NURSING EXAM QUESTIONS WITH ANSWERS TESTED AND VERIFIED SOLUTIONS 2023/2024 UPDATES, Exams of Nursing

Download NURSING EXAM QUESTIONS WITH ANSWERS TESTED AND VERIFIED SOLUTIONS 2023/2024 UPDATES and more Exams Nursing in PDF only on Docsity! NURSING EXAM QUESTIONS WITH ANSWERS TESTED AND VERIFIED SOLUTIONS 2023/2024 UPDATES • Question 1 Which part of the brain controls blood pressure, heart rate and respiration? 1.2 out of 1.2 points Selected Answer: Correct Answer: Medulla Medulla • Question 2 1.2 out of 1.2 points A three-year-old is brought to the burn unit after pulling a pot of hot soup off the stove spilling onto to her body. She sustained 18% second degree burns on her legs and 20% third degree burns on her chest and arms. Total body surface area burned is 38%. What ICD-10-CM codes should be reported for the burns (do not include External Cause codes for the accident)? Selected Answer: Correct Answer: T21.31XA, T22.30XA, T24.209A, T31.32 T21.31XA, T22.30XA, T24.209A, T31.32 Response Feedback: ICD-10-CM Coding states to sequence first the code that reflects the highest degree of burn when more than one burn is present. In this case, the burns on her chest and arms are third degree and should be reported first. In the Index to Diseases, look for Burn/chest wall (anterior)/third degree referring you to code T22.30XA; Burn/arm(s)/ third degree guiding you to code T22.30XA; Burn/legs/second degree guiding you to code T24.209A. Refer to ICD-10-CM for instructions on assigning a code from category T31. • Question 3 0 out of 1.2 points A patient is positioned on the scanning table headfirst with arms at the side for an MRI of the thoracic spine and spinal canal. A contrast agent is used to improve the quality of the images. The scan confirms the size and depth of a previously biopsied leiomyosarcoma metastasized to the thoracic spinal cord. What CPT? and ICD- 10-CM codes are reported? Selected Answer: [None Given] Correct Answer: 72147, C79.49 • Question 4 A couple with inability to conceive has fertility testing. The semen specimen is tested for volume, count, 1.2 out of 1.2 points motility and a differential is calculated. The findings indicate infertility due to oligospermia. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 89320, N46.11 89320, N46.11 Response Feedback: Choose the CPT? code completely identifying the service. Only use multiple codes if there is no code describing everything performed. Only use V codes when there is no final diagnosis. In this case, a very specific diagnosis is known and the code is used. In the CPT? Index, look for S e m e n A n a l y s i s d i r e c t i n g y o u t o c o d e r a n g e 8 9 3 0 0 - 8 9 3 2 2 . C o d e 8 9 3 2 0 reports all of the tests performed. For the ICD-10-CM diagnosis, code, look in the Index to Diseases, for Infertility/male/oligospermia leading you to N46.11. • Question 13 1.2 out of 1.2 points Subjective: Six-year-old girl twisted her arm on the playground. She is seen in the ED complaining of pain in her wrist. Objective: Vital Signs: stable. Wrist: Significant tenderness laterally. X-ray is normal Assessment: Wrist sprain Plan: Over the counter Anaprox. give twice daily with hot packs. Recheck if no improvement. What is the E/M code for this visit? Selected Answer: Correct Answer: 99281 99281 Response Feedback: Emergency Department services must meet or exceed three of the three key components. The physician performed a problem focused history (brief HPI, no ROS, no PFSH), a problem focused exam (one body area is examined), and low MDM (for one new problem to the examiner, one data point for the X-ray, and low level of risk). The problem focused history and exam lead us to select 99281 as the appropriate code. • Question 14 The meaning of the root “blephar/o” is: 1.2 out of 1.2 points Selected Answer: Correct Answer: Eyelid Eyelid • Question 15 An anesthesiologist is medically supervising six cases concurrently. What modifier is reported for the anesthesiologist’s service? 1.2 out of 1.2 points Selected Answer: AD Correct Answer: AD Response Feedback: An anesthesiologist who is medically supervising reports anesthesia service separately from the CRNA. The anesthesia modifier for the anesthesiologist depends on the number of concurrent cases. There are six concurrent cases; therefore, the appropriate modifier to report is AD for the anesthesiologist. • Question 16 1.2 out of 1.2 points 45-year-old patient with liver cancer is scheduled for a liver transplant. The patient?s brother is a perfect match and will be donating a portion of his liver for a graft. Segments II and III will be taken from the brother and then the backbench reconstruction of the graft will be performed, both a venous and arterial anastomosis. The orthotopic allotransplantation will then be performed on the patient. What CPT? codes are reported? Selected Answer: Correct Answer: 47140, 47146, 47147, 47135 47140, 47146, 47147, 47135 Response Feedback: In the CPT? Index, look for Hepatectomy/Partial/Donor. Code 47140 represents the portion of the liver taken from the donor to be allotransplanted. Codes 47146 and 47147 represent the backbench work with venous and arterial anastomosis. In the CPT? Index, look for Transplantation/Liver/Allograft Preparation to find these codes. We have a vein and an artery anastomosed so we only report each of these codes one time. The final code of 47135 represents the orthotopic allotransplantation into the patient; this is found in the CPT? Index with Transplantation/Liver. • Question 17 1.2 out of 1.2 points A patient is brought to the operating suite when she experiences a large output of blood in her chest tubes post CABG. The physician performing the original CABG yesterday is concerned about the post-operative bleeding. He explores the chest and finds a leaking anastomosis site and he resutured. Selected Answer: Correct Answer: 35820-78 35820-78 Response Feedback: This is a postoperative exploration and modifier 78 is necessary because this is an unplanned return to the OR by the same physician during the global period of another procedure. Modifier 78 is used for a return to the OR for complications. This was an exploration for postoperative hemorrhage of the chest, 35820, which can be found in the CPT? Index under Exploration/Blood Vessel/Chest, 35820. • Question 18 A patient diagnosed with glaucoma has: 1.2 out of 1.2 points Selected Answer: Correct Answer: Abnormally high intraocular pressure Abnormally high intraocular pressure • Question 19 0 out of 1.2 points A patient with hypertensive end stage renal failure, stage V, and secondary hyperparathyroidism is evaluated by the physician and receives peritoneal dialysis. The physician evaluates the patient once before dialysis begins. What CPT? and ICD-10-CM codes are reported? Selected Answer: [None Given] Correct Answer: 90945, I12.0, N18.6, N25.81 • Question 20 1.2 out of 1.2 points The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a piece of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it, the mass was removed. There was a capsule around this, containing what appeared to be a black- colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal, he wanted me to, so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 10121, M79.5, Z18.10 10121, M79.5, Z18.10 Response Feedback: In CPT? index, see Integumentary System/Removal/Foreign Body, you are directed to code range 10120-10121. The surgeon indicated in the note they considered this incision and removal of foreign body to be complicated leading us to code 10121. In the ICD-10-CM Index to Diseases, see Foreign body/retained/fragments/subcutaneous tissue, you are directed to M79.5. There is no mention of granuloma of the skin making L92.3 incorrect. The patient did not have an acute laceration with a foreign body in an open wound. In the Tabular List, instructions for M79.5 state to use an additional code from Z18.0 to Z18.10 to identify the foreign body. Z18.10 indicates a retained metal fragment. • Question 21 1.2 out of 1.2 points 5- year-old patient is experiencing atrial fibrillation with rapid ventricular rate. The anesthesia department is called to insert a non-tunneled central venous (CV) catheter. What CPT® code is reported? Selected Answer: Correct Answer: 36556 36556 Response Feedback: An anesthesia service was NOT performed; therefore, 00400 is not reported. Look in the CPT® Index for Catheterization/Central Venous and reference is made to See Central Venous Catheter Placement. Many codes are listed. The catheter is non-tunneled; therefore, there are two codes from which to choose; 36555 and 36556, based on patient age. This patient is 5-years-old; therefore, 36556 is correct. • Question 22 1.2 out of 1.2 points A patient has a Transtelephonic rhythm strip pacemaker evaluation for his dual chamber pacemaker. It has been more than two months from his last evaluation due to him moving. The physician evaluates remotely retrieved information, checking the device?s current programming, battery, lead, capture and sensing function, and heart rhythm. The monitoring period has been 35 days. What can the physician report for the service? Selected Answer: Correct Answer: 93293 93293 Response Feedback: According to CPT? guidelines, codes 93293-93296 may be reported once every 90 days; his last evaluation was more than two months ago. Also, the monitoring period has been more than 30 days. Modifier 52 is not an acceptable modifier for 93293. Look in the CPT? index under Pacemaker, Heart/Evaluation and Programming/Remote, you are referred to 93293-93294, 93296. Code 93293 is reported because of the transtelophonic rhythm monitoring for a dual chamber pacemaker. • Question 23 1.2 out of 1.2 points A pregnant female is Rh negative and at 28 weeks gestation. The child?s father is Rh positive. The mother is given an injection of a high-titer Rho (D) immune globulin, 300 mcg, IM. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 90384, 96372, O36.0130, Z3A.28 Selected Answer: Correct Answer: 57120, N81.2 57120, N81.2 Response Feedback: This surgical procedure of a colpocleisis is performed to prevent uterine prolapse. In this procedure, the walls of the vagina are sewn together. This obliterates the vagina and prevents uterine prolapse. It is only done in patients not sexually active. In the CPT? Index, look for Colpocleisis, guiding you to code 57120. The reason for the operation is uterine prolapse. In the ICD-10-CM Index to Diseases, look for Prolapse/uterus, guiding you to code N81.2. • Question 30 The Surgical Global Package applies to services performed in what setting? 