CPC practice exam 1

Question 25 The patient is 25 weeks pregnant with triplets. The OB/GYN performs a transabdominal ultrasound to assess heart rate and fetal position. How is this service coded? A. 76816 x 3 B. 76815 x 3 C. 76815 D. 76801, 76802 x 3

C (The patient is 25 weeks pregnant eliminating multiple choice D. The phrase in the scenario to help you choose the correct radiology service is "to assess heart rate and fetal position," which guides you to code 76815 for one or more fetuses. Code 76816 is incorrect, because this is used for ultrasound follow-up for re-evaluation of fetal size.)

Question 45 What is a pathologic fracture? A. A break in a weakened bone caused by disease B. Any fall from a standing height (fragile) C. Fracture caused by some type of accident (traumatic) D. Overuse injury caused by repetitive forces placed on the bone (stress)

A

Question 50 A Medicare patient is hospitalized three days with pneumonia. Which part of Medicare is responsible to help cover the hospital stay? A. A B. B C. C D. D

A

Question 42 The matrix, hyponychium, and lunula are part of the: A. Ear B. Nail C. Mouth D. Colon

B

Question 29 A surgeon excised a breast lesion on patient with suspected breast cancer. The lesion was removed and sent to the lab for stat evaluation. The surgeon will keep the patient in the OR until the results are determined by the pathologist. Using gross and microscopic examination, with microscopic evaluation of the surgical margins, the lesion was determined to be malignant. The margins were clear. The pathologist contacted the surgeon in the OR to discuss the results and a report was immediately generated. What codes are reported for this encounter? A. 88307, 88329 B. 88305, 88329 C. 88305, 88331 D. 88307, 88325

A (A gross and microscopic examination with microscopic evaluation of the surgical margins was performed on a breast lesion. This eliminates code 88305 which is for breast biopsy or reduction mammoplasty. Surgical Pathology code 88307 describes a gross and microscopic exam with microscopic evaluation of the surgical margins of a breast lesion. There was an intraoperative consultation by the pathologist with the surgeon which is reported with 88329.)

Question 39 Mr. Lee is diagnosed with secondary diabetes due to acute pancreatitis in which he takes insulin. The pancreatitis is determined to be alcohol-induced. Daily insulin is prescribed to bring his blood sugars under control. The patient is to return in one-month and labs were ordered for one-week prior to the appointment. Select the correct diagnoses for these conditions. A. K85.20, E08.9, Z79.4 B. E08.9, K85.20, Z79.4 C. K85.20, E09.9, Z79.84 D. K85.20, E08.9

A (ICD-10-CM Guideline I.C.4.a.6.b states the sequencing of secondary diabetes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08, E09 and E13. Category E08 indicates to code first the underlying condition; this eliminates answer choice B. Coding guideline I.C.4.a.6 indicates to report an additional code from category Z79 to identify long-term (current) use of insulin or oral hypoglycemic drugs; eliminating answer choice D. In the Alphabetic Index look for Diabetes/due to underlying condition referring you to E08.9. In the Tabular List, category E08 says to Code first the underlying condition such as pancreatitis K85-K86 and Use additional code to identify control using insulin (Z79.4). Code K85.20 describes alcohol induced acute pancreatitis without necrosis or infection is sequenced first, followed by E08.9 secondary diabetes and Z79.4 for use of insulin for control; eliminating answer choice C.)

Question 37 Mrs. Estrada sees her ophthalmologist for a follow-up of glaucoma diagnosed at her last visit. A complete eye exam is performed that includes measurement of eye pressure, inspection of the eye's drainage angle, exam of the optic nerve, testing of peripheral vision, a computer measure of the optic nerve and measurement of the thickness of the cornea. The results of the exam determine her glaucoma is stable. She will continue on her medication with no changes to the prescription. The ophthalmologist documents primary open-angle of both eyes with mild stage in the right eye and moderate stage in the left eye. How is the glaucoma reported? A. H40.1111, H40.1122 B. H40.2111, H40.2122 C. H40.20X0 D. H40.1132

A (ICD-10-CM Guideline I.C.7.a.3 states when a patient has bilateral glaucoma and each eye is documented as having the same type, but different stages, and the classification does not distinguish laterality, assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage document for each eye. This eliminates answer choices C and D. In the Alphabetic Index locate Glaucoma/open angle/primary referring you to H40.11. Subcategory H40.11 requires a 6th and 7th character. Use H40.1111 for right eye, mild stage and H40.1122 for left eye, moderate state.)

