CPB Chapter 6 Practical Application
What is the correct place of service code of an emergency room encounter?
23
A 6-year old girl is injured in a automobile accident. She is transported to the emergency room by ambulance. What is the correct place of service for the transport?
41
An ESRD patient is being treated for anemia and their HCT reading has been 37% for the past 3 months. Which modifier is applied to the ESA?
EE
A Medicare patient receives a routine screening flexible sigmoidoscopy for cancer screening. What is the correct CPT or HCPCS Level II code?
G0104 Reason:Because this is a Medicare patient, a HCPCS code is used if available. Look in the HCPCS Index for Sigmoidoscopy, cancer screening and you are directed to G0104, G0106. G0105 is for a high-risk individual and G0106 is for a barium enema, neither of which are mentioned in this scenario.
A patient is new to Medicare this year and sees his local family physician for his initial preventive physical for Medicare. What CPT or HCPCS Level II code is reported?
G0402 Reason: The patient's anemia is due to the chronic kidney disease. The HCT level has been less than 39% for 3 consecutive months.
A 72-year old Medicare patient is seen for a subsequent annual wellness visit. What CPT or HCPCS Level II code is reported?
G0439 Reason: The patient is receiving an Annual wellness visit, subsequent. The scenario does not indicate that this is the initial visit.
A patient presents for a procedure that Medicare may not pay for due to medical necessity. This is explained to the patient. The patient stills wants to have the procedure and agrees to pay in the event that Medicare denies the claim. What modifier should be applied to the procedure to indicate the patient has signed an ABN?
GA Reason: GA indicates that an ABN is on file and allows the provider to bill the patient if Medicare denies the claim.
What is the route of administration for the drug Vancomycin HCL?
IV, IM Reason: Look in the HCPCS Level II Table of Drugs and Biologicals for Vancomycin HCL. The routes of administration are IV and IM.
A patient receives Remicade via a 45-minute infusion. What is the correct CPT/HCPCS Level II combination?
J1745,96365. Reason: The HCPCS Level II code is J1745. The correct administration code is 96365 because Remicade is not a chemotherapy or other highly complex drug.
A patient receives Rituxan via a 3 hour, 15-minute infusion. What is the correct CPT/HCPCS Level II combination?
J9310, 96413, 96415 x 2 Reason: Rituxan is a chemotherapy drug. For chemotherapy administration the first hour is coded 96413 and additional 2 hours is coded 99415. The final 15 minutes is not billable as it was not longer than 30 minutes.
