Download Medical Coding and Billing Cases and more Exams Anatomy in PDF only on Docsity!
AAPC Chapter 20: Medicine
A patient is referred to a psychiatrist for management after displaying erratic and unusual behavior at work. The patient discloses a difficult family situation. The psychiatrist meets with the family and the patient for 50 minutes. What is the correct code for the family psychotherapy session? - 90847 A provider has ordered de-ironing by therapeutic phlebotomy to be performed weekly. The patient is diagnosed with hemochromatosis and therapeutic phlebotomy is used to avoid irreversible tissue damage. One unit of blood is removed weekly. What CPT® and ICD-10-CM codes are reported for each weekly visit treatment? - 36430, 99195, E83. A dialysis patient undergoes duplex scan of his hemodialysis access site to determine the pattern and blood flow in his arteries and veins. Select the appropriate CPT® code for reporting this service. - 93990 A patient mangled his left hand in machinery requiring amputation at the wrist. The wound has healed and the patient is fitted with an artificial hand. The device has a molded socket, flexible elbow hinges and triceps pad. A total of 30 minutes was spent training the patient to use the prosthesis. What codes are reported for the prosthesis, training and diagnosis? - 97761 x 2, L6050, Z44.8, Z89. A child displayed emotional outbursts, inability to interact appropriately with peers and his teacher, and was not effective in grasping lessons deemed suitable for his age. The school counselor requested psychological testing to determine if the child had been placed in classes appropriate to his abilities. Testing was administered by a clinical psychologist who spent 10 hours face-to-face with the patient and 3 hours preparing the report of the results. Code the psychologist's service. - 96130, 96131 x A patient has a collapsed arch on her left foot. The physician prescribed a custom orthotic insert for the patient's shoe to support the collapsed arch. The patient visits the physician to receive the orthotic and is instructed how to position it inside the shoe for maximum results. The patient walks around the treatment room and hallway to determine if there is a comfortable fit. The session lasts 15 minutes. What is the code for this service? - 97760
A patient continues to have low back pain after lifting a heavy bin while cleaning the basement. The chiropractor manipulates both the lumbar and sacral areas. What is the correct code? - 98940 A patient ingested a toxic substance and was administered ipecac in the Emergency Department to empty the stomach. What is the correct code for this service? - 99175 An established patient on multiple prescriptions had concerns about possible drug interactions with a new prescription. She requested consultation from the local pharmacist before leaving the pharmacy. The pharmacist met with her for 23 minutes to discuss possible interactions with her current medications and assured her it was not likely the new medication would cause significant side effects. What is/are the code(s) for the pharmacist's service(s)? - 99606, 99607 A child was bitten by a dog tested positive for rabies, and is seen for an injection of rabies immune globulin. Select the appropriate procedure codes for this service. - 90375, 96372 A patient with renal failure needs to begin dialysis treatments. He and his daughter both complete training for managing dialysis at home. - 90989 A patient with chronic gastrointestinal disturbances undergoes complete ultrasonic scanning of the intestinal vascular structure to determine if blood flow is adequate. Select the appropriate CPT® code for reporting this service. - 93975 A 4 year-old has not reached the expected developmental milestones for her age group. She was referred by her pediatrician for extensive developmental testing. The psychologist spends an hour administrating multiple function studies, using standardized instruments and reported the results to the child's pediatrician. Code the psychologist's service. - 96112
An 18 year-old ESRD patient is receiving dialysis services and has had two face-to-face visits with her physician for 25 days. On the 26th day she is admitted to the hospital for inpatient management without a complete assessment. She remains in the hospital until the end of the month. Code for the physician services for the 25 days. - 90969 x 25 A patient who suffers from nasal congestion, rhinitis and facial swelling after being stung by honeybees undergoes allergen immunotherapy. The physician provides a single injection of bee venom. What is the correct code for this service? - 95130 A patient needs a renal transplant. The patient has been on dialysis and is awaiting a suitable donor. A clinical psychologist meets with the patient to assess the patient's ability to comply with the requirements and drug regimen if a donor match is found. The session lasts 2 hours. What is the correct code for this service? - 96150 x 8 A patient sustained a severe ankle sprain playing basketball. The ankle is stiff and without complete range of motion. The physician refers the patient for physical therapy. Prior to treatment, the therapist evaluates the