed with 45388. Is this correct? If not, what code is billed?

45338

Newborn male is scheduled for a circumcision. He is sterilely prepped and draped. A penile nerve block is performed. The circumcision is performed by a ring device. Hemostasis is achieved. Vaseline Gauze dressing applied. Patient tolerated the procedure well. How is this encounter coded?

54150

Vasectomy reversal is performed, bilaterally, using the operating microscope. Choose the procedure code(s)

55400-50, 69990

Claim is billed 58555, 58558-51 for a patient having a diagnostic hysteroscopy. Hysteroscopy cervical biopsy is performed. Is this coding correct? If not, what code(s) is (are) used?

58558

Patient with multilevel disk degeneration with stenosis has consented in having a steroid injection for pain management into the right L5-S1 paravertebral facet joint. The needle is inserted under fluoroscopic guidance and a steroid mixture was then injected. The same procedure was performed on the left L5-S1 facet joint without complications. How is this procedure reported?

64493-50

A 6 year-old female with prominent ears undergoes a bilateral otoplasty. Surgeon makes an incision just behind the ear in the natural fold where the ear is joined to the head exposing the cartilage. Cartilage is trimmed and shaped and the incision is closed. Temporary sutures are placed to secure the ear until healing is accomplished. The procedure is repeated on the other ear. What CPT® code is reported?

69300-50

Which reporting option below is correct for CPT® code 69424?

69424-50

What CPT® code is reported for an MRI of the brain without contrast?

70551

What is the correct CPT® code to use for testing stool for occult blood by guaiac for a patient presenting with a chronic gastric ulcer and the provider takes two specimens as part of the digital examination?

82272

Which reporting option below is correct for immunization administration for vaccines or toxoids?

90460, 90474

Which reporting option below is correct for immunization administration for vaccinesor toxoids?

90460, 90474

A 12 month-old is coming in to see the pediatrician to receive an MMR vaccination subcutaneously. Counseling was provided to the mother about the vaccine. What codes are reported for the vaccination?

90707, 90460, 90461 x 2

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?

94774

A patient presents to her oncologist's office for scheduled chemotherapy. The patient is severely dehydrated. The physician decides to schedule the chemotherapy for another day and orders hydration therapy to be performed today instead of the chemotherapy. The therapy is ordered and administered for 1 hour and 10 minutes. Select the code(s) reported for the hydration.

96360

A 5 year-old fell on broken glass and required suturing of a laceration. Due to the age and combative behavior of the patient, the provider utilized moderate sedation while repairing the laceration. The provider gave the child 50 mg of Ketamine IM. A nurse monitored the patient during the procedure which took 30 minutes. What CPT® code is reported for moderate sedation?

99152, 99153

A patient is seen by his family provider at the provider's office. The patient last saw the provider four years prior. Which range of codes would a code be selected from?

99201-99205

A patient comes into the office for follow up of neck pain. The provider documents an expanded problem focused history, a problem focused exam and medical decision making of low complexity. What E/M code is reported for this visit?

99213

Which reporting option below is correct use of a modifier with an E/M code?

99213-25

A patient is seen for a follow-up visit in the hospital. A problem focused interval history, an expanded problem focused exam, and MDM of low complexity. What E/M code is reported?

99231

CPT® code used to report a supplemental or additional procedure appended to a primary procedure (standalone) code. Add-on codes are recognized by the CPT® symbol +used throughout the CPT® code book.

Add-on Code

What is the full CPT® code description for 00846?

Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy

What is the full descriptor for CPT® code 35632?

Bypass graft, with other than vein; ilio-celiac

The period (0-90 days as determined by the health plan) and services provided for a surgery inclusive of preoperative visits, intraoperative services, post-surgical complications not requiring a return trip to the operating room, postoperative visits, post-surgical pain management by the surgeon, and several miscellaneous services as defined by the health plan, regardless of setting (for example, in a hospital, an ambulatory surgical center (ASC), or physician office).

Global Package

An assigned indicator, which determines classification for a minor or major surgery, based on relative value unit (RVU) calculations.

Global Surgery Status Indicator

Codes for surgery include the performance of the surgery as well as:

Local anesthesia, including digital nerve blocks

Surgeries classified as major have a global surgical period that includes the day before the surgery, the day of surgery, and any related follow-u

Major Surgery

When tissue glue is used to close a wound involving the epidermis layer how is it reported?

as a simple closure