Question 4 A 4 year-old is brought into the Emergency Department after a fall from a swing in the school playground. He is favoring his left arm. On examination, there is tenderness over medial epicondyle valgus instability. A two-view X-ray of the elbow is taken, and the results show a displaced humeral medial epicondyle fracture. An orthopedic surgeon is called in to treat the fracture. The patient is prepped and anesthetized. With fluoroscopic guidance, the fracture is reduced. Using a drill, pins are inserted directly through the skin into bone traversing the fracture site. The wound is dressed and a splint is applied to immobilize the arm. The patience is discharged from recovery and will see the surgeon in one week for follow-up. What CPT® and ICD-10-CM codes will the orthopedic surgeon report? A. 24566-LT, S42.442A, W09.1XXA, Y92.219 B. 24560-LT, S42.442A, W09.8XXA, Y92.219 C. 24640-LT, S42.445A, W09.8XXA, Y92.219 D. 24538-LT, S42.449A, W09.1XXA, Y92.219

A (If you are starting the process of elimination with the CPT® codes, the fracture is a humeral medial epicondyle fracture. Answer choice C is eliminated because that is for radial head subluxation. Answer choice D is eliminated because that is for a supra or transcondylar humeral fracture. The fracture was reduced (with manipulation) and because pins were also used for the fracture treatment code 24566 is the correct CPT® code. For the ICD-10-CM codes, code S42.449A is for an incarcerated fracture which is not indicated in the question eliminating this answer choice. ICD-10-CM code S42.445A is for a non-displaced fracture, but the question indicates that the fracture was displaced reporting code S42.442A. The patient fell from a swing in the school playground reporting external cause codes W09.1XXA and Y92.219.)

Question 18 The patient was diagnosed with nuclear sclerotic cataract in the right eye. She was taken to the operating room and an extracapsular cataract extraction using a cutting and suction technique with an intraocular lens insertion in the right eye was performed. Capsule support was insufficient and the surgeon had to suture the lens behind the iris to keep it in place. What CPT® code is reported? A. 66982-RT B. 66984-RT C. 66940-RT D. 66985-RT

A (Lens material was not removed, eliminating multiple choice C. The cataract removal and insertion of the intraocular lens were performed during the same surgery session, eliminating multiple choice D. This was a complex cataract removal because the lens had to be sutured in place eliminating multiple choice B.)

Question 24 A 25 year-old patient had anesthesia for a craniectomy to drain a subdural hematoma under general anesthesia. The anesthesiologist performed all required steps for medical direction while directing one CRNA. What modifier(s) and CPT® code(s) is/are reported for the anesthesiologist and CRNA services? A. 00211-QY and 00211-QX B. 00210-AA C. 00210-QK and 00210-QZ D. 00211-QK and 00211-QX

A (The procedure is a craniectomy for evacuation of a hematoma, eliminating answer choices B and C. An anesthesiologist who is medically directing care reports their service separately from the CRNA, depending on the number of concurrent cases and the appropriate modifiers for distinction. Because there was only one case, the appropriate modifiers to report are QY for the physician and QX for the CRNA. A QZ modifier would indicate the case was performed by a non-medically directed CRNA. Refer to your HCPCS Level II codebook to verify these anesthesia modifiers.)

Question 16 A patient with chronic lower back pain is seen in the outpatient clinic for L4-L5 facet joint denervation bilaterally. Two nerves innervating L4-L5 facet joint on the right were targeted with cooled radiofrequency with a default setting of 60 degree Celsius with fluoroscopic guidance. The procedure was repeated on the left. Report the CPT® code(s)? A. 64999-50 B. 64635-50, 64636-50 C. 64635-50 D. 64999

A (The procedure is destruction by low-grade thermal energy at facet joint L4-L5 bilaterally. The notes in CPT® above code 64633 indicate that low grade thermal energy denervation is reported with 64999. Code 64635 can only be used for denervation by thermal energy above 80 degree Celsius, eliminating B and C. Modifier 50 is appended for the bilateral procedure, which was only performed at one facet joint bilaterally.)

Question 5 A 24 year-old with chronic right ankle pain is scheduled to receive an injection at the Pain Clinic. Under ultrasonic guidance, a 22-gauge spinal needle is introduced into the joint and a total volume of 40 mg of Kenalog is injected. What are the correct codes? A. 20606-RT, J3301 x 4 B. 20605-RT, 79642, J3301 x 1 C. 20550-RT, J3301 x 4 D. 20606-RT, 76942, J3301 x 1

A (This is an injection in the joint so answer choice C is eliminated. Code 20550 is reported for trigger points which are injections in muscle(s) not the joint. The injection was performed under ultrasound guidance eliminating answer choice B. 20605 is reported for without ultrasound guidance. There is a parenthetical note under code 20606 not to report code 76942 separately, eliminating answer choice D. HCPCS Level II code J3301 is for Kenalog 10 mg. 4 units are reported for 40 mg of Kenalog.)