patient. The therapist docu-ments a brief history and exam of the ankle and determines the sprain is uncomplicated with no other injury to the ankle. The therapist recommends an additional 5 sessions for strength and endurance and no basketball for two weeks. The clinical decision making is of low complexity. The patient has a one-hour therapy session on the same day. What is the correct code(s)? - 97161-GP, 97110-GP x 4 A patient with polyneuropathy in the feet undergoes osteopathic manipulation in an effort to improve tingling and numbness sensations. The provider manipulates both feet during the session. What is/are the correct code(s)? - 98925 A diabetic patient who has not been successful managing his diet meets personally with a Registered Dietician for one hour to develop a diet plan. What is the correct code for this service? - 98960 x 2 A physician provides medical testimony in a suspicious death case. What is the correct code for this service? -
A nurse visites a patient in the home to manage infusion of a thrombolytic agent for two hours. What is the correct code for this visit? - 99601 A patient experienced a stressful personal event and meets with her psychiatrist in his office for 45 minutes for the purpose of evaluating her potential to return to work. Which CPT® code accurately reports the service? - 90834 A patient with long-time stress urinary incontinence undergoes biofeedback training for improvement of urine leakage. Which CPT® code accurately reports the service? - 90911 A patient with chronic skin rashes on the hands visits an allergist for evaluation and receives 12 percutaneous scratch tests with various household products. What is the code for the scratch test? - 95004 x 12 A nurse practitioner, who is a trained genetic counselor, met with a couple and their child who has Duchenne muscular dystrophy. The couple is considering another child but wants to know the potential risk of their future children being born with the same disorder. The session lasts 1.5 hours. What is the correct code for this service? - 96040 x 3 A patient presents with a complaint of continuing left shoulder pain after falling from her patio onto a wooden step. No fracture was identified at the time of the fall. After assessing the patient, the chiropractor manipulates the shoulder region. What is/are the correct code(s)? - 98943 A patient in a rural setting with limited travel resources visits his physician for a physical examination. Lab work is done. The physician advises the patient that if the results are negative, he does not need to return to the office. The nurse emails the patient that the results were negative, and the patient does not need to return for six months unless new symptoms appear. One month later, the patient emails the office with a request to change his current medication to a less-expensive generic version. The nurse answers the email, advising one of his medications could be changed to a generic version and refills will be called to the pharmacy as needed. She also responds to several questions the
A patient with long-time stress urinary incontinence undergoes biofeedback training for improvement of urine leakage. Which CPT® code accurately reports the service? - 90911 Rationale: Code 90911 describes biofeedback training for the urethral sphincter. In the CPT® Index, look for Biofeedback Training/Anorectal. A dialysis patient undergoes duplex scan of his hemodialysis access site to determine the pattern and blood flow in his arteries and veins. Select the appropriate CPT® code for reporting this service. - 93990 Rationale: Code 93990 describes a scan of hemodialysis access and includes arterial inflow, body of access and venous outflow. In the CPT® Index, look for Hemodialysis/Duplex Scan of Access. A 4-year-old has not reached the expected developmental milestones for her age group. She was referred by her pediatrician for extensive developmental testing. The psychologist initiated multiple function studies, using standardized instruments and reported the results to the child's pediatrician. Code the psychologist's service. - 96111 Rationale: Code 96111 describes extensive testing for developmental assessment, including interpretation and report. In the CPT® Index, look for Developmental Testing. A cancer patient will receive chemotherapy by intrathecal delivery. A spinal puncture is necessary to accommodate the catheter. What is the correct code for this service? - 96450 Rationale: Code 96450 describes intrathecal delivery of chemotherapy agents. The code includes the spinal puncture. The drugs are separately coded using HCPCS II codes. Spinal catheter placement is included in the technique. In the CPT® Index, look for Spine Chemotherapy/Administration. A patient with a long history of migraine headaches decides to try acupuncture in an attempt to reduce the symptoms. The provider uses acupuncture with electrical stimulation during a 15-minute, face-to-face encounter with the patient. What is/are the correct code(s)? - 97813 Rationale: Code 97813 describes a 15-minute encounter with one-on-one patient contact using acupuncture with electrical stimulation. In the CPT® Index, look for Acupuncture/with Electrical Stimulation.