1.2 out of 1.2 points Selected Answer: Correct Answer: All of the above All of the above Response Feedback: The Medicare approved amount for surgery includes the following services when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, eg, in 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 1.2 out of 1.2 points A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This attempt was unsuccessful. The physician then dilates the esophagus transendoscopically using a balloon (25mm). What CPT? code(s) is/are reported? Selected Answer: Correct Answer: 43220 43220 Response Feedback: Because the esophageal dilation by using a bougie (43450) was unsuccessful it is not reported. The esophagus was successfully dilated by performing transendoscopic balloon dilation (43220). This is the only code reported. In the CPT? Index, look for Esophagus/Dilation/Endoscopic directing you to several codes. • Question 32 A gonioscopy is an examination of what part of the eye: 1.2 out of 1.2 points Selected Answer: Correct Answer: Anterior chamber of the eye Anterior chamber of the eye • Question 33 1.2 out of 1.2 points Margaret has a cholecystoenterostomy with a Roux-en-Y; five hours later she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and peritonitis was setting in. What is the correct coding for the subsequent services on this date of service? The same surgeon took her back to the OR as the one who performed the original operation. What CPT? code is reported? Selected Answer: Correct Answer: 49402-78 49402-78 Response Feedback: CPT? code 49402 represents the removal of a foreign body (sponge from previous surgery) from the peritoneal cavity. In the CPT? Index, look for Removal/Foreign Body/Peritoneum. Modifier 78 indicates this was an unplanned return to the OR, by the same physician for a related procedure following an initial procedure during the initial procedures postoperative period. • Question 34 1.2 out of 1.2 points A patient with Sickle cell anemia with painful sickle crisis received normal saline IV, 100 cc per hour to run over 5 hours for hydration in the physician?s office. She will be given Morphine & Phenergan, prn (as needed). What codes are reported? Selected Answer: Correct Answer: 96360, 96361 x 4, J7050 x 2, D57.00 96360, 96361 x 4, J7050 x 2, D57.00 Response Feedback: In the CPT? Index, look for Hydration, you are directed to codes 96360-96361. The hydration will run 5 hours at 100 cc per hour. Code the hydration therapy as 96360 for the first hour, then 96361 x 4 to get a total infusion time of 5 hours. Code for the normal saline with J7050 x 2 units for 500 cc (HCPCS Level II). The type of Sickle Cell anemia is not identified, but the patient has painful sickle crisis. In the ICD-10-CM Index to Diseases, look for Crisis/sickle cell. Apply code D57.00. • Question 35 1.2 out of 1.2 points 41-year-old male is in his doctor’s office for a follow up of an abnormality, which was noted, on an abdominal CT scan. He is to have a chest X-ray due to chest tightness. He otherwise states he feels well and is here to go over the results of his chest X-ray (PA and Lateral) performed in the office and the CT scan performed at the diagnostic center. The results of the chest X-ray were normal. CT scan was sent to the office and the physician interpreted and documented that the CT scan of the abdomen showed a small mass in his right upper quadrant. What CPT® codes are reported for the doctor’s office radiological services? Selected Answer: Correct Answer: 71020, 74150-26 71020, 74150-26 Response Feedback: The chest X-ray was taken in the doctor’s office and interpreted. This means the doctor’s office can bill for the code without appending a modifier. Modifier 26 is appended to the CT scan code, because, it was performed at another site and the physician only interpreted the image. Look in the CPT® Index for X-ray/Chest directing you to 71010-71035, and CT Scan/without Contrast/Abdomen directing you to 74150, 74176, 74178. • Question 36 In a legal hearing to determine child support there is a dispute about the child?s paternity. The court orders a 0 out of 1.2 points paternity test, and a nasal smear is taken from the plaintiff and the child. The plaintiff is confirmed as the father of the child. Choose the CPT?, ICD-10-CM codes and modifier for the paternity testing. Selected Answer: 89190-32, Z31.448 Correct Answer: 86910-32, Z02.81 • Question 37 Operative Report Diagnosis: Basal Cell Carcinoma Procedure: Mohs micrographic excision of skin cancer. Site: face left lateral canthus eyelid Pre-operative size: 0.8 cm Indications for surgery: Area of high recurrence, area of functional and/or cosmetic importance Discussed 1.2 out of 1.2 points procedure including alternative therapy, expectations, complications, and the possibility of a larger or deeper defect than expected requiring significant reconstruction. Patient?s questions were answered. Local anesthesia 1:1 marcaine and 1% lidocaine with epinephrine. Sterile prep and drape. Stage 1: The clinically apparent lesion was marked out with a small rim of normal appearing tissue and excised down to subcutaneous fat level with a defect size of 1.2 cm. Hemostasis was obtained and a pressure bandage placed. The tissue was sent for slide preparation. Review of the slides show clear margins for the site. Repair: Complex repair. Repair of Mohs micrographic surgical defect. Wound margins were extensively undermined in order to mobilize tissue for closure. Hemostasis was achieved. Repair length 3.4 cm. Narrative: Burrows triangles removed anteriorly (medial) and posteriorly (lateral). A layered closure was performed. Multiple buried absorbable sutures were placed to re-oppose deep fat. The epidermis and dermis were re-opposed using monofilament sutures. There were no complications; the patient tolerated the procedure well. Post-procedure expectations (including discomfort management), wound care and activity restrictions were reviewed. Written Instructions with urgent contact numbers given, follow-up visit and suture removal in 3-5 days What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 17311, 13152-51, C44.119 17311, 13152-51, C44.119 Response Feedback: In the CPT? Index, see Mohs Micrographic Surgery, you are directed to code range 17311- 17315. Code selection is based on location and stages. This operative note indicates the location is on the face and only one stage is performed, making 17311 the correct code choice. According to subsection guidelines for Mohs Micrographic Surgery, repairs are coded separately. This is a complex repair on the eyelid measuring 3.4 cm making 13152 the correct code choice. Modifier 51 is used to indicate multiple procedures. In the ICD-10-CM Index to Diseases, look in the Neoplasm Table for skin/canthus (eye)/basal cell carcinoma/Primary (column). The code is C44.119. • Question 38 1.2 out of 1.2 points Code 00940, anesthesia for vaginal procedures, has a base value of three (3) units. The patient was admitted under emergency circumstances, qualifying circumstance code 99140, which allows two (2) extra base units. A pre-anesthesia assessment was performed and signed at 2:00 a.m. Anesthesia start time is reported as 2:21 am, and the surgery began at 2:28 am. The surgery finished at 3:25 am and the patient was turned over to PACU at 3:36 am, which was reported as the ending anesthesia time. Using fifteen-minute time increments and a conversion factor of $100, what is the correct anesthesia charge? Selected Answer: Correct Answer: $1,000.00 $1,000.00 Response Feedback: Determining the base value is the first step in calculating anesthesia charges and payment expected. Time reporting is the second step. Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in either the operating room or an equivalent area. Pre-anesthesia assessment time is not part of reportable anesthesia time, as it is considered in the base value assigned. Anesthesia time ends when the anesthesiologist is no longer in personal attendance. Ending time is generally reported when the patient is safely placed under you to several codes. In reviewing the codes, 27506 is the correct choice. The debridement prior to the intramedullary rodding is reported with 11012 which is found in the CPT? Index under Debridement/Bone/with Open Fracture and/or Dislocation which eliminates choice A. Modifier RT is appended to indicate the procedure is performed on the right side. • Question 45 1.2 out of 1.2 points A physician orders a quantitative FDP. What CPT® code is reported? Selected Answer: Correct Answer: 85370 85370 Response Feedback: Check for unfamiliar abbreviations in the Index. Read codes closely to identify whether they are quantitative, semi-quantitative, or qualitative. In the CPT® Index, see FDP, you are directed to See Fibrin Degradation Products, this refers you to See Pathology and Laboratory/Fibrin Degradation Products. • Question 46 Baby boy is born by cesarean section in the hospital. The mother has a history of diabetes mellitus, which complicated the management of her pregnancy. In addition, the mother abused cocaine throughout her pregnancy. The newborn was monitored for drug withdrawal, however no symptoms were noted and the toxicology report came back negative. ABO incompatibility was documented, but the Coomb's test was negative. What ICD-10-CM codes should be reported for the newborn?s record? 1.2 out of 1.2 points Selected Answer: Correct Answer: Z38.01, P00.89 Z38.01, P00.89 Response Feedback: According to ICD-10-CM Guidelines codes are only used on the maternal record. Code Z38.01 is coded as a principal/first listed code to report the type of birth. This is found in the Index to Diseases by looking for Newborn/single/born in hospital/with cesarean delivery or section. Because the newborn was observed for effects of the maternal drug use, look in the Index to Diseases for Observation/suspected/condition/newborn/specified NEC. Report codes Z38.01 and P00.89 since the other conditions were not present or treated. • Question 47 1.2 out of 1.2 points A surgeon performs a high thoracotomy with resection of a single lung segment on a 57-year-old heavy smoker who had presented with a six-month history of right shoulder pain. An apical lung biopsy had confirmed lung cancer. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 32484, C34.10 32484, C34.10 Response Feedback: A segment of the lung is removed. In the CPT? Index, look up Removal/Lung/ Single Segment. This directs you to code 32484. We have a confirmed diagnosis of apical lung cancer, a cancer in an upper lobe, which is code C34.10. The term apical means the tip of a pyramidal or rounded structure, so apical lung cancer means the tumor/cancer is located at the top or upper lobe of the lung. We find this by looking in the Neoplasm Table under lung/upper lobe. In the primary malignant column we are directed to code C34.10. • Question 48 1.2 out of 1.2 points The physician performs an iridotomy using laser on both eyes for chronic angle closure glaucoma; procedure includes local anesthesia. