Download AAPC CPC Final Exam 2024-2025 With 100% Correct And Verified Answers and more Exams Advanced Education in PDF only on Docsity! AAPC CPC Final Exam 2024-2025 With 100% Correct And Verified Answers The minimum necessary rule is based on sound current practice that protected health information should NOT be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. What does this mean? a. Staff members are allowed to access any medical record without restriction b. Providers should develop safeguards to prevent unauthorized access to protected health information. c. Practices should only provide minimum necessary information to patients. d. All of the above. - Correct Answer-b. Providers should develop safeguards to prevent unauthorized access to protected health information. EHR stands for: a. Electronic health record b. Extended health record c. Electronic health response d. Established health record - Correct Answer-a. Electronic health record The AAPC offers over 500 local chapters across the country for the purpose of a. Continuing education and networking b. Membership dues c. Regulations and bylaws d. Financial management - Correct Answer-a. Continuing education and networking What does the abbreviation MAC stand for? a. Medicaid Alert Contractor b. Medicare Advisory Contractor c. Medicare Administrative Contractor d. Medicaid Administrative Contractor - Correct Answer-c. Medicare Administrative Contractor The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are ______. a. Permanent b. Consistent and appropriate c. Frequent d. Swift and enforceable - Correct Answer-b. Consistent and appropriate Through which vessel is oxygenated blood returned to the heart from the lungs? a. Pulmonary vein b. Bronchial vein c. Pulmonary artery d. Bronchial artery - Correct Answer-a. Pulmonary vein Muscle is attached to bone by what method? a. Tendons, ligaments, and directly to bone b. Tendons, aponeurosis, and directly to bone c. Ligaments, aponeurosis, and directly to bone d. Tendons and cartilage - Correct Answer-b. Tendons, aponeurosis, and directly to bone Lacrimal glands are responsible for which of the following? a. Production of tears b. Production of vitreous c. Production of mydriatic agents d. Production of zonules - Correct Answer-a. Production of tears Melasma is defined as: a. Lines where the skin has been stretched b. A discharge of mucus and blood c. A dark vertical line appearing on the abdomen d. Brownish pigmentation appearing on the face - Correct Answer-d. Brownish pigmentation appearing on the face A gonioscopy is an examination of what part of the eye: a. Anterior chamber of the eye b. Lacrimal duct c. Interior surface of the eye d. Posterior segment - Correct Answer-a. Anterior chamber of the eye What type of code is assigned when the provider documents the reason for a patient seeking healthcare services that is not for an injury or disease? a. Non-specific code b. External cause code (V00-Y99) c. Z code (Z00-Z99) d. ICD-10-PCS - Correct Answer-c. Z code (Z00-Z99) What is the ICD-10-CM code for hay fever? - Correct Answer-J30.1 a. S61.222A b. S61.227A c. S61.242A d. S60.452A - Correct Answer-d. S60.452A A 16-year-old male is brought to the ED by his mother. He was riding his bicycle in the park when he fell off the bike. The patient's right arm is painful to touch, discolored, and swollen. The X-ray shows a closed fracture of the ulna. What ICD-10-CM codes are reported? a. S52.201A, V19.9XXA, Y92.830 b. S52.201A, V18.4XXA, Y92.831 c. S52.201A, V18.0XXA, Y92.830 d. S52.209A, V18.4XXA, Y92.830 - Correct Answer-c. S52.201A, V18.0XXA, Y92.830 A 12-month-old receives the following vaccinations: Hepatitis B, Hib, Varicella, and Mumps-measles-rubella. What ICD-10-CM code(s) is/are reported for the vaccinations? a. B19.10, B01.9, B26.9, B05.9, B06.9, Z23 b. Z23, B19.10, B01.9, B26.9, B05.9, B06.9 c. Z23 d. B19.10, B01.9, B26.9, B05.9, B06.9 - Correct Answer-c. Z23 The Table of Drugs in the HCPCS Level II book indicates various medication routes of administration. What abbreviation represents the route where a drug is introduced into the subdural space of the spinal cord? a. IT b. SC c. IM d. INH - Correct Answer-a. IT A patient is in the OR for an arthroscopy of the medial compartment of his left knee. A meniscectomy is performed. What is the correct code used to report for the anesthesia services? a. 01400 b. 01402 c. 29880-LT d. 29870-LT - Correct Answer-a. 01400 What is the correct CPT® code for a MRI performed on the brain first without contrast and then with contrast? a. 70554 b. 70553 c. 70552 d. 70551 - Correct Answer-b. 70553 How are ambulance modifiers used? a. They identify the time elements of the ambulance service. b. They identify the mileage traveled during the encounter. c. They identify ambulance place of origin and destination. d. they identify emergency or non-emergency transport types. - Correct Answer-c. They identify ambulance place of origin and destination. What is the correct CPT® code for the wedge excision of a nail fold of an ingrown toenail? - Correct Answer-11765 Rationale: In the CPT® Index, look for Excision/Nail Fold referring you to 11765. A patient is taken to surgery for removal of a squamous cell carcinoma of the right thigh. What is the correct diagnosis code for today's procedure? a. C44.722 b. C44.702 c. D79.89 d. C79.2 - Correct Answer-a. C44.722 In ICD-10-CM, what type of burn is considered corrosion? - Correct Answer-Burns due to chemicals Joe has a terrible problem with ingrown toenails. He goes to the podiatrist to have a nail permanently removed along with the nail matrix. What CPT® code is reported? a. 11720 b. 11730 c. 11750 d. 11765 - Correct Answer-c. 11750 The patient is seen for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest area and was continued on the right and the lateral trochanteric and posterior aspect of the medial thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a compression garment was applied. What CPT® codes are reported? a. 15877, 15878-50-51 b. 15877, 15879-50-51 c. 15830, 15839-50-51, 15847 d. 15830, 15832-50-51 - Correct Answer-b. 15877, 15879-50-51 The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a fragment of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, and we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it; the mass was removed. There was a granuloma capsule around this, containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal. He wanted me - Correct Answer-a. 10121, L92.3, Z18.10, Z85.828 In ICD-10-CM, what classification system is used to report open fracture classifications? a. Gustilo classification for open fractures b. PHF classification of fractures c. Danis-Weber classification d. Muller AO classification of fractures - Correct Answer-a. Gustilo classification for open fractures A patient presented with a right ankle fracture. After induction of general anesthesia, the right leg was elevated and draped in the usual manner for surgery. A longitudinal incision was made parallel and posterior to the fibula. It was curved anteriorly to its distal end. The skin flap was developed and retracted anteriorly. The distal fibula fracture was then reduced and held with reduction forceps. A lag screw was inserted from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then applied to the lateral contours of the fibula with cortical and cancellous bone screws. Final radiographs showed restoration of the fibula. The wound was irrigated and closed with suture and staples on the skin. Sterile dressing was applied followed by a posterior splint. What CPT® code is reported? a. 27823-RT b. 27792-RT c. 27814-RT d. 27787-RT - Correct Answer-b. 27792-RT A 49-year-old female presented with chronic deQuervain's disease and has been unresponsive to physical therapy, bracing or cortisone injection. She has opted for more definitive treatment. After induction of anesthesia, the patient's left arm was prepared and draped in the normal sterile fashion. Local anesthetic was injected using a combination 2% lidocaine and 0.25% Marcaine. A transverse incision was made over the central area of the first dorsal compartment. The subcutaneous tissues were gently spread to protect the neural and venous structures. The retractors were placed. The fascial sheath of the first dorsal compartment was then incised and opened carefully. b. Right c. Inverted d. Superficial - Correct Answer-a. Left In the cath lab a physician places