A patient presents with a complaint of continuing left shoulder pain after falling from her patio onto a wooden step. No fracture was identified at the time of the fall. After assessing the patient, the chiropractor manipulates the shoulder region. What is/are the correct code(s)? - 98943 Rationale: Code 98943 describes extraspinal manipulation, one or more regions. In the CPT® Index, look for Manipulation/Chiropractic. A patient calls her physician to discuss the refill of a current prescription. She speaks with the registered nurse who discusses the patient's current status and advises that the prescription to be called into her pharmacy. The call lasts 12 minutes. What is the correct code for this service? - 98967 Rationale: Code 98967 describes a telephone discussion with a nonphysician qualified healthcare professional for 11-20 minutes. The discussion did not lead to an appointment within the next 24 hours or the soonest available appointment and was not related to an E/M service within the previous seven days. In the CPT® Index, look for Telephone/Evaluation and Management/Nonphysician. A physician agrees to meet a patient at the office on Sunday afternoon to assess a repeat problem. Special equipment in the physician office is needed to evaluate the condition. Normal office hours are Monday-Friday. What is the correct code for this service? - 99050 Rationale: Code 99050 describes services provided on holidays & weekends that are outside of normal business hours. In the CPT® Index, look for After Hours Medical Services. A post-surgical patient is discharged from the hospital to home. The patient still has a urinary catheter needing attention for the next several days. The physician arranges for patient care through a home care agency. Code the non-physician healthcare professional's service. - 99507 Rationale: Patients often discharge to home when they no longer need the hospital level of care, but still need some assistance. The physician typically arranges the care with a home care agency by sending a qualified person to the patient's home. Code 99507 describes home care for maintenance of catheters. In the CPT® Index, look for Home Services/Catheter Care. CASE 1 10-Year-old established patient (The patient is established.) presents today for well child check (Patient presents for a preventive exam.) with mother with complaints of frequent urination during the day.
Urinalysis: Ketones, nitrite, leukocytes normal; trace blood, low specific gravity. (Urinalysis lab test performed in the office) Couns - 99393-25, 17110, 90471, 90716, 81002; Z00.121, F90.9, B07.9, R35.0, Z CASE 2 Pre-procedure Diagnosis: Asthma Post-procedure Diagnosis: Asthma (Post procedural diagnosis used for coding.) Procedure: Psychophysiological Therapy Biofeedback The patient returned to clinic with daily diary documenting home peak flow readings and asthma symptoms. Diary was assessed and discussed with patient. Patient reports reduced dosing with inhaled steroids and fewer asthmatic episodes. Lungs and respiratory resistance assessed. Lungs clear, no wheezes or rhonci noted. (Psychophysiological training.) HRV biofeedback was performed using a physiograph. (Biofeedback documentation.) ECG data were collected from the left arm and right leg, and were digitized at 510 Hz. EEG biofeedback equipment attached and baroreflex gain was assessed with beat-to-beat BP recordings and digitized at a rate of 252 samples per second. The sensor was placed on the participant's right middle finger, and the hand was elevat - 90875; J45. CASE 3 Performed in the office Pre-procedure Diagnosis: Gastro-esophageal reflux disease (GERD), Heartburn
Post-procedure Diagnosis: GERD (Post procedure diagnosis used for coding.) Procedure: Esophageal pH monitoring with Bravo pH Capsule (Acid reflux testing) Patient was placed in supine position on examining bed, IV moderate sedation was administered. Visualization of esophagus with anatomic markers located during endoscopy. Endoscopy was removed and the Bravo pH Capsule delivery system was passed into the esophagus using the oral passage until the attachment site was obtained at approximately 5cm proximal to the upper margin of the LES. The external vacuum pump was activated pulling the adjacent esophageal mucosa into the fastening well. Vacuum gauge at 600 mm Hg and held for 10 seconds. The plastic safety guard on handle was then removed and the activation button was depressed and turned attaching the pH - 91035; K21. CASE 4 Pre-procedure Diagnosis: Sleep Apnea Post-procedure Diagnosis: Obstructive sleep apnea Procedure: Overnight Sleep Study 35-year-old patient in Hospital Sleep Lab for attended, overnight polysomnogram. (Polysomnogram performed.) Patient oriented to room and changed into overnight clothing and brought into lab by patient. Latency to sleep onset slightly prolonged at 32.3 minutes. During the first 82 minutes of sleep, 80 obstructive apneas were manifested (Respiratory Effort). The lowest SpO2 during the non- supplemented sleep period was 73% (Oxyhemoglobulin saturations (SPO2)). CPAP was then applied at 5 cm H2, and sequentially titrated to a final pressure of 18 cm H2O. The Apnea-hypopnea index (AHI) changed from 60 events/hr to 4 events/hr. SpO2 increased to 90%.
