PROCEDURE CODING EXAM (CH 12, 15, 16 and 17)

Appended to surgeon's E/M codes during postoperative period for services unrelated to surgery.

Modifier -24

Two months ago, a patient underwent an abdominal aortic aneurysm repair, which has a 90-day global period. The patient returned to the surgeon's office for evaluation of a right leg circulatory problem related to his diabetic condition. What modifier should be reported?

-24

The cardiologist performed heart catheterization in the hospital on her patient. What modifier is required when the cardiologist reports her services?

-26

What modifier would be reported for the repair of an abdominal aortic aneurysm and also a repair of the inferior mesenteric artery?

-51

A surgeon performs part of a planned procedure. What modifier should be reported?

-52

An orthopedist examines a patient and determines that he has a ruptured C3-C4 intervertebral disk with severe radiating pain to the right arm. The orthopedist fully examines the patient's history and performs x-rays and a complete physical. After reviewing the films, the orthopedist requests that a neurologist perform the actual surgery because the orthopedist does not routinely perform surgery on the cervical spine. The orthopedist will submit the surgical code for this procedure along with which modifier?

-56

Which modifier is appropriate for a second planned debridement provided during the global period of the first debridement?

-58

A provider shaves several lesions from the patient's back and at the same session biopsies a lesion on the chest. Is a modifier required for the second code, and, if so, which one?

-59

Which modifier is appropriate for spinal fusion performed by two surgeons of different specialties?

-62

Which modifier is appropriate for a gallbladder removal provided during the global period of a foot amputation?

-79

A mobile clinic performed an HIV antibody immunoassay laboratory test using a kit or transportable single-use-kit. Which of the following modifiers would be assigned?

-92

During the performance of a left lung lobectomy, a surgeon discontinues the surgery when he realizes the patient is going into shock. What code should be reported?

32480, -53

Which of the following codes is a designed separate procedure?

49000

What is the modifier that is used when a bronchoscopy is performed under general anesthesia?

-23

What is the typical reimbursement rate for codes that are approved and located on a fee schedule when reported with modifier -50?

150% or 1.5 times the allowed amount.

After mammography findings of a density in both breasts, a patient undergoes puncture aspiration of a cyst in each breast. What code should be reported?

19000, -50

Elective cancellation of a bunionectomy (28296) occurs before prepping the patient's skin and transport to the OR. You are coding for the OP facility in this situation. What modifier, if any, should be reported?

28296, -73

A Category III code will be archived for how many years from its date of publication or revision in the CPT code manual unless it is demonstrated that a temporary code is still needed?

5

Evaluation and management (E/M) codes.

Cognitive Codes

Perform general business support functions, such as human resources (the hiring of personnel), public relations, purchasing and legal services.

Administrative Departments

Summary of CPT codes exempt from modifier -63.

Appendix F

Represents the various types of professional services performed by physicians and other healthcare professionals.

CPT Code Set

Provide medical, surgical, rehabilitation, and psychiatric services for patients.

Clinical Departments

Identifying the clinical signs, symptoms, disease processes, and treatments of patients' conditions.

Coding Skill

The superficial fascia or hypodermis.

Connective Tissue

Can be accomplished surgically or nonsurgically.

Debridement

Accomplished by chemicals, heat, or freezing.

Destruction

A patient underwent an excision of skin lesion, which has a 10-day global period. Within the 10 days, the patient returned for evaluation of the excised area. What modifier, if any, would be reported?

Do not report a modifier

After labor analgesia is provided and the patient is suddenly ready to deliver much earlier than expected, the coder should add +99140 to the anesthesia code.

False

CPT modifiers are used with CPT codes and durable medical equipment services.

False

Code 00562 is the correct code for a 50-year old patient who undergoes aortic valve replacement without a pump oxygenator.

False

Codes +01968 and +01969 are reported with the delivery codes 59500 and 59510.

False

Debridement is not done on joints or nerves.

False

Gynecomastia is reported for female patients only.

False

HCPCS Level II codes are mandated for reporting procedures and services for physicians and non-physicians and are only permitted on Medicare claims.

False

Health insurance plans are considered traditional employers in the medical field.

False

If people make mistakes while entering data into the office's electronic medical record system, the system will correct the information.

False

Inserting an instrument into the body is not a form of introduction.

False

Many jobs in hospitals and physician practices require only actual coding experience but not coding certification.

False

Medical coders do not need to have professional liability insurance.

False

Medicare accepts consult codes for an inpatient and nursing home visit as long as it is appended with modifier AI.