a catheter in the aortic arch from a right femoral artery puncture to perform an angiography. Fluoroscopic imaging is performed by the physician. What CPT® code(s) is/are reported? a. 36222 b. 36200, 75605-26 c. 36215, 75605-26 d. 36221 - Correct Answer-d. 36211 Rationale: The aorta is the trunk of the system, so this is a non-selective catheterization. Look in CPT Index for Angiography/Cervicocerebral Arch. Only one code is reported for the catheterization and fluoroscopic imaging which is code 36221 Which statement is TRUE regarding codes for hypertension and heart disease in ICD- 10-CM? A) Only one code is required to report hypertension and heart failure. B) Hypertension and heart disease have an assumed causal relationship. C) Hypertension and heart disease without a stated causal relationship must be coded separately. D) Hypertension with heart disease is always coded to heart failure. - Correct Answer-B) Hypertension and heart disease have an assumed causal relationship. Rationale: ICD-10-CM Coding Guidelines I.C.9.a states a causal relationship is presumed between hypertension and heart involvement. Only if the documentation specifically states they are unrelated, are they to be coded separately. ICD-10-CM guideline I.C.9.a.1 indicates two codes are required to report hypertension and heart failure. A patient presents for extremity venous study. Complete noninvasive physiologic studies of both lower extremities were performed. Which CPT® code is reported? - Correct Answer-93970 Rationale: Code 93970 reports a complete bilateral noninvasive physiologic study of extremity veins. This study is found in the CPT® Index by looking for Vascular Studies/Venous Studies/Extremity which directs you to 93970-93971. Modifier 50 is not appended because the term bilateral is included in the code description for 93970. When reporting an encounter for screening of malignant neoplasms of the intestinal tract, what does the 5th character indicate? A) History of malignancy in the intestinal tract B) Laterality of the intestinal tract C) Anatomic location being screened in the intestinal tract D) Screening codes for malignant neoplasms of the intestinal tract are only reported with four characters. - Correct Answer-C) Anatomic location being screened in the intestinal tract Bile empties into the duodenum through what structure? A) Pyloric sphincter B) Biliary artery C) Common bile duct D) Common hepatic duct - Correct Answer-C) Common Bile Duct What ICD-10-CM code is reported for non-erosive duodenitis? a. K29.80 b. K29.90 c. K29.81 d. K29.91 - Correct Answer-a. K29.80 A 57-year-old patient with chronic pancreatitis presents to the operating room for a pancreatic duct-jejunum anastomosis by the Puestow-type operation. What CPT® and ICD-10-CM codes are reported for the encounter? a. 48548, K85.90 b. 48520, K86.1 c. 48520, K85.80 d. 48548, K86.1 - Correct Answer-d. 48548, K86.1 The urologist is called to the operating room to repair a kidney laceration status post MVA. The urologist examines the kidney and repairs a small 2 cm laceration of the kidney. What CPT® code is reported for this service? a. 50525 b. 50520 c. 50500 d. 50526 - Correct Answer-c. 50500 Transurethral resection of bladder neck and nodular prostatic regrowth. What CPT® code is reported for this service? a. 55801 b. 52630 c. 52500 d. 52640 - Correct Answer-b. 52630 Rationale: CPT 52630 is reported for a transurethral resection of residual or regrowth of the prostatic tissue. In the the CPT index look for Transurethral Procedure/Prostate/Resection. CPT 52500 is a separate procedure and considered an integral part of the prostate resection. CPT 52640 is used for the transurethral resection of a postoperative bladder neck contracture. A 63-year-old male presents for the insertion of an artificial inflatable urinary sphincter for urinary incontinence. A 4.5 cm cuff, 22 ml balloon, 61-70 mmHg artificial inflatable urinary sphincter was inserted. What CPT® code is reported for this service? - Correct Answer-53445 Rationale: In the CPT® Index look for Insertion/Prosthesis/Urethral Sphincter. You're directed to 53444-53445. Codes 53446-53448 are for the removal or removal/replacement of the inflatable sphincter. CPT® 53445 describes the insertion of an inflatable urethra/bladder neck sphincter, including placement of pump, reservoir and cuff. The patient has significant morbid obesity and her pannus has been retracted to help with dissection. The planned procedure is to place a catheter/tube to drain the bladder. It is apparent she has quite a bit of scarring from her previous surgeries and appears to have an old sinus tract just above the symphysis. A midline incision is made following her old scar from just above the symphysis for a length of about 4-6cm. The sinus tract was excised, as this was also in the midline, and carefully dissected down to the level of the fascia. It does not appear to be an actual hernia, as there are no ventral contents within it. Again, there is quite a bit of distortion from previous scarring because of the obesity, but staying in the midline, the fascia is incised just above the symphysis of a length of about 2cm. The fat and scar are incised above the fascia more superiorly and with palpation, mesh from a previous hernia r - Correct Answer-a. 51040-53 What does the abbreviation VBAC mean? - Correct Answer-Vaginal Birth After Cesarean A patient is seen for three extra visits during the third trimester of her 30-week pregnancy because of her history of pre-eclampsia during her previous pregnancy which puts her at risk for a recurrence of the problem during this pregnancy. No problems develop. What diagnosis code(s) is/are reported for these three extra visits? a. O09.893, Z3A.30 b. O14.03, Z3A.30 c. Z34.83 d. Z34.83, O09.893, Z3A.30 - Correct Answer-a. O09.893, Z3A.30 A pregnant patient presents to the ED with bleeding, cramping, and concerns of loss of tissue and material per vagina. On examination, the physician discovers an open Rationale: During the procedure, a tympanoplasty is performed. There is no mention of a mastoidectomy or ossicular chain reconstruction being performed. From the CPT® Index look for Tympanoplasty/without Mastoidectomy then verify the code in the numeric section. Modifier LT is used to indicate the procedure was performed on the left ear. What are the three classifications of anesthesia? a. General, regional, and epidural b. General, regional, and monitored anesthesia care c. General, regional, and moderate sedation d. General, MAC, and conscious sedation - Correct Answer-b. General, regional, and monitored anesthesia care What is the ICD-10-CM coding for personal history of colonic polyps? a. Z83.71 b. K51.418 c. K63.5 d. Z86.010 - Correct Answer-d. Z86.010 A patient undergoes heart surgery for angina decubitus and coronary artery disease (CAD). What ICD-10-CM coding is reported? a. I25.118 b. I25.10 c. I20.9 d. I25.119 - Correct Answer-a. I25.118 A patient presents to the OR for a craniotomy with evacuation of a hematoma. What CPT® coding is reported for the anesthesiologist's services? a. 00210 b. 61312 c. 61314 d. 00211 - Correct Answer-d. 00211 An anesthesiologist is medically supervising six cases concurrently. What modifier is reported for the anesthesiologist's service? a. QX b. QK c. AA d. AD - Correct Answer-d. AD A patient arrives at the urgent care facility with a swollen ankle. Anteroposterior and lateral view X-rays of the ankle are taken to determine whether the patient has a fractured ankle. What CPT® code(s) is/are reported? a. 73600 X 2 b. 73610 c. 73600, 73610 d. 73600 - Correct Answer-d. 73600 A 32-year-old patient with cervical cancer is in an outpatient facility to have HDR brachytherapy. The cervix is dilated and under ultrasound guidance six applicators are inserted with iridium via the vagina to release its radiation dose. The placement is in the cervical cavity (intracavitary). What CPT® code is reported for the physician service? - Correct Answer-77762-26 Response Feedback: Rationale: Patient is receiving a type of internal radiation therapy delivering a high dose of radiation (HDR) from implants (applicators with the iridium) placed via the vaginal cavity (intracavitary). This is found in the CPT® Index by looking for Brachytherapy/Intracavitary Application directing you to 0395T, 77761-77763. The CPT® subsection guidelines under the heading Clinical Brachytherapy, definitions are given to differentiate simple, intermediate and complex brachytherapy. Code 77762 is reported for the intracavitary application of five to 10 sources (intermediate); six applicators were used for this procedure making 77762 the correct code. A patient who may have a stricture of the artery is undergoing an aortogram in which the left femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta. Contrast medium was injected, and films taken by serialography showing the aortoiliac inflow vessels were widely patent. The bilateral common femoral arteries appear normal. What CPT® codes are reported for the professional component? a. 36200, 75625-26 b. 36200, 75805-26 c. 36200, 75630-26 d. 36200, 75635-26 - Correct Answer-c. 36200, 75630-26 Myocardial Perfusion Imaging (MPI)—Office Based TestIndications: Chest pain.Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion.Findings: This is a technically fair study. There was no stress induced electrocardiographic changes noted. There were no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%.Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. - Correct Answer-b. 78452 HCPCS Level II codes specifically for Pathology and Laboratory services all start with what letter? a. G b. A c. P d. Q - Correct Answer-c. P A physician orders a General Health Panel, all tests except a creatinine, including CBC with automated differential. What CPT® code(s) is/are reported? a. 80050-52 b. 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520 c. 80050 d. 80050-22 - Correct Answer-b. 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520 What diagnosis codes are reported for metastatic adenocarcinoma to the lungs from an unknown primary location? a. D49.1, D49.9 b. D02.21, D02.22, C34.90 c. C78.01, C78.02, C80.1 d. C34.90, C80.1 - Correct Answer-c. C78.01, C78.02, C80.1 Flow cytometry is performed for DNA analysis. What CPT® code is reported? a. 88184 b. 88182 c. 88187 d. 88189 - Correct Answer-b. 88182 According to CPT® guidelines, what is the first step in selecting an evaluation and management code for an E/M service provided in a hospital? a. Determine if time is the determining component b. Determine the level of history c. Review the code descriptors and examples for the category or subcategory selected. d. Determine the level of medical decision making - Correct Answer-c. Review the code descriptors and examples for the category or subcategory selected. chamber pacemakerDESCRIPTION: The chest was prepped with Betadine and draped in the usual sterile fashion. Local anesthesia was obtained by infiltration of 1% Xylocaine. A subfascial incision was made about 2.5 cm below the clavicle, and the old pulse generator was removed. Using the Seldinger technique, the subclavian vein was cannulated and through this, the old atrial lead was removed, and a new atrial lead (serial # 6662458) was placed in the right atrium and to the atrial septum. Thresholds were obtained as follows: The P-wave was 1.4 millivolts, atrial threshold was 1.6 millivolts with a resultant current of 3.5 mA and resistance of 467 ohms.Using a second subclavian stick in the Seldinger technique, the old ventricular lead was removed and a new ventricular lead (serial - Correct Answer-a. 33235, 33208-51, 33233-51 Operative Report PREOPERATIVE DIAGNOSIS:Prolapsed vitreous in anterior chamber with corneal edema POSTOPERATIVE DIAGNOSIS:Same OPERATION PERFORMED:Anterior vitrectomy The patient is a 72-year-old woman who approximately 10 months ago underwent cataract surgery with a YAG laser capsulotomy, developed corneal edema and required a corneal transplant. The patient has done well. Over the last few weeks, she developed posterior vitreous detachment with vitreous prolapse to the opening in the posterior capsule with vitreous into the anterior chamber with corneal touch and adhesion to the graft host junction and early corneal edema. The patient is admitted for anterior vitrectomy.PROCEDURE: The patient was prepped and draped in the usual manner after first undergoing retrobulbar anesthetic. A lid speculum was inserted. An incision was made at approximately the 10 o'clock meridian 3 mm in length, 2 mm posterior to the limbus, - Correct Answer-c. 67010 Operative Report Indications: This is a third follow-up EGD dilation on this 40-year-old patient for a pyloric channel ulcer which has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation. Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray. Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The pyloric channel was again widened. The ulcer, as previously seen, was well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into the second portion of the duodenum, revealing normal mucosa. Marked deformity and scarring was seen in the proximal bulb. Following t - Correct Answer-d. 43245, 43239-51, K31.1, Z87.11 Benign prostatic hypertrophy with outlet obstruction and hematuria. Operation: TURP Anesthesia: Spinal Description of procedure: The patient was placed on the operating room table in a sitting position and spinal anesthesia induced. He was placed in the lithotomy position, prepped and draped appropriately. Resection began at the posterior bladder neck and extended to the verumontanum (a crest near the wall of the urethra). Posterior tissue was resected first from the left lateral lobe, then right lateral lobe, then anterior. Depth of resection was carried to the level of the circular fibers. Bleeding vessels were electrocauterized as encountered. Care was taken to not resect distal to the verumontanum, thus protecting the external sphincter. At the end of the procedure, prostatic chips were evacuated from the bladder. Final inspection showed good hemostasis and intact verumontanum. The instruments were removed, Foley - Correct Answer-d. 52601 Rationale: TURP is a Transurethral Resection of the Prostate and reported with 52601. In the CPT index TURP directs you to see Prostatectomy, Transurethral 52601, 52630. A TURP is not a bilateral procedure and is not reported with modifier 50. Code 52630 is reported when it is done for residual growth of the obstructive prostate tissue. Operative Report PROCEDURE: Left L3-L4 peri-articular paravertebral facet joint injection.PATIENT HISTORY: The patient is a 67-year-old woman referred by Dr. X for repeat diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral facet joint injection. She had no relief of symptoms from that injection.TECHNIQUE: The patient was positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically, despite trying numerous angles. This was explained to the patient who wished to proceed with the injection. A 22-gauge 6-inch spinal needle was advanced toward the - Correct Answer-d. 64493 Rationale: Nerve block injections are selected based on location and number of levels. Code 64493 is described as a paravertebral facet joint of lumbar spine, single level. This code descriptor includes imaging guidance, and it is not reported separately. In CPT index look for Injections/Paravertebral Facet Joint/Nerve/with image guidance. A patient with a long history of endometriosis has an open surgical approach to perform an exploratory laparotomy for an enlarged right ovary seen on ultrasound with other possible masses on the uterus and in the peritoneum. Exploration reveals these masses to be endometriosis including a chocolate cyst (endometrioma) of the right ovary, right fallopian tube and peritoneum. The endometriomas are all small, less than 5 cm, and laser is used to ablate them, except the ovarian cyst, which is excised. During the procedure the patient also has a tubal ligation. What are the CPT® and ICD-10-CM codes reported for this service? a. 49203, 58611, N80.1, N80.2, N80.3, Z30.2 b. 58662, 58600-51, N80.1, N80.2, N80.3, Z30.2 c. 49203, 58671-51, N80.8 d. 49000, 58662-51, 58925-51, 58671-51, N80.1, N80.2, N80.3, Z30.2 - Correct Answer-a. 49203, 58611, N80.1, N80.2, N80.3, Z30.2 Preoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangioma Postoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangioma Procedures Performed: Aspiration of left orbital cyst with injection of Kenalog Anesthesia: General Complications: None Estimated Blood Loss: Minimal Indications for Procedure: The patient presents with a small cyst of the superior medial left orbit felt to be suggestive for hemangioma versus lymphangioma. Risks, benefits, and alternatives of steroid injection to inactivate the cyst were reviewed. These risks included failure to work and significant visual loss. After discussion, they elected to proceed. Description of Procedure: After informed operative consent was obtained, the patient was brought to the operating room and laid in the supine position. General anesthetic was administered per the anesthesiologist. A 25-gauge needle on a 5-cc syringe was placed within the - Correct Answer-d. 67415-LT, H05.812 Rationale: The provider aspirated a cyst that was in the left orbit. In the CPT index look for Aspiration/Orbital Contents referring you to code 67415. Code 67500 is reported when there is an injection of a therapeutic or local anesthetic behind the eyeball(retrobulbar). Diagnoses documented as versus are not definitive diagnosis codes and are not coded. The postoperative header indicates and orbital cyst. In the ICD-10-CM alphabetical index look for Cyst/orbit referring you to code H05.81. Verify code in the Tabular List. A 6th character is required to indicate which eye; 2 is reported for the left eye. PROCEDURES PERFORMED: 1. Bilateral facet joint injections, L4-L5 2. Bilateral facet joint injections, L5-S1. 