Question 8 Patient presents for diagnostic bronchoscopy. Under general anesthesia, flexible bronchoscopy is performed and both the right and left bronchus are examined. Following this two transbronchial lung biopsies are taken from the right upper lobe, and one transbronchial biopsy is taken from the right middle lobe. Another transbronchial biopsy is taken from the left upper lobe. All are submitted separately to pathology. Report the CPT® codes. A. 31628 x 2, 31632 x 2 B. 31628, 31632 x 2 C. 31628, 31632 x 2, 31622-59 D. 31628 x 2, 31632 x 2, 31622-59

B (A diagnostic endoscopy is always included in surgical bronchoscopy, so 31622 is not reported. Code 31628 is for the transbronchial biopsy of the right upper lobe. Report only one unit even though two biopsies were taken of the right upper lobe. Refer to the parenthetical note under 31628. Then report 31632 for each additional lobe that has a biopsy(s). Two units are required - one for the right middle lobe and one for the biopsy of the left upper lobe.)

Question 19 This 30 year-old male patient is seen in our office today for a rash on his arms and chest for 3 days. We last saw this patient 4 years ago for removal of a skin lesion. The patient has an ongoing sinus infection and was seen by his PCP last week who prescribed Amoxicillin. I suspect his rash is an allergic reaction to the Amoxicillin. I advised the patient to contact his PCP to see if a change in the antibiotic should be considered and to purchase an over-the-counter antihistamine to relieve the itching and redness from the rash. An expanded problem focused history, expanded problem focused exam and low medical decision making was documented. Which E/M service is reported? A. 99213 B. 99202 C. 99203 D. 99212

B (According to CPT® guidelines: A new patient is one who has not received any professional services from the physician or another physician in a group of exact same specialty within the last three years. This eliminates answer choices A and D. All three of the key components of a new patient office visit must be met or exceeded. The history and exam meet the requirement for 99202 and the medical decision making exceeds the requirement for code 99202. To report 99203, we need a detailed history and detailed exam.)

Question 40 Which of the following is NOT part of the sinuses? A. Ethmoid B. Turbinate C. Maxillary D. Sphenoid

B (Refer to code range 31231-31259 in the CPT® codebook that shows procedures for the different sinuses. In the ICD-10-CM Alphabetic Index look for Sinusitis you will see subterms listed for the different sinuses.)

Question 44 What does the lab term presumptive mean in code range 83805-80307? A. The descriptor of a device that measures multiple analytes. B. Drug test results that indicate possible, but not definitive, presence of drugs and or drug metabolites. C. A term used to describe definitive identification definitive identification/quantitation procedures that are secondary to presumptive screening methods. D. Specific identification of individual drugs and drug metabolites.

B (The correct answer is b. In the CPT® Professional Edition code book, Pathology and Laboratory/Drug Assay section, there is a table of Definitions and Acronym Conversion Listing.)

Question 6 A 54 year-old male goes to an orthopedic urgent care clinic for severe right knee pain with swelling and difficulty bearing weight on the right leg. Examination and X-rays determine he has a bucket-handle tear of the medial and lateral meniscus. Outpatient surgery is schedule for the following day. The patient is appropriately prepped and anesthetized. Incisions are made in the knee area and an arthroscope is inserted through one of the incisions into the knee joint. Saline solution was inserted to expand the area around the knee joint. The joint is inspected and instruments used to enter the medial compartment and the meniscal tear is sutured. The lateral compartment entered next and the meniscus is sutured. The area is irrigated, checked for bleeding, the instruments are removed, and incisions closed. Code the procedure and diagnosis codes. A. 29880-RT, S83.251A, S83.211A B. 29883-RT, S83.251A, S83.211A C. 29882-RT, S83.281A, S83.241A D. 29881-RT, S83.241A, S83.251A

B (The correct answer is b. In the CPT® Professional Edition code book, Pathology and Laboratory/Drug Assay section, there is a table of Definitions and Acronym Conversion Listing.)

Question 32 Mr. Baker sees the ophthalmologist for the first time for an eye exam. The ophthalmologist obtains medical history from Mr. Baker and performs a general medical examination which includes an external and ophthalmoscopic exam, gross visual fields, biomicroscopy, tonometry and refraction. The correct CPT® codes for this encounter are: A. 92014, 92015 B. 92004, 92015 C. 92004, 92015, 92081 D. 92014, 92015, 92081

B (This is a new patient to the ophthalmologist. This eliminates answer choices A and D. The guidelines for Ophthalmology define a comprehensive exam as a general evaluation of the complete visual system. The service includes history, general medical observation, external and ophthalmoscopic exam, gross visual fields and basic sensorimotor exam. If may also include a biomicroscopy. Code 92004 is the correct code for a comprehensive exam for this new patient. The refraction may be coded in addition to the exam. In the CPT® Index locate Ophthalmology, Diagnostic/Refractive Determination and you're directed to 92015. Gross visual fields are included in the comprehensive exam and not coded.)

