CPT/HCPCS Coding
The chart on page 7 shows how APC payments are calculated. Which three of the following scenarios are considered special exceptions to the APC payment?
- If the patient is exceptionally costly - If a rural SCH - Cancer or children hospital eligible for transitional OP payment
A patient undergoes a modified radical mastectomy. What would be the correct CPT code assignment for the anesthesiologist's services?
00404
The patient received anesthesia for laparoscopic cholecystectomy. What is the correct CPT code assignment for the anesthesiologist's services?
00790
The patient received anesthesia for an open reduction of a fracture of the head of the tibia. What would be the correct CPT code assignment for the anesthesiologist's services?
01392
Fine needle aspiration biopsy of a cyst of a thyroid nodule under fluoroscopic guidance.
10007
Operative Report Diagnosis: Left thigh abscess. Procedure: Incision and drainage of left thigh abscess. Indications: An otherwise healthy 2-year-old male presented with progressive swelling, redness, and pain of the upper left thigh area. The area in question on the left thigh now has a fluctuant center, and incision and drainage is indicated. Description of Procedure: With the patient in the supine position under general anesthesia, the upper anterior left leg was prepped with Betadine and draped in a sterile fashion. We used an 18-gauge needle and a small syringe to aspirate grossly purulent grayish material from the center of the fluctuant area, and this was sent for aerobic and anaerobic routine bacterial culture. We then made a small transverse incision directly through the area, entering a cavity and obtaining a substantial amount of additional purulent material. We gently probed the area and broke up any loculations. The abscess appeared to be quite superficial and did not extend grossly beyond the subcutaneous tissues. It did extend laterally to the edge of the indurated area, and we opened our incision very slightly towards that lateral area to make sure that the area was adequately drained. The wound was irrigated with saline, and then packed open with ¼-inch strip gauze. The area was dressed with a 4 × 4 and wrapped with a Kerlix. The patient tolerated the procedure well and was taken to the recovery room in stable condition.
10060
In the clinic, the physician performed a simple incision and drainage of a pilonidal cyst.
10080
The surgeon performed a punch biopsy of the right upper chest skin lesion and an incisional skin biopsy of a lesion of the neck.
11106, 11105
Reference codes 11200 and 11201 for removal of skin tags. What is the correct code assignment for removal of 16 skin tags?
11200, 11201
Shaving of 1.5 cm epidermal lesion, scalp.
11307
A patient is seen with a superficial nevus of the left nasal ala (size 0.5 cm × 1.5 cm). The physician shaved the entire nevus with minimal blood loss. The specimen was submitted to pathology for analysis.
11312
An asymmetric nevi, total excision size of 1.0 cm x 2.0 cm was removed from the patient's back. Pathology report identifies the specimen as "interdermal nevi." What is the correct CPT code assignment for this procedure?
11402
Operative Note: Excision of epidermal benign lesion on dorsum hand measuring 1.9 cm x 0.5 cm x 0.8 cm.The hand was prepped and draped in the usual fashion after obtaining satisfactory analgesia with infiltration of local anesthesia. An elliptical skin incision was made surrounding the lesion. The skin lesion was completely excised and closed with interrupted 4-0 Dexon for the subcutaneous tissue and skin with 4-0 Dexon. Neosporin ointment was applied.
11422
Reference codes 11920 through 19222 for tattooing. What is the correct code assignment for tattooing of 40 sq cm of skin?
11921, 11922
Emergency Department Record This 3-year-old male was carried into the ED by mother who states, "a fish tank fell over on him" cutting his forehead and cheek. No LOC, PERRTL: patient alert and oriented. Patient has a 3 1/2 cm superficial laceration over the right eye across forehead and 1-1/2 cm superficial laceration on right cheek. Local anesthesia administered, wound irrigated and sutured with 6-0 nylon.
12013
Operative Report Preoperative Diagnosis: Probable squamous cell carcinoma, left middle finger Postoperative Diagnosis: Probable squamous cell carcinoma, left middle finger, pending pathology report. Procedure: Wide excision of skin lesion, left middle finger, closure with local flaps The patient was brought to the operating room and placed in supine position on the operating table. Local anesthesia was administered to the area of the skin lesion. A 2 mm clear margin was extended around the 1.0 cm × 1.0 cm lesion. Skin flaps were mobilized and rotated into position and reapproximated with interrupted sutures of 5-0 monofilament nylon. Hemostasis was achieved by pressure. A dry, sterile dressing was applied. Patient tolerated the procedure well. Pathological Diagnosis: Lesion, skin of left middle finger: Keratoacanthoma, completely excised.
14040
What is the correct CPT code assignment for laser removal of three (3) nevi of the arm (size approximately 2.0 cm, 1.5 cm, 0.5 cm)?