3. Fluoroscopy. TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the desired levels were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual palpation located the sacral hiatus. The 6-inch, 20-gauge needle with a slight volar bend was inserted using fluoroscopy into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were injected in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient tolerated the procedure well with no complications and was transferred to recovery in good condition. What CPT® codes are reported? a. 64493-50 x 2 d. Cortex - Correct Answer-b. Medulla Upon leaving the stomach, nutrients move through the small intestine in what order? a. Duodenum, jejunum, ileum. b. Jejunum, ileum, duodenum c. Jejunum, duodenum, ileum d. Duodenum, ileum, jejunum - Correct Answer-a. Duodenum, jejunum, ileum. Bone marrow harvesting is a procedure to obtain bone marrow from a donor. Bone marrow collected from a close relative is: a. Autoinfusion b. Allogenic c. Alloplasty d. Autologous - Correct Answer-b. Allogenic A respiratory disease characterized by overexpansion and destruction of the alveoli is identified as: a. Respiratory distress syndrome b. Emphysema c. Pneumoconiosis d. Cystic fibrosis - Correct Answer-b. Emphysema The terms malignant, benign, in situ and uncertain behavior are all terms used when coding what? a. Seeds b. Lumps c. Skin rashes d. Neoplasms - Correct Answer-d. Neoplasms What do brackets [ ] indicate in the ICD-10-CM Alphabetic Index? a. Use the code(s) in brackets first. b. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation. c. Use the code(s) in brackets as the only code. d. Do not assign the code in brackets. - Correct Answer-b. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation. What is the ICD-10-CM code for nausea? a. R11.0 b. R11.11 c. T75.3XXA d. R11.2 - Correct Answer-a. R11.0 A 45-year-old female with malignant Müllerian duct cancer is receiving her first treatment of chemotherapy. What diagnosis codes are reported? a. C79.82, Z51.11 b. C57.7, Z51.11 c. Z51.11, C57.7 d. Z51.11, D28.7 - Correct Answer-c. Z51.11, C57.7 A 30-year-old female patient was seen in the ED with complaints of diarrhea for the past four days. She was also complaining of lower abdominal pain. After examination, the patient was diagnosed with viral gastroenteritis. She was instructed to drink plenty of fluids and to begin eating solids only after the diarrhea has subsided. What diagnosis code(s) would be reported for this encounter? a. R10.31, R19.7 b. K52.9 c. A08.4, R10.84, R19.7 d. A08.4 - Correct Answer-d. A08.4 What is the ICD-10-CM code for a patient with postoperative anemia due to acute blood loss during the surgery who needs a blood transfusion? a. D53.0 b. D50.0 c. D62 d. D64.9 - Correct Answer-c. D62 A patient is having surgery to repair a recurrent left inguinal hernia without obstruction. What ICD-10-CM code is reported? a. K40.21 b. K40.91 c. K40.20 d. K40.90 - Correct Answer-b. K40.91 A 45-year-old patient is scheduled to have an INFUSAID pump installed. He has primary liver cancer and the pump is being inserted for continuous administration of 5- FU. A pocket is created just under the skin and the pump is placed in the pocket. A catheter is attached to the pump and to the subclavian vein. The pump is filled with a chemotherapy agent provided by the hospital and the patient is given his first treatment and observed for adverse reaction and discharged to home. What ICD-10-CM codes are reported? a. Z51.11, C22.8 b. Z51.11, C22.9 c. C22.9, Z51.12 d. C22.8, Z51.11 - Correct Answer-a. Z51.11, C22.8 Rationale: ICD-10-CM Guideline I.C.2.e.2 indicates an encounter for chemotherapy code is to be reported as the primary code with a code for the cancer as secondary when the reason for the visit is solely for chemotherapy. Look in the ICD-10-CM Alphabetic Index for Chemotherapy (session) (for)/cancer Z51.11. For the malignancy, look in the ICD-10-CM Table of Neoplasms for liver/primary and use the code from the Malignant Primary column which directs the coder to C22.8. Verify code selection in the Tabular List. A patient with hypertension presents to the outpatient hospital radiology department for an ultrasound due to a suspected suspicious mass. The patient's provider performed an ACTH and a 24-hour urinary free cortisol and short suppression test confirming the diagnosis of Cushing's disease. The radiology report indicated a 5.5 cm right adrenal mass that appeared well circumscribed and rounded. The final diagnosis indicated Cushing's disease secondary to a right adrenal tumor. The hypertension is due to the Cushing's syndrome. What ICD-10-CM codes are reported? a. D49.7, I15.2 b. D49.7, E24.9, I15.2 c. C74.91, E24.9, I10 d. C74.91, E24.9, I15.2 - Correct Answer-b. D49.7, E24.9, I15.2 Rationale: The patient has Cushing's disease secondary to an adrenal tumor. First code the adrenal tumor. We are told that there is a right adrenal tumor; however, we are not given more information as to a specific type of adrenal tumor and whether it is benign or malignant. In the ICD-10-CM Alphabetic Index look for Tumor (see also Neoplasm, unspecified behavior, by site). Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic/adrenal and use the code from the Unspecified Behavior column directing you to D49.7. Next, in the ICD-10-CM Alphabetic Index find Cushing's/syndrome or disease which directs the coder to E24.9. The unspecified code for Cushing's syndrome is used because we are not given the specific type of Cushing's the patient has. The Cushing's syndrome is associated to the hypertension. Look for Hypertension/due to/endocrine disorder referring you to code I15.2. Verify all codes in the Tabular List. A 58-year-old patient sees the provider for confusion and loss of memory. The provider diagnoses the patient with early onset stages of Alzheimer's disease with dementia. What ICD-10-CM codes are reported? a. G30.0, F02.80 b. F02.80, G30.0, F29, R41.3 c. F02.80, G30.0 d. G30.0, F02.80, F29, R41.3 - Correct Answer-a. G30.0, F02.80 What type of fracture is considered traumatic? a. Comminuted fracture b. Pathological fracture c. Stress fracture d. Spontaneous fracture - Correct Answer-a. Comminuted fracture A pregnant woman in her 40th week has gestational diabetes which is controlled by diet. What ICD-10-CM code(s) is/are reported? a. O24.113, O24.410, Z3A.40 Response Feedback: Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well-being of the patient. CPT® modifiers are found on the inside front cover and in Appendix A of the CPT® code book. CPT® Category III codes reimburse at what level? a. 100 percent b. 85 percent c. 10 percent d. Reimbursement, if any, is determined by the payer - Correct Answer-d. Reimbursement, if any, is determined by the payer Response Feedback:Rationale: Per AMA, there are no relative value units (RVUs) assigned to these codes. Payment for these services or procedures is based on the policies of payers. What is the correct code for the application of a short arm cast? a. 29075 b. 29280 c. 29065 d. 29125 - Correct Answer-a. 29075 Rationale: In the CPT® Index, look for Cast/Type/Ambulatory/Short Arm. The code you are directed to use is 29075. A patient presents to the office with a suspicious lesion of the nose. The physician takes a biopsy of the lesion and pathology determines the lesion to be uncertain. What is the correct diagnosis code to report? a. D22.39 b. C44.301 c. D48.5 d. D49.2 - Correct Answer-c. D48.5 The patient is diagnosed with a superficial basal cell carcinoma of the neck and cheek. After discussion with the physician about different treatment options the patient decides to have these lesions destroyed using cryosurgery. Consent is obtained and the areas are prepped in a sterile fashion. With the use of cryosurgery, the physician destroys the lesion on the neck measuring 2.3 cm and the lesion on the cheek measuring 0.8 cm. What CPT® codes are reported? a. 17000, 17003 b. 17273, 17281-51 c. 17272, 17281-51 d. 11623, 11641-51 - Correct Answer-b. 17273, 17281-51 Response Feedback: Rationale: Basal cell carcinoma is a malignant lesion. In the CPT® Index, look for Destruction/Lesion/Skin/Malignant, you are directed to code range 17260-17286, 96567. 