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 66761-50, H40.2230 66761-50, H40.2230 Response Feedback: In the CPT? Index, look for Iridotomy/by Laser Surgery directing you to 66761. Code 66761 describes the use of laser surgery to perform an iridotomy for glaucoma. Modifier 50 would be used to identify the procedure is performed on both eyes. In ICD-10-CM Index to Diseases, look for Glaucoma/angle closure/chronic directs you to code H40.2230 and is verified in the Tabular List as Chronic angle-closure glaucoma. • Question 49 HIPAA was made into law in what year? 1.2 out of 1.2 points Selected Answer: Correct Answer: Response Feedback: 1996 1996 HIPAA was adopted into law in 1996 • Question 50 When an anesthesiologist is medically supervising six cases, what modifier is reported for the CRNA’s medically directed service? 0 out of 1.2 points Selected Answer: AD Correct Answer: QX • Question 51 Under general anesthesia, a 45-year-old patient was sterilely prepped. The wrist joint was injected with Marcaine and epinephrine. Three arthroscopic portals were created. The articulating surface between the scaphoid and the lunate clearly showed disruption of the ligamentous structures. We could see soft tissue pouching out into the joint; this was debrided. There was abnormal motion noted within the scapholunate articulation. At this point the C-arm was brought in; arthroscopic instruments were placed in the joint and confirmed the location of the shaver as a probe in the scapholunate ligament. There was a significant gap 1.2 out of 1.2 points between the capitate and lunate. K-wire was utilized from the dorsal surface into the lunate, restoring the space. Further examination revealed gross instability between the capitate and lunate. With the wrist in neutral position, a K-wire was passed through the scaphoid, through the capitate and into the hamate. This provided stabilization of the wrist joint. Stitches were placed, and a thumb spica cast was applied. What CPT? code(s) should be reported? Selected Answer: Correct Answer: 29847 29847 Response Feedback: The wrist arthroscopy and stabilization was surgically performed to provide stabilization. Look in the CPT? Index for Arthroscopy/Surgical/Wrist directing you to 29843-29847. Check the tabular listing and 29847 reports arthroscopy of the wrist with internal fixation for fracture or instability. Although several K-wires were passed, 29847 is reported only once. The diagnostic arthroscopy is included in the procedure code, 29847 and is not coded separately. • Question 52 A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear medicine scan) and ultrasound and is found to have only one diseased parathyroid. A minimally invasive parathyroidectomy is performed. What CPT? and ICD-10-CM codes are reported for the surgery? 1.2 out of 1.2 points Selected Answer: Correct Answer: 60500, E21.0 60500, E21.0 Response Feedback: In the CPT ? Index, look for Parathyroidectomy or Parathyroid Gland/Excision and you are directed to code range 60500-60505. The diseased gland is determined prior to the surgery, so only the parathyroidectomy is coded with 60500. In the ICD-10-CM Index to Diseases, look for Hyperparathyroidism/primary and you are directed to E21.0. Verification in the Tabular list confirms code selection. • Question 53 1.2 out of 1.2 points After intravenous administration of 5.1 millicuries Tc-99m DTPA, flow imaging of the kidneys was performed for approximately 30 minutes. Flow imaging demonstrated markedly reduced flow to both kidneys bilaterally. What CPT® code is reported? Selected Answer: Correct Answer: 78701 78701 Response Feedback: The nuclear imaging test follows the blood as it flows to the kidneys identifying any obstruction and to determine the rate at which the kidneys are filtering. The scenario does not document the function of the tubes and ducts . In the CPT® Index, look for Nuclear Medicine/Diagnostic/Kidney/Vascular Flow directing you to code range 78701-78709. • Question 54 Lacrimal glands are responsible for which of the following? 1.2 out of 1.2 points Selected Answer: Correct Answer: Production of tears Production of tears • Question 55 Which of the following is true about the tympanic membrane? 0 out of 1.2 points Selected Answer: Correct Answer: It sits within the middle ear It separates the external ear from the middle ear • Question 56 1.2 out of 1.2 points Newborn twin girls delivered at 27 weeks, weighing 850 grams for twin A and 900 grams for twin B. Both were diagnosed with extreme immaturity. What ICD-10-CM codes should be reported for both twins? 1.2 out of 1.2 points The radiology term “fluoroscopy” is described as: Selected Answer: Correct Answer: An X-ray procedure allowing the visualization of internal organs in motion An X-ray procedure allowing the visualization of internal organs in motion • Question 64 A 47-year-old patient was previously treated with external fixation for a Grade III left tibial fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Intrafragmentary compression was 0 out of 1.2 points applied with three screws. The harvested bone graft was packed into the fracture site. What CPT? and ICD-10- CM codes are reported? Selected Answer: Correct Answer: 27724-LT, S82.101K 27724-LT, S82.102K • Question 65 70-year-old female presents with a complaint of right knee pain with weight bearing activities. She is also 0 out of 1.2 points developing pain at rest. She denies any recent injury. There is pain with stair climbing and start up pain. An AP, Lateral and Sunrise views of the right knee are ordered and interpreted. They reveal calcification within the vascular structures. There is decreased joint space through the medial compartment where she has near bone-on- bone contact, flattening of the femoral condyles, no fractures noted. The diagnosis is right knee pain secondary to underlying localized degenerative arthritis. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 73560, M17.9 73562, M17.11 • Question 66 Which statement is TRUE regarding the Instruction for use of the CPT® codebook? 1.2 out of 1.2 points Selected Answer: Correct Answer: Response Feedback: Select the name of the procedure or service that accurately identifies the service performed. Select the name of the procedure or service that accurately identifies the service performed. CPT® Instructions for the use of the CPT® codebook include “select the name of the procedure or service that accurately identifies the service performed.” • Question 67 1.2 out of 1.2 points A patient with hypertension presents to the same day surgery department for removal of her gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery. What ICD-10-CM codes are reported? Selected Answer: &@ Z01.810, K80.20, 110 Correct Answer: Z01.810, K80.20, I10 Response Feedback: In the Index to Diseases, look for Examination/preoperative/cardiovascular Z01.818. Next, in the Index to Diseases, look up Cholelithiasis directing you to K80.20. Code I10 is for Hypertension and is indexed in the Hypertension Table. Correct codes and sequencing are Z01.810, K80.20 and I10. Sequencing of preoperative clearance first, next the reason for the surgery, last any other findings or diagnoses. • Question 68 Wire placement in the lower outer aspect of the right breast was done by a radiologist the day prior to this 1.2 out of 1.2 points procedure. During this operative session, the surgeon created an incision through the wire track and the wire track was followed down to its entrance into breast tissue. A nodule of breast tissue was noted immediately adjacent to the wire. This entire area was excised by sharp dissection, sent to pathology and returned as a benign lesion. Bleeders were cauterized, and subcutaneous tissue was closed with 3-0 Vicryl. Skin edges were approximated with 4-0 subcuticular sutures and adhesive strips were applied. The patient left the operating room in satisfactory condition. What should be the correct code(s) for the surgeon?s services? Selected Answer: Correct Answer: 19125-RT 19125-RT Response Feedback: Documentation indicates a localization wire was placed prior to the surgery by a radiologist. We are asked to select the code for the surgeon?s services, code 19285 is not reported. In the CPT? Index, see Excision/Breast/Lesion indicating range 19120, 19125-19126. Code 19125 describes excision of breast lesion identified preoperatively with a radiology marker. • Question 69 A patient suffering from cirrhosis of the liver presents with a history of coffee ground emesis. The surgeon 1.2 out of 1.2 points diagnoses the patient with esophageal gastric varices. Two days later, in the hospital GI lab, the surgeon ligates the varices with bands via an UGI endoscopy. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 43244,K74.60, I85.10 43244,K74.60, I85.10 Response Feedback: Ligation of esophageal gastric varices endoscopically is coded with CPT? code 43244.This is indexed in CPT? under Ligation/Esophageal Varices. The patient has cirrhosis reported with code K74.60, in the ICD-10-CM Index to Diseases, look up Cirrhosis/liver directing you to K74.60 and reporting I85.10 for the esophageal varices. • Question 70 What does “non-facility” describe when calculating Physician Fee Schedule payments? 