ICD-10-CM Coding and CPT® Code Selection for Medical Procedures, Exams of Nursing

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Final Exam 2017 Review  Question 7_ 1 out of 1 points Which of the following is true about the function of the cochlea Selected Answer: (^) d. It transmits sound only. Correct Answer: (^) d. It transmits sound only. Response Feedback: Rationale: As the stapes footplate moves the oval window, and creates waves in the perilymph of the scala vestibuli of the cochlea, the round window membrane moves, which causes movement of the endolymph inside the cochlear duct. This causes the basilar membrane to vibrate, which in turn cause the organ of Corti (inner hair cells) to send electrical impulses along the auditory nerve to the brain.  Question 12_ 1 out of 1 points Which diagnosis code(s) below reports pain in the left and right ears? Selected Answer: (^) a. H92. Correct Answer: (^) a. H92. Response Feedback: Rationale: ICD-10-CM allows for the reporting of laterality (right, left, bilateral). For bilateral sites, the final character of the code indicates laterality. ICD-10-CM guideline I.B.13 indicates if no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. There is a bilateral code provided for pain in the left and right ears H92.03. You would not report two separate codes.  Question 15_ 1 out of 1 points A 10 month-old comes into the pediatrician’s office for a harsh, bark-like cough. She is diagnosed with croup. The mother also wants the pediatrician to look at a rash that has developed on her leg. The pediatrician prescribes over the counter medication of acetaminophen for the croup and hydrocortisone cream for the rash on the leg. She is to follow up in five days or return earlier if the conditions worsen. What ICD-10-CM code(s) should be reported for this visit? Selected Answer: (^) a. J05.0, R Correct Answer: (^) a. J05.0, R Response Feedback: Rationale: Signs and symptoms that are associated with a disease process should not be reported, refer to ICD-10-CM guideline I.B.5. For this case the ICD-10-CM code R05 should not be reported because cough is a symptom of the croup. Codes for signs and symptoms that are not routinely associated with a definitive diagnosis should be reported, according to ICD-10-CM guidelines 1.B.4 and I.B.5. For this case the rash is reported because it is not related or associated to the croup. Look for Croup in the ICD-10-CM Alphabetic Index referring you to code J05.0. Look for Rash in the Alphabetic Index referring you to code R21. Verify both codes in the Tabular List.

 Question 17_ 1 out of 1 points A 32 year-old patient with hyperthyroidism has an ultrasound to determine why her neck is enlarged. The results of the ultrasound reveal a uninodular goiter. What ICD-10-CM code is reported? Selected Answer: (^) a. E05. Correct Answer: a. E05. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Hyperthyroidism/with/goiter/nodular/uninodular which directs you to E05.10. The code can also be found by looking in the Alphabetic Index for Goiter/uninodular/toxic or with hyperthyroidism which guides you to code E05.10. Verify code selection in the Tabular List.  Question 19_ 1 out of 1 points A patient with type 2 diabetes presents with diabetic macular edema and proliferative diabetic retinopathy in the right eye. What ICD-10-CM code(s) is/are reported? Selected Answer: (^) c. E11. Correct Answer: c. E11. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index Diabetes, diabetic (mellitus) (sugar)/type2/with/retinopathy/proliferative/with macular edema which directs you to E11.351-. There is a checkmark next to the code in the Alphabetic Index reminding the coder to check the Tabular List for the 7th^ character to show laterality. From the Tabular List, assign 7th^ character 1 to identify the right eye.  Question 20_ 1 out of 1 points A patient is coming in for follow up of his essential hypertension and cardiomegaly. Both conditions are stable and he is told to continue with his medications. The two conditions are unrelated. What ICD-10-CM code(s) is/are reported? Selected Answer: (^) d. I10, I51. Correct Answer: (^) d. I10, I51. Response Feedback: Rationale: According to ICD-10-CM guidelines, I.C.9.a.1, if the documentation does not have a causal relationship between the hypertension and heart disease (eg, Cardiomegaly due to the hypertension) the conditions are coded separately. Look in the ICD-10-CM Alphabetic Index for Hypertension I10. Then look for Cardiomegaly I51.7. Verify code selection in the Tabular List.  Question 21_ 1 out of 1 points What would be considered an adverse effect? Selected Answer: (^) d. Rash developing when taking penicillin. Correct Answer: (^) d. Rash developing when taking penicillin.