17110
Operative Report Preoperative Diagnosis: Mass, superior aspect of the left breast Postoperative Diagnosis: Benign mass, superior aspect of the left breast Operation: Excision The patient is a female who has had a lump palpable over the superior aspect of the left breast for the past several months. It has been observed in the office. I had done a needle aspiration and did not get any fluid out. After multiple observations, the patient was very concerned about carcinoma and wanted to have this area excised. Surgical Technique: The patient was lying down supine. The left breast was scrubbed with Betadine scrub and paint and draped in the classical fashion. The patient has a transverse incision near where we are feeling this lump, which was over about the 11 o'clock position, high up in the superior aspect of the left breast. A transverse incision was made underneath the breast tissue and adipose tissue was completely taken out. Hemostatic was ascertained with electrocoagulation. The wound was closed using interrupted 3-0 Vicryl sutures, the skin was closed with subcuticular running 5-0 Dexon. Benzoin and Steri-Strips and a pressure dressing were applied. All counts were normal. It was the impression of the pathologist that it represented a benign process in the left breast.
19120-LT
Which of the following can be identified as a new code in CPT 2020?
20560
Operative Report. Excision of right upper arm lipoma. Indications: painful mass in arm. An incision was made along the upper arm over the 2.0 cm lipoma, which was deep in the subfascia. Electrocautery was used to obtain hemostasis. Wound was closed. CPT codes: 11402 excision benign lesion. 17110 destruction, lesion. 24076 excision, soft tissue.
24076
Closed reduction of right radial shaft fracture.
25505-RT
Operative NotePreoperative Diagnosis: Painful left wristPostoperative Diagnosis: Closed distal radial fractureOperation: Closed reduction of left wristUnder satisfactory general anesthesia the patient was placed in supine position. The hand was secured with traction. The fracture was reduced and the alignment was checked with imaging.
25605-LT
Emergency Department NoteThe patient was seen in the ED with a staple embedded in the left index finger. An automatic staple gun impaled a staple into the DIP joint. A 1% lidocaine digital block was performed, and incision was made into the joint and the staple was removed with no complications. He was told to watch for any red streaks, swelling, pain or pus.
26080-F1
Excision of enchondroma of finger
26210
Operative Report Preoperative Diagnosis: Osteomyelitis, fifth metatarsal, left Postoperative Diagnosis: Same Procedure: Amputation of toe The patient was brought to the operating room and placed in supine position. After adequate general anesthesia was obtained, the left foot was scrubbed, prepped, and draped in the usual manner. No tourniquet was utilized. A skin incision was made along the lateral border of the fifth metatarsal and carried down to the subcutaneous tissue in line with the skin incision. Bleeders were clamped and electrocoagulated. Dissection was carried down to the base of the fifth metatarsal where an osteotomy was made at the base. The bone was then delivered from the wound and sent to the pathology department. There was erosion of the head of the fifth metatarsal consistent with osteomyelitis. The toe was amputated and the entire specimen was sent to the pathology department. All of the tissues were débrided. The wound was irrigated and hemostasis assured. The subcutaneous tissue was very loosely reapproximated utilizing 4-0 Vicryl suture. The skin was not closed and was allowed to drain. A sterile dressing was applied to the wound. The patient was then transferred to the recovery room in satisfactory condition.
28810-LT
Operative Report. Diagnosis: internal derangement of medical meniscus with degenerative changes. Lateral meniscus is normal. procedure: arthroscopic debridement, partial medial meniscectomy. CPT codes: 29877 arthroscopy, knee; debridement. 29880 arthroscopy, knee; meniscectomy (medial and lateral). 29881 arthroscopy, knee; meniscectomy (medial or lateral).
29881
Operative Report Preoperative Diagnosis: Internal derangement left knee Postoperative Diagnosis: Tear of lateral meniscus Operative Procedure: Left knee arthroscopy, partial meniscectomy The arthroscope was inserted through the routine superolateral portal as well as an inferomedial portal for insertion of scope and instruments. The knee joint was then examined in routine manner, the medial meniscus was intact. The lateral meniscus was partially detached and this portion was removed. No other defects were noted. The knee was irrigated well using normal saline. The instruments were removed from the knee. Wound closed with #4-0 nylon and dressed. Estimated blood loss 0. Intravenous fluids 1000 cc. Specimen: meniscus. Complications:
29881-LT
Clinic Record Procedure: Laryngoscopy This 45-year-old patient is seen in the ENT clinic for a chronic sore throat. The patient's mouth is open wide and the tongue held down with a tongue depressor. The laryngeal mirror is inserted into the back of the mouth just above the uvula. I was able to visualize the epiglottis, larynx, and vocal cords. On the larynx appeared a small lesion. The patient is advised to have the lesion removed in the Outpatient Surgery Department on Tuesday.
31505
Reference codes 31515 through 31530. What is the correct code assignment for a direct laryngoscopy with tracheoscopy to determine the cause of chronic hoarseness in a 65-year-old patient?
31525
Operative Report Preoperative Diagnosis: Chronic laryngitis with polypoid disease Postoperative Diagnosis: Same Procedure: Laryngoscopy with removal of polyps After adequate premedication, the 60-year-old female patient was taken to the operating room and placed in supine position. The patient was given a general oral endotracheal anesthetic with a small endotracheal tube. The Jako laryngoscope was then inserted. There were noted to be large polyps on both vocal cords, essentially obstructing the glottic airway when the tube was in place. The polyps appeared larger on the right cord. Using the straight-cup forceps, the polyps were removed from the left cord first. The polyps were removed from the right cord up to the anterior commissure. There was very minimal bleeding noted. This opened up the airway extremely well. The patient was extubated and sent to recovery in good condition.