Question 13 A 37 year-old female is in the hospital ambulatory surgery center for treatment of two tumors on her right kidney. The patient is placed in a prone position in the CT scanner and local anesthetic is injected in the kidney area of the lower back. Using CT guidance, the physician inserts a cryoprobe into the tumor. Cryotherapy is applied for 10 minutes. The cryoprobe is adjusted to another location of the tumor and cryotherapy applied for 10 minutes. The probe is removed and a dressing is applied to area where the cryoprobe was inserted. The correct CPT® code is: A. 50592, 77013-26 B. 50593, 77013-26 C. 50593 x 2, 77013-26 D. 50593-50, 77013-26

B (This is a percutaneous ablation of the renal tumors using cryotherapy. This eliminates answer choices A. In the code description it indicates: tumor(s). The letter s in parenthesis means no matter how many tumors are ablated you only report the code once. Modifier 50 is used if the right and left kidney had tumors that needed ablation. The parenthetical instruction tells us imaging guidance and monitoring is coded in addition to the procedure. 77013 is used for CT guidance.)

Question 14 A five-week old male is seen for a circumcision. After local anesthesia, the foreskin is pulled away from the body of the penis and the foreskin is surgical excised. An antibiotic ointment was applied to the penis and bandage placed. Select the appropriate code for this surgery: A. 54150 B. 54160 C. 54161 D. 54164

C (The method used for a circumcision is a determining factor in code selection. This was a surgical excision eliminating answer choice A. Answer choice B is used for a surgical circumcision for a neonate (28 days or less). Answer choice D is used for a frenulotomy. A frenulotomy procedure is performed primarily to release tissue restricting movement of the glans penis. Answer choice C is the correct answer.)

Question 12 A gastroenterologist performs a screening colonoscopy on a 55 year-old patient. All parts of the colon up to and including the terminal ileum were examined. Four polyps were found in the descending colon, varying from 8 mm to 10 mm. These were resected by snare technique. Two smaller polyps in the descending colon were removed by hot biopsy forceps. Report the CPT® and ICD-10-CM codes. A. 45385 x 4, 45384-59 x 2, Z12.11, D12.4 B. 45385, 45384-59, Z12.11, D12.4 C. 45385, 45384-59, 45378-59, D12.4, Z12.11 D. 45385, 45384-59, D12.4

B (Two different techniques were used for the removal of the polyps. Four polyps removed by the snare technique (45385) and two polyps by hot biopsy forceps (45384). In the code description of both codes you see the word: polyp(s). The letter s in parentheses indicates no matter how many polyps are removed the code is only reported once. This eliminates answer choice A. Code 45378 is a diagnostic colonoscopy and because polyps were removed, it then becomes a surgical/therapeutic colonoscopy and is not reported separately. This eliminates answer choice C. For the ICD-10-CM codes this is a screening colonoscopy. ICD-10-CM coding guideline I.C.21.c.5 indicates "A screening code may be a first-listed code if the reason for the visit is specifically the screening exam." It further reads, "Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis." ICD-10-CM codes are Z12.11, D12.4.)

Question 41 The brachial artery is located in the: A. Head B. Upper Leg C. Upper Arm D. Lower Leg

C

Question 47 Which statement is TRUE for reporting burn or corrosion codes? A. Nonhealing burns are coded as sequlae codes. B. When sequencing burn codes the lowest degree is always reported as the primary code. C. A burn due to a chemical, use the corrosion code. D. An infected burn site is reported with one code.

C

Question 48 Modifiers 1P, 2P, and 3P go on which codes? A. Category I CPT® Codes B. ICD-10-CM Codes C. Category II CPT® Codes D. Anesthesia codes

C

Question 49 Which of the following would NOT be considered medically necessary? A. A diagnostic Pap smear for personal and family history of cervical cancer. B. A thyroid function test for a patient on drug therapy for primary hypothyroidism. C. Plastic surgery on a patient that wants a smaller and straighter nose. D. A bacterial urine culture for symptoms indicative of a possible UTI (urinary tract infection).

C

Question 9 A patient presents to his oncologist with difficulty breathing. He is currently being treated for left lung cancer. He is diagnosed with left pleural effusion due to lung metastasis to the pleura and a decision is made to perform a left thoracentesis. Using imaging guidance, a needle is inserted into the pleural and 300 cc of fluid is drained. Because there is so much fluid, the oncologist decides to insert a tunneled pleural catheter with cuff. Using the same thoracentesis needle, a guidewire is inserted and the catheter is threaded over the guidewire and placed into the pleural cavity under fluoroscopic guidance. The distal end of the catheter is then tunneled and the cuff is inflated. The cuff is secured with two silk sutures and a bandage is applied. What CPT® code(s) is (are) reported? A. 32550 B. 32556 C. 32550, 75989-26 D. 32557

C (A thoracentesis with imaging guidance was performed and through the same site an indwelling tunneled pleural catheter with cuff was inserted. This eliminates answer choices B and D. The correct code is 32550. A parenthetical note below this code indicates to use 75989 for imaging guidance, if performed. Append modifier 26 for the professional service.)