Post-procedure Diagnosis: Varicose vein disease with inflammation, venous insufficiency, leg pains due to varicose veins Procedure: Peripheral Vascular Duplex Ultrasound Evaluation of the Venous Anatomy of the Lower Extremities Patient's right and left leg venous anatomy was examined in the standing position utilizing a B-Mode Duplex ultrasound machine with a 12 MHz probe. The focus was to determine the location and flow characteristics of both the deep and superficial venous systems. The evaluations included dynamically focused gray-scale and color imaging supplemented by Doppler spectroanalysis. Valsalva maneuver as well as calf and thigh compressions were performed to determine the patency and direction of blood flow, the exact paths of venous reflux in the major venous trunks, tributaries, and perforator vein - 93970; I83.11, I83.12, I83. CASE 7 Pre-procedure Diagnosis: Excessive Daytime Sleepiness, Snoring, Epworth Score 18 Post-procedure Diagnosis: Sleep Study Procedure: Polysomnogram, attended 25 year-old patient underwent overnight polysomnogram with the recording of EEG, EOG, submental and anterior tibialis EMG, respiratory effort, nasal and oral airflow, EKG, continuous pulse oximetry. Total time in bed of 386 minutes and a total of sleep time of 221 minutes. The sleep latency was 24 minutes and the REM sleep latency was 18 minutes. Throughout the night, the patient had a total of 256 episodes of arousals and 6 awakenings. Sleep efficiency was 56%. No apparent parasomnia noted. The average oxygen saturation was reported to be 95% with the lowest saturation being 84%. There were no periodic leg movements for an index of 0.0 and cardiac arrhythmias were not present. Impression: Mild sleep apnea What are the CPT® and ICD-10-CM codes reported - 95810;
G47.
CASE 8
Pre-procedure Diagnosis: Analysis of Vagal Nerve Stimulator (VNS), epilepsy with history of seizures Post-procedure Diagnosis: Analysis of Vagal Nerve Stimulator (VNS), epilepsy with history of seizures Procedure: Vagal Nerve Stimulator Analysis Patient here for VNS implant analysis with possible adjustments. The programming head was placed over the implanted neurostimulator located within the patient's neck-left side. Impedance was verified insuring parameters within normal limits. Parameters charted on flowchart within medical record. Operating status of neurostimulator reflects on. Estimated time for analysis/interrogation was 20 minutes in duration. Patient denies questions at this time. Will repeat analysis in three months. What are the CPT® and ICD-10-CM codes reported? - 95970; Z46. G40. CASE 9 Pre-procedure Diagnosis: Extensive keratosis lesions of left anterior neck Post-procedure Diagnosis: keratosis lesions left anterior neck Procedure: Blue Light Photodynamic Therapy with topical skin sensitizing agent
What are the CPT® and ICD-10-CM codes reported? - A 5 year-old fell on broken glass and required suturing of a laceration. Due to the age and combative behavior of the patient, the provider utilized moderate sedation while repairing the laceration. The provider gave the child 50 mg of Ketamine IM. A nurse monitored the patient during the procedure which took 30 minutes. What CPT® code is reported for moderate sedation? - 99152, 99153 Rationale: Moderate sedation is often used for pediatric patients in situations not normally requiring sedation. In this case, the provider administered sedation with a nurse assisting in monitoring the patient. In the CPT® Index look for Sedation/Moderate/with Independent Observation and you are directed to code range 99151-99153. Code selection is based on age of the patient and the length of time. Code 99152 describes an encounter using moderate sedation, and the physician or other qualified health care professional rendering the diagnostic or therapeutic service also manages the sedation. This code is specific for the age of the patient and up to 15 minutes of time. Add-on 99153 is for each additional 15 minutes of intraservice time. A patient was brought to the emergency department in cardiac arrest. The physician immediately initiated CPR. What CPT® code is reported for CPR? - 92950 Rationale: Medical personnel usually begin cardiopulmonary resuscitation (CPR) which provides artificial breathing and chest compressions for a person in cardiac arrest. In the CPT® Index you can look for either CPR or Cardiopulmonary Resuscitation or Resuscitation/Cardiopulmonary. All indexed items direct you to code 92950. A cardiologist provided an interpretation and report of an EKG. What CPT® code is reported? - 93010 Rationale: In the CPT® Index look for EKG and you are directed to see Electrocardiography. For Electrocardiography/Evaluation you are directed to 0178T-0180T, 93000, 93010, 93660. 