Medical Billing and Coding Certification Exam Questions with Answers, Exams of Nursing

Download Medical Billing and Coding Certification Exam Questions with Answers and more Exams Nursing in PDF only on Docsity! MEDICAL BILLING AND CODING CERTIFICATION EXAM QUESTIONS WITH ANSWERS A 22-year-old female has a retained Kirschner wire in the left little finger. Using local anesthesia, the left upper extremity was thoroughly cleansed with Betadine. The end portion of the little finger was opened by a transverse incision through the subcutaneous tissue to the bone. The retained Kirschner wire was located within the distal phalanx. It was removed and closed with sutures. What CPT® code is reported? 20670- F4 20680- F4 In the CPT® Index, look for Removal/Fixation Device. You are referred to 20670-20680. Review the codes to choose the appropriate service. 20680 is the correct code because a deep incision was made to the bone to locate the wire for removal. Modifier F4 is reported to indicate the finger the procedure is performed on. A patient is seen in the same-day surgery unit for an arthroscopy to remove some loose bodies in the shoulder area. What CPT® code should be reported? 2981 9 A Type I, high velocity open right femur shaft fracture was incurred when a 15-year-old female pedestrian was hit by a car while crossing the street. She was taken to the operating room within four hours of her injury for thorough irrigation and debridement, including excision of devitalized bone. The patient was prepped, draped, and positioned. Intramedullary rodding was carried out with proximal and distal locking screws. What CPT® and ICD-10-CM codes should be reported? A. 27507-RT, 11044-51-RT, S72.301C, V03.90XA, VV03.19V B. 27506-RT, 11012-51-RT, S72.301B, V03.90XA In the ICD-10-CM Index to Diseases and Injuries, look for Fracture, traumatic/femur, femoral/shaft directing you S72.30-. In the Tabular List, seven characters are required to complete the code. The sixth character indicates laterality and the seventh character indicates the episode of care and the type of fracture. The complete code is S72.301B. In the External Cause of Injuries Index look for Accident/transport/pedestrian/car directs you to subcategory V03.99-. In the Tabular List A. 58673-50, 58672-51-RT B. 58750-50, 58760-51-RT There are two different procedures performed in this scenario. The first one is the reversal of the tubal ligation. This is where the closed portions of the fallopian tube are excised (removed) and are connected by suturing the clean edges together (anastomosis). In the CPT® Index, look for Anastomosis/Fallopian tube or Tubotubal guiding you to code 58750. The question indicates tubes, meaning both tubes were performed on appending modifier 50 with this code. The second procedure performed is reconstruction of the fimbriae (finger- like projections at the end of the fallopian tubes), which is a fimbrioplasty due to adhesions found at the end of the right tube. In the CPT® Index, look for Fimbrioplasty/Uterus guiding you to code 58760. Two modifiers are appended with this code. Modifier 51 to indicate more than one procedure was performed and modifier RT indicates only the right tube was performed on. Both of these procedures were performed with an incision, not laparoscopically. Cryosurgical ablation of the prostate is performed for prostate cancer. What CPT® and ICD-10- CM codes are reported for this service? 55873, C61 A partial cystectomy is performed due to the prior administration of radiation. It is complicated due to extensive adhesions and requires an additional 2 hours beyond the usual cystectomy procedure. What CPT® code is reported for this service? 51555- 22 5155 5 In the CPT® Index look for Cystectomy/Partial/Complicated. The description of code 51555 is Cystectomy; complicated (e.g., post-radiation, previous surgery, difficult location). Modifier 22 is not appended to the code as it already includes the additional work involved in the procedure. Transurethral resection of a medium-size (3.0cm) bladder tumor was performed in an outpatient setting. What CPT® code is reported for this service? 52235 What CPT® and ICD-10-CM codes are reported for diagnosis of a recurrent unilateral reducible femoral hernia repair? 49555, K41.91 Bile empties into the duodenum through what structure? Common bile duct A patient is seen in the ED for nausea and vomiting that has persisted for 4 days. The ED physician treats the patient for dehydration, which is documented in the patient’s record as the final diagnosis. What ICD-10-CM code(s) is/are reported for this encounter? R11.2, E86.0 E86.0 In the ICD-10-CM Index to Diseases and Injuries, look for Dehydration directing you to E86.0. Because there is a definitive diagnosis, the definitive diagnosis is reported instead of the symptoms. What is the CPT® code for the removal of a foreign body from the esophagus via the thoracic area? 4304 5 What is the eponym for a pancreatoduodenectomy? A. Meckel’s procedur The surgeon performed an insertion of an intraocular lens prosthesis. The treatment plan was established and discussed with the patient six weeks earlier when the cataract was removed (by the same surgeon). What CPT® code is reported? 66983- 58 In the CPT® Index look for Insertion/Intraocular Lens/Manual or Mechanical Technique/Not Associated with Concurrent Cataract Removal and directs you to code 66985. The procedure was planned because it was decided to perform this procedure with the patient before the cataract removal was performed six weeks earlier. This “planned” procedure indicates the need for modifier 58 Staged or related procedure or service by the same physician during the postoperative period. The patient has returned to the operating room to aspirate a seroma that has developed from a gynecologic surgical procedure that was performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported? A. 10140-78, S20.20XS B. 10160-78, N99.820 The provider performed a puncture aspiration of a seroma (clear body fluid built up where tissue has been removed by surgery). In the CPT® Index, look for Cyst/Skin/Puncture Aspiration. Code 10160 is the correct code for the puncture aspiration. Even though it does not specifically state “seroma” it is the code to report. This is not a staged return to the operative suite for the puncture aspiration of the seroma. Modifier 78 is used because the patient is returning to the operative suite with a complication in the global period. The diagnosis is reported as a post-operative complication and the code selection in ICD-10-CM is based on the initial procedure performed. This is stated to be a genitourinary system procedure. In the Alphabetic Index look for Seroma – see Hematoma. Look for Hematoma/postoperative (post-procedural) – see Complication, post-procedural, hemorrhage. Look for Complication/post-procedural/genitourinary organ or structure/following procedure on genitourinary organ or structure referring you to N99.820. Verification in the Tabular List confirms code selection. A patient is diagnosed with actinic keratosis of the chest and arms. She presents to her physician’s office for the destruction of these lesions. Using cryosurgery the physician destroys 4 lesions on the right arm, 4 lesions on the left forearm, and 4 lesions on the chest. What CPT® and ICD-10-CM codes are reported? 