1.2 out of 1.2 points Selected Answer: Correct Answer: non-hospital owned physician practices non-hospital owned physician practices Response Feedback: “Non-facility” location calculations are for private practices or non-hospital-owned physician practices. Reimbursement is higher for private practices because the practice incurs the full expense of providing the service. Selected Answer: [None Given] Correct Answer: 99291-25, 31500, 92950 • 0.6 out of 0.6 points A 31-year-old secretary returns to the office with continued complaints of numbness involving three radial digits of the upper right extremity. Upon examination, she has a positive Tinel?s test of the median nerve in the left wrist. Anti-inflammatory medication has not relieved her pain. Previous electrodiagnostic studies show sensory mononeuropathy. She has clinical findings consistent with carpal tunnel syndrome. She has failed physical therapy and presents for injection of the left carpal canal. The left carpal area is prepped sterilely. A 1.5 inch 25 or 22 gauge needle is inserted radial to the palmaris longus or ulnar to the carpi radialis tendon at an oblique angle of approximately 30 degrees. The needle is advanced a short distance about 1 or 2 cm observing for any complaints of paresthesias or pain in a median nerve distribution. The mixture of 1 cc of 1% lidocaine and 40 mg of Kenalog-10 is injected slowly along the median nerve. The injection area is cleansed and a bandage is applied to the site. What codes are reported? Selected Answer: Correct Answer: 20526, J3301 x 4 20526, J3301 x 4 Response Feedback: Look in your HCPCS codebook in the Table of Drugs and Biologicals for Kenolog-10, you are referred to code J3301and then check the tabular listing to verify. Code J3301 is reported for 10 mg, you need to report 4 units to cover the 40 mg given. For the CPT? code, look in the CPT? Index for Injection/Carpal Tunnel/Therapeutic, 20526. • Question 2 A patient has a history of chronic venous embolism in the superior vena cava (SVC) and is having a 0.6 out of 0.6 points radiographic study to visualize any abnormalities. In outpatient surgery the physician accesses the subclavian vein and the catheter is advanced to the superior vena cava for injection and imaging. The supervision and interpretation of the images is performed by the physician. What codes are reported for this procedure? Selected Answer: Correct Answer: 36010, 75827-26 36010, 75827-26 Response Feedback: A radiographic study of the superior vena cava is performed to visualize and evaluate any abnormalities. For the insertion of the catheter look in the CPT® Index for Catheterization/Vena Cava referring you to code 36010. For the radiology code look in the CPT® Index for Venography/Vena Cava guiding you to code range 75825-75827. Radiology code 75827 is correct for the superior vena cava. Modifier 26 is appended to the radiology code, because the physician is performing the procedure in an outpatient facility setting. • Question 3 The Medicare program is made up of several parts. Which part is most significant to coders working in physician offices and covers physician fees without the use of a private insurer? 0.6 out of 0.6 points Selected Answer: Part B Correct Answer: Part B Response Feedback: Medicare Part B helps to cover medically-necessary doctors’ services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. Medicare Part B is an optional benefit for which the patient must pay a premium, and which requires a yearly co-pay. Medicare Part B is the most significant portion of the Medicare program for coders working in physician offices. • Question 4 Use both and when locating and assigning a diagnosis code. 0.6 out of 0.6 points Selected Answer: Correct Answer: Alphabetic Index and Tabular List Alphabetic Index and Tabular List Response Feedback: According to the ICD-10-CM guidelines Section 1.B.1 both Alphabetical Index and Tabular List are used to locate and assign a code. Reliance on only using the Alphabetic Index or the Tabular List will lead to errors and less specificity in reporting codes. • Question 5 0.6 out of 0.6 points 59-year-old patient is having surgery on the pericardial sac, without use of a pump oxygenator. The perfusionist placed an arterial line. What CPT® code(s) is/are reported for anesthesia? Selected Answer: Correct Answer: 00560 00560 Response Feedback: Look for Anesthesia/Heart in the CPT® Index or Anesthesia/Intrathoracic System. Check this listing with the Anesthesia Subsection, Intrathoracic to determine 00560 is the correct code reported for patient’s age and without use of a pump oxygenator. The arterial line placement is NOT reported because the perfusionist, not the anesthesia provider, performed it. • Question 6 0.6 out of 0.6 points Surgical laparoscopy with a cholecystectomy and exploration of the common bile duct, for cholelithiasis. What CPT? and ICD-9-CM codes are reported? Selected Answer: Correct Answer: 47564, K80.20 47564, K80.20 Response Feedback: Code 47564 is accurate for laparoscopic cholecystectomy when the exploration of the common bile duct is also performed. In the CPT? Index, look for Cholecystectomy/Laparoscopic directing you to 47562. We have a diagnosis of cholelithiasis but no mention of obstruction and not with cholecystitis, thus the correct ICD-10-CM code is K80.20. In the Index to Diseases, look for Cholelithiasis directing you to K80.20 • Question 7 A physician uses cryotherapy for removal trichiasis. What CPT? and ICD-10-CM codes are reported? 0.6 out of 0.6 points Feedback: the CPT? Index for Skin Graft and Flap/Tissue Transfer which directs you to 14000-14350. Based on the measurement calculating to 9.28 sq cm (2.9 cm x 3.2 cm = 9.28 cm2) and the location of the scalp, the correct CPT? code is 14020. For the ICD-10-CM code look in the Neoplasm Table for Skin/scalp/squamous cell carcinoma (C44.42). • Question 10 0.6 out of 0.6 points A patient with Sickle cell anemia with painful sickle crisis received normal saline IV, 100 cc per hour to run over 5 hours for hydration in the physician?s office. She will be given Morphine & Phenergan, prn (as needed). What codes are reported? Selected Answer: Correct Answer: 96360, 96361 x 4, J7050 x 2, D57.00 96360, 96361 x 4, J7050 x 2, D57.00 Response Feedback: In the CPT? Index, look for Hydration, you are directed to codes 96360-96361. The hydration will run 5 hours at 100 cc per hour. Code the hydration therapy as 96360 for the first hour, then 96361 x 4 to get a total infusion time of 5 hours. Code for the normal saline with J7050 x 2 units for 500 cc (HCPCS Level II). The type of Sickle Cell anemia is not identified, but the patient has painful sickle crisis. In the ICD-10-CM Index to Diseases, look for Crisis/sickle cell. Apply code D57.00. • Question 11 A patient has a complete TTE performed to assess her mitral valve prolapse (congenital). The physician performs the study in his cardiac clinic. 0.6 out of 0.6 points Selected Answer: Correct Answer: 93303 93303 Response Feedback: Patient has a congenital cardiac anomaly.Procedure was performed in the physician?s clinic; therefore, the global service is reported ? meaning no modifier is necessary. This code is found in the CPT? Index under Echocardiography/Transthoracic/Congenital Cardiac Anomalies, and you are referred to 93303-93304. Code 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete is correct. • Question 12 Operative Report PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration. POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration. OPERATION PERFORMED: Debridement and split thickness autografting of left foot ANESTHESIA: General endotracheal. INDICATIONS FOR PROCEDURE: This patient with multiple complications from Type II diabetes has 0.6 out of 0.6 points developed ulcerations which were debrided and homografted last week. The homograft is taking quite nicely; the wounds appear to be fairly clean; he is ready for autografting. DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the operating room and placed in the supine position on the operating table. Anesthetic monitoring was instituted, internal anesthesia was induced. The left lower extremity is prepped and draped in a sterile fashion. Staples were removed and the homograft was debrided from the surface of the wounds. One wound appeared to have healed; the remaining two appeared to be relatively clean. We debrided this sharply with good bleeding in all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked sponges. With good hemostasis a donor site was then obtained on the left anterior thigh, measuring less than 100 cm2. The wounds were then grafted with a split- thickness autograft that was harvested with a patch of Brown dermatome set at 12,000 of an inch thick. This was meshed 1.5:1. The donor site was infiltrated with bupivacaine and dressed. The skin graft was then applied over the wound, measured approximately 60 cm2 in dimension on the left foot. This was secured into place with skin staples and was then dressed with Acticoat 18's, Kerlix incorporating a catheter, and gel pad. The patient tolerated the procedure well. The right foot was redressed with skin lubricant sterile gauze and Ace wrap. Anesthesia was reversed. The patient was brought back to the ICU in satisfactory condition. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 15120-58, 15004-58, E11.622, L97.529 15120-58, 15004-58, E11.622, L97.529 Response Feedback: The wound was prepped with sharp debridement. Look in the CPT? Index for Creation/Recipient Site (range 15002-15005). Code selection is based on location and size. Then a split thickness graft was performed. Look in the CPT? Index for Skin Graft and Flap/Split Graft referring you to range 15100-15101-15120-15121. The measurement applies to the recipient area, which is stated as 60 cm2. A split thickness autograft to the foot for the first 100 sq cm is coded with 15120. The operative note states, ?The homograft is taking quite nicely, the wounds appear to be fairly clean; he is ready for autografting,? indicating this is a staged procedure and modifier 58 is appended. In the ICD-10-CM Index, see Diabetic/ulcer/foot, directing you to L97.529. Although there are complications, it does not indicate it is uncontrolled. L97.529 is used for ulcer of the foot. • Question 13 67-year-old gentleman with localized prostate cancer will be receiving brachytherapy treatment. Following 0.6 out of 0.6 points calculation of the planned transrectal ultrasound, guidance was provided for percutaneous placement of 1- 125 seeds into the prostate tissue. What CPT? code is reported for needle placement to insert the radioactive seeds into the prostate? Selected Answer: Correct Answer: 55875 55875 Response Feedback: Brachytherapy is a form of radiation in which radioactive seeds or pellets are implanted directly into the tissue being treated to deliver their dose of radiation in a direct fashion and longer period of time. The placement of the seeds is performed percutaneously (going through the skin by needle). The code is indexed in CPT? under Prostate/Insertion/Needle guiding you to code 55875. • Question 14 0.6 out of 0.6 points A patient has a Transtelephonic rhythm strip pacemaker evaluation for his dual chamber pacemaker. It has been more than two months from his last evaluation due to him moving. The physician evaluates remotely retrieved information, checking the device?s current programming, battery, lead, capture and sensing function, and heart rhythm. The monitoring period has been 35 days. What can the physician report for the service? Selected Answer: Correct Answer: 93293 93293 Response Feedback: According to CPT? guidelines, codes 93293-93296 may be reported once every 90 days; his last evaluation was more than two months ago. Also, the monitoring period has been more than 30 days. Modifier 52 is not an acceptable modifier for 93293. Look in the CPT? index under Pacemaker, Heart/Evaluation and Programming/Remote, you are referred to 93293-93294, 93296. Code 93293 is reported because of the transtelophonic rhythm monitoring for a dual chamber pacemaker. • Question 15 Which part of the brain controls blood pressure, heart rate and respiration? 