31540
The surgeon performed an open mitral valve replacement with cardiopulmonary bypass.
33430
The surgeon created a femoral-popliteal artery bypass using a vein graft.
35556
The 45-year-old patient has a peripherally central venous catheter inserted under ultrasound guidance.
36573
The surgeon replaces the peripherally inserted central venous catheter (PICC) through same access.
36584
The surgeon performs an open thrombectomy of an AV fistula, without revision of the dialysis graft. What is the correct CPT code assignment for this procedure?
36831
A patient was taken to the endoscopy suite. The flexible endoscope was passed from the mouth into the esophagus and continued into the stomach and into the duodenal bulb. Based on this documentation, what CPT code would be selected to represent this procedure?
43235
Operative Report. Diagnosis: Dysphagia. Procedure: EGD with esophageal dilation. Endoscope inserted orally and advanced to the duodenum. All structures looked normal. The scope was removed. Due to the patient's dysphagia, I passed a 50 French Maloney dilator to be sure there were no areas of narrowing unappreciated on endoscopy. CPT Codes: 43235 EGD, diagnostic. 43233 EGD with dilation. 43450 Dilation of esophagus, by unguided sound or bougie.
43235, 43450
EGD (transoral) with removal of a piece of a chicken bone.
43247
Operative Report. Operative Note: Patient had a lower GI endoscopy that extended from the anus to the cecum. A snare removal of a polyp in the sigmoid colon was performed and a small amount of bleeding was cauterized at the operative site. CPT Codes: 45338 sigmoidoscopy with removal using snare. 45382 colonoscopy with control of bleeding. 45385 colonoscopy with removal using snare.
45385
The physician performed a colonoscopy that extended from the anus to the cecum and used a snare to remove a polyp of the transverse colon.
45385
Operative Report Preoperative Diagnosis: History of Colon Polyps Postoperative Diagnosis: Polyp of Colon Procedure: Colonoscopy and polypectomy Indications: The patient is a 46-year-old who had a polyp removed a little over a year ago and presents for a follow up at this time. Findings: The patient was taken to the Procedure Room and placed in the supine position. The patient was given initially 50mg of Demerol and 3mg of Versed. Next, a rectal exam was performed and the scope was introduced. The prep was poor. The scope could be passed up to an area of about 35 cm and a polyp was found. It was removed with a snare and then brought out with the biopsy forceps through that port. This specimen was sent to the Pathologist for further evaluation. The scope was brought around to the ascending colon. I could not get the scope to any further. I could not find any gross pathologic changes. The patient received an additional Demerol and Versed during the procedure to a total of 75 of Demerol and 9 of Versed. The scope was then carefully withdrawn and the puddles of fluid were evacuated as the scope was withdrawn. Good hemostasis was found at the site of the polypectomy. The scope was then carefully withdrawn. The patient tolerated the procedure reasonably well. There were no complications. The patient left the Procedure Room in stable condition. Follow up: The patient will follow up in my office in 7 to 14 days. The patient will be given a prescription for Anusol suppositories.
45385-52
What is the correct code assignment for: destruction of 2 groups of internal hemorrhoids with use of infrared coagulation?
46930
What is the correct code assignment for percutaneous radiofrequency ablation of a neoplasm of the liver performed under CT guidance?
47382, 77013
Operative Report Preoperative Diagnosis: Cholecystitis with cholelithiasis Postoperative Diagnosis: Same Operative Procedure: Laparoscopic cholecystectomy Indications: A 77-year-old woman experienced upper abdominal pain and was diagnosed with cholelithiasis. The risks and benefits of the procedure were explained in detail. Technique: With the patient under general anesthesia, the abdomen was prepped and draped in the usual fashion. A small infraumbilical skin incision was made, carried down through the adipose tissue. The fascia was opened in the midline, and the peritoneal cavity under direct vision using laparoscopic technique. There was adequate insufflation of CO2. A 10-mm trocar was introduced into the upper abdomen to the right of the midline, two 55-mm trocars were introduced in the right upper quadrant area under directed camera vision. Examination noted multiple adhesions in the gallbladder area. At this point, I was notified that the patient's blood pressure was 150/80 and then dropped to 90/55. The blood pressure was stabilized but the decision was to abort the procedure at this time. All trocars were taken out under direct camera vision. The CO2 was desufflated. Infraumbilical incision was closed using 4-0 Vicryl subcuticular sutures, and Steri-Strips. She will be closely monitored and I will contact her primary care physician to discuss her condition. For hospital outpatient reporting, what is the correct code assignment?