96567 is for photodynamic therapy. 17260-17286 is used for cryosurgery. Code selection is based on location and size. For the neck, a code from range 17270-17276 is selected. The neck lesion is 2.3 cm making 17273 the correct code. For the cheek, a code from range 17280-17286 is selected. The cheek lesion is 0.8 cm making 17281 the correct code choice. Modifier 51 is appended to 17281 to indicate multiple surgeries. What CPT® code(s) would best describe treatment of 9 plantar warts removed and 6 flat warts all destroyed with cryosurgery during the same office visit? a. 17110, 17111-52 b. 17110, 17003 c. 17110 d. 17111 - Correct Answer-d. 17111 Rationale: Cryosurgery is a method of destruction using extreme cold to destroy the lesion. In the CPT® Index look for Destruction/Warts/Flat referring you to CPT® codes 17110 and 17111. In the numeric section guidelines under the Integumentary section, subheading Destruction, flat warts and plantar warts are both included in the definition of lesions. Warts are considered benign lesions; they are coded from code range 17110-17111. A total of 15 lesions were destroyed by cryosurgery. Code 17111 represents the destruction of 15 or more lesions. Patient presents with a suspicious lesion on her left arm. With the patient's permission the physician marked the area for excision. The margins and lesion measured a total of 0.9 cm. The wound measuring 1.2 cm was closed in layers using 4-0 Monocryl and 5-0 Prolene. Pathology later reported the lesion to be a sebaceous cyst. What codes are reported? a. 11402, L72.3 b. 11401, D22.62 c. 12031, 11401-51, L72.3 d. 13121, 11401-51, D22.62 - Correct Answer-c. 12031, 11401-51, L72.3 Response Feedback: Rationale: Understanding a sebaceous cyst is benign, look in the CPT® Index for Skin/Excision/Lesion/Benign referring you to code ragen 11400-11446. The lesion is coded based on size and location. Report 11401 for excision of the 0.9 cm arm lesion. The note also indicates the wound was closed in layers allowing for intermediate closure and is also coded based on location and size. Report 12031 for intermediate closure of 1.2 cm. Modifier 51 is appended to 11401 to show additional procedures in the same session. In the ICD-10-CM Alphabetic Index look for Cyst/sebaceous directing you to L72.3. Verify code selection in the Tabular List. Operative ReportPre-Operative and Post-Operative Diagnosis: Squamous cell carcinoma, left legOpen wound, right legPersonal history of squamous cell carcinoma, right legINDICATIONS FOR SURGERY: The patient is an 81-year-old white man with biopsy proven squamous cell carcinoma of his left leg. I marked the areas for excision with gross normal margins of 5 mm, and I drew my planned skin graft donor site from his left lateral thigh. He also had an open wound of his right leg from a squamous cell carcinoma excised four months ago; the skin graft had not taken. We plan on re-skin grafting the area. The patient is aware of all of these markings, and understands the surgery and location.DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. IV Ancef was given. I used plain lidocaine for his local anesthetic throughout the procedure until the skin grafts were inset. The anterior of his leg and the thigh were i - Correct Answer-c. 15100, 11603-51-LT, 15002-51-RT Response Feedback: Rationale: The first excision is for a malignant neoplasm of the left leg measuring 2.5 cm and repaired with a split thickness skin graft measuring 5.1 cm 2. In the CPT® Index look for Skin/Excision/Lesion/Malignant referring you to code range 11600-11646. The site is the leg, which narrows down the code range to 11600-11606. The size of the lesion is 2.5 cm making code 11603 correct. The second excision is a surgical wound preparation of an open wound of the right leg. Look in the CPT® Index for Skin Graft and Flap/Recipient Site Preparation directing you to code range 15002-15005. Report 15002 for the leg wound, which was repaired with a split thickness autograft measuring 3.2 cm2. Split thickness autografts are added together (5.1 cm2 + 3.2 cm2) for a total graft size of 8.3 cm2. In the CPT® Index look for Skin Graft and Flap/Split Graft referring you to codes 15100, 15101, 15120, 15121. Report 15100 for the split-thickness graft. Because the original surgery on the right leg was four months ago, this surgery is outside of any global period, so no additional modifier is needed. Modifier 51 is appended to indicate multiple procedures in the same session. The acronym BKA means: a. bilateral knee amputation b. below knee amputation c. bursitis knee & arthritis d. bilateral knee arthritis - Correct Answer-b. below knee amputation This 45-year-old male presents to the operating room with a painful mass of the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient's shoulder was noted. The mass appeared to be benign in nature. With deep blunt dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported? a. 23075-RT b. 23066-RT c. 23030-RT d. 23076-RT - Correct Answer-a. 23075-RT Rationale: Look in the CPT® Index for Excision/Tumor/Shoulder and you are referred to 23071-23078. Code 23075 reports the excision of a soft tissue mass (tumor), parenthetical statement under code 32540 instructing us to report the correct lung removal code with 32540 if performed. Which option is TRUE regarding reporting codes for cytomegaloviral pneumonitis in ICD-10-CM? a. Only the pneumonia is reported, it is not necessary to report the underlying diseases. b. Pneumonia is reported first; the underlying disease is reported second. c. One code is used to report both the pneumonia and the cytomegaloviral disease. d. The underlying disease is reported first; pneumonia is reported second. - Correct Answer-c. One code is used to report both the pneumonia and the cytomegaloviral disease. Rationale: ICD-10-CM Tabular List does not have the instructional note to code first underlying disease that is seen for codes listed in ICD-10-CM for category code B25. Both conditions are reported with one code in ICD-10-CM. Repair of coronary vessel is called: a. Endarterectomy b. Angioplasty c. Aortic d. Endovascular - Correct Answer-b. Angioplasty In the cath lab, from a right femoral artery access, the following procedures are performed: Catheter placed in the left renal, accessory renal superior to the left renal and one main right renal artery. Radiologic supervision and imaging are performed in all locations. What CPT® code(s) is/are reported? a. 36245, 36245-59, 36245-59, 36252-26 b. 36252 c. 36252, 36251 d. 36245-LT, 36245-59-LT, 36245-59-RT, 75774-26 - Correct Answer-b. 36252 Response Feedback: Rationale: Look in the CPT® Index for Angiography/Renal Artery referring you to code range 36251-36254. This is a bilateral procedure, with an accessory left renal artery. Code 36252 includes bilateral and accessory renal angiography, and radiologic supervision and imaging. Aortography and bilateral extremity angiography were performed. The physician placed the catheter in the aorta at the level of the renal arteries and injected contrast for the aortography and repositioned the catheter just above the bifurcation for angiography of the lower extremities. Which CPT® codes are reported? a. 36200, 75716-26 b. 36200, 75630-26 c. 36200, 75625-26, 75716-26 d. 36200, 75625-26, 75710-50-26 - Correct Answer-c. 36200, 75625-26, 75716-26 Response Feedback: Rationale: Because the catheter was repositioned, and separate studies were performed, both the aortography and the extremity angiography are