Response Feedback: Rationale: Adverse reaction occurs when a prescription medicine or drug is taken according to physician instruction, or manufacturer’s instruction, and the patient develops a reaction to the medication. Adverse reactions happen in spite of proper administration.  Question 24_ 1 out of 1 points A 14 year-old male patient was injured while skateboarding. The injuries included a displaced transverse fracture of the right femur shaft with multiple significant abrasions of the right thigh. What ICD-10-CM codes are reported? Selected Answer: d. S72.321A, V00.138A, Y93. Correct Answer: (^) d. S72.321A, V00.138A, Y93. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/femur, femoral/shaft/transverse (displaced) S72.32-. In the Tabular List seven characters are needed to complete the code. The complete diagnosis code is S72.321A because the fracture is on the right femur and this is the initial encounter. Fracture coding guideline I.C.19.b.1 states separate codes for more superficial injuries of the same site (such as abrasions) should not be assigned. To find the External Cause code, look in the ICD-10-CM External Cause of Injuries Index for Accident/transport/pedestrian/conveyance/skateboard guiding you to V00.138. In the Tabular List the seventh character A is chosen. Next you report an external cause code for the Activity by looking for Activity/skateboarding guiding you to Y93.51. There is no mention of the place of occurrence, so it is not coded.  Question 25_ 1 out of 1 points The patient is admitted for radiation therapy for metastatic bone cancer, unknown primary. She developed severe vomiting secondary to the radiation. What ICD-10-CM code(s) is/are reported? Selected Answer: (^) d. Z51.0, C79.51, C80.1, R11. Correct Answer: (^) d. Z51.0, C79.51, C80.1, R11. Response Feedback: Rationale: The reason for the encounter is for radiation Z51.0. ICD-10-CM Coding Guideline, Section I.C.2.e.2, states if a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy assign code Z51.0, Encounter for radiation therapy, or Z51.11, encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. ICD-10-CM Coding Guideline, Section I.C.2.b, states the secondary cancer is listed first because the radiation therapy is directed to the secondary site. In the ICD-10-CM Alphabetic Index, look for Encounter (with health service) (for)/radiation therapy (antineoplastic) guiding you to code Z51.0. Next go to the ICD-10-CM Table of Neoplasms, look for Neoplasm, neoplastic/bone (periosteum)/Malignant Secondary column which is C79.51. When the site of the primary cancer is unknown, code C80.1, Neoplasm, neoplastic/Malignant Primary column is reported. The last code is for the vomiting that developed during treatment. Look in the ICD-10-CM Alphabetic Index for Vomiting guiding you to code R11.10.

 Question 29_ 1 out of 1 points What codes are voluntarily reported to payers, provide evidence-based performance-measure data? Selected Answer: (^) d. CPT® Category II codes Correct Answer: (^) d. CPT® Category II codes Response Feedback: Rationale: Per AMA, CPT® Category II codes are a set of supplemental tracking codes used for performance measurement.  Question 31_ 1 out of 1 points Which statement is TRUE regarding the Table of Neoplasms in ICD-10-CM? Selected Answer: b. There are six columns in the Table of Neoplasms; Malignant Primary, Malignant Secondary, Ca in situ, Benign, Uncertain Behavior and Unspecified Behavior. Correct Answer: b. There are six columns in the Table of Neoplasms; Malignant Primary, Malignant Secondary, Ca in situ, Benign, Uncertain Behavior and Unspecified Behavior. Response Feedback: Rationale: The Table of Neoplasms in ICD-10-CM is broken down into six columns: Malignant Primary, Malignant Secondary, Ca in situ, Benign, Uncertain Behavior, and Unspecified Behavior.  Question 32_ 1 out of 1 points The patient is here to see us about some skin tags on her neck and both underarms. She has had these lesions for some time; they are irritated by her clothing, itch, and at times have a burning sensation to them. We discussed treatment options along with risks. Informed consent was obtained and we proceeded. We removed 16 skin tags from the right axilla, 16 skin tags from the left axilla, 10 from the right side of the neck and 17 from the left side of the neck. What CPT® and ICD-10-CM codes are reported? Selected Answer: (^) c. 11200, 11201 x 5, L91. Correct Answer: (^) c. 11200, 11201 x 5, L91. Response Feedback: Rationale: In the CPT® Index look for Skin/Tags/Removal and you are directed to codes 11200,

11201. Code selection is based on the number of skin tags removed. A total of 59 skin tags were removed. Code 11200 is reported for the first 15. 11201 is reported for each remaining 10 (or part thereof) removed. The words “part there of” in the code description mean you do not need to have a complete total of 10 lesions to report the add-on code. The add-on code can be reported if the additional lesions are 10 and under; so it is not necessary to append modifier 51 to this add-on code. 11200, 11201 x 5 is correct. Modifier 51 is not required for an add-on code. In the ICD-10-CM Alphabetic Index look for Tag/skin and you are directed to L91.8. Verify in the

Tabular List.  Question 36_ 1 out of 1 points Hallux rigidus is a condition affecting what part of the body? Selected Answer: (^) c. Foot Correct Answer: (^) c. Foot Response Feedback: Rationale: Hallux rigidus is an arthritic condition of the first metatarsophalangeal joint and one of the treatments for it is a cheilectomy.  Question 45_ 1 out of 1 points A patient with a diagnosis of chronic sphenoidal sinusitis undergoes a bilateral sinusotomy. While the provider examines the diseased sphenoid sinus, she takes a biopsy of the sphenoidal masses and removes the mucosa with several polyps. Transseptal sutures are placed and the intraoral incision is closed in a single layer. The nose is packed and external nasal dressings are placed. What CPT® and ICD-10-CM codes are reported? Selected Answer: (^) d. 31051-50, J32.3, J33. Correct Answer: (^) d. 31051-50, J32.3, J33. Response Feedback: Rationale: In the CPT® Index, look up Sinusotomy/Sphenoid Sinus directing you to codes 31050-