Question 15 A 35 year-old male has been seeing the urologist for infertility. The urologist schedules an examination of the right and left vas deferens for possible blockage. After the patient is prepped and anesthetized, the surgeon makes an incision in the scrotum. The vas deferens is incised to provide access for the injection of contrast media. The vas deferens is separated from adjacent spermatic cord structures and isolated. He then inserts a Foley catheter and an air-filled balloon is used to prevent reflux of contrast medium into the bladder. Contrast media is injected into the seminal vesicles and epididymis to determine any obstruction. At the conclusion, the surgeon irrigates the area, checks for bleeding, removes any instruments, and closes the incision. Select the appropriate code for this procedure. A. 55300-50, 74440-26 B. 55300-22, 74440-26 C. 55300, 74440-26 D. 55300-RT, 55300-LT, 74440-26

C (A vasotomy was performed for a vasogram to determine if any blockages were present. The code description indicates the code is for unilateral or bilateral, which indicates the code covers for one or both vas deferens and there is no need to report modifier 50 or modifiers RT and LT. Modifier 22 is incorrect to report as there is no indication that substantial additional work was performed. The parenthetical statement below 55300 instructs to code 74440 for radiological supervision and interpretation.)

Question 1 A 50 year-old female saw her dermatologist for removal of a basal cell carcinoma on her right arm. An 8.0 cm lesion that included the margins was drawn out and a 15-blade scalpel was used for full excision of the lesion. A layered closure was performed after the removal. The specimen was sent for permanent histopathologic examination. What are the CPT® code(s) for this procedure? A. 11606 B. 11606, 12004-51 C. 11606, 12034-51 D. 11606, 13121-51, 13122

C (According to CPT® guidelines "Repair by intermediate or complex closure should be reported separately". The intermediate repair code is reported because it was a layered closure. Modifier 51 is appended to indicate multiple procedures performed during the same operative session.)

Question 33 Anna will be studying in Panama during the fall term of her senior year in college. It is recommended she be up-to-date on her immunizations and receive Hep A and Typhoid as well. She verifies she is up-to-date with her immunizations and makes an appt to get the Hep A and Typhoid vaccines. At her visit, the MA administers the Hep A adolescent dosage-2 dose schedule, IM and typhoid vaccine, IM. What codes are reported for the vaccinations? A. 90634, 90691, 90471 x 2 B. 90633, 90690, 90460, 90461 C. 90633, 90691, 90471, 90472 D. 90634, 90690, 90471, 90472

C (Administration of Hepatitis A 2 dose schedule IM (90633) and typhoid vaccine IM (90691) were performed by the MA without counseling. Codes 90460 and 90461 are reported when the physician or qualified health care professional provides face-to-face counseling. This eliminates answer choice B. For administration without face-to-face counseling report 90471-90474. For this case we report 90471 for the IM injection of a single vaccine and add-on code 90472 for the additional vaccine.)

Question 30 A female patient has jaw pain and sharp upper body pain. An EKG was performed showing elevated S-T segments. Lab orders are given for one serial, total CPK enzyme levels and two more subsequent labs of the total CPK. How do you code for the lab procedures? A. 82550, 82550-76 x 2 units B. 82552, 82552-91 x 2 units C. 82550, 82550-91 x 2 units D. 82550 x 3 units

C (CPK enzymes levels are reported with 82550, which is a total creatinine kinase. A series of three was ordered. When lab tests are repeated as a result of a physician order and not due to an error in the test, modifier 91 is reported on the lab codes to indicate the services were repeated. The second and third CPK test is reported with 2 units of 82550 with modifier 91. Code 82550 is the correct code to use for a total CPK; code 82552 is used if isoenzymes are measured.)

Question 28 Sharon Smith's new employer requires drug screening for amphetamines, opiates and TCH. The lab performs a presumptive drug test that is read by instrument assisted direct optical observation. How will the lab code for this test? A. 80305, Z02.83 B. 80306, Z02.83 C. 80306, Z02.1 D. 80306 x 3, Z02.1

C (Code 80306 describes drug testing done by instrument assisted direct optical observation, eliminating answer choice A. CPT® guidelines indicate to report only one code for multiple drug classes no matter the number of drug class procedures or results on any date of service. This eliminates answer choice D. In the ICD-10-CM Alphabetic Index look for Encounter for/administration purpose only/examination for employment referring you to Z02.1. Verify in the Tabular List.)

