Chapter 19 Procedural Coding

Which area gives instructions on how to code within a specific chapter?

Guidelines

Which of the following is the correct code for vaginal hysterectomy (255 g) including removal of fallopian tubes and ovaries with appendectomy?

58291, 44950-51

The "key" to showing medical necessity for a procedure or service is:

accurate code linkage.

For reporting purposes, CPT considers a patient "new" if he or she has not received professional services within the past _______ year(s).

3

Which of the following CPT conventions indicates the code description is revised?

Blue triangle

Listed below are the actions one would take to find a code in the CPT manual. Put each action in proper order in which it is performed.

1. Locate the procedure in the alphabetic index at the back of the book. 3. Verify the code in the numeric section of the book and look for any needed add-on codes or modifiers. 2. Review each description and indented term under the main term.

Refer to the report below. In the blank spaces, type the term(s) that would be used to provide the meaning shown in the margin to the right.

1. The (1)evaluation and management code listed the patient as new; however, we have several claims from your office for this patient within the past year. 2. The patient SOAP notes indicate a (2)modifier should have been used with the (3)procedure code as the patient was seen for more than one issue.3. The (4)Global Period for this type of code is 90 days. I would suggest that you use the (5)current procedural terminology and the current (6)International Classifications of Diseases to make the necessary corrections to this claim.

Place in order the steps that should be taken when locating CPT codes.

1. Using the encounter form and/or the patient's chart, find the service performed. 2. Ensure that the services were documented in the patient's chart. 3. Using Volume II, look up the CPT code for the service performed. 4. Verify the code number in the numeric index and note any code range. 5. Choose the correct code from the range. 6. Determine the appropriate modifiers. 7. Record the number on the health claim form. 8. Match the procedure with the diagnosis that verifies medical necessity.

All of the following are sections of the CPT manual except

Integumentary

Which of the following is/are components of a surgical package?

Preoperative work-up Surgery itself Usual postoperative follow-up

Which of the following CPT conventions indicates the code is new to the current edition?

Red dot

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Louisa is a 42-year-old mother-to-be. Because of maternal age, an amniocentesis and a chromosome analysis of the amniotic fluid (15 cells) is ordered. When the results are returned, the fetus is diagnosed with Down syndrome, also known as Trisomy 21, mosaicism type.

CPT: 59000, 88267

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list modifiers with the code they relate to as necessary. Include a hyphen in between the code and the modifier. Example Procedure: 43846-74. Be sure to list the codes, one code per box, in the correct order, from top to bottom, and in the proper column. You may not need all of the spaces provided. Case Study: Aaron is a 3-year-old with documented "failure to thrive". Although he appears to eat well, he has chronic diarrhea and is not gaining weight as expected. Upper and lower GIs (esophagogastroduodenoscopy and colonoscopy) are performed. The provider is concerned the patient may have celiacs disease and will order food allergy testing.

CPT: 43235, 45378

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Donna is 40 years old and is pregnant with her first child. Everything appears to be moving along normally, but because of her age, an amniocentesis is done to check on the health of the fetus.

CPT: 59000

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Mari Lou is a 55-year-old white female, S/P hysterectomy at age 41. She feels she is getting shorter, and after being measured during her physical several weeks ago, it does appear she has "lost" several inches. At her request, a bone densitometry of the axial skeleton (DXA) and blood calcium test are ordered. Her diagnosis is post-menopausal osteoporosis.

CPT: 77080, 82310

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list modifiers with the code they relate to as necessary. Include a hyphen in between the code and the modifier. Example Procedure: 43846-74. Be sure to list the codes, one code per box, in the correct order, from top to bottom, and in the proper column. You may not need all of the spaces provided. Case Study: Karen is a 16 year-old head cheerleader at the local high school. She fainted at the recent pep rally and her mother is concerned about apparent weight loss and disinterest in food. Karen states she has just been too busy to worry about eating and says she feels fine. On examination, at 5'4", Karen only weighs 90 lbs. At last year's physical exam, she was noted to have weighed 110. She says she has to keep her weight down to remain active on the cheerleading squad. General physical exam appears normal, except she does appears somewhat emaciated and dehydrated. Thirty minutes were spent taking a comprehensive history and examination. Comprehensive metabolic panel and vitamin D level are ordered. Working diagnosis is anorexia and moderate malnutrition per the lab results. She is being referred for mental health and nutrition counseling.