31051. 31051 is appropriate for the reporting of biopsies taken in the sphenoids as well as removal of mucosa and polyps. The procedure was an open procedure, it was not performed endoscopically. Modifier 50 is appended to indicate the procedure was performed bilaterally. Indexing for ICD-10-CM codes is Sinusitis (chronic)/sphenoidal directing you to code J32.3 and Polyp/sinus (sphenoidal) is J33.8.  Question 46_ 1 out of 1 points Which main coronary artery bifurcates into two smaller ones? Selected Answer: (^) d. Left Correct Answer: (^) d. Left Response Feedback: Rationale: The initial segment of the left coronary artery is the left main coronary artery. This blood vessel is about the diameter of a soda straw and is less than an inch long. It branches into two slightly smaller arteries: the left anterior descending (LAD) coronary artery and the left circumflex coronary (LCX) artery.  Question 47_ 1 out of 1 points A patient presents to the outpatient surgery department for revision to his autogenous radiocephalic fistula so he can continue his hemodialysis. What is the correct CPT® code?

Selected Answer: d. 36832 Correct Answer: (^) d. 36832 Response Feedback: Rationale: The patient is undergoing revision of the arteriovenous (radiocephalic) fistula. Look in the CPT® Index for Arteriovenous Fistula/Revision/without Thrombectomy referring you to code 36832.  Question 48_ 1 out of 1 points Physician replaces a single chamber permanent pacemaker with a dual chamber permanent pacemaker. Selected Answer: c. 33214 Correct Answer: c. 33214 Response Feedback: Rationale: Code 33214 is used for the conversion of a single chamber system to a dual chamber system, which includes removal of the previously placed pulse generator, testing of existing lead, insertion of new lead, and insertion of new pulse generator. Look in the CPT® index for Pacemaker, Heart/Upgrade.  Question 50_ 1 out of 1 points 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. Selected Answer: c. 93620, 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. This is found in the CPT® index under Electrophysiology Procedure 93600-93660.  Question 56_ 1 out of 1 points What is the correct CPT® code for a percutaneous pyelostolithotomy with dilation and basket extraction measuring 1 cm? Selected Answer: c. 50080 Correct Answer: c. 50080 Response Feedback: Rationale: Pyelostolithotomy/Percutaneous in the CPT® index refers you to code range 50080-

50081. Code selection is based on the size of the kidney stone (calculus).Code 50080 is a Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm.

 Question 65_ 1 out of 1 points What is the code for ultrasound evaluation of a fetus and mother, usually done early in pregnancy (first trimester), to confirm fetal age, set an anticipated delivery date, for qualitative assessment of amniotic fluid volume/gestational sac shape and examination of the maternal uterus and adnexa? Selected Answer: d. 76801 Correct Answer: (^) d. 76801 Response Feedback: Rationale: The service being performed in this question is an ultrasound to evaluate the fetus and mother in the first trimester. This service is located in the CPT® Index under Ultrasound/Pregnant Uterus referring you to codes 76801-76815. This scenario does not qualify for a non-stress test; there is no monitoring of the fetal heart.  Question 69_ 1 out of 1 points A 41-year-old female has carpal tunnel syndrome in her left hand. The patient underwent release of the carpal ligament with internal neurolysis. An incision was made directly over the carpal ligament through the skin to the carpal ligament. Under direct vision the carpal ligament was divided and then internal neurolysis of the median nerve was performed using magnifying loupes. What CPT® code is reported? Selected Answer: c. 64721 Correct Answer: c. 64721 Response Feedback: Rationale: In the Index, look for Carpal Tunnel Syndrome/Decompression. 64721 is the correct code because it is the median nerve being stretched (neurolysis) to relieve the pain in the wrist for a person with carpal tunnel syndrome.  Question 70_ 1 out of 1 points A patient recently experienced muscle atrophy and noticed she did not have pain when she cut herself on a piece of glass. The provider decides to obtain a needle biopsy of the spinal cord under ultrasound guidance in the outpatient setting. The biopsy results come back as syringomyelia. What CPT® and ICD-10-CM codes are reported for the biopsy procedure? Selected Answer: (^) d. 62269, 76942-26, G95. Correct Answer: (^) d. 62269, 76942-26, G95. Response Feedback: Rationale: In the CPT® Index look for Biopsy/Spinal Cord/Percutaneous and you are directed to code 62269. Instructional note under code 62269 indicates for radiological supervision and interpretation, see 76942, 77002, and 77012. Ultrasound guidance for needle placement, 76942, can be separately billed. Modifier 26 is appended for the professional services. In the ICD-10-CM Alphabetic Index look for Syringomyelia which directs you to code G95.0. Verification in the Tabular List confirms code selection.  Question 77_ 1 out of 1 points The patient had surgery to remove and replace an existing Hickman catheter. The anesthesiologist reported a postoperative diagnosis of a catheter related bloodstream infection (CRBSI). What ICD-10-CM code(s) is/are