False

Modifiers are universal and can be appended to any HCPCS Level I or II code.

False

Physicians set up outpatient clinics and ambulatory surgical centers (ASCs) that are considered facility-based outpatient care.

False

Registered Health Information Administrators (RHIAs) interact with only the clinical and administrative levels of an organization.

False

Report an E/M code for an anesthesia preoperative services provided just before surgery.

False

The O symbol found throughout the CPT manual indicates the code is a new code for that year.

False

The mastopexy code 19316 is reported for reducing the size of a patient's breast.

False

Use of +99100 with 00834 is the correct way to code for a hernia repair for an 11-month old child.

False

A physician bills and is paid the full amount on the fee schedule.

Fee-For-Schedule

The category codes established by the AMA as a set of temporary CPT codes for emerging technologies, services, and procedures is what kind of Category code?

III

Which of the following can stand alone or be followed by three modifying terms?

Main term

Part of the provider's defense against accusations that patients were not treated correctly.

Medical Records

Performance measures for the delivery of health care by medical professionals.

Medical Standards of Care

One of AHIMA's certifications.

National Cancer Registrars Association

Built on a strong foundation of medical terminology, anatomy, and physiology.

Pathophysiology

Financial reward to physicians for following the best medical practices to ensure patients' health.

Pay-For-Performance Measurements

What is the correct way to code an anesthesia modifier used for the CRNA's services under the medical direction of an anesthesiologist?

QX

To correctly report MOHS surgery.

Report all stages of excision plus any tissue blocks beyond five in each stage.

To report an adjacent tissue procedure.

Report only the adjacent tissue transfer code and include the size of both the original and the secondary defect.

A malignant lesion was sent to pathology to determine if the margins are clear or if further excision is necessary. The margins were not clear and an additional excision of 0.5 cm was performed during the same operative session. How will the surgeon report this procedure?

Report the first excision diameter plus the additional 0.5 cm with one code.

A continual process of providing clinical services, billing, collecting payments, and paying for the cost of operations.

Revenue Cycle

Produces vitamin D3.

Skin

The epidermis and the dermis.

The cutaneous membrane

Which of the following criteria must be met to be included in the CPT Code Set?

The procedure or service must be commonly performed by many physicians across the country.

Which of the following is not descriptive of E/M codes?

They are provided by specialists in E/M coding.

A debridement is done to leave behind viable tissue.

True

A geographic adjustment factor is a number that is used to multiply each relative value element so that it better reflects a geographical area's relative costs.

True

A patient's history of long-term uncontrolled asthma requires the -P3 modifier.

True

A surgeon is asked to consult on a patient in the hospital and determines that surgery is required that day or the following day. If the surgeon submits the consult code with a -25 modifier and performs the required surgery the same day, the evaluation and management (E/M) service will be bundled into the reimbursement for the procedure.

True

Attend modifier -QS to represent monitored anesthesia care with code 31622 for a diagnostic bronchoscopy.

True

Effective communicators have the skill of empathy; their actions convey that they understand the feelings of others.

True

File management with Microsoft Windows and document or spreadsheet management using Microsoft Office are generally considered essential.

True

If a claim is submitted with a procedure code with modifier -76, special documentation is required to get the claim paid.

True

Level II modifiers, which are alphanumeric, are called HCPCS modifiers.

True

Medical coding begins when the patient is given care in a physician office, hospital, or other setting, and the provider documents the service.

True

Medical standards of care are state-specified performance measures.

True

Moderate sedation does not include minimal sedation or monitored anesthesia care.

True

Modifiers cannot be appended to Category III codes.

True

Patient medical records are legal documents.

True

Procedure codes may be located in the CPT manual by using any of six methods, one being abbreviations.

True

Qualifying circumstances add-on codes are not considered modifiers.

True

Radiofrequency is a form of ablation.

True

The destruction of a premalignant lesion is reported with code 17000.

True

The hypodermis is not technically part of the integumentary system.

True

The national uniform relative value unit (RVU) is based on three cost elements.

True

To report debridement associated with an open fracture, use the code range 11010-11012.

True

When coding for anesthesia services provided for multiple procedures, use only the anesthesia code for the most complex procedure.

True

Hardware and software owned by the practice or facility on which various programs are set up.

Turnkey Systems

Which of the following is not a correct wound repair guideline?

When performing multiple repairs, use modifier -59.

Codes 15002-15005 are used to describe what services?

Wound preparation requiring skin graft.