47562-74
Operative Report Preoperative Diagnosis: Right initial inguinal hernia and umbilical hernia Postoperative Diagnosis: Same Procedure: This 78-year-old patient was taken to Surgery, where he was prepped and draped in the normal sterile fashion. Incision was made from 2 cm above the pubic tubercle toward the anterior iliac spine and deepened to the external oblique. The external oblique was opened. The patient's cord was elevated on a Penrose drain. He had a very large direct inguinal hernia, no indirect hernia. All of the areas were freed up, and a piece of mesh was designed in a keyhole fashion and sutured in place with 2-0 Prolene, avoiding the nerve. Irrigation was performed. The external oblique was closed with 2-0 running chromic. Irrigation was performed again. Scarpa's fascia was reapproximated using 3-0 chromic, and the skin was closed with staples. The umbilical hernia was then dissected out after an incision was made beneath the umbilicus. The hernia sac was removed. The fascia was closed with figure-of-eight sutures of 0 Prolene. 2-0 chromic was used to tack down the skin and also reapproximate the subcutaneous area. A running subcuticular of 4-0 Vicryl was placed and Benzoin and Steri-Strips were applied. A dry sterile dressing was applied to each. Betadine was applied to the hernia. The patient was returned to the recovery room in stable condition.
49505-RT, 49585
Reference codes 49491 through 49525 for inguinal hernia repair. What is the correct code for an initial inguinal herniorrhaphy for incarcerated hernia (patient is 47 years old)?
49507
The patient had a laparoscopic incisional herniorrhaphy for a recurrent reducible hernia. The repair included insertion of mesh. What is the correct code assignment?
49656
A patient undergoes a retrograde urethrocystogram. The same physician performs both the injection and the supervision and interpretation. What is the correct CPT code assignment for this physician?
51610, 74450
A cystourethroscopy with ureteroscopy was performed to remove a calculus lodged in the left ureter.
52352
The patient has a diagnosis of benign prostatic hypertrophy. With the use of AquaBeam water ablation therapy, the enlarged prostate tissue was removed.
53854
Operative Report Preoperative Diagnosis: History of recurrent foreskin infection Postoperative Diagnosis: Same Procedure: Circumcision Indications: The patient has had some evidence of recurrent foreskin infection and his wife has had recurrent infections and her gynecologist recommended that Mr. K. undergo circumcision. The patient presented at this time to complete that recommendation. Procedure: The patient was taken to the Operating Room and placed in supine position. General anesthetic was initiated. After good anesthesia was achieved the patient's penis was prepped and draped in the appropriate fashion. A straight hemostat was used to crush the foreskin on the dorsal aspect first. After it had been placed for a period of time the hemostat was released and the crushed segment was then divided. A similar action was performed on the ventral side. This was done down to the desired site of the circumcision. Then a #3-0 chromic suture was placed on the dorsum ventral side connecting the cut ends of tissue. Curved hemostats were used circumferentially around the penis on the right side to the desired length of circumcision. After the tissue was crushed it was divided and then the excess foreskin was removed. Good hemostasis was achieved using the Bovie and the remaining cut ends of the tissue were reapproximated using interrupted #3-0 chromic suture. Similar action was done on the left side. Remaining cut edges of the tissue were reapproximated using interrupted #3-0 chromic sutures. Vaseline gauze was placed at the suture line followed by dry gauze. The patient tolerated the procedure well. There were no complications. The patient left the Operating Room in stable condition. Follow up: The patient will follow up in my office in 7 to 10 days. He was given a prescription for Darvocet N 100 mg.
54150-52
Operative Report Preoperative Diagnosis: Right hydrocele Postoperative Diagnosis: Right spermatocele Operation: Right spermatocelectomy Indications for Procedure: This 54-year-old male has a history of right-sided scrotal enlargement. Scrotal ultrasound preoperatively was consistent with right hydrocele. Operation: The patient was brought to the operative suite, placed in supine position and general anesthesia was administered. His scrotum was shaved. He was then sterilely prepped and draped in the usual manner. A transverse incision across the right hemiscrotum was then made approximately 3.5 cm in length using electrocautery to further dissect this area. The right-sided fluid sac was then exuded from the right hemiscrotum. It seems to be a right spermatocele. Using meticulous care and caution, the spermatocele was divided from the testicle and the vas deferens was identified. There as a moderate degree of difficulty as the spermatocele had separated the epididymis from the patient's right testicle. So using meticulous care, this was divided free from his spermatocele. The spermatocele was handed off intact to the scrubbed personnel. Hemostasis was achieved. The epididymis was then re-attached to the testicle. The testicle was then replaced into the right hemiscrotum. The wound was closed using a #2-0 locking running chromic stitch and the superficial skin was closed in a horizontal mattress fashion. Patient tolerated the procedure well and was sent to recovery in satisfactory condition. Pathology Report: spermatocele
54840
What is the correct code assignment for a cervical conization with loop electrical excision?
57522
Operative Report Preoperative Diagnosis: Abnormal uterine bleeding Postoperative Diagnosis: Same Procedure: Diagnostic hysteroscopy with D&C There was an approximately 8-mm polyp of the cervix. The remainder of the endocervix was unremarkable. Uterine cavity was somewhat difficult to visualize but no obvious abnormalities. Minimal tissue on D&C. Patient was taken to the OR with an IV in place, received general anesthesia and was placed on the operating table in semi-dorsolithotomy position with her legs held by staff. She was then prepped and draped. Pelvic exam was performed. Weighted speculum was placed and single tooth tenaculum placed anteriorly on the cervix. Visualization was good. Diagnostic hysteroscopy was introduced into the endocervix on direct visualization and into the intrauterine cavity. The above findings were noted with no obvious pathology. This was withdrawn and cervix dilated to #8 Hagar. Sharp uterine curette was introduced and the uterine cavity systematically curetted with minimal amount of tissue. Bleeding was negligible and procedure was terminated. Patient tolerated the procedure well and was taken to the recovery room in good condition. Estimated blood loss 15 cc.