reported? Selected Answer: (^) c. T80.211A Correct Answer: (^) c. T80.211A Response Feedback: Rationale: A catheter related bloodstream infection (CRBSI) is a complication. In ICD-10-CM Alphabetic Index look for Infection/due to or resulting from/Hickman catheter/bloodstream which directs you to code T80.211-. In the Tabular List a 7th^ character is required to complete the code. Character A is selected for initial encounter.  Question 82_ 1 out of 1 points 25-year-old female in her last trimester of her pregnancy comes into her obstetrician’s office for a fetal biophysical profile (BPP). An ultrasound is used to first monitor the fetus’ movements showing three movements of the legs and arms (normal). There are two breathing movements lasting 30 seconds (normal). Non-stress test (NST) of 30 minutes showed the heartbeat at 120 beats per minute and increased with movement (normal or reactive). Arms and legs were flexed with fetus’ head on it chest, opening and closing of a hand. Two pockets of amniotic fluid at 3cm were seen in the uterine cavity (normal). Biophysical profile scored 9 out of 10 points (normal or reassuring). What CPT® code is reported by the obstetrician? Selected Answer: (^) a. 76818 Correct Answer: (^) a. 76818 Response Feedback: Rationale: A biophysical test (BPP) measures the health of the fetus during pregnancy. Points are given (0, 1 or 2) in five areas (fetal movement, tone, heart rate, breathing, amniotic fluid volume). A non-stress test (NST) monitors the baby's heart rate over a period of 20 minutes or more looking for accelerations with baby's movement. Because fetal non-stress test is included in code 76818, code 59025 Fetal non-stress test, should not be reported separately. This is found in the CPT® Index under Fetal Biophysical Profile directing you to 76818-76819.  Question 85_ 1 out of 1 points A young child is taken to the OR to reduce a meconium plug bowel obstruction. A therapeutic enema is performed with fluoroscopy. The patient is in position and barium is instilled into the colon through the anus for the reduction. What CPT® code is reported by the independent radiologist for the radiological service? Selected Answer: (^) b. 74283- Correct Answer: b. 74283- Response Feedback: Rationale: A therapeutic enema was performed with contrast (barium) to reduce the meconium plug (intraluminal obstruction). In the CPT® Index look for Enema/Therapeutic/for Intussusception directing you to 74283. The code description includes therapeutic enema with contrast for intraluminal obstruction. Modifier 26 denotes the professional service.

 Question 86_ 1 out of 1 points What is the code for gross and microscopic examination (surgical pathology) of breast tissue from a simple mastectomy? Selected Answer: (^) c. 88307 Correct Answer: (^) c. 88307 Response Feedback: Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam. Review these codes to determine the correct code. There are a number of codes for examination of breast tissue. The coder must be careful to choose the code describing the exact specimen received. Simple mastectomy is listed under 88307.  Question 87_ 1 out of 1 points A patient has a traumatic head injury and some cerebrospinal fluid (CSF) is removed to limit potential damage from swelling of the brain. The CSF is sent to pathology for examination and the results show unusual cytological counts, although no specific findings. The patient has had no previous symptoms known to his family members. What is the ICD-10-CM code for this examination of CSF? Selected Answer: (^) d. R83. Correct Answer: (^) d. R83. Response Feedback: Rationale: Code R83.6 is used to describe non-specific abnormal findings on examination of CSF. If the patient had previously identified disease or symptoms or if the study findings are definitive for a specific disease process, that would have been coded instead. In the ICD-10-CM Index to Diseases and Injuries, look for Abnormal/cerebrospinal fluid/cytology, R83.6. Verification in the Tabular List confirms code.  Question 88_ 1 out of 1 points A physician orders a General Health Panel, all tests except a creatinine, including CBC with automated differential. What CPT® code(s) is/are reported? Selected Answer: a. 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520 Correct Answer: a. 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520 Response Feedback: Rationale: The panel codes may not be reported unless the exact tests specified in the panel code have been performed. If any test is left out, code each test individually. In the CPT® Index, look for Blood Tests/Panels/General Health, read all instructions and notes.  Question 91_ 1 out of 1 points