Question 2 A 30 year-old female has chronic eczema on both arms. The areas are encrusted and scaly with severe itching. A debridement was performed on the eczematous areas of both arms totaling 25% body surface. What CPT® code(s) should be reported? A. 11004 B. 11001, 11000 C. 11000, 11001 x 2 D. 11000

C (Debridement of eczematous skin is reported with 11000 for up to 10% of body surface. Add-on code 11000 is used for each additional 10% of the body surface, or part thereof. Code 11000 for the first 10% and code 11001 x 2 for the additional 15%. Answer choice A is used for debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection of external genitalia and perineum. Answer choice B is an add-on code and may not be listed first. Answer choice D codes only up to 10% of body surface and requires add-on code 11001.)

Question 38 A patient with a long history of hypertension is recently diagnosed with mild hypertensive chronic kidney disease. Select the correct diagnoses for these conditions. A. I13.10, N18.2 B. N18.2, I12.9 C. I12.9, N18.2 D. I12.9, N18.3

C (ICD-10-CM Guideline I.C.9.2 states to assign codes from category I12 when both hypertension and a condition classifiable to category N18 (CKD) is present. This eliminates answer choice A. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of CKD. This eliminates answer choice B. ICD-10-CM Guideline I.C.14.a.1 identifies stages 1-5 of CKD. Stage 2 equates to mild; stage 3 equates to moderate; stage 4 equates to severe. In the Alphabetic Index locate Hypertension, hypertensive/with/kidney involvement referring you to see Hypertension/kidney. Locate Hypertension/kidney/with/stage 1 through stage 4 chronic kidney disease referring you to I12.9. In the Tabular List, I12.9 indicates to Use additional code to identify the stage of chronic kidney disease (N18.1-N18.4, N18.9). Review the codes from category N18 in the Tabular List and locate the code for mild CKD. N18.2 represents mild CKD.)

Question 20 This 60 year-old female patient is seen on day three of her hospitalization for pneumonia and dehydration. She is responding well to antibiotics and is tolerating oral fluids. I will keep her here for two more days and consider discharge at that time. An expanded problem focused interval history, a detailed exam and low medical decision making was documented in the patient's chart. What E/M service is reported? A. 99221 B. 99233 C. 99232 D. 99234

C (The patient is being seen on the day three as an inpatient by the provider. Subsequent hospital care codes will be reported, eliminating answer choice A. According to CPT® guidelines: Subsequent hospital care requires at least two of three key components. The history meets the requirement for 99232 and the exam exceeds the requirement for 99232. To report 99233, we need a detailed history or medical decision making of high complexity.)

Question 7 A patient has CABG surgery. A sequential saphenous vein graft is tacked to two arteries: obtuse marginal and left circumflex. The left subclavian artery is used for a sequential arterial graft and is tacked to these three arteries: ramus, the diagonal, and the left anterior descending coronary arteries. What CPT® codes are reported. A. 33535, 33510-51 B. 33533, 33517 C. 33535, 33518 D. 33534, 33518-51

C (This surgery involved a sequential vein graft and a sequential arterial graft. In the CPT® codebook Professional Edition, look for the illustration under CPT® for Coronary Artery Bypass - Sequential Combined Arterial-Venous Grafting (below add-on code 33530). A note in that illustration indicates "to determine the number of bypass grafts in a coronary artery bypass (CABG) count the number of distal anastomoses (contact points) where the bypass graft artery or vein is sutured to the diseased coronary artery(s)." The saphenous vein (venous graft) had two contact points (obtuse marginal, left circumflex). The left subclavian artery (arterial graft) has three contact points to three coronary arteries (ramus, diagonal, and LAD). Report 33535 for the arterial grafting to three coronary arteries and add-on code 33518 is for the 2 venous grafts, making C the correct answer. Add-on codes are modifier 51 exempt, making answer choice D incorrect. Choice A is not correct because 33510 is reported when only venous grafting is being performed. Choice B is incorrect because this reports one venous graft and one arterial graft.)

Question 23 A 42 year-old male with type 2 diabetes (PS 2) undergoes ERCP for stent placement in the common bile duct under general anesthesia. The anesthesia was provided by a CRNA under the medical direction of an anesthesiologist directing 4 other CRNAs concurrently. What does the CRNA report? A. 00732-QK-P2 B. 00811-QK-P2 C. 00732-QX-P2 D. 00811 QX-P2

C (You have been asked to report the services of the CRNA. Answer choices A and B are eliminated because QK is reported for the anesthesiologist directing 2 to 4 CRNAs. To find the anesthesia code look in the CPT® Index for Anesthesia/Abdomen/Endoscopy referring you to 00731, 00732, 00811-00813. 00811-00813 are used for anesthesia on the lower abdomen. The common bile duct is in the upper abdomen. 00732 is specific to anesthesia for ERCP. Refer to your HCPCS Level II codebook to verify these anesthesia modifiers.)