CPT: 80053 (INCOMPLETE)

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Matthew Davies arrives at the office for lab work. His provider is ordering a lipid panel, which consists of cholesterol, triglycerides, HDL, and LDL breakdown. Matthew's diagnosis is mixed hyperlipidemia.

CPT: 80061, 83721

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Maren formerly abused IV drugs. She has been clean for over 5 years but lately has not been feeling well. Her abdomen appears bloated, she is suffering from bouts of nausea, and her scleras appear to have a yellowish tinge to them. After running a Hep A antibody, Hep B core antibody, Hep B surface antigen, and Hep C antibody, she is diagnosed with chronic and acute Hepatitis B.

CPT: 80074

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Oliva is a 6-month-old infant with a diagnosis of (classical) PKU (phenylketonuria). The physician has ordered labs for phenylalanine and phenylketones to check on her levels to make sure her current treatment is effective.

CPT: 84030, 84035

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Richard was referred to the hematologist because of persistent easy bruising with purpura and petechiae. Diagnosis at this time is idiopathic thrombocytopenia. In addition to the high-level-complexity consult, testing includes CBC w/platelet count and automated WBC differential, platelet assay (reticulated), and bone marrow biopsy (trocar), which also reveals aplastic anemia.

CPT: 85025, 85055, 38221 (INCOMPLETE)

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Marta is 2 weeks old. She is continuously cyanotic, even on oxygen. Transesophageal echocardiogram looking for congenital anomalies and PET (Positron Emission Tomography) scan of the heart reveal transposition of the great vessels.

CPT: 93315, 78459

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list modifiers with the code they relate to as necessary. Include a hyphen in between the code and the modifier. Example Procedure: 43846-74. Be sure to list the codes, one code per box, in the correct order, from top to bottom, and in the proper column. You may not need all of the spaces provided. Case Study: Mari Lou has not been feeling well. Muscles are cramping, she feels sluggish and her neck seems "swollen". After a complete physical exam and extensive medical history, her new provider orders labs including a general health panel, and a parathyroid hormone level. Her diagnosis is hypocalcemia and hypoparathyroidism (idiopathic). Further testing will be performed.

CPT: 99205, 80050, 83970

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list modifiers with the code they relate to as necessary. Include a hyphen in between the code and the modifier. Example Procedure: 43846-74. Be sure to list the codes, one code per box, in the correct order, from top to bottom, and in the proper column. You may not need all of the spaces provided. Case Study: Isobel is a 3-year-old female brought in by mom because of a sore throat and fever for the last several days. Isobel also appears to be less energetic than usual. On examination, her pharynx appears erythematous with exudate noted. Visit is checked off for an existing patient, Exp problem-focused history and exam with low complexity MDM. A rapid strep culture (direct optical observation; group A) and CBC (automated) are completed in the office. Diagnosis: Strep pharyngitis and mild nutritional anemia. Mom is given an appointment to meet with the hospital nutritionist when Isobel is feeling better.

CPT: 99213, 87880 (INCOMPLETE)

Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnostic code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Remember to use required punctuation and placeholders as necessary to create a complete code meeting specificity guidelines. Then determine the most accurate CPT and/or HCPCS procedure code(s) along with any modifier(s), if appropriate. Please list the Procedure and/or HCPCS code in the appropriate column and add any appropriate modifier(s) in the column directly adjacent to the procedure column titled for modifiers. Case Study: Ricardo comes in for an HIV test, which is positive for HIV, and confirmatory Western Bot is then completed. Ricardo states he is asymptomatic. One week later, he returns complaining of a new skin lesion. On examination (E/M for existing patient; expanded problem-focused history, detailed exam, and moderate complexity decision making), the lesion is identified as Kaposi's sarcoma and his diagnosis is upgraded to AIDS.

CPT: 99214, 86689 (INCOMPLETE)

The __________ codes are considered to be the most important of the CPT codes.

E/M

What is the correct HCPCS code for a folding walker with wheels?

E0143

Listed below are the six main sections of the CPT manual. Match the range of codes with the appropriate section.

Evaluation and Management 99201-99499 Anesthesiology 00100-01999, 99100-99140 Surgery 10021-69990 Radiology 70010-79999 Pathology and Laboratory 80047-89398 Medicine 90281-99199, 99500-99607

Identify whether Fraudulent billing or Honest billing from the choices in the dropdown box that matches the statements.

FRADULENT BILLING • Coding services that were not performed • Performing procedures that are not medically necessary • Unbundling of services • Reporting the same service twice HONEST BILLING • Not overstating the complexity of the decision-making process • Coding to the highest specificity • Reporting the extent of patient history taken