If the pain is sharp, stabbing or dull, what is the component of the History of Present Illness (HPI)? Selected Answer: (^) b. Quality Correct Answer: (^) b. Quality Response Feedback: Rationale: Quality describes a problem’s characteristics. Sharp, stabbing or dull refer to the characteristics of pain.  Question 92_ 1 out of 1 points Dr. Howitzer sees Mrs. Jones in Clinic Eight for sudden loss of consciousness while watching the Olympic Torch go by. He is a new provider to the neurology department. Dr. Drake Rinaldi, a prominent member of the neurology faculty at the university saw Mrs. Jones last month. Dr. Howitzer performs a history including 3 HPI elements and 2 ROS, a detailed exam and has medical decision making of high complexity. The final diagnosis given is transient loss of consciousness. The patient makes a follow-up appointment to see Dr. Rinaldi in one week. What is the appropriate diagnosis and E/M code for this visit? Selected Answer: (^) d. 99214, R Correct Answer: (^) d. 99214, R Response Feedback: Rationale: E/M Guidelines define an established patient as one who has received professional services from the physician – or another physician of the same specialty who belongs to the same group practice – within the past three years. The patient was seen the previous month by another member in the same group practice of the neurology department making this an established patient. The level of history is expanded problem focused defined by a brief HPI and an extended ROS The exam is described as detailed and the MDM is of high complexity. For an established patient, you must meet or exceed two of the three key elements—making this a detailed visit. Two of the three key elements in this visit meet the requirements for 99214. Look in the ICD-10-CM Index to Diseases Injuries for Loss/consciousness, transient directing you to code R55.  Question 100_ 1 out of 1 points A patient with bilateral sensory hearing loss is fitted with a digital, binaural, behind the ear hearing aid. What HCPCS Level II and ICD-10-CM codes are reported? Selected Answer: (^) a. V5261, Z46.1, H90. Correct Answer: (^) a. V5261, Z46.1, H90. Response Feedback: Rationale: In the HCPCS Level II Index look for Hearing aid/Binaural/Digital/BTE referring you to V5261. The purpose of the visit is the fitting of the hearing aid. Look in the ICD-10-CM Alphabetic Index for Fitting (and adjustment) (of)/hearing aid directing you to Z46.1. The condition necessitating the hearing aid is bilateral sensory hearing loss. In the Alphabetic Index, look for Deafness/sensorineural/bilateral which directs you to H90.3. Verification in the Tabular List confirms code selection.

(Additional Submission)  Question 7_ 1 out of 1 points What is endometriosis? Selected Answer: d. When the endometrial tissue grows outside of the uterus Correct Answer: (^) d. When the endometrial tissue grows outside of the uterus Response Feedback: Rationale: It may attach to the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts. As hormones change during the menstrual cycle, this tissue breaks down and may cause painful adhesions, or scar tissue. Pregnancy may have an influence in preventing or ameliorating the disease.  Question 8_ 1 out of 1 points Which of the following does NOT contribute to refraction in the eye? Selected Answer: (^) d. Macula Correct Answer: (^) d. Macula Response Feedback: Rationale: Also called “macula lutea,” it is an oval-shaped yellow spot surrounding the fovea near the center of the retina in the eye, 2mm from the optic nerve. It contains a pit, no blood vessels, and the fovea centralis which contains only retinal cones. Central high-acuity vision occurs when an image is focused directly on the fovea centralis of the macula lutea.  Question 15_ 1 out of 1 points In the ED, a 50 year-old male complains of severe bloating and stomach cramps, some nausea, vomiting and diarrhea for the past four months. In the last three weeks, he has had pain in middle right side of his back which radiates around his rib cage as well as stomach gurgling with massive pain. After examination, the provider determines he has irritable bowel syndrome with diarrhea. What diagnosis code(s)is/are reported? Selected Answer: (^) d. K58. Correct Answer: (^) d. K58. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Syndrome/irritable/bowel. You are directed to K58.0. Refer also to ICD-10-CM Guideline I.B.4. Signs and Symptoms and I.B.15. Syndromes. Verification in the Tabular List confirms code selection.  Question 16_ 1 out of 1 points When it is documented that the patient is both using tobacco and has a dependence on tobacco, how is this reported in ICD-10-CM?

Selected Answer: a. The dependence on tobacco is the only code reported based on the hierarchy in the ICD-10-CM Guidelines. Correct Answer: a. The dependence on tobacco is the only code reported based on the hierarchy in the ICD-10-CM Guidelines. Response Feedback: In ICD-10-CM Guidelines I.C.5.b.2, there are codes for use, abuse, and dependence. Only one code should be assigned to identify the pattern of use. This is based on the following hierarchy: use, abuse, dependence. If the documentation shows both use and dependence, only dependence is reported.  Question 17_ 1 out of 1 points What ICD-10-CM code is used for the first episode of an acute myocardial infarction? Selected Answer: d. I21. Correct Answer: (^) d. I21. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index, look for Infarct, infarction/myocardium, myocardial (acute) (with stated duration of 4 weeks or less) guiding you to I21.3. Verify code selection in the Tabular List.  Question 18_ 1 out of 1 points A patient returns to the provider for an injection to relieve low back pain from a car accident. What ICD-10-CM code(s) is/are reported? Selected Answer: (^) b. M54. Correct Answer: (^) b. M54. Response Feedback: Rationale: Per ICD-10-CM guideline I.C.6.b.1, if the pain is not specified as acute or chronic, do not assign codes from category G89, except for post-thoracotomy pain, postoperative pain, neoplasm related pain or central pain syndrome. Look in the ICD-10-CM Alphabetic Index for Pain/low back which directs the coder to M54.5. Verify code selection in the Tabular List.  Question 19_ 1 out of 1 points A patient with amyloidosis being treated for glomerulonephritis. What ICD-10-CM codes are reported? Selected Answer: (^) a. E85.4, N Correct Answer: (^) a. E85.4, N Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Glomerulonephritis/in (due to)/amyloidosis guiding you to codes E85.4 [N08]. In the Alphabetic Index the brackets identify manifestation codes. In the Tabular List code N08 has a code first instructional note to first code amyloidosis (E85.4). Your primary code is E85.4 for Amyloidosis followed by N08 for the manifested Glomerulonephritis. Verify code selection in the Tabular List.