Question 43 What does MRSA stand for? A. Methicillin resistant Streptococcus aureus B. Methicillin resilient Staphylococcus aureus C. Methicillin resilient Streptococcus aureus D. Methicillin resistant Staphylococcus aureus

D

Question 46 The prefix leuk/o means? A. Red B. Soft C. Hard D. White

D

Question 34 A physician provided a limited follow-up inpatient telehealth consultation. How would this be reported? A. G0407 B. G0425 C. G0408 D. G0406

D (A telehealth follow-up inpatient consultation, limited is reported with G0406.)

Question 31 A patient with meningitis receives an intravenous infusion of 1000mg of Rocephin. The infusion time is two hours. How is this reported? A. 96365, J0715 x 2 B. 96369, J0715 x 2 C. 96369, 96370, J0715 x 2 D. 96365, 96366, J0715 X 2

D (Code 96365 is used for Intravenous infusion, for therapy, initial up to 1 hour. Add-on code 96366 is used for each additional hour. This eliminates answer choices B and C which are for subcutaneous infusion. There is a parenthetical instruction in 96365 to specify substance or drug. In the HCPCS Level II Table of Drugs and Biologicals locate Rocephin. You're directed to SEE Ceftizoxime Sodium. Locate Ceftizoxime Sodium Table of Drugs and Biologicals and you're directed to J0715 per 500 mg. The patient received 1000mg. This is coded as J0715 x 2.)

Question 36 Tom was recently diagnosed with Type 2 diabetes. His physician recommends he attend self-management training and schedules it for the following week. Tom attends a one hour individual self-training at the hospital outpatient department. How would this be reported? A. G0109 x 2 B. G0108 C. G0109 D. G0108 x 2

D (Code G0108 is used for individual outpatient diabetes self-management training per 30 minutes. You would indicate x 2 for a one-hour visit (60 min).)

Question 35 John noticed several small, crusty bumps on his scalp and made an appointment with a dermatologist. The dermatologist diagnosed the bumps as actinic keratoses and recommended treatment with a combination of Aminolevulinic Acid HCL and photodynamic therapy. What HCPCS Level II code and route of administration is used for Aminolevulinic Acid HCL? A. J0280, IV B. J7309, IM C. J7309, SC D. J7308, OTH

D (In the Table of Drugs and Biologicals look for Aminolevulinic Acid HCL. The J code is J7308 and the route of administration is OTHER. The Aminolevulinic Acid HCL solution is applied to the skin by the dermatologist.)

Question 17 A 70 year-old with severe cervical stenosis with right arm pain and numbness presents for C5 and C6 laminoplasties. Report the CPT® code(s). A. 63050 x 2 B. 63045, 63048 C. 63045-50, 63048-50 D. 63050

D (Laminoplasty is performed on C5 and C6 making 63050 the correct code. This code includes the work performed on 2 or more vertebral segments. It is not reported twice. Codes 63045, 63048 are not correct because there is no mention of a laminectomy (removal of the spinous process) being done. )

Question 22 Edward, a 71 year-old patient with hypertensive heart disease and diabetes, requires coronary artery bypass with pump oxygenator. Dr. Blake, the anesthesiologist, documents PS 4 and performs general endotracheal anesthesia. Report Dr. Blake's service. A. 00562-AA-P4, 99100 B. 00562-QY-P4 C. 00567-AA-P4 D. 00567-AA-P4, 99100

D (The anesthesia modifier AA denotes that the service was provided by an anesthesiologist. There is no mention that Dr. Blake was directing one CRNA, eliminating answer choice B. 00567 is correct for anesthesia for a CABG with use of pump oxygenator, eliminating answer choice A. Add-on code 99100 is used to report age over 70, eliminating answer choice C. Look in the CPT® Index for Anesthesia/Heart/Coronary Artery Bypass Grafting referring you to 00566, 00567. Refer to your HCPCS Level II codebook to verify these anesthesia modifiers.)

Question 11 The patient is a 68 year-old male with morbid obesity that presented with small bowel obstruction. He had laparoscopic surgery with partial bowel resection seven days ago. He has returned with complications having severe abdominal pain and concern of another bowel obstruction. He has returned to the operating room where a midline incision is made and he is found to have necrosis of the anastomosis site. The anastomosis was reopened and approximately 6 inches of large intestine was removed from each end. Reanastomosis was then performed and the abdomen was closed. Report the CPT® code. A. 44130-58 B. 44202-58 C. 44204-78 D. 44140-78

D (The easiest way to start process of elimination is by using the modifiers. In the coding scenario there is a complication of the initial surgery performed one week ago and now the patient is returning to the operating room. This eliminates answer choices A and B because modifier 58 is used for a planned/more extensive procedure within the global period, not a complication. The difference between codes 44204 and 44140 is the surgical approach (open vs laparoscopy) to perform the partial colectomy. Because a 'midline incision' was made this makes it an open surgery, eliminating answer choice C which is for the laparoscopy.)