17000, 17003 x 11, L57.0 A malignant lesion of the forehead measuring 1.0 cm was removed. The operative report states skin margins are 1.1 cm on all sides. Layered closure was performed. How is this coded? A. 11602, 12051-51 B. 11644, 12052-51 CPT® guidelines under Excision—Malignant Lesions state closure other than simple can be coded separately. Look in the CPT® Index for Skin/Excision/Lesion/Malignant. Excision codes are based on location and size. The documented size is 1.0 cm with 1.1 cm on all sides, making the total size with two margins 3.2 cm excision on the forehead (11644). Because the closure is intermediate, it is also reported. Look in the CPT® Index for Repair/Skin/Wound/Intermediate. The intermediate closure is also based on location and size; and reported with code 12052, with modifier 51 Multiple procedures. What is used for a placeholder when a code does not have six characters to keep the seventh character extender in the seventh position? The letter x Which statement is true regarding the Neoplasm Table in ICD-10-CM? There are six columns in the Neoplasm Table; Primary malignancy, secondary malignancy, CA in situ, benign, and uncertain behavior. INDICATIONS FOR CORONARY INTERVENTION: Acute inferior myocardial infarction. Documented mildly occlusive plaque with many clots in the right coronary artery. PROCEDURE: Insertion of a temporary pacemaker in the right femoral vein. Primary stenting of the right coronary artery with a 4.5 x 16 mm Express stent. Angio-Seal to the vessels of the right common femoral artery post-procedure, and also Angio-Seal of the right common femoral vein. out the proximal left anterior descending thrombus. At this point, the patient was emergently intubated, and multiple pressors were started, including dopamine, Levophed, vasopressin, and epinephrine. Following this, a laser was attempted to cross the lesion an excimer laser X80 Spectranetics 0.9 Vitesse; however, this laser was unable to cross the lesion. Therefore, a long balloon, a 2.0 x 40 millimeter Cross Sail balloon, was used to cross the lesion and inflate multiple segments of the mid-left anterior descending up to a maximum inflation pressure of ten atmospheres. This improved flow, though by no means restored it to normal. Therefore, following this, longer balloon inflations were performed utilizing a 2.0 x 20 millimeter Cross Sail balloon up to fourteen atmospheres for one and a half minutes. This did not improve significantly the flow distally, and therefore the decision was made to try to stent the mid- segment with a 2.5 x 9-millimeter zipper MX stent to a maximum inflation pressure of fourteen atmospheres. This resolved the issue in terms of the mid left anterior descending lesion; however, beyond the stent there continued to be residual stenosis, and multiple balloons were used to balloon this up to a 2.5 x 20-millimeter balloon up to fourteen atmospheres. The final result in the left anterior descending revealed a lesion in the mid-left anterior descending that was approximately 40 percent, there was TIMI III flow throughout the proximal and mid-left anterior descending. However, at the level of the apex, there was TIMI 0 flow. Throughout the angioplasty, the patient had episodes of bradycardia, and a temporary pacemaker was placed, this was removed at the end of the procedure. IMPRESSION: Successful stent to the mid left anterior descending, complicated by a thrombotic event in the left anterior descending system. The final result was a successful stent to the mid-left anterior descending with residual TIMI 0 flow in the distal left anterior descending. We returned to the right coronary artery and successfully employed a 4.5 x 16 mm Express sent. At the end of the case, an intra-aortic balloon pump was placed in the left femoral artery sheath, and the patient was sent to the Coronary Care Unit on multiple pressors including epinephrine, vasopressin, Levophed, and dopamine. 92928-RC, 92928-LD, 33967, 92973 What is included in all vascular injection procedures? Necessary local anesthesia, introduction of needles or catheters, injection of contrast media with or without automatic power injection, and/or necessary pre-and post-injection care specifically related to the injection procedure. Response Feedback: CPT® guidelines under Vascular Injection Procedures indicate the above-listed in d as being included. A patient is seen in the endoscopy suite for a diagnostic maxillary sinusotomy. During the sinusotomy, the physician observes some diseased tissue that needs to be removed. The physician decides to perform a maxillary antrostomy with tissue removal. Bleeding is controlled. The patient tolerated the procedure well. What CPT® code(s) should be reported? 31231, 31267 3126 7 According to the CPT® guidelines for coding endoscopies, a surgical sinus endoscopy includes a sinusotomy and diagnostic endoscopy. In the CPT® Index, look up Sinus/Sinuses/ Maxillary/Antrostomy and you are directed to code range 31256-31267. We see code 31267 represents a surgical maxillary antrostomy with maxillary tissue removal. An operative report lists excisional bilateral biopsies of deep cervical nodes and biopsy of right deep axillary nodes as the procedures performed. The pathology report comes back confirming lymphadenitis. What CPT® codes are reported? 38510-50, 38525-51-RT A physician supervises a patient during a cardiac stress test performed at the hospital and writes the interpretation and report. Which code(s) should be reported for the physician not employed by the hospital? 93016, 93018