 Question 21_ 1 out of 1 points What does the 7th^ character A indicate in Chapter 19? Selected Answer: (^) a. Initial encounter Correct Answer: (^) a. Initial encounter Response Feedback: Rationale: According to ICD-10-CM guideline I.C.19.a the 7th^ character A represents the initial encounter for each encounter where active treatment is received for the condition.  Question 23_ 1 out of 1 points A patient is admitted to surgery to treat an open fracture to the shaft of the right humerus and a simple closed fracture of the left tibia following an ATV accident. What ICD-10-CM codes are reported? Selected Answer: (^) c. S42.301B, S82.202A, V86.99XA Correct Answer: (^) c. S42.301B, S82.202A, V86.99XA Response Feedback: Rationale: This is a traumatic fracture since the patient was in an accident. In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/humerus/shaft, which refers you to subcategory code S42.30-. In the Tabular List, the code needs seven characters. The 6th^ character 1 indicates the right humerus. The7th^ character B indicates that this is an initial encounter for an open fracture. The resulting code is S42.301B. The simple fracture is classified as a closed fracture. Look in the Alphabetic Index for Fracture, traumatic/tibia (shaft) which refers you to S82.20-. Verification in the Tabular List shows a 6th^ character 2 for left tibia and 7thcharacter A for initial encounter for closed fracture. For the ATV accident, refer to the ICD-10-CM External Cause of Injuries Index. Look for Accident/transport/all-terrain vehicle occupant (nontraffic) directing you to subcategory V86.99-. The Tabular List shows this code needs seven characters. A placeholder X is used for the 6th^ character, while the 7th^ character is A for the initial encounter. The complete code is V86.99XA.  Question 24_ 1 out of 1 points 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? Selected Answer: (^) d. S52.201A, V18.0XXA, Y92. Correct Answer: d. S52.201A, V18.0XXA, Y92. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/ulna (shaft), guiding you to subcategory S52.20-. The Tabular List indicates seven characters are needed to complete the code. The 6thcharacter 1 is for the right arm, and the 7th^ character A is for an initial encounter for closed fracture. To find the external cause codes you will look in the ICD-10-CM External Cause of Injuries Index. Look for Accident (to)/transport/pedal cyclist/driver/noncollision accident/nontraffic which guides you to subcategory V18.0. The Tabular List indicates an

appropriate 7th^ character is to be added to each code from category V18. You will need placeholder X for the 5th^ and 6th^ characters and the 7th^ character is A for the initial encounter. The second external cause code identifies the place of occurrence. In the External Cause of Injuries Index look for Place of occurrence/park (public) directing you to code Y92.830. Verify code selection in the Tabular List.  Question 28_ 1 out of 1 points What is the correct HCPCS Level II code for parenteral nutrition solution amino acid, 3.5%? Selected Answer: (^) c. B Correct Answer: (^) c. B Response Feedback: Rationale: In the HCPCS Level II Index, look for Parenteral nutrition/solution. You are directed to codes B4164-B5200. When you review the B codes, B4168 is reported.  Question 29_ 1 out of 1 points The Global Surgical Package applies to services performed in what setting? Selected Answer: (^) d. All of the above Correct Answer: (^) d. All of the above Response Feedback: Rationale: The services included in the global surgical package may be furnished in any setting, including hospitals, ASCs, and physicians' offices. Visits to a patient in an intensive or critical care unit are also included if made by the surgeon.  Question 31_ 1 out of 1 points What is another term for hives? Selected Answer: (^) b. Urticaria Correct Answer: (^) b. Urticaria Response Feedback: Rationale: Urticaria can also be described as hives and shows on the skin as raised, red, itchy wheals.  Question 33_ 1 out of 1 points A 50-year-old female has telangiectasias of the face on both cheeks. She is very bothered by this and presents to have them destroyed via laser. The physician lasers one cutaneous vascular lesion on each cheek; each lesion measuring 2 square cm. What CPT® code(s) is/are reported?

Selected Answer: (^) a. 17106 Correct Answer: (^) a. 17106 Response Feedback: Telangiectasias are small dilated blood vessels, commonly referred to as “spider veins,” or acne rosacea—a benign lesion. In the CPT® Index, look for Destruction/Lesion/Vascular, Cutaneous and you are referred to code range 17106 – 17108. Code selection is based on size. Each lesion is 2cm2, making the total size 4 cm2.  Question 41_ 1 out of 1 points What CPT® code is reported for a frontal sinusotomy, nonobliterative, with osteoplastic flap, brow incision? Selected Answer: (^) d. 31086 Correct Answer: (^) d. 31086 Response Feedback: Rationale: In the CPT® Index, look up Sinusotomy/Frontal Sinus/Nonobliterative ,directing you to code range 31086-31087. Code selection is based on whether it is a brow incision or coronal incision. 31086 is the correct code.  Question 42_ 1 out of 1 points Which option is TRUE regarding reporting codes for cytomegaloviral pneumonitis in ICD-10-CM? Selected Answer: d. One code is used to report both the pneumonia and the cytomegaloviral disease. Correct Answer: d. One code is used to report both the pneumonia and the cytomegaloviral disease. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Pneumonitis which directs you to see also Pneumonia. Look for Pneumonia/cytomegaloviral B25.0. It can also be found under Pneumonia/in (due to)/cytomegalovirus disease B25.0. Verify in the Tabular List.  Question 45_ 1 out of 1 points A patient with a diagnosis of chronic sphenoidal sinusitis undergoes a bilateral sinusotomy. While the provider examines the diseased sphenoid sinus, she takes a biopsy of the sphenoidal masses and removes the mucosa with several polyps. Transseptal sutures are placed and the intraoral incision is closed in a single layer. The nose is packed and external nasal dressings are placed. What CPT® and ICD-10-CM codes are reported? Selected Answer: (^) d. 31051-50, J32.3, J33. Correct Answer: (^) d. 31051-50, J32.3, J33. Response Feedback: Rationale: In the CPT® Index, look up Sinusotomy/Sphenoid Sinus directing you to codes 31050-