Question 21 Anna is a healthy 3 year-old who is seeing Dr. Baker for the first time for a well-child visit. The mother says the child recently started pre-school two days a week and cries when she leaves. She was assured this will most likely be temporary until Anna becomes familiar with the teacher and other students. Dr. Baker advised the mother that Anna will be exposed to more childhood diseases now that she is in pre-school and to call the office if she has any concerns. A comprehensive exam was documented and a review of Anna's immunization record from her previous pediatrician. She is up to date on her immunizations. The next well-child visit will be at 4 years. A vision and hearing screening will be done at that visit as well as DTaP, IPV, Varicella, MMR immunizations. What E/M service is report? A. 99392 B. 99205 C. 99204 D. 99382

D (The patient is coming in for a well child visit for which preventive E/M codes are reported; eliminating answer choices B and C. According to CPT® guidelines: Preventive Medicine Services are determined based on the age of the patient, and whether the patient is new or established. The comprehensive exam is an age-appropriate exam of the patient, and not the same as the comprehensive exam referred to in other E/M code categories. The correct code is 99382 for an initial comprehensive preventive medicine evaluation and management for early childhood (age 1 through 4 years).)

Question 3 A 35 year-old male is diagnosed with a malignant melanoma on his right foot. The surgeon removed the melanoma using Mohs micrographic surgery. The lesion is mapped and three tissue blocks were removed in the first stage. Each block was examined by the surgeon for malignancy. A second stage was performed with 6 tissue blocks; each block was examined by the surgeon for malignancy. There was a negative result after the final block was examined. The site is closed with sutures. What procedure codes are reported? A. 17311, 17314, 17314 B. 17313, 17315 C. 17260, 17311, 17314 D. 17311, 17312, 17315

D (The procedure performed is Mohs Micrographic Surgery. Destruction of lesion would not be coded separately eliminating multiple choice answer C. Mohs codes are based on the anatomic grouping by code, the number of stages taken, and number of blocks per stage. The surgery was on the foot using code 17311 for the 1st stage with three blocks; add-on code 17312 is used for the 2nd stage representing five blocks in the 2nd stage, and add-on code 17315 reports the 6th block in the second stage.)

Question 26 A urologist suspects hydronephrosis in a 45 year-old female and performs an ultrasound in his office. An ultrasound is performed on both kidneys, the ureters and the bladder. The urologist owns his equipment and interprets the ultrasound and writes a report in the patient's chart. His findings confirm hydronephrosis of the left renal pelvis and he schedules the patient for cystoscopy and ureteropyleography. The physician will bill the service as: A. 76770-26-TC B. 76770-26 C. 76770-TC D. 76770

D (The ultrasound study was for hydronephrosis and both kidneys, the ureters, and bladder were examined, making this a complete retroperitoneal ultrasound for urinary tract pathology per the CPT® guidelines above code 76770. The urologist owns the equipment and reviews and interpreted the ultrasound so the global code 76770 is reported. Modifier 26 is used with 76770 when the provider supervises and interprets the ultrasound, taken in a facility setting, eliminating answer choices A and B. Modifier TC is reported by a facility to indicate the only their equipment was used for the procedure. This eliminates answer choice C.)

Question 10 A 55 year-old male presents to the outpatient surgery center for ERCP with cholangiography. A stricture of the common bile duct is found and the decision is made to perform balloon dilation and placed two side-by-side stents in the common bile duct. Report the service. A. 43277, 43274 B. 43275 x 2, 43274 x 2 C. 43276 D. 43274, 43274-59

D (Two stents were placed in the common bile duct reporting code 43274. There is no indication that stents were removed and/or exchanged eliminating answer choices B and C. Balloon dilation was not performed eliminating answer choice A. Per parenthetical notes, the balloon dilation 43277 cannot be reported with 43274 in the same duct. Parenthetical note under 43274 indicates to use modifier 59 with 43274 for each additional stent placed.)

Question 27 A bilateral mammogram was performed on the left and right breasts to analyze lesions detected on a screening mammogram. What CPT® code is reported? A. 77065-50 B. 77066 C. 77066-50 D. 77067-50

b (This is a diagnostic mammogram because there was an abnormality seen on a prior screening mammogram. This eliminates answer choice D. A screening mammogram is performed on women who have no signs of breast cancer. A diagnostic mammogram is performed when the patient has symptoms or signs of breast cancer or following a screening mammogram with suspicious results. There is a specific code for bilateral mammogram eliminating answer choice A. Modifier 50 is not reported with code 77066 because the code description already indicates this code is for both breasts eliminating answer choice C.)