58558
What is the correct CPT code assignment for hysteroscopy with lysis of intrauterine adhesions?
58559
Operative Report. Diagnosis: Desires sterilization. Procedure: tubal banding. Scope was inserted, abdomen explored and tubes were identified bilaterally and banded with Silastic bands. Good ischemic at close of procedure. Abdomen deflated of gas and instruments removed. CPT Codes: 58615 occlusion of fallopian tubes by device. 58671 laparoscopy with occlusion of oviducts by device.
58671
The physician performs an exploratory laparotomy with bilateral salpingo-oophorectomy. What is the correct CPT code assignment for this procedure?
58720
The surgeon created a twist drill hole for evacuation of a subdural hematoma.
61108
Operative Report Preoperative Diagnosis: Laceration of nerve and tendon, left 5th digit Postoperative Diagnosis: Ulnar nerve laceration, no tendon laceration, left 5th digit Operation: Repair of ulnar nerve Procedure: The patient was brought into the operating room and prepared and draped in the usual sterile manner. A tourniquet was used and inflated to approximately 250 mm of mercury after exsanguination of the hand. Tendons were noted to be completely intact. The nerve was then isolated in both proximal and distal ends and with the use of an operating microscope 9-0 sutures were placed in the epineurium, six through and through sutures placed. When this was finished the nerve was checked for congruity. It should be stated that the nerve was trimmed and the fascicles were lined up end to end as best as possible. After this, copious irrigation was undertaken and bleeders were cauterized. The skin was then closed with 5-0 nylon and a sterile dressing was applied. The tourniquet was let down and a clam digger splint with a rubber band through the nail was placed to ensure range of motion. The patient was discharged to recovery room without complications and there was approximately 15 cc blood loss. No blood replacement. 400 cc of Ringers lactate was used in the case.
64836-F4, 69990
A physician documented the following surgical procedure for treatment of chronic otitis media: "Myringotomy with insertion of ventilating tubes in both ears. Performed under general anesthesia." What is the correct CPT code assignment for this procedure?
69436-50
A single-view, frontal X-ray of the chest was taken and the radiologist provided only the supervision and interpretation for the procedure. What is the correct CPT code assignment for the radiologist's services?
71045-26
The patient undergoes MRI of the pelvis, first with no contrast, and then followed by contrast material.
72197
A patient is seen in the Emergency Department after falling and injuring his elbow. A CT scan is performed for evaluation.
73200
The radiologist provides only the supervision and interpretation of a hysterosalpingography. What is the correct CPT code assignment for the radiologist?
74740
A physician orders part of a Hepatic Function Panel: Serum Albumin, Total Bilirubin, Direct Bilirubin and SGPT, SGOT. What is the correct CPT code assignment?
82040, 82247, 82248, 84460, 84450
The pathologist performed a gross and microscopic examination of a kidney biopsy. What is the correct CPT code assignment?
88305
A physician draws blood to test for levels of T3 on a non-Medicare patient. The blood is sent to an outside laboratory for analysis. When billing for the physician's services, which of the following modifiers should be appended to CPT code 84480?
90
Which of the following can be identified as a CPT code from the Medicine section?
92611
Which of the following can be identified as a CPT code number from the Medicine section?
92611
What is the correct code assignment for a left cardiac catheterization performed with left ventriculography?
93452
What is the correct code assignment for electrophysiologic evaluation of dual-chamber transvenous pacing cardioverter-defibrillator?
93642
A limited duplex scan of the patient's lower extremity veins was performed. What is the correct code assignment?
93971
What is the correct code assignment for bilateral EMG of cranial nerves?
95868
What is the correct CPT code assignment from the Medicine chapter for IM injection of Leukine?
96372
The new patient is seen in the physician's office for a rash across the lower back. The physician performs a problem-focused history, expanded problem-focused examination with straightforward medical decision-making. What is the appropriate E/M service code?
99201
Office Visit Date of service: 9/28/18 Last date of treatment: 8/3/15 The patient is seen for a chief complaint of shortness of breath and fatigue. The physician performs a detailed history, comprehensive examination, and medical decision-making is of moderate complexity. What is the correct E/M code for this service?
99203
Office Visit Date of service: 1/3/18 Last date of treatment: 2/12/15 The patient is seen for a cough and sore throat. The physician performs a problem-focused history, expanded problem-focused examination, and medical decision making is straightforward. What is the correct E/M code for this service?
99212
The physician documents an initial observation care visit with a detailed history, comprehensive examination with moderate medical decision-making. What is the appropriate E/M service code?
99218
For the subsequent hospital care E/M service, the physician documents an expanded focused-interval history and examination with low-complexity medical decision-making. What is the appropriate E/M service code?
99232
A patient is seen in the emergency department with a severe headache that is not responding to over the counter medications. The physician performs a detailed history and examination with medical decision making of high complexity. What is the correct E/M code, as reported by the physician, for this encounter?