93660 involves a tilt table evaluation. The remaining codes are 93000, 93010. 93000 includes the 12 lead EKG in addition to the interpretation and report. The provider only provided the interpretation and report making 93010 the correct code choice. A patient with coronary atherosclerosis underwent a PTCA in the left anterior descending and in the first diagonal of the LD. What CPT® code(s) is/are reported? - 92920-LD, 92921-LD Rationale: PTCA stands for percutaneous transluminal coronary angioplasty. In the CPT® Index look for PTCA and you are directed to see Percutaneous Transluminal Angioplasty. Under Percutaneous
Transluminal Angioplasty/Artery/Coronary you are directed to code range 92920-92921. Code 92920 is used for the main coronary artery which is the left anterior descending. The add-on code 92921 is used to report the PTCA to a branch off of the left anterior descending - the first diagonal. 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? - 92604 Rationale: Cochlear implants differ from hearing aids; they bypass the damaged part of the ear. The use of a cochlear implant involves relearning how to hear and react to sounds. In the CPT® Index look for Cochlear Device/Programming which directs you to codes 92602, 92604. The code selection is based on the age of the patient and whether it is the initial programming or subsequent reprogramming. Code 92604 describes subsequent reprogramming for a patient age 7 or older. What ICD-10-CM code is reported when a flu vaccine is administered? - Z Rationale: In the ICD-10-CM Alphabetic Index look for Vaccination (prophylactic)/encounter for Z23. Verification in the Tabular List confirms Z23 is for an encounter for immunization. This code is nonspecific as to the type of vaccination that is given. The type of vaccination given (i.e. influenza, MMR, DPT) will be specified by procedure/HCPCS codes. A 49 year-old female was brought to the emergency department. She was lethargic, but awake. She is four years post liver transplant. Neurology was consulted who determined the patient was encephalopathic with altered mental status. There was some question whether she had a seizure. An EEG and WADA test were performed. What CPT® and ICD-10-CM codes are reported? - 95958, G93.40, R41.82, Z94. Rationale: In the CPT® Index look for WADA Activation Test and you are directed to code 95958. You can also see Electroencephalography/Monitoring/with WADA Activation. The WADA activation test is coded as 95958 and includes EEG monitoring. For the diagnoses, look in the ICD-10-CM Alphabetic Index for Encephalopathy and you are directed to G93.40. Next, look for Alteration (of), Altered/mental status directing you to R41.82. The patient is also status post liver transplant, which is found in the Alphabetic Index by looking for Transplant(ed) (status)/liver which directs you to Z94.4. Verification of the codes in the Tabular List confirms code selections. What ICD-10-CM code is reported for an anaphylactic reaction to peanuts, initial encounter? - T78.01XA Rationale: In the ICD-10-CM Alphabetic Index look for Anaphylactic/shock or reaction which states see Shock, anaphylactic. Look for Shock/anaphylactic/due to food (nonpoisonous)/peanuts which
disturbance/with emotional disturbance and you are directed to F43.25. F43.25 includes disturbances of conduct, so F43.24 is not reported separately. Verification in the Tabular List confirms code selection. What ICD-10-CM code is reported for a fear of spiders? - F40. Rationale: Look in the ICD-10-CM Alphabetic Index for Fear of which states see Phobia. Phobia, phobic/animal/spiders directs you to F40.210. This can also be found in the Alphabetic Index by looking for Arachnophobia F40.210. Verify code selection in the Tabular List. A patient has an open wound on his left lower leg caused by a cat bite. The animal tested negative for rabies, but the wound has failed to heal and became infected by Clostridium perfringens. The patient underwent hyperbaric oxygen therapy attended and supervised by the provider. What CPT® and ICD-10-CM codes are reported? - 99183, S81.852A, B96.7, W55.01XA Rationale: In the CPT® Index look for Hyperbaric Oxygen Pressurization and you are directed to code