reported. Look in the CPT® Index for Catheterization/Aorta referring you to 36160-36200. In the CPT® Index see Aorta/Aortography referring you to 75600-75630. To locate angiography of the lower extremities, look for Angiography/Leg Artery referring you to 73706, 75635, 75710-75716. Modifier 26 reports the professional service. In the cardiac suite, an electrophysiologist performs an EP study. With programmed electrical stimulation, the heart is stimulated to induce arrhythmia. Observed is right atrial and ventricular pacing, recording of the bundle of His, right atrial and ventricular recording and left atrial and ventricular pacing and recording from the left atrium. What CPT® coding is reported? a. 93620, 93618, 93621 b. 93619, 93621 c. 93620, 93621, 93622 d. 93600, 93602, 93603, 93610, 93612, 93618, 93621, 93622 - Correct Answer-c. 93620, 93621, 93622 Response Feedback: Rationale: The studies performed make up a comprehensive study (93620) which includes: evaluation with right atrial pacing and recording, right ventricular pacing and recording, and His bundle recording with induction of or attempted induction of arrhythmia. Left atrial pacing and recording (+93621) and left ventricular pacing and recording (+93622) are add-on codes. Look in the CPT® Index for Electrophysiology Procedure which directs you to 93600-93660. What is the CPT® code for removal of a foreign body from the esophagus via the thoracic area? a. 43045 b. 43215 c. 43500 d. 43020 - Correct Answer-a. 43045 Rationale: In the CPT® Index, look for Esophagus/Removal/Foreign Bodies referring you to 43020, 43045, 43194, 43215, 74235. There are two open approaches and two endoscopic approaches in the CPT® code book for the removal of a FB from the esophagus. 43020 is via a cervical approach and 43045 is via a thoracic approach, making code 43045 the correct choice. What ICD-10-CM code is reported for acute gastritis with bleeding? a. K29.00 b. K29.70 c. K29.71 d. K29.01 - Correct Answer-d. K29.01 Rationale: In ICD-10-CM, Gastritis is identified by specific four character codes to indicate with or without bleeding. Look in the ICD-10-CM Alphabetic Index for Gastritis (simple)/acute (erosive)/with bleeding K29.01. What is the correct ICD-10-CM coding for diverticulosis of the small intestine which has been present since birth? a. K57.10 b. Q43.8 c. K57.90 d. K57.90, Q43.8 - Correct Answer-b. Q43.8 Rationale: If a condition has been present since birth, it is considered congenital. Look in the ICD-10-CM Alphabetic Index for Diverticulosis/small intestine which refers you to K57.10. Verification in the Tabular list has an Excludes1 note under category code K57 for a congenital diverticulum of intestine and directs you to code Q43.8. Congenital diverticulum is in the list of congenital malformations beneath code Q43.8. A 4-year-old patient, who accidentally ingests valium found in his mother's purse, is found unconscious and rushed to the ED. The child is treated by the ED physician, who inserted a tube orally into the stomach and performed a gastric lavage, removing the stomach contents. What CPT® and ICD-10-CM codes are reported? a. 43754, R40.20, T42.71XA b. 43753, T42.4X1A, R40.20 c. 43755, T43.501A d. 43756, T42.71XA - Correct Answer-b. 43753, T42.4X1A, R40.20 Rationale: Code 43753 is the correct CPT® code for gastric lavage performed for the treatment of ingested poison. Look in the CPT® Index for Gastric Lavage, Therapeutic/Intubation. The ICD-10-CM code for the poisoning is found in the Table of Drugs and Chemicals by looking for Valium/Poisoning, Accidental (unintentional) column, referring you to code T42.4X1-. In the Tabular List a 7 th character is needed to complete the code. A is reported as the 7 th character because this was the patient's initial encounter.The next code is the manifestation of ingesting the Valium, unconsciousness. Unconsciousness is found in the ICD-10-CM Alphabetic Index and directs you to see Coma R40.20. The Tabular List confirms this code is reported for unconsciousness. Patient is a 40-year-old female presenting for repeat urethral dilation for urethral stricture using the instillation of a saline solution. What CPT® code is reported for this service? a. 53665 b. 53661 c. 53605 d. 53660 - Correct Answer-b. 53661 d. 60210 - Correct Answer-a. 60220 Rationale: The patient had a unilateral thyroidectomy. Because only the right side is removed, it is a total unilateral (partial) thyroidectomy. In the CPT® Index look for Thyroidectomy/Partial directing you to code range 60210-60225. 60220 reports a unilateral total thyroid lobectomy with or without isthmusectomy. What ICD-10-CM code is reported for Ataxia telangiectasia? a. G11.0 b. G11.3 c. G31.89 d. R27.0 - Correct Answer-b. G11.3 A 59-year-old is suffering from foraminal spinal stenosis. Patient is to have a L4-L5 laminectomy on the right side. Under general anesthesia a knife dissection was made on the back and was taken down to the fascia. The fascia on the right side of the spine was stripped. The deep Taylor retractor was placed. Using an intraoperative X-ray, the physician traced out the foramen of L4-L5. There appeared to be some compression at this lamina into the foramen and significant stenosis. The provider removed the spinous process and lamina. Nerve roots canals are freed by removal of the facet. Compression is relieved by removing bony overgrowth around the foramen. What CPT® code is reported for this procedure? a. 63017 b. 63005 c. 63047 d. 63030 - Correct Answer-c. 63047 Response Feedback: Rationale: In the CPT® Index look for Laminectomy/with Facetectomy directing you to 63045-63048, 0202T, 0274T, 0275T. A laminectomy with knife dissection is being performed for spinal stenosis eliminating codes 0202T, 0274T, and 0275T. Codes 63045-63048 are reported based on location. This was performed on the lumbar, making the correct code 63047. 63030 is a code specific to the interspaces and codes 63001 and 63017 specifically state without facetectomy making them incorrect choices. What ICD-10-CM code is used to report acute actinic otitis externa of the left ear? a. H60.512 b. H60.62 c. H60.542 d. H66.90 - Correct Answer-a. H60.512 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Otitis/externa/acute/actinic and you are directed to H60.51-. Verification in the Tabular List indicates a 5 th character is reported for laterality. 5th character of 2 is for left ear. An 89-year-old patient who has significant partial opacities in the lens of the left eye presents for phacoemulsification and lens implantation. What ICD-10-CM code is reported? a. H25.9 b. H26.40 c. H26.9 d. H26.112 - Correct Answer-c. H26.9 Response Feedback: Rationale: In the ICD-10-CM Alphabetical Index look for Opacity, opacities/lens which states see Cataract. Look in the Alphabetic Index for Cataract and the user is directed to the default code H26.9. Confirmation in the Tabular List confirms code selection. What CPT® code(s) is/are reported for the placement of two adjustable sutures during strabismus surgery involving the horizontal muscles? a. 67334, 67335-51 b. 67318 c. 67312, 67335 d. 67316, 67335-51 - Correct Answer-c. 67312, 67335 Response Feedback: Rationale: Code 67312 represents strabismus surgery on two (2) horizontal muscles. In the CPT® Index look for Strabismus/Repair/Two Horizontal Muscles. In the numeric section below code 67316, there is a parenthetical note with instructions to use code 67335 in addition to codes 67311-67334 when adjustable sutures are used for primary procedure reflecting number of muscles operated on. Code 67335 is an add-on code and exempt from multiple procedures modifier 51. This is located in the CPT® Index by looking for Strabismus/Repair/Adjustable Sutures. A patient with mixed conductive and sensorineural hearing loss in the right ear has tried multiple medical therapies without recovery of her hearing. Patient has consented to have an electromagnetic bone conduction hearing device implanted in the temporal bone. What CPT® and ICD-10-CM codes are reported? a. 69710-RT, H90.11 b. 69714-RT, H90.8 c. 69710-RT, H90.71 d. 69930-RT, H90.0 - Correct Answer-c. 69710-RT, H90.71 Response Feedback: Rationale: In the CPT® Index look for Hearing Aid/Implants/Bone Conduction/Implantation. You are referred to 69710. Review the code to verify accuracy. In the ICD-10-CM Alphabetical Index look for Loss (of)/hearing which states see also Deafness. Look for Deafness/mixed