99284
Skilled Nursing Home Visit Date of service: 1/9/18 Last date of treatment: 12/22/17 Physician visits and elderly patient in the skilled care facility. Physician performs a detailed interval history, comprehensive examination, and medical decision making is of moderate complexity. In addition, the physician reviewed the medical record and the recent lab results. What is the correct E/M code for this service?
99309
Rolling River Community Village-Patient Visit Physician sees a new patient in the independent living area of this retirement community. The physician performs a detailed history, expanded problem-focused examination and medical decision making is of moderate complexity. What is the correct E/M code for this service?
99325
The physician conducts a home visit for an established patient who is bed-ridden. A comprehensive interval history and comprehensive examination is performed with medical decision-making of moderate complexity. What is the correct E/M code for this encounter?
99350
The physician documented the appropriate elements to report complex chronic care management services (99487-99489). If the total duration was 1 hour and 45 minutes, the CPT code assignment would be:
99487, 99789
You may also receive payments in addition to standard OPPS payments for which of the following?
A rural adjustment
In most cases, the unit of payment under the OPPS is what?
APC
Which of the following documentation elements would be found in the examination section?
Abdomen is soft with active bowel sounds
The CPT manual is published and maintained by the:
American Medical Association (AMA)
Which of the following contains a complete description of CPT modifiers?
Appendix A
Which of the following contains a comprehensive summary of CPT additions, deletions, and revisions since last year?
Appendix B
Which of the following diagnoses would not meet medical necessity for a patient needing a chest x-ray?
Atherosclerosis
When were APCs implemented?
August 1, 2000
A patient visits a physician's office for back pain. The services for this patient would be submitted on what claim form?
CMS-1500
HCPCS Level II (known as HCPCS) was developed by:
Centers for Medicare and Medicaid Services (CMS)
Which of the following groups and organizations is responsible for maintaining the HCPCS Level II codes
Centers for Medicare and Medicaid Services (CMS)
Sometimes new services are assigned to New Technology APCs, which are based on similarity of resource use only, until cost data are available to permit assignment to a ________ APC.
Clinical
A patient is seen in the emergency department following an accident. The physician documents that the wound required multiple layers and extensive undermining. According to CPT definitions, this type of repair would be classified as:
Complex
Effective January 1, 2015, CMS established _____________ APCs to provide all-inclusive payments for certain procedures. This policy packages payment for all items and services typically packaged under the OPPS. It also packages payment for other items and services that are not typically packaged under the OPPS.
Comprehensive
Partial hospitalization is paid on a per diem basis. The payment represents the expected ____ of a day of intensive and structured outpatient mental health care in a partial hospitalization program provided in the hospital or in a CMHC.
Cost
CMS assigns individual services or Healthcare Common Procedure Coding System (HCPCS) codes to APCs based on similar clinical characteristics and similar what?
Costs
Which of the following procedures can be identified as destruction of lesions?
Cryosurgery of lesion
The conversion factor (CF) translates the scaled relative weights into ______ payment rates.
Dollar
Which of the following modifiers would be appended to a CPT code for repair of the right upper eyelid?
E3
All of the following documentation elements would be found in the History component, except:
Extremities show no edema
True or False? The 34-year-old patient receives an administration of Zoster vaccine (HZV) by IM injection. The correct code assignment is 90460, 90736?
False
True or False? Bilateral maxillary sinusotomies is reported as 31020, no modifier necessary.
False (Append modifier 50 to the CPT code)
True or False? The correct code assignment for an arthrocentesis, ring finger of left hand is 20600-LT.
False- 20600-F3 (modifier F3 designates ring finger of left hand)
A physician states that an acoustic reflex test of the left ear was performed. CPT code 92568-LT would be reported.
False- As stated in the CPT guidelines for audio logic function tests, all descriptors refer to testing of both ears. Use modifier 52 if the test is applied to one ear instead of two
Modifier 59 may be appended to an unlisted code such as 29999.
False- It is not appropriate to append any modifier to an unlisted code because modifiers provide the means by which the reporting physician can indicate that a service or procedure has been altered by some specific circumstance, but not changed in its definition or code. Unlisted codes do not describe a specific service; therefore, it is not necessary to utilize modifiers
True or False? Incision and drainage of carbuncle on left hip is performed. The correct code assignment is 10060-LT.
False- No modifier is appended because the CPT description does not specify site and the procedure was performed on the skin
True or False? Code 55250-50 is reported for a bilateral vasectomy.
False- no modifier is needed, code description states "unilateral or bilateral"
A patient was being treated for a spontaneous abortion, and the physician performed a D&C (facility price). True or false: The following CPT code assignment (O03.4) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; 58120 is for a nonobstetric D&C. The correct code is 59812. The facility price for code 58120 is $228.85. The facility price for code 59812 is $309.58. The result is an underpayment of $80.73.
Physician excised a 2.0-cm lesion (basal cell carcinoma) from the patient's left arm. The excised margins extended 0.6 cm from around the lesion. A simple repair was used to close the wound (facility price).True or false: The following CPT code assignment (C44.619) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; CPT code 11403 is for excision of a benign lesion, but this case specifies excision for a malignant lesion. The correct code assignment is 11604. The facility price for code 11403 is $153.17 The facility price for code 11604 is $223.08. The result is an underpayment of $69.91.