31051. 31051 is appropriate for the reporting of biopsies taken in the sphenoids as well as removal of mucosa and polyps. The procedure was an open procedure, it was not performed endoscopically. Modifier 50 is appended to indicate the procedure was performed bilaterally. Indexing for ICD-10-CM codes is Sinusitis (chronic)/sphenoidal directing you to code J32.3 and

Polyp/sinus (sphenoidal) is J33.8.  Question 48_ 1 out of 1 points A PICC with a port is placed under fluoroscopic guidance for a 45 year-old patient for chemotherapy infusion by a physician. The procedure was performed in the hospital. Report the codes for the physician. Selected Answer: (^) c. 36571, 77001- Correct Answer: (^) c. 36571, 77001- Response Feedback: Rationale: Look in the CPT® Index for Central Venous Catheter Placement/Insertion/Peripheral/with Port and you are referred to 36570-36571. The age of patient is 45; therefore, report 36571. Fluoroscopic guidance for central venous access is reported with 77001 and can be found by looking in the CPT® Index for Fluoroscopy/Venous Access Device directing you to 36598, 77001. The correct code for fluoroscopy is 77001. Modifier 26 is necessary to show the professional service only.  Question 51_ 1 out of 1 points What is the eponym for a pancreatoduodenectomy? Selected Answer: (^) d. Whipple procedure Correct Answer: (^) d. Whipple procedure Response Feedback: Rationale: A Whipple procedure is also known as a pancreatoduodenectomy. Look in the CPT® Index for Whipple Procedure; it refers you to code 48150. The code description verifies that this procedures deals with a pancreatectomy and duodenectomy. The other eponyms can be found in the CPT® Index, and do not involve the removal of the pancreas and duodenum.  Question 52_ 1 out of 1 points What is the correct coding for a physician who performs an UGI radiological evaluation of the esophagus, stomach and first portion of the duodenum with barium and double-contrast in the hospital GI lab? (Physician is not employed by the hospital) Selected Answer: (^) a. 74246- Correct Answer: (^) a. 74246- Response Feedback: Rationale: A radiological evaluation is an X-ray. UGI stands for Upper Gastrointestinal (GI). Look in the CPT® Index for Gastrointestinal Tract/X-ray/with Contrast (for the double-contrast) You are directed to code 74246-74249. Code 74249 represents the same procedure if done with small intestine follow through, but here we only performed up to the first portion of duodenum making 74246 the most appropriate code. The UGI is performed in the hospital using hospital equipment. The physician is not indicated to be an employee of the hospital so we must report the professional services (component) only by appending modifier 26.  Question 56_ 1 out of 1 points

What are the reproductive glands that produce male hormones? Selected Answer: (^) d. Testes Correct Answer: (^) d. Testes Response Feedback: Rationale: The testes are male gonadal paired glands located in the scrotum that secrete testosterone and contain the seminiferous tubules where sperm is produced. They are surrounded on the front and sides by a serous membrane called the tunica vaginalis.  Question 61_ 1 out of 1 points Mrs. Jones, G1P0, is diagnosed with polyhydramnios and is scheduled for amniocentesis to aspirate some of the excessive fluid from the amniotic sac. The amniocentesis is performed under ultrasound guidance. What is/are the code(s) for the procedure performed? Selected Answer: (^) b. 59001 Correct Answer: (^) b. 59001 Response Feedback: Rationale: In the CPT® Index look for Amniocentesis/Therapeutic/Amniotic Fluid Reduction directing you to code 59001. Read the parentheses in the code descriptor; this code includes the ultrasound guidance. The ultrasound guidance is not separately reported. 59000 is for diagnostic amniocentesis.  Question 62_ 1 out of 1 points Ultrasound indicates a 20 week fetus has a distended bladder and the decision is made to perform vesicocentesis. The procedure is successful and the bladder is emptied. What CPT® is code reported for this procedure? Selected Answer: (^) d. 59074 Correct Answer: (^) d. 59074 Response Feedback: Rationale: In the CPT® Index, look for Fetal Procedure/ Fluid Drainage guiding you to

 Question 64_ 1 out of 1 points Mrs. Smith is visiting her mother and is 150 miles away from home. She is in the 26th week of pregnancy. In the late afternoon she suddenly feels a gush of fluids followed by strong uterine contractions. She is rushed to the hospital but the baby is born before they arrive. In the ED she and the baby are examined and the retained placenta is delivered. The baby is in the neonatal nursery doing okay. Mrs. Smith has a 2nd degree perineal laceration secondary to precipitous delivery which was repaired by the ED physician. She will return home for her postpartum care. What ICD-10-CM and CPT® codes are reported by the ED physician?