0.6 out of 0.6 points Selected Answer: expectations (including discomfort management), wound care and activity restrictions were reviewed. Written Instructions with urgent contact numbers given, follow-up visit and suture removal in 3-5 days What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 17311, 13152-51, C44.119 17311, 13152-51, C44.119 Response Feedback: In the CPT? Index, see Mohs Micrographic Surgery, you are directed to code range 17311- 17315. Code selection is based on location and stages. This operative note indicates the location is on the face and only one stage is performed, making 17311 the correct code choice. According to subsection guidelines for Mohs Micrographic Surgery, repairs are coded separately. This is a complex repair on the eyelid measuring 3.4 cm making 13152 the correct code choice. Modifier 51 is used to indicate multiple procedures. In the ICD-10-CM Index to Diseases, look in the Neoplasm Table for skin/canthus (eye)/basal cell carcinoma/Primary (column). The code is C44.119. • Question 19 0.6 out of 0.6 points 47-year-old male presents with chronic back pain, and lower left leg radiculitis. A laminectomy is performed on the inferior end of L5. The microscope is used to perform microdissection. There was a large extradural cystic structure on the right side underneath the nerve root as well as the left. The entire intraspinal lesion was evacuated. What CPT? code(s) is/are reported for this procedure? Selected Answer: Correct Answer: 63267, 69990 63267, 69990 Response Feedback: In the CPT? Index, look for Laminectomy/for Excision/Intraspinal Lesion/Other than Neoplasm and you are directed to code range 63265-63268 and 63270-63273. The code range is divided based on whether the lesion is extradural or intradural. In this case, it is extradural narrowing the range to 63265-63268. The range is further divided based on the section of the spine the lesion is located. Laminectomy with evacuation of an intraspinal lesion in the lumbar spine is described by code 63267. The use of a microscope is documented by 69990. In the CPT? Index, look for Operating Microscope. • Question 20 0.6 out of 0.6 points Margaret has a cholecystoenterostomy with a Roux-en-Y; five hours later she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and peritonitis was setting in. What is the correct coding for the subsequent services on this date of service? The same surgeon took her back to the OR as the one who performed the original operation. What CPT? code is reported? Selected Answer: Correct Answer: 49402-78 49402-78 Response Feedback: CPT? code 49402 represents the removal of a foreign body (sponge from previous surgery) from the peritoneal cavity. In the CPT? Index, look for Removal/Foreign Body/Peritoneum. Modifier 78 indicates this was an unplanned return to the OR, by the same physician for a related procedure following an initial procedure during the initial procedures postoperative period. • Question 21 Sialography is an X-ray of : 0.6 out of 0.6 points Selected Answer: Correct Answer: Salivary glands Salivary glands • Question 22 0.6 out of 0.6 points A patient presents with a healed fracture of the left ankle. The patient was placed on the OR table in the supine position. After satisfactory induction of general anesthesia, the patient?s left ankle was prepped and draped. A small incision about 1 cm long was made in the previous incision. The lower screws were removed. Another small incision was made just lateral about 1 cm long. The upper screws were removed from the plate. Both wounds were thoroughly irrigated with copious amounts of antibiotic containing saline. Skin was closed in a layered fashion and sterile dressing applied. What CPT? code(s) should be reported? Selected Answer: Correct Answer: 20680-LT 20680-LT Response Feedback: When reporting the removal of hardware (pins, screws, nails, rods), the code is selected by fracture site, not the number of items removed or the number of incisions that are made. To report 20670 or 20680 more than once, there would need to be more than one fracture site involved. In this case, there is only one fracture site even though two incisions are made. We know the removal is deep because the screws were in the bone. In the CPT? Index, look for Removal/Implantation. The correct code is 20680. Modifier LT is appended to indicate the procedure is performed on the left side. • Question 23 0.6 out of 0.6 points An 11-month-old patient presented for emergency surgery to repair a severely broken arm after falling from a third story window. What qualifying circumstance code(s) may be reported in addition to the anesthesia code? Selected Answer: Correct Answer: 99100, 99140 99100, 99140 Response Feedback: Each of the qualifying circumstances codes identifies a different circumstance, and more than one may be appended when applicable, unless the reported anesthesia code already contains the risk factor. In this case, 99100 is assigned for extreme age of one year or younger and 99140 is assigned for emergency conditions. • Question 24 0.6 out of 0.6 points A patient is seen in the hospital?s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was performed and included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 24579-RT, S42.451 24579-RT, S42.451 A patient with congestive heart failure and chronic respiratory failure is placed on home oxygen. Prescribed treatment is 2 L nasal cannula oxygen at all times. A home care nurse visited the patient to assist with his oxygen management. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 99503, I50.9, J96.10 99503, I50.9, J96.10 Response Feedback: In the CPT? Index, look for Home Services/Respiratory Management, you are directed to code 99503. In the ICD-10-CM Index to Diseases, look for Failure/heart/congestive and you are directed to I50.9. Then look for Failure/respiration/chronic, you are directed to I96.10. Confirmation in the Tabular List confirms code selection. • Question 33 Dr. Inez discharges Mr. Blancos from the pulmonary service after a bout of pneumococcal pneumonia. She 0.6 out of 0.6 points spends 45 minutes at the bedside explaining to Mr. Blancos and his wife the medications and IPPB therapy she ordered. Mr. Blancos is a resident of the Shady Valley Nursing Home due to his advanced Alzheimer’s disease and will return to the nursing home after discharge. On the same day Dr. Inez re-admits Mr. Blancos to the nursing facility. She obtains a detailed interval history, does comprehensive examination and the medical decision making is moderate complexity. What is/are the appropriate evaluation and management code(s) for this visit? Selected Answer: Correct Answer: 99239, 99304 99239, 99304 Response Feedback: Hospital discharge is a time-based code. The documentation states that the physician spent 45 minutes discharging the patient. In the CPT® Index, look for Hospital Services/Discharge Services. Code 99239 is for 30 minutes or more. Upon discharge the patient was readmitted to a skilled nursing facility (SNF), where he is a resident. CPT® guidelines preceding the Nursing Facility Services codes state when a patient is discharged from the hospital on the same day and readmitted to a nursing facility both the discharge and readmission should be reported. Initial nursing facility care codes require the three key components to meet or exceed the requirements. Documentation tells us the physician provided a detailed history, comprehensive exam, and medical decision making was of moderate complexity. Code 99304 states the history and exam can be detailed or comprehensive. Our documentation shows it to be of moderate complexity, which meets the requirements. Because our history is only detailed, the requirements are not met for 99305. • Question 34 0.6 out of 0.6 points A patient with AIDS presents for follow up care. An NK (natural killer cell) total count is ordered. What CPT® code(s) is/are reported? Selected Answer: Correct Answer: 86357 86357 Response Feedback: Although there are a number of cells that attack viruses and other infectious organisms, NK cells are specifically identified by code 86357. In the CPT® Index, see Natural Killer (NK) Cells. • Question 35 0.6 out of 0.6 points An ICU diabetic patient who has been in a coma for weeks as the result of a head injury becomes conscious and begins to improve. The physician performs a tracheostomy closure and since the scar tissue is minimal, the plastic surgeon is not needed. What CPT? and ICD-10-CM codes are reported for this procedure? Selected Answer: Correct Answer: 31820, Z43.0, S06.9X5A, E11.9 31820, Z43.0, S06.9X5A, E11.9 Response Feedback: In the CPT? Index, look for Tracheostomy/Surgical Closure/without Plastic Repair. This directs you to code 31820. In the Index to Diseases, look up Attention to/tracheostomy, and report Z43.0. It is reported as a primary code since the closure of the tracheostomy is the reason for the procedure performed. Diabetic coma (E11.641) is not reported because the coma resulted from a head injury not diabetes. Coma would not be reported because it is resolved and the patient no longer has it. In the Index to Diseases, look up Injury/head directing you to S06.9X5A. Diabetes is reported with E11.9. • Question 36 0.6 out of 0.6 points A pregnant female is Rh negative and at 28 weeks gestation. The child?s father is Rh positive. The mother is given an injection of a high-titer Rho (D) immune globulin, 300 mcg, IM. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 90384, 96372, O36.0130, Z3A.28 90384, 96372, O36.0130, Z3A.28 Response Feedback: When a mother is Rh negative and the father is Rh positive, fetal hemolytic anemia may develop in the fetus. In the CPT? Index, look for Immune Globulins/Rho (D), you are directed to code range 90384-90386. A full dose is 300 mcg. Code 90384 is reported. According to the guidelines for Immune Globulins, an administration code is also reported. In the CPT? Index, look for Immune Globulin Administration/Injection directing you to 96372. The administration code for intramuscular injection is 96372. In the ICD-10-CM Index to Diseases, look for Rh antigen/incompatibility/affecting management of pregnancy, you are directed to O36.0130 and Z3A.28 • Question 37 0.6 out of 0.6 points A CT scan confirms improper ossification of cartilages in the upper jawbone and left side of the face area for a patient with facial defects. The CT is performed with contrast material in the hospital. What CPT® code is reported by an independent radiologist contracted by the hospital? Selected Answer: Correct Answer: 70487-26 70487-26 Response Feedback: The CT scan with contrast is performed on the maxillofacial area. The maxilla is the upper part of the jawbone. In the CPT® Index, look for CT Scan/with Contrast/Maxilla directing you to 70487. Modifier 26 is denotes the professional service. • Question 38 Magnetic resonance imaging of the chest is first done without contrast medium enhancement and then is performed with an injection of contrast. What CPT® code(s) is/are reported for the radiological services? 0.6 out of 0.6 points Selected Answer: Correct Answer: 71552 71552 Response Feedback: The patient is having magnetic resonance imaging in which the images were performed first without contrast and again following the injection of contrast. In the CPT® Index, look for Magnetic Resonance Imaging (MRI)/Chest directing you to 71550-71552. • Question 39 A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture while on 0.6 out of 0.6 points vacation. The patient was put under general anesthesia and the elbow was reduced and was stable. The medial elbow was held in the appropriate position and was reduced in acceptable position and elevated to treat non- surgically. A long arm splint was applied. The patient is referred to an orthopedist when she returns to her home state in a few days. What CPT? code(s) are reported? Selected Answer: Correct Answer: 24565-54-RT, 24605-54-51-RT 24565-54-RT, 24605-54-51-RT Response Feedback: In the CPT? Index, look for Fracture/Humerus/Epicondyle/Closed Treatment. You are referred to code 24560-24565. Review the codes to choose the appropriate service. 24565 is the correct code to report an epicondyle fracture manipulated (reduced) without a surgical incision to perform the procedure. In the CPT? Index, look for Dislocation/Elbow/Closed Treatment. You are referred to 24600, 24605. Review the codes to choose appropriate service. 24605 is the correct code because the patient was put under general anesthesia to perform the procedure. Modifier 54 is used to report the physician performed the surgical portion only. The patient is referred to an orthopedist for follow up or postoperative care. Modifier 51 is used to report multiple procedures were performed. Append modifier RT to indicate the procedure is performed on the right side. • Question 40 0.6 out of 0.6 points What temporary HCPCS Level II codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals? Selected Answer: Correct Answer: C codes C codes Response Feedback: Outpatient PPS (C1300-C9899) Guideline explains C codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals to report new technology procedures, medical devices, drugs, biologicals, and radiopharmaceuticals; that do not have other HCPCS codes assigned. Other facilities may report C-codes at their discretion. • Question 41 A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear medicine scan) and ultrasound and is found to have only one diseased parathyroid. A minimally invasive parathyroidectomy is performed. What CPT? and ICD-10-CM codes are reported for the surgery? 0.6 out of 0.6 points Selected Answer: Correct Answer: 60500, E21.0 60500, E21.0 43-year-old patient with a severe systemic disease is having surgery to remove an integumentary mass from his neck. What CPT® code and modifier are reported for the anesthesia service? Selected Answer: Correct Answer: 00300-P3 00300-P3 Response Feedback: Look in the CPT® Index for Anesthesia/Neck, which lists a range of codes or Anesthesia/Integumentary System/Neck which lists one code, 00300. A P3 modifier may be reported for a patient with severe systemic disease. • Question 46 70-year-old female presents with a complaint of right knee pain with weight bearing activities. She is also 0.6 out of 0.6 points developing pain at rest. She denies any recent injury. There is pain with stair climbing and start up pain. An AP, Lateral and Sunrise views of the right knee are ordered and interpreted. They reveal calcification within the vascular structures. There is decreased joint space through the medial compartment where she has near bone-on- bone contact, flattening of the femoral condyles, no fractures noted. The diagnosis is right knee pain secondary to underlying localized degenerative arthritis. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 73562, M17.11 73562, M17.11 Response Feedback: Look in the CPT? Index for X-ray/Knee 73560-73564, 73580. Code 73562 reports three views of one knee. The scenario is reported with one ICD-9-CM code. In the ICD-10-CM Index to Diseases (Alphabetical Index) look for Arthritis/degenerative, there is a see also note to go to Osteoarthrosis. Under Osteoarthrosis /localized, guides you to code, M17.11. • Question 47 0.6 out of 0.6 points What surgical status indicator represents the Surgical Global Package for endoscopic procedures (without an incision)? Selected Answer: Correct Answer: 000 000 Response Feedback: Per CMS Internet-only manuals (IOM) Medicare Claims Processing Manual – surgical status indicator 000 = Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable. • Question 48 0.6 out of 0.6 points A three-year-old is brought to the burn unit after pulling a pot of hot soup off the stove spilling onto to her body. She sustained 18% second degree burns on her legs and 20% third degree burns on her chest and arms. Total body surface area burned is 38%. What ICD-10-CM codes should be reported for the burns (do not include External Cause codes for the accident)? Selected Answer: Correct Answer: T21.31XA, T22.30XA, T24.209A, T31.32 T21.31XA, T22.30XA, T24.209A, T31.32 Response Feedback: ICD-10-CM Coding states to sequence first the code that reflects the highest degree of burn when more than one burn is present. In this case, the burns on her chest and arms are third degree and should be reported first. In the Index to Diseases, look for Burn/chest wall (anterior)/third degree referring you to code T22.30XA; Burn/arm(s)/ third degree guiding you to code T22.30XA; Burn/legs/second degree guiding you to code T24.209A. Refer to ICD-10-CM for instructions on assigning a code from category T31. • Question 49 0 out of 0.6 points A patient is diagnosed with an injury to the facial nerve. The surgeon performs a neurorrhaphy with nerve graft to restore innervation to the face using microscopic repair. The surgeon created a 2 cm incision over the damaged nerve, dissected the tissues and located the nerve. The damaged nerve was resected and removed. The 3.0 cm graft taken from the sural nerve was sutured to the proximal and distal ends of the damaged nerve. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 64886, 69990, S09.93XA 64885, 69990, S04.50XA • Question 50 0.6 out of 0.6 points A surgeon performs a high thoracotomy with resection of a single lung segment on a 57-year-old heavy smoker who had presented with a six-month history of right shoulder pain. An apical lung biopsy had confirmed lung cancer. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 32484, C34.10 32484, C34.10 Response Feedback: A segment of the lung is removed. In the CPT? Index, look up Removal/Lung/ Single Segment. This directs you to code 32484. We have a confirmed diagnosis of apical lung cancer, a cancer in an upper lobe, which is code C34.10. The term apical means the tip of a pyramidal or rounded structure, so apical lung cancer means the tumor/cancer is located at the top or upper lobe of the lung. We find this by looking in the Neoplasm Table under lung/upper lobe. In the primary malignant column we are directed to code C34.10. • Question 51 What three components are considered when Relative Value Units are established? 0.6 out of 0.6 points Selected Answer: Correct Answer: Physician work, Practice expense, Malpractice Insurance Physician work, Practice expense, Malpractice Insurance Response Feedback: Per CMS - Relative value units (RVUs) – RVUs capture the three following components of patient care: Physician work RVU, Practice Expense RVU, and Malpractice RVUs. • Question 52 0.6 out of 0.6 points When a patient has a condition that is both acute and chronic and there are separate entries for both, how is it reported? Selected Answer: Code both sequencing the acute first Correct Answer: Code both sequencing the acute first Response Feedback: According to the ICD-10-CM Section 1.B.10 coding guidelines, if the same condition is described as both acute (subacute) and chronic, and separate entries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) first. • Question 53 42-year-old patient presented to the urgent care center with complaints of slight dizziness. He had received 0.6 out of 0.6 points 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 physician detected no obvious abnormalities, but the patient was advised to see a cardiologist within the next 2 - 3 days. The physician interpreted and provided a report for the rhythm strip and Chest X-ray. What CPT? and ICD-10-CM codes are reported for the physician employed by the urgent care center who performed a Level 3 office visit in addition to the ancillary services? Selected Answer: Correct Answer: 99213-25, 71020, 93040, R42 99213-25, 71020, 93040, R42 Response Feedback: 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. The chest X-ray, 2 views, is reported with 71020. In the CPT? Index, look for X-ray/Chest. The EKG and rhythm strip are read, interpreted and a report is written by the physician. 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, you are referred to CPT? code 93040. The diagnosis is dizziness (R42). In the ICD-10-CM Index to Diseases, look for Dizziness. • Question 54 22-year-old developed gas gangrene (gas bacillus infection) and went into septic shock after a surgical procedure. What ICD-10-CM codes should be reported? 0 out of 0.6 points Selected Answer: Correct Answer: R65.20, T81.12XA, A48.0 A48.0, T81.12XA, R65.21 • Question 55 0.6 out of 0.6 points 72-year-old patient is undergoing a corneal transplant. An anesthesiologist is personally performing monitored anesthesia care. What CPT? code and modifier(s) are reported for anesthesia? Selected Answer: Correct Answer: 00144-AA-QS 00144-AA-QS Response Feedback: An anesthesiologist who is personally performing services reports the service with a modifier AA. The service performed was MAC (Monitored Anesthesia coverage); therefore, modifier QS is also reported. Modifier QS always follows the anesthesia provider modifier. • Question 56 The meaning of the root “blephar/o” is: 0.6 out of 0.6 points F11.23 • Question 63 A patient suffering from cirrhosis of the liver presents with a history of coffee ground emesis. The surgeon 0 out of 0.6 points diagnoses the patient with esophageal gastric varices. Two days later, in the hospital GI lab, the surgeon ligates the varices with bands via an UGI endoscopy. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 43400, K74.3, I85.10 43244,K74.60, I85.10 • Question 64 The patient is coming in for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and 0.6 out of 0.6 points lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest area and was continued on the right and the lateral trochanteric and posterior aspect of the medial thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a compression garment was applied. What CPT? code(s) are reported? Selected Answer: Correct Answer: 15877, 15879-50-51 15877, 15879-50-51 Response Feedback: In the CPT? Index, see Lipectomy/Suction Assisted or Liposuction. You are referred to 15876- 15879. Review the codes to choose the appropriate service. There were three body areas where liposuction was performed. Code 15877 covers the liposuction of the posterior iliac crest and abdomen. Code 15879 covers liposuction of the thighs. Modifier 50 is appended to code 15879 to indicate the left and right thighs were performed on. Modifier 51 is appended to indicate more than one procedure was performed in the same surgical session. • Question 65 0.6 out of 0.6 points A patient with hypertension presents to the same day surgery department for removal of her gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery. What ICD-10-CM codes are reported? Selected Answer: Correct Answer: Z01.810, K80.20, I10 Z01.810, K80.20, I10 Response Feedback: In the Index to Diseases, look for Examination/preoperative/cardiovascular Z01.818. Next, in the Index to Diseases, look up Cholelithiasis directing you to K80.20. Code I10 is for Hypertension and is indexed in the Hypertension Table. Correct codes and sequencing are Z01.810, K80.20 and I10. Sequencing of preoperative clearance first, next the reason for the surgery, last any other findings or diagnoses. • Question 66 Local Coverage Determinations are administered by ? 0.6 out of 0.6 points Selected Answer: Correct Answer: Each regional MAC Response Feedback: Each regional MAC Each Medicare Administrative Contractor (MAC) is then responsible for interpreting national policies into regional policies • Question 67 0.6 out of 0.6 points A patient is positioned on the scanning table headfirst with arms at the side for an MRI of the thoracic spine and spinal canal. A contrast agent is used to improve the quality of the images. The scan confirms the size and depth of a previously biopsied leiomyosarcoma metastasized to the thoracic spinal cord. What CPT? and ICD- 10-CM codes are reported? Selected Answer: Correct Answer: 72147, C79.49 72147, C79.49 Response Feedback: In the CPT? Index, look for Magnetic Resonance Imaging (MRI)/Diagnostic/Spine/Thoracic for the code range. Code 72147 describes and MRI of the thoracic spine with contrast. This is a secondary (metastasized) cancer to the thoracic spinal cord. It is indexed in the ICD-10- CM Index to Diseases (Alphabetical Index) under Leiomyosarcoma see Neoplasm, connective tissue, malignant. In the Neoplasm Table look for Neoplasm/connective tissue/cord (true) (vocal)/spinal (thoracic)/Malignant/Secondary (column) you are guided to code C79.49. • Question 68 What agency maintains and distributes HCPCS Level II codes? 0 out of 0.6 points Selected Answer: Correct Answer: AMA CMS • Question 69 0.6 out of 0.6 points Code 00940, anesthesia for vaginal procedures, has a base value of three (3) units. The patient was admitted under emergency circumstances, qualifying circumstance code 99140, which allows two (2) extra base units. A pre-anesthesia assessment was performed and signed at 2:00 a.m. Anesthesia start time is reported as 2:21 am, and the surgery began at 2:28 am. The surgery finished at 3:25 am and the patient was turned over to PACU at 3:36 am, which was reported as the ending anesthesia time. Using fifteen-minute time increments and a conversion factor of $100, what is the correct anesthesia charge? Selected Answer: Correct Answer: $1,000.00 $1,000.00 Response Feedback: Determining the base value is the first step in calculating anesthesia charges and payment expected. Time reporting is the second step. Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in either the operating room or an equivalent area. Pre-anesthesia assessment time is not part of reportable anesthesia time, as it is considered in the base value assigned. Anesthesia time ends when the anesthesiologist is no longer in personal attendance. Ending time is generally reported when the patient is safely placed under postoperative supervision, usually in the Post Anesthesia Care Unit (PACU) or equivalent area. Physical status modifiers and/or qualifying circumstances may also be added to the charge. In the scenario above, Base units equal three (3) plus two (2) emergency qualifying circumstances units (Base 3 + QC 2 = 5 units). Five (5) time units, in fifteen minute increments, is calculated by taking the anesthesia start time (2:21) and the anesthesia end time (3:36) and determining one hour 15 minutes (75/15 = 5) of total anesthesia time. Ten units (5 + 5 = 10) are then multiplied by the $100 conversion factor (10 X $100 = $1,000.00). • Question 70 The diagnostic statement indicates respiratory failure due to administering incorrect medication. Valium was administered instead of Xanax. What ICD-10-CM codes should be reported? 0 out of 0.6 points Selected Answer: Correct Answer: J96.90, T42.4X1A T42.4X4A, J96.90 • Question 71 0.6 out of 0.6 points 33 year-old male was admitted to the hospital on 12/17/XX from the ER, following a motor vehicle accident. His spleen was severely damaged and a splenectomy was performed. The patient is being discharged from the hospital on 12/20/XX. During his hospitalization the patient experienced pain and shortness of breath, but with an antibiotic regimen of Levaquin, he improved. The attending physician performed a final examination and reviewed the chest X-ray revealing possible infiltrates and a CT of the abdomen ruled out any abscess. He was given a prescription of Zosyn. The patient was told to follow up with his PCP or return to the ER for any pain or bleeding. The physician spent 20 minutes on the date of discharge. What CPT® code is reported for the 12/20 visit? Selected Answer: Correct Answer: 99238 99238 Response Feedback: The patient is being discharged from the hospital. Hospital discharge codes are determined based on the time documented the physician spent providing services to discharge the patient. The provider documented 20 minutes, which is reported with 99238. • Question 72 Patient undergoes a mitral valve repair with a ring insertion and an aortic valve replacement, on cardiopulmonary bypass. 0.6 out of 0.6 points Selected Answer: Correct Answer: 33426, 33405-51 33426, 33405-51 Response Feedback: 33426 reports mitral valve valvuloplasty with a prosthetic ring, and 33405 reports an aortic valve replacement with cardiopulmonary bypass. Modifier 51 is required on the second procedure to indicate multiple procedures performed during the same setting. Look in the CPT? Index for Valvuloplasty/Mitral Valve, you are referred to 33425-33427. You can find the aortic valve replacement in the Index under Replacement/Aortic Valve. You must examine the range of codes given for this procedure. • Question 73 When are providers responsible for obtaining an ABN for a service not considered medically necessary? 0.6 out of 0.6 points Selected Answer: Correct Answer: Prior to providing a service or item to a beneficiary Selected Answer: Correct Answer: 23350, 73040-26 23350, 73040-26 Response Feedback: Contrast material is being injected into the shoulder joint for a radiographic look of the joint and internal structures (arthrogram). Look in the CPT? Index for Arthrography/Shoulder/Injection for 23350. In the Musculoskeletal Section, there is a parenthetical note under code 23350 that states to use code 73040 for radiographic arthrography. Modifier 26 is required to indicate the radiologic professional service. • Question 81 Lacrimal glands are responsible for which of the following? 0.6 out of 0.6 points Selected Answer: Correct Answer: Production of tears Production of tears • Question 82 0.6 out of 0.6 points A 37 year old woman presents with abdominal pain, bleeding unrelated to menses and an abnormal pap showing LGSIL (low grade squamous intraepithelial lesion). Treatment is hysteroscopy with thermoablation of the endometrium and cryocautery of the cervix. This is performed without difficulty. What are the CPT? and ICD- 10-CM codes reported for this procedure? Selected Answer: Correct Answer: 58563, 57511-51, R87.612 58563, 57511-51, R87.612 Response Feedback: The endometrium is destroyed with thermoablation under the guidance of the hysteroscope. In the CPT? Index, look for Hysteroscopy/Ablation/Endometrial, guiding you to code 58563. The abnormal pap smear (LGSIL) is treated with cryocautery. In the CPT? Index, look for Cervix/Cauterization/Cryocautery leading you to code 57511. This diagnosis is indexed in the ICD-10-CM Index to Diseases under Findings/Papanicolaou (smear)/cervix/with low grade squamous intraepithelial lesion (LGSIL) guiding you to code R87.612. • Question 83 A 56-year-old woman with biopsy-proven carcinoma of the vulva with metastasis to the lymph nodes has complete removal of the skin and deep subcutaneous tissues of the vulva in addition to removal of her 0.6 out of 0.6 points inguinofemoral, iliac and pelvic lymph nodes bilaterally. The diagnosis of carcinoma of the vulva with 7 of the nodes also positive for carcinoma is confirmed on pathologic review. What are the CPT? and ICD-10-CM codes reported for this procedure? Selected Answer: Correct Answer: 56640-50, C51.9, C77.4 56640-50, C51.9, C77.4 Response Feedback: The patient has her vulva removed to treat malignancy (vulvectomy, radical complete). She also has removal of skin and deep subcutaneous tissue from of the vulva, inguinofemoral, iliac and pelvic lymph nodes. In the CPT? Index, look for Vulvectomy/Radical/Complete/ with Inguinofemoral, Iliac, and Pelvic Lymphadenectomy giving you code 56640. All these parts being removed are found in the code description for code 56440. There is a parenthetical note under this code stating: For bilateral procedure, report 56640 with modifier 50. This scenario needs two ICD-10-CM codes. The first one is to show the carcinoma of the vulva. This is indexed in the ICD-10-CM Index to Diseases under, Neoplasm (table)/Vulva/Malignant/Primary (column) guiding you to code C51.9. The second diagnosis code is for the metastasis of the cancer to the lymph nodes. This is indexed in the Neoplasm Table under subinguinal/Malignant/Secondary (column), guiding you to code C77.4. • Question 84 0.6 out of 0.6 points A patient with hypertensive end stage renal failure, stage V, and secondary hyperparathyroidism is evaluated by the physician and receives peritoneal dialysis. The physician evaluates the patient once before dialysis begins. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 90945, I12.0, N18.6, N25.81 90945, I12.0, N18.6, N25.81 Response Feedback: In the CPT? Index, look for Dialysis/Peritoneal, you are directed to codes 90945, 90947 & 4055F (an outcomes measurement code). The peritoneal dialysis with one physician evaluation is reported with 90945. A combination code is reported for a patient with hypertension and renal failure. The two conditions are not reported separately. In the Hypertension Table, look for Hypertension/with/chronic kidney disease/stage V or end stage renal disease/Unspecified column directs you to 403.91. The instructions for category 403 state to use an additional code to identify the stage of CKD. In the ICD-10-CM Index to Diseases, look for Disease/renal/end- stage, directing you to N18.6 for end stage renal disease. The patient also has secondary hyperparathyroidism reported with N25.81, found in the Index to Diseases under Hyperparathyroidism. • Question 85 0.6 out of 0.6 points 60-year-old woman is seeking help to quit smoking. She makes an appointment to see Dr. Lung for an initial visit. The patient has a constant cough due to smoking and some shortness of breath. No night sweats, weight loss, night fever, CP, headache, or dizziness. She has tried patches and nicotine gum, which has not helped. Patient has been smoking for 40 years and smokes 2 packs per day. She has a family history of emphysema. A limited three system exam was performed. Dr Lung discussed in detail the pros and cons of medications used to quit smoking. Counseling and education was done for 20 minutes of the 30 minute visit. Prescriptions for Chantrix and Tetracylcine were given. The patient to follow up in 1 month. A chest X-ray and cardiac work up was ordered. Select the appropriate CPT code(s) for this visit. Selected Answer: Correct Answer: 99203 99203 Response Feedback: Patient is coming to the doctor’s office for help to quit smoking. The patient is new. The physician documents that 20 minutes of the 30 minute visit was spent counseling the patient. E/M Guidelines identify when time is considered the key or controlling factor to qualify for a E/M service. When counseling and/or coordination of care is more than 50% face to face time in the office or other outpatient setting, time may be used to determine the level of E/M. The correct code is 99203 based on the total time of the visit which is 30 minutes. • Question 86 0.6 out of 0.6 points Subjective: Six-year-old girl twisted her arm on the playground. She is seen in the ED complaining of pain in her wrist. Objective: Vital Signs: stable. Wrist: Significant tenderness laterally. X-ray is normal Assessment: Wrist sprain Plan: Over the counter Anaprox. give twice daily with hot packs. Recheck if no improvement. What is the E/M code for this visit? Selected Answer: Correct Answer: 99281 99281 Response Feedback: Emergency Department services must meet or exceed three of the three key components. The physician performed a problem focused history (brief HPI, no ROS, no PFSH), a problem focused exam (one body area is examined), and low MDM (for one new problem to the examiner, one data point for the X-ray, and low level of risk). The problem focused history and exam lead us to select 99281 as the appropriate code. • Question 87 0.6 out of 0.6 points 41-year-old male is in his doctor’s office for a follow up of an abnormality, which was noted, on an abdominal CT scan. He is to have a chest X-ray due to chest tightness. He otherwise states he feels well and is here to go over the results of his chest X-ray (PA and Lateral) performed in the office and the CT scan performed at the diagnostic center. The results of the chest X-ray were normal. CT scan was sent to the office and the physician interpreted and documented that the CT scan of the abdomen showed a small mass in his right upper quadrant. What CPT® codes are reported for the doctor’s office radiological services? Selected Answer: Correct Answer: 71020, 74150-26 71020, 74150-26 Response Feedback: The chest X-ray was taken in the doctor’s office and interpreted. This means the doctor’s office can bill for the code without appending a modifier. Modifier 26 is appended to the CT scan code, because, it was performed at another site and the physician only interpreted the image. Look in the CPT® Index for X-ray/Chest directing you to 71010-71035, and CT Scan/without Contrast/Abdomen directing you to 74150, 74176, 74178. • Question 88 Which of the following is true about the tympanic membrane? 0.6 out of 0.6 points Selected Answer: Correct Answer: It separates the external ear from the middle ear It separates the external ear from the middle ear • Question 89 0.6 out of 0.6 points A 3-year-old girl is playing with a marble and sticks it in her nose. Her mother is unable to dislodge the marble so she takes her to the physician?s office. The physician removes the marble with hemostats. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 30300, T17.1XXA 30300, T17.1XXA Response Feedback: Since the marble is a foreign body, look in the CPT? Index for Nose/Removal/Foreign Body. Here you are directed to use code 30300. For the ICD-10-CM code first look up in the Index to Diseases Foreign Body/entering through orifice/nose or nostril. This directs us to code T17.1XXA..Verify codes in the Tabular List. Medicine/Diagnostic/Kidney/Vascular Flow directing you to code range 78701-78709. • Question 97 0.6 out of 0.6 points The patient was taken to the operating room and placed in the dorsal lithotomy position, prepped and draped in the usual sterile fashion. A vertical paramedian incision was made along the left side of the umbilicus from the symphysis and taken up to above the umbilicus. This incision was carried down to the rectus muscles, which were separated in the midline. The peritoneal cavity was entered with findings as described. The ascitic fluid was removed and hand-held retractors were used to assist in surgical exposure. The tumor was resected from the hepatic flexure into the mid transverse colon. The resection was extended into the left upper quadrant and the attachments were also clamped, cut and suture ligated with 2-0 silk sutures in a stepwise fashion until mobilization of the tumor mass could be brought medial and hemostasis was obtained. Attempts to find a dissection plane between the tumor mass and the transverse colon were unsuccessful as it appeared that the tumor mass was invading into the wall of the bowel with extrinsic compression and distortion of the bowel lumen. Given the mass could not be resected without removal of bowel, attention was directed to mobilization of the splenic flexure. Retroperitoneal dissection was started in the pelvis and continued along the left paracolic gutter. The ligamentous and peritoneal attachments were taken down with Bovie cautery in a stepwise fashion around the splenic flexure of the colon until the entire left colon was mobilized medially. Similar steps were then carried on the right side as the right colon and hepatic flexure were mobilized. The peritoneal and ligamentous attachments were taken down with Bovie cautery. Vascular attachments were clamped, cut, and suture ligated with 2-0 silk until the right colon was mobilized satisfactorily. The GIA stapler was introduced and fired at both ends to dissect the tumorous bowel free. The bowel was delivered off the operative field. Attention was then directed towards re-anastomosis of the colon. Linen-shod clamps were used to gently clamp the proximal and distal segments of the large bowel. The staple line was removed with Metzenbaum scissors, and the colon lumen was irrigated. The silk sutures were used to divide the circumference of the bowel into equal thirds, and the proximal and distal edges of the bowel were reapproximated with silk sutures. The posterior segment of the bowel was then retracted and secured with a TA stapler, ensuring a full thickness bowel wall insertion into the staple line. The additional two thirds were also isolated and, with the TA stapler, clamped, ensuring that all layers of the bowel wall were incorporated into the anastomosis. A third staple line was fired and the integrity of the anastomosis was checked. First complete hemostasis was noted. There was well beyond a finger width lumen within the large bowel. The linen-shod clamps were released and gas and bowel fluid were moved through the anastomosis aggressively with intact staple line, no leakage of gas or fluid. The abdomen was then irrigated and water was left over the anastomosis. The anastomosis was manipulated with no extravasation of air. The abdomen and pelvis were then irrigated aggressively. The Mesenteric trap was then reapproximated with interrupted 3-0 silk suture ligatures. All sites were inspected and noted to be hemostatic. Attention was directed towards closing. What is the correct CPT? and ICD-10-CM coding for this report? Selected Answer: Correct Answer: 44140, 44139, C18.3, C18.8 44140, 44139, C18.3, C18.8 Response Feedback: CPT? codes 44140 and 44139 accurately represent the tumor resected from the hepatic flexure and transverse colon (partial colectomy 44140) and the mobilization of the splenic flexure (44139) due to inability to resect the mass without removal of the bowel. In the CPT? Index, look for Colectomy/Partial directing you to 44140. For the second code, in the CPT? Index, look for Colectomy/Partial/with Splenic Flexure Mobilization directing you to 44139. ICD-10-CM codes are C18.3, in the Neoplasm Table, look for hepatic/flexure (colon), in the Malignant Primary column directing you to C18.3. C18.8 in the Neoplasm Table, see intestine, intestinal/large/contiguous/sites, in the Malignant Primary column directing you to C18.8. • Question 98 An anesthesiologist is medically supervising six cases concurrently. What modifier is reported for the anesthesiologist’s service? 0.6 out of