The patient was diagnosed with a suspicious left breast mass. Under ultrasound guidance, percutaneous, the surgeon inserted a breast marker and performed a biopsy (facility price). True or false: The following CPT code assignment (N63) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; The correct code is 19083 (ultrasound guidance). The facility price is $174.79 for code 19081 versus $164.70 for code 19083. The result is an overpayment of $10.09.
A patient suffered an abdominal aortic aneurysm. Under fluoroscopic guidance, the surgeon inserted a modular bifurcated endograft that extended into both iliac arteries (facility price).True or false: The following CPT code assignment (I71.4) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; The correct code is 34705. The facility price is $1454.54 for code 34703. The facility price is $1599.78 for code 34705. The result was an underpayment of $145.24.
The physician repaired the 2.0-cm superficial laceration of the forehead and 2.5-cm laceration of the scalp with simple wound closures (non-facility price). True or false: The following CPT code assignment (S01.81XA) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; The correct codes are 12011 and 12001. These two wound repairs cannot be added because they are not from the same anatomic site code description. The non-facility price for code 12013 is $116.41. The non-facility price is $111.36 for code 12011 and it is $91.18 for code 12001. Code 12001 would be discounted by 50 percent by the payer due to multiple procedures performed in the same operative session (billing process).
An established patient was seen in the physician's office for sore throat and fever. The physician performed a problem-focused history, problem-focused examination and medical decision making was of low complexity. The final diagnosis was acute pharyngitis (nonfacility price). True or false: The following CPT code assignment (J20..9) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; The documentation supports code 99212. The non-facility price is $45.77 for code 99212 versus $75.32 for code 99213. The result is an overpayment of $29.55.
For a patient who had been experiencing occasional rectal bleeding, the surgeon performed a colonoscopy that extended to the cecum. A biopsy was taken of tissue in the ascending colon; the source of the bleeding was not found (facility price).True or false: The following CPT code assignment (K62.5) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
False; The only code that should be reported is 45380. The surgeon did not perform any procedure related to the rectal bleeding. The facility price for code 45382 is $273.18. The facility price for code 45380 is $211.55.
The 35-year-old patient undergoes an incisional hernia repair (lower abdomen) and the anesthesia code is 00830.
False; correct code is 00832
Anesthesia is provided for a patient that is having a reverse shoulder replacement. The correct code assignment is 01634.
False; correct code is 01638
The radiologist performed a lymphangiography of the lower extremities. The correct code is 75803-50.
False; correct code is 75803
The patient undergoes an ultrasound of the gallbladder. The correct code assignment is 76700.
False; correct code is 76705
The correct code assignment for a Gross and microscopic examination of a wedge biopsy of the lung is 88305.
False; the correct code is 88307
The CPT book is updated:
For use in January
The physician documents that the patient is seen for a sore throat and low-grade fever for two days. Although he has been gargling with warm salt water, it was not helping. What part of this documentation would be considered "modifying factors" in the history-of-present-illness documentation element?
Gargling with warm salt water is not helping
The physician documents that she changed the cardiac pacemaker battery. In CPT, the battery is called a(n):
Generator
To account for _________ differences in input prices, the labor portion of the national unadjusted payment rate (60 percent) is further adjusted by the hospital wage index for the area where payment is being made. The remaining 40 percent is not adjusted.
Geographic
The scaled relative weight for an APC measures the resource requirements of the service and is based on the _________ mean cost of services in that APC.
Geometric
Which of the following diagnoses would not meet medical necessity for a patient needing an ultrasound?
Gingivitis
What HCPCS Level II modifier would be appended to a laboratory test that was ordered by the court system?
H9
Patient is seen by her primary care physician for headaches. The physician performs a physical exam, reviews data, and outlines management options. Which of the following key components is missing from this case?
History
A patient is seen in a clinic for a laceration of the elbow. The wound required suturing. On the claim form, which of the following types of codes would be assigned to represent the laceration?
ICD-10-CM
What codes will the hospital use on its billing form to present the diagnosis of "fractured humerus?"
ICD-10-CM
Which of the following code sets would be used to capture a coronary artery bypass procedure for hospital services?
ICD-10-PCS
Separate payments are not made for packaged services, which are considered a(n) ________ part of another service that is paid under the OPPS.
Integral
The payment rate for a New Technology APC is set at the ________ of the applicable New Technology APC's cost range.
Midpoint
The patient is seen by a primary care specialist in the Community Partnership for persistent cough and watery eyes. Five months later, the patient sees an allergist in the same Community Partnership office. The allergist would identify this patient as:
New
Ambulatory Payment Classifications (APCs) are part of which payment system?
OPPS
Some examples of usually packaged services are all supplies; ancillary services; anesthesia; perating and recovery room use; clinical diagnostic laboratory tests; procedures described by add-on codes; implantable medical devices (such as pacemakers); nexpensive drugs under a per-day drug threshold packaging amount; drugs, biologicals, and radiopharmaceuticals that function as supplies (including diagnostic radiopharmaceuticals, contrast agents, stress agents, implantable biologicals, and skin substitutes); guidance services; image processing services; intraoperative services; imaging supervision and interpretation services; and ___________ services.