- The wound is complicated due to the infection. In the ICD-10-CM Alphabetic Index look for Bite(s) (animal) (human)/leg (lower) and you are directed to S81.85-. Tabular List shows seven characters are needed to complete the code. The 6th character 2 indicates the left leg. 7th character A indicates initial encounter for receiving active treatment. The infectious agent is identified as Clostridium perfringens. Look for Infection/Clostridium/perfringens/as cause of disease classified elsewhere directing you to code B96.7. The external cause is the cat bite. Look in the ICD-10-CM External Cause of Injuries Index for Bite, bitten by/cat which directs you to code W55.01-. Tabular List shows seven characters are needed to complete the code. A placeholder X is assigned to the 6th character and A is assigned for initial encounter for the 7th character. A patient with hypertensive cardiovascular disease is admitted by his primary care provider. What is/are the correct ICD-10-CM code(s) for this encounter? - I11. Rationale: In the ICD-10-CM Alphabetic Index look for Hypertension, hypertensive/cardiovascular/disease (arteriosclerotic) (sclerotic) which states to see Hypertension, heart. Look for Hypertension/heart (disease) (conditions in I51.4-I51.9 due to hypertension) directing you to I11.9. ICD-10-CM guideline, I.C.9.a.1., states code I11- is used when a causal relationship is stated or implied. Tabular List confirms code I11.9 is correct as heart failure is not documented. A 42 year-old patient presented to the urgent care center with complaints of slight dizziness. He had received services at the clinic about 2 years ago. The patient related this episode happened once previously and his 51 year-old brother has a pacemaker. A chest X-ray with 2 views and an EKG with rhythm strip were ordered (equipment owned by the urgent care center). The provider detected no obvious abnormalities, but the patient was advised to see a cardiologist within the next two - three
days. The provider interpreted and provided a report for the rhythm strip and chest X-ray. What CPT® and ICD-10-CM codes are reported for the provider employed by the urgent care center who performed a level 3 office visit in addition to the ancillary services? - 99213-25, 71046, 93040, R Rationale: The patient is an established patient to an urgent care clinic. A code from 99211-99215 is reported. Level three is reported with 99213. Because an EKG was also performed, a modifier 25 is appended to the office visit. The X-ray & EKG equipment are owned by the clinic. In the CPT® Index look for X-ray/Chest referring you to 71045-71048. The chest X-ray, 2 views, is reported with 71046. The EKG and rhythm strip are read, interpreted and a report is written by the provider. Modifiers 26 and TC are not appended to the radiology codes because the urgent care center owns the equipment and the radiologist is an employee of the urgent care center. In the CPT® Index look for Electrocardiography/Rhythm/Tracing and Evaluation and you are referred to CPT® code 93040. With no confirmed diagnosis, refer to the initial symptoms. The diagnosis is dizziness (R42). In the ICD-10-CM Alphabetic Index look for Dizziness. Verification in the Tabular List confirms code selection. 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? - V5261, Z46.1, H90. 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. A qualified genetics counselor is working with a child who has been diagnosed with fragile X syndrome. After extensive research about the condition, she meets with the parents to discuss the features of the disease and the child's prognosis. The session lasted 45 minutes. What CPT® and ICD- 10-CM codes are reported? - 96040, Q99. Rationale: In the CPT® Index look for Medical Genetics which directs you to 96040. The genetics counseling session is reported as face-to-face time per 30 minutes. Report 1 unit for the first 30 minutes. Since the remaining time is 15 minutes, it is not reported separately per the Medical Genetics and Genetic Counseling Services guidelines. Fragile X syndrome is a congenital chromosomal anomaly that may include mental retardation. In the ICD-10-CM Alphabetic Index look for Syndrome/fragile X. The condition is reported with code Q99.2. Verification in the Tabular List confirms code selection. A therapist in a residential care facility works with a nonverbal autistic child, age 4. In this session the therapist uses drawing paper and washable markers. The therapist sat with the child and began to