Selected Answer: (^) b. 59414, 59300-51, O73.0, O70.1, Z3A.26, Z37. Correct Answer: (^) b. 59414, 59300-51, O73.0, O70.1, Z3A.26, Z37. Response Feedback: Rationale: The ED physician did not deliver the baby. The ED physician performed the removal of the retained placenta after the delivery. Look in the CPT® Index for Placenta/Delivery referring you to 59414. The ED physician repaired the perineal laceration. Look in the CPT® Index for Repair/Vagina/ Postpartum referring you to code 59300. Verify the codes in the numeric section. Modifier 51 is appended to 59300 for additional procedures during the same session. The first diagnosis code to report is delivery of the retained placenta. In the ICD-10-CM Alphabetic Index, look for Delivery/complicated/by/placenta, placental/retained/without hemorrhage referring you to O73.0. The second diagnosis code to report is for the second- degree perineal laceration. Look in the Alphabetic Index for Laceration/perineum/female/during delivery/second degree O70.1. Next, code the weeks of pregnancy. Look in the Alphabetic Index for Pregnancy/weeks of gestation/26 weeks Z3A.26. The last code to report is the outcome of the delivery. Look in the Alphabetic Index for Outcome of delivery/single NEC/live born, referring you to code Z37.0. Verify all codes in the Tabular List.  Question 68_ 1 out of 1 points How is Streptococcal A Meningitis reported in ICD-10-CM? Selected Answer: c. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second. Correct Answer: c. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Meningitis/streptococcal (acute) which directs the coder to G00.2. In the Tabular List, G00.2 has a note to use an additional code to further identify the organism. The organism is Streptococcus A. In the Alphabetic Index, look for Streptococcus, streptococcal/group/A, as cause of disease classified elsewhere which directs the coder to B95.0.  Question 71_ 1 out of 1 points What ICD-10-CM code(s) is/are reported for bilateral cataracts? Selected Answer: (^) a. H26. Correct Answer: (^) a. H26. Response Rationale: In the ICD-10-CM Alphabetic Index look for Cataract and you are directed to the

Feedback: default code H26.9. Modifiers are not appended to diagnosis codes. There is no documentation to support that the cataracts are congenital. Even though the cataract is in both eyes, it is only necessary to report the ICD-10-CM code once per ICD-10-CM guideline I.B.12.  Question 72_ 1 out of 1 points A patient with a cyst-like mass on his left external auditory canal was visualized under the microscope and a microcup forceps was used to obtain a biopsy of tissue along the posterior superior canal wall. What CPT® code is reported? Selected Answer: b. 69105-LT Correct Answer: b. 69105-LT Response Feedback: Rationale: In the CPT® Index, look for Auditory Canal/External/Biopsy. Verify in the CPT® Auditory System Section. Code 69105 with modifier LT is correct since the biopsy was taken from the left ear in the auditory canal.  Question 85_ 1 out of 1 points What ICD-10-CM code is reported for an adverse effect to diagnostic iodine, initial encounter? Selected Answer: (^) d. T50.8X5A Correct Answer: (^) d. T50.8X5A Response Feedback: Rationale: Look in the ICD-10-CM Table of Drugs and Chemicals for Iodine/diagnostic. Report the code from the Adverse Effect column T50.8X5. In the Tabular List, T50.8X5 requires a seventh character. A is reported for the initial encounter.  Question 91_ 1 out of 1 points If the pain is sharp, stabbing or dull, what is the component of the History of Present Illness (HPI)? Selected Answer: (^) b. Quality Correct Answer: (^) b. Quality Response Feedback: Rationale: Quality describes a problem’s characteristics. Sharp, stabbing or dull refer to the characteristics of pain.  Question 93_ 1 out of 1 points When tissue glue is used to close a wound involving the epidermis layer how is it reported? Selected Answer: (^) d. As though it was a simple closure Correct Answer: (^) d. As though it was a simple closure Response Feedback: Rationale: The Guidelines for Repair (Closure) include tissue adhesive. These codes are designated for wound closure utilizing suture, staples, or tissue adhesive, either singly or in

combination with each other. Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code.  Question 96_ 1 out of 1 points A cardiologist provided an interpretation and report of an EKG. What CPT® code is reported? Selected Answer: (^) c. 93010 Correct Answer: (^) c. 93010 Response Feedback: Rationale: In the CPT® Index, look for EKG and you are directed to see Electrocardiography. For Electrocardiography/Evaluation you are directed to 93000, 93010, 93660. 93660 involves a tilt table evaluation. The remaining codes are 93000, 93010. The physician only provided the interpretation and report making 93010 the correct code choice.