conductive and sensorineural/unilateral. You are referred to H90.7-. Review the code in the Tabular List to verify accuracy and 5 th character 1 is for right ear Report the appropriate anesthesia code for an obstetric patient who had a planned general anesthesia for cesarean hysterectomy. a. 01962 b. 01963 c. 01967 d. 01969 - Correct Answer-b. 01963 Response Feedback: Rationale: Use the CPT® Index look for Anesthesia/Hysterectomy/Cesarean which directs you to 01963, 01969. Review the codes in the numeric section to determine that code 01963 is the appropriate code. Note: Code +01969 is an add-on code and cannot be coded without a primary procedure code. What time is used to report the start of anesthesia time? a. When the anesthesiologist begins to prepare the patient for anesthesia b. During the pre-anesthesia assessment c. Surgery start time d. Entering the operating room - Correct Answer-a. When the anesthesiologist begins to prepare the patient for anesthesia Response Feedback: Rationale: Per Anesthesia Guidelines in the CPT® code book under the subheading Time Reporting: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in the operating room (or an equivalent area). Pre-anesthesia assessment time is not part of reportable anesthesia time, as it is considered in the base values assigned. A 77-year-old patient was scheduled for a left total hip replacement due to degenerative joint disease (DJD) and the anesthesiologist documented the DJD as primary. The pre- anesthesia assessment indicates the patient had surgery in 2015 for gastroesophageal reflux disease (GERD). What ICD-10-CM coding is reported? a. M16.7 b. M16.12 c. K21.9 d. M16.9, K21.9 - Correct Answer-b. M16.12 Mr. Johnson, age 82, having been in poor health with diabetes and associated peripheral neuropathy, is having a fem-pop bypass. The anesthesiologist documents he has severe systemic disease. What coding is correct for anesthesia? a. 01272-AA-P3 b. 01272-AA-P2, 99100 c. 01260-AA-P2, 99100 d. 01270-AA-P3, 99100 - Correct Answer-d. 01270-P3, 99100 Rationale: Fem-pop bypass is an abbreviation for femoral-popliteal bypass of arteries in the upper leg. Look in the CPT® Index for Anesthesia/Bypass Graft/Leg, Upper which Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fracti - Correct Answer-d. 78452 Response Feedback: Rationale: Tomographic myocardial perfusion imaging was performed. In this procedure the patient receives an intravenous injection of a radionuclide which localizes in nonischemic tissue. SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. In the CPT® Index look for Heart/Myocardium/Perfusion Study which directs you to 78451-78454. The MPI was performed at rest and exercise (which is stress), reporting code 78452 for multiple studies. In what section of the Pathology chapter of CPT® will a coder find codes for a FISH test? a. Other Procedures b. Cytopathology c. Chemistry d. Immunology - Correct Answer-b. Cytopathology A patient with deep vein thrombosis requires heparin to maintain therapeutic anticoagulation levels. He has regular PTT's drawn to monitor his level of anticoagulation. What CPT® code is reported? a. 85730 b. 85520 c. 80299 d. None of these - Correct Answer-a. 85730 Response Feedback: Rationale: Look in the CPT® Index for PTT. There is a note to See Thromboplastin, Partial Thromboplastin Time (PTT). PTT stands for Thromboplastin time, partial. Look in the CPT® Index for Thromboplastin/Partial Thromboplastin Time (PTT). Code 85730 is the correct code, there is no mention of substitution. A young man is bitten by a dog found to have rabies. Although he shows no symptoms of rabies, testing is done to see if he has the infection. The tests come back negative. What diagnosis code is used to establish the medical necessity for the service? a. A82.9 b. Z23 c. Z20.3 d. None of the code choices - Correct Answer-c. Z20.3 Response Feedback: Rationale: When there is known exposure without symptoms, use the Z code for exposure to communicable diseases. In the ICD-10-CM Alphabetic Index, look for Exposure (to)/rabies. You are directed to Z20.3. Verify code in the Tabular List. A patient will be undergoing a transplant and needs HLA tissue typing with DR/DQ multiple antigen and lymphocyte mixed culture. How will these services be coded? a. 86805-26, 86817 b. 86806-26, 86817 c. 86816-26, 86821 d. 86817, 86821 - Correct Answer-d. 86817, 86821 Response Feedback:Rationale: In the CPT® Index look for Tissue/Typing/Human Leukocyte Antigen (HLA)/Antibodies. Code 86817 is the correct code to report for HLA tissue typing with DR/DQ. Then, look in the CPT® Index for Tissue/Typing/Lymphocyte Culture referring you to code 86821. Codes 86805 and 86806 are for lymphocytotoxicity, not Using the 1995 & 1997 guidelines, which elements of HPI are met in this statement? Patient complains of headache and blurry vision for the past 3 days. a. Quality, duration and timing b. Quality, severity and timing c. Location, severity and duration d. Location, quality and duration - Correct Answer-d. Location, quality and duration A new patient visits the internal medicine clinic today for diabetes, hypertension, arthritis, and a history of cardiac disease. The provider performs a medically appropriate history and exam. Blood pressure is high. All other conditions are stable. Labs ordered are HbA1c and complete blood count (CBC). Changing the dosage for blood pressure medication. Will follow up in 3 months. What CPT® code is reported? a. 99213 b. 99204 c. 99214 d. 99203 - Correct Answer-b. 99204 Response Feedback: Rationale: In the CPT® Index look for Office and/or Other Outpatient Services/Office Visit/New Patient and you are directed to codes 99202-99205. 2021 E/M Guidelines for Office and Other Outpatient services are reported based on Medical decision making and requires two of three elements to be met or exceeded for a new patient. 2+ stable chronic illness and 1 chronic illness with exacerbation (Moderate), two unique lab tests are ordered (HbA1c and CBC) (Low/Limited), level of risk - prescription management (Moderate). Correct code is 99204. A provider visits Mr. Smith's home monthly. Today, the provider performs a problem focused history, an expanded problem focused examination and a medical decision making of low complexity. What CPT® code is reported? a. Home visits are no longer reportable. b. 99347 c. 99348 d. 99349 - Correct Answer-c. 99348 Response Feedback: Rationale: In the CPT® Index look for Home Services/Established Patient and you are directed to code range 99347-99350. Two of three key components must be met to support a level of visit for established patient home services. 99348 is the correct code choice. A 65-year-old was admitted in the hospital two days ago and is being examined today by his primary care physician, who has been seeing him since he has been admitted. Primary care physician is checking for any improvements or if the condition is worsening. CHIEF COMPLAINT:CHF INTERVAL HISTORY: CHF symptoms worsened since yesterday. Now has some resting dyspnea. HTN remains poorly controlled with systolic pressure running in the 160s. Also, I'm concerned about his CKD, which has worsened, most likely due to cardio-renal syndrome. REVIEW OF SYSTEMS: Positive for orthopnea and one episode of PND. Negative for flank pain, obstructive symptoms or documented exposure to nephrotoxins. PHYSICAL EXAMINATION: GENERAL: Mild respiratory distress at rest VITAL SIGNS: BP 168/84, HR 58, temperature 98.1. LUNGS: Worsening bibasilar crackles CARDIOVASCULAR: RRR, no MRGs. EXTREMITIES: Show worsening lower extremity edema. LABS: BUN 5 - Correct Answer-d. Subsequent Hospital Visit (99231-99233) Response Feedback: Rationale: This is a subsequent hospital visit which is reported with code range 99231- 99233. The patient was admitted in the hospital two days ago and the primary care physician has been seeing the patient since he has been admitted to the hospital. Initial Hospital Visit (99221-99223) is when the doctor is initially admitting the patient to the hospital. Inpatient Consultation (99251-99255) is when the provider requests for another provider to see the patient to recommend care for a specific condition or to accept ongoing management for the patient's condition. Established Patient Office/Outpatient Visit (99211-99215) is when the patient is being seen in the office setting, not the hospital. A 15 year old underwent placement of a cochlear implant 1 year