Procedural Coding Study Review with Complete Solutions: CPT Manual Exercises | Exams Nursing

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Chapter 19 Procedural Coding Study Review with Complete

Solutions

Listed below are the six main sections of the

CPT manual. Match the range of codes with the

appropriate section. - -00100-01999,

99100-99140 Anesthesiology

10021-69990 Surgery

70010-79999 Radiology

80047-89398 Pathology and Laboratory

90281-99199, 99500-99607 Medicine

99201-99499 Evaluation and Management

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.

- Verify the code in the numeric section of the

book and look for any needed add-on codes or

modifiers.

- Review each description and indented term

under the main term.

- Locate the procedure in the alphabetic index at

the back of the book. - -1. Locate

2. Review

3. Verify

Place in order the steps that should be taken

when locating CPT codes.

Determine the appropriate modifiers.

Choose the correct code from the range.

Record the number on the health claim form.

Ensure that the services were documented in the

patient's chart.

Using Volume II, look up the CPT code for the

service performed.

Verify the code number in the numeric index and

note any code range.

Match the procedure with the diagnosis that

verifies medical necessity.

Using the encounter form and/or the patient's

chart, find the service performed. - -1.

Using Encounter

2. Ensure

3. Using Volume II

4. Verify

5. Choose

6. Determine

7. Record

8. Match

The (1) listed the patient as new; however, we

have several claims from your office for this

patient within the past year.

The patient SOAP notes indicate a (2) should

have been used with the (3) code as the patient

was seen for more than one issue.

The (4) for this type of code is 90 days. I would

suggest that you use the (5) and the current (6)

to make the necessary corrections to this claim. -

-1. evaluation and management code

2. Modifier

3. procedure

4. Global Period

5. current procedural terminology

6. International Classifications of Diseases

Identify whether Fraudulent billing or Honest

billing.

1. Coding services that were not performed

2. Not overstating the complexity of the decision-

making process

3. Performing procedures that are not medically

necessary

4. Unbundling of services

5. Coding to the highest specificity

6. Reporting the same service twice

7. Reporting the extent of patient history taken -

-1. Fraudulent billing

2. Honest billing

3. Fraudulent billing

4. Fraudulent billing

5. Honest billing

6. Fraudulent billing

7. Honest billing

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Listed below are the six main sections of the CPT manual. Match the range of codes with the appropriate section. - - 00100 - 01999, 99100 - 99140 Anesthesiology 10021 - 69990 Surgery 70010 - 79999 Radiology 80047 - 89398 Pathology and Laboratory 90281 - 99199, 99500-99607 Medicine 99201 - 99499 Evaluation and Management 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.

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

Review
Verify Place in order the steps that should be taken when locating CPT codes. Determine the appropriate modifiers. Choose the correct code from the range. Record the number on the health claim form. Ensure that the services were documented in the patient's chart. Using Volume II, look up the CPT code for the service performed. Verify the code number in the numeric index and note any code range. Match the procedure with the diagnosis that verifies medical necessity. Using the encounter form and/or the patient's chart, find the service performed. - - 1. Using Encounter
Ensure
1. Using Volume II
2. Verify
3. Choose
4. Determine
5. Record
6. Match The (1) listed the patient as new; however, we have several claims from your office for this patient within the past year. The patient SOAP notes indicate a (2) should have been used with the (3) code as the patient was seen for more than one issue. The (4) for this type of code is 90 days. I would suggest that you use the (5) and the current (6) to make the necessary corrections to this claim. -
  - 1. evaluation and management code
7. Modifier
8. procedure
9. Global Period
10. current procedural terminology
11. International Classifications of Diseases Identify whether Fraudulent billing or Honest billing.
12. Coding services that were not performed
13. Not overstating the complexity of the decision- making process
14. Performing procedures that are not medically necessary
15. Unbundling of services
16. Coding to the highest specificity
17. Reporting the same service twice
18. Reporting the extent of patient history taken -
  - 1. Fraudulent billing
19. Honest billing
20. Fraudulent billing
21. Fraudulent billing
22. Honest billing
23. Fraudulent billing
24. Honest billing

Solutions

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 Procedure Codes: 80061 is the CPT code for a lipid panel, which includes a total serum cholesterol (82465), HDL cholesterol (83718), and triglycerides (84478). CPT guidelines state when ordered tests fit into a panel, the panel must be coded and not the individual tests. The LDL cholesterol (83721) is not included in the panel and so will be coded and billed separately. No modifiers are required. 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 Procedure Codes: Code 84030 is the code for phenylalanine (PKU) in the blood. CPT 84035 is the code for phenylketones, qualitative. No modifiers are required with this scenario. 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 Procedure Codes: CPT 82310 is the code for measurement of blood calcium levels. CPT 77080 is the code for the dual energy X-ray absorptiometry (DXA), bone density study, 1 or more sites, axial skeleton. 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, 99245 (MOD. 25) Procedure Codes: CPT 99245 is the consult for a new patient is a highly complex condition. Some payers may require a modifier 25 attached to the "E/M" code, which means that an exam was performed and necessary in addition to procedure (bone marrow biopsy) or service performed on the same date of service by the same provider. CPT 85025 is used for a CBC with platelet count and automated differential study. CPT 85055 is the code for a reticulated platelet count. CPT 38221 is the CPT code for a bone marrow biopsy using a needle or trocar to obtain the sample. Louisa is a 42-year-old mother-to-be. Because of maternal age, an amniocentesis and a chromosome analysis of the amniotic fluid ( 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 Procedure Codes:

Solutions

level testing. 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 Procedure Codes: Upper GI (esophagogastroduodenoscopy) is coded as 43235. Diagnostic colonoscopy is coded as 45378. 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 99215, 80053, 82306 Procedure Codes: Due to the comprehensive history and examination E/M code 99215 would be appropriate. A comprehensive metabolic study is coded as CPT 80053 and as it is not included in the panel, CPT 82306 is coded to identify the Vitamin D assay. 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 Procedure Codes: The CPT code for transesophageal echocardiogram looking specifically for congenital anomalies is 93315. The CPT code for PET scan of the heart is

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 Procedure Codes: The CPT code for such diagnostic amniocentesis (screening) is 59000. If any counseling is provided based on these results, genetic counseling would then be coded. All of the following are sections of the CPT manual except - - Integumentary Which area gives instructions on how to code within a specific chapter? - - Guidelines Which of the following CPT conventions indicates the code is new to the current edition? - - Red dot

Solutions

Which of the following CPT conventions indicates the code description is revised? - - Blue triangle The __________ codes are considered to be the most important of the CPT codes. - - E/M 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 is/are components of a surgical package? Surgery itself Preoperative work-up Usual postoperative follow-up Only the surgery itself and usual post-op care are included - - All of these 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 What is the correct HCPCS code for a folding walker with wheels? - - E The "key" to showing medical necessity for a procedure or service is: - - accurate code linkage.

Procedural Coding Study Review with Complete Solutions: CPT Manual Exercises, Exams of Nursing

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