Observation
Which of the following E/M services rely on documentation of new vs. established patient?
Office visits
Within each APC, payment for dependent, ancillary, supportive, and adjunctive items and services is ________ into payment for the primary independent service.
Packaged
Which of the following services require the patient's age as a criterion for selection of E/M service?
Preventative Medicine Services
A surgeon performed a procedure that is unfamiliar to the coder and the coder is having trouble locating an appropriate CPT code. What should the coder's next action be?
Research the description about the procedure
A surgeon performed a procedure that is unfamiliar to the coding professional, who is having trouble locating an appropriate CPT code. What should the coding professional do next?
Research the description of the procedure
Which of the following is considered part of the Social History?
Served in the military
The payment rate and copayment calculated for an APC apply to each _______ within the APC.
Service
A MRI of brain (without contrast material) was performed to rule out the diagnosis of cerebral vascular accident. The correct code assignment is 70551.
True
Office Visit Date of service 11/24/18 Last date of treatment: 7/12/17 The patient is seen for a routine blood pressure check. Nurse documents BP: 135/90. Nurse asks about diet and exercise program. Patient offers no complaints. True or False? The correct E/M code for this service is 99211.
True
Physician Office Record Physician monitors the management of a patient who it taking long-term warfarin therapy. The physician monitors the dosage with appropriate INR testing and reviews medication dosage and provides patient education. True or False? The correct code assignment is 93793.
True
The patient receives anesthesia for repair of cleft palate. CPT code 00172 is reported.
True
The physician orders the patient to have a lipid panel to include: total serum cholesterol, triglycerides, and HDL levels. The correct code assignment is 80061.
True
The radiological exam included two views of the mandible. The correct code assignment is 70100.
True
The radiologist performed an MRI, without contrast, of the patient's knee. The correct code assignment is 73721.
True
True or False? A 62-year-old patient is seen in the outpatient hemodialysis clinic for 3 face-to-face visits in the month of July for treatment of end-stage renal disease. CPT code 90961 is assigned.
True
True or False? The patient received an evaluation of auditory rehabilitation status for surgically implanted device, 1 hour and 15 minute visit. CPT codes 92626 and 92627 are assigned.
True
True or False? The patient receives a 30-minute IV infusion of 2 g of Rocephin. In addition to the J code, the CPT code 96365 should be assigned.
True
True or False? The physician performs chiropractic manipulation treatment of three spinal regions. The correct code assignment is 98941.
True
True or False? The correct code assignment for a closed reduction of fractured phalange, 5th digit, right foot is 28515-T9.
True
True or False? The correct code assignment for an extracapsular cataract extraction with insertion of lens, OS is 66984-LT.
True
True or False? The patient reported that she experienced severe back and shoulder pain because of her large breasts. The physician performed a reduction mammoplasty. The correct code assignment is 19318-50.
True
True or False?A patient was seen by his family practitioner two years ago. A cardiologist in the same group practice now sees this patient for the first time. For E/M code selection for the cardiologist, the patient would be classified as new.
True
If everything listed in code 95922 is not performed, the code is reported with modifier 52.
True- CPT code 95922 requires both a passive title and a valsalva maneuver be performed. If only one or the other is performed, then modifier 52, reduced services, should be appended to the code
CPT code 69610 (tympanic membrane repair) is considered to be unilateral.
True- Unilateral. If the procedure is performed bilaterally, modifier 50, bilateral procedure, should be appended
The surgeon performed a screening colonoscopy and reached the cecum, but due to a poor prep, the procedure was discontinued and rescheduled. Modifier 53 would be appended to the colonoscopy code for the physician's service.
True- it is appropriate to append the modifier
The patient was taken to the outpatient surgical suite with the diagnosis of chronic hoarseness. The surgeon performed a flexible bronchoscopy with bronchial cell washings and brushings (facility price).True or false: The following CPT code assignment (R49.0) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
True; The facility price is $137.31.
The physician documented the diagnosis as calculus of the ureter. The surgeon performed a cystoscopy, a ureteroscopy for fragmentation of the stone, and insertion of a double J stent (non-facility price True or false: The following CPT code assignment (N20.1) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
True; The non-facility price is $434.27.
A patient with menorrhagia underwent a laparoscopic lysis of adhesions of fallopian tube and excision of benign tumor of ovary (non-facility price).True or false: The following CPT code assignment (N92.0) is correct for this scenario? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool.
True; The non-facility price is $728.71.
For the June 7, 2020 patient encounter, the hospital will electronically submit codes on what billing form?
UB-04
The payment rates for most separately payable medical and surgical services are determined by multiplying the prospectively established scaled relative weight for the service's clinical APC by a conversion factor (CF) to arrive at a national __________ payment rate for the APC.
Unadjusted
The patient had a total abdominal hysterectomy with bilateral salpingectomy. The coder selected the following codes 58150 and 58700. The assignment of these two codes together would be referred to as:
Unbundling
Which of the following terms is associated with graft material harvested from an animal to be used for a human?
Xenograft