ago. It now needs to be reprogrammed. What CPT® code is reported for the reprogramming? a. 92603 b. 92601 c. 92604 d. 92602 - Correct Answer-c. 92604 Response Feedback: 3. Fluoroscopy. TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the desired levels were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual palpation located the sacral hiatus. The 6-inch, 20-gauge needle with a slight volar bend was inserted using fluoroscopy into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were injected in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient tolerated the procedure well with no complications and was transferred to recovery in good condition. What CPT® codes are reported? a. 64493-50, 64494 x 2 b. 64493-50, 64494 x 2, 77002-26 c. 64493-50, 64494-50-51, 77002-26 d. 64493-50 x 2 - Correct Answer-a. 64493-50, 64494 x 2 Response Feedback: Rationale: In the CPT® Index, look for Injection/Paravertebral Facet Joint/Nerve/with Image Guidance directing you to 64490-64495. Code selection is based on the location and the number of levels. The initial and one additional separate level lumbar facet joint injections performed bilaterally, at two levels, so use modifier 50 on facet injection codes 64493. Modifier 51 is not reported on add-on code +64494 because add-on codes are exempt from modifier 51. Add-on codes are exempt from modifier 50. Report +64494 twice to indicate this was performed bilaterally. Depending on the payer, modifiers RT and LT may be appended. Fluoroscopy was utilized for all services and is bundled in codes 64490-64495 and not reported separately. Preoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangioma Postoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangioma Procedures Performed: Aspiration of left orbital cyst with injection of Kenalog Anesthesia: General Complications: None Estimated Blood Loss: Minimal Indications for Procedure: The patient presents with a small cyst of the superior medial left orbit felt to be suggestive for hemangioma versus lymphangioma. Risks, benefits, and alternatives of steroid injection to inactivate the cyst were reviewed. These risks included failure to work and significant visual loss. After discussion, they elected to proceed. Description of Procedure: After informed operative consent was obtained, the patient was brought to the operating room and laid in the supine position. General anesthetic was administered per the anesthesiologist. A 25-gauge needle on a 5-cc syringe was placed within the - Correct Answer-a. 67415-LT, H05.812 Response Feedback: Rationale: The provider aspirated a cyst that was in the left orbit. In the CPT® Index look for Aspiration/Orbital Contents referring you to code 67415. Code 67500 is reported when there is an injection of a therapeutic or local anesthetic behind the eyeball (retrobulbar). Diagnoses documented as versus are not definitive diagnosis codes and are not coded. The postoperative header indicates an orbital cyst. In the ICD-10-CM Alphabetical Index look for Cyst/orbit referring you to code H05.81-. Verify code in the Tabular List. A 6 th character is required to indicate which eye; 2 is reported for the left eye. This 56-year-old female presented with a degenerative posteromedial meniscal flap tear of the right knee. After appropriate preoperative evaluation, the patient was taken to the operating room where general anesthesia was instituted. The patient was placed supine on the operating table. The right lower extremity was sterilely prepped and draped for arthroscopic surgery. The leg was exsanguinated and the tourniquet inflated. The arthroscope was introduced first through the anterolateral portal with medial suprapatellar portal utilized. The lateral compartment looked fairly good. There were some minimal medial degenerative changes. In the medial compartment there was a full-thickness area of osteochondral degeneration with a flap of cartilage noted. It was possible to remove this with a bleeding bony bed with beveled edges of cartilage. The ligament itself was intact. The retropatellar area was normal with Grade I chon - Correct Answer-d. 29881 Response Feedback: Rationale: This was a surgical arthroscopy of the knee. In the CPT® Index look for Arthroscopy/Surgical/Knee, directing you to 29866-29868, 29871-29889. The medial meniscectomy and debridement are reported with 29881. In this case the synovectomy, code 29875, is a separate procedure and bundled with 29881; it is not reported separately. Operative Report Indications: This is a third follow-up EGD dilation on this 40-year-old patient for a pyloric channel ulcer which has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation. Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray. Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The pyloric channel was again widened. The ulcer, as previously seen, was well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into the second portion of the duodenum, revealing normal mucosa. Marked deformity and scarring was seen in the proximal bulb. Following t - Correct Answer-a. 43245, 43239-51, K31.1, Z87.11 Response Feedback: Rationale: The procedures performed are correctly represented by codes 43245 (balloon dilation) and 43239 (biopsies). In the CPT® Index, look for Esophagogastroduodenoscopy/Flexible Transoral/Dilation of Gastric/Duodenal Stricture referring you to 43245. Next look for Esophagogastroduodenoscopy/Flexible Transoral/Biopsy referring you to 43239. Modifier 51 is reported to indicate multiple procedures performed on the same day, same session. In the operative note, the diagnosis codes are reported from the Impressions. ICD-10- CM codes are K31.1 for the pyloric stricture. In the ICD-10-CM Alphabetic Index look for Stricture/pylorus. The stricture was acquired due to peptic ulcer disease, which is healed. Report with history code Z87.11. In the Alphabetic Index, look for History/personal (of)/disease or disorder (of)/digestive system/peptic ulcer disease referring you to Z87.11. Verify codes in the Tabular List. This 36-year-old female presents with an avulsed anterior cruciate ligament off the femoral condyle with a complete white on white horizontal cleavage tear of the posterior horn of the medial meniscus, causing instability. A general endotracheal anesthesia was performed, and the patient was placed supine on the operating table. The right lower extremity was prepped with Betadine and draped free. Standard arthroscopic portals were created, and the knee was systematically examined and probed. The posterior horn of the medial meniscus was noted to be buckled and frayed. This area was carefully probed and found to be irreparable. It was decided that our best option was to proceed with a limited partial meniscectomy, with the goal being to leave as much viable meniscal tissue as possible. Therefore, a medial infrapatellar portal was developed with a longitudinal stab wound. A series of straight-angled and curved basket pu - Correct Answer-b. 29888-RT, 29881-51-RT Response Feedback: Rationale: The anterior cruciate ligament repair can be found in the CPT® Index by looking for Cruciate Ligament/Repair/Arthroscopic Repair 29888, 29889. This was the anterior cruciate ligament; 29888 is the correct code. A medial meniscectomy was also performed which is reported with 29881. In the CPT® Index look for Arthroscopy/Surgical/Knee referring you to 29866-29868, 29871-29889. This is a medial meniscectomy 29881. Modifier -51 is required to report multiple procedures performed during the same session. The patellar tendon bone graft is included in 29888. The notchplasty (29999) is also bundled as only one procedure can be reported per compartment (patellofemoral). Modifier RT is appended to indicate the right side. Operative Report PREOPERATIVE DIAGNOSIS: Prolapsed vitreous in anterior chamber with corneal edema POSTOPERATIVE DIAGNOSIS: Same OPERATION PERFORMED: Anterior vitrectomy The patient is a 72-year-old woman who approximately 10 months ago underwent cataract surgery with a YAG laser capsulotomy, developed corneal edema and required a corneal transplant. The patient has done well. Over the last few weeks, she developed posterior vitreous detachment with vitreous prolapse to the opening in the posterior capsule with vitreous into the anterior chamber with corneal touch and adhesion to the graft host junction and early corneal edema. The patient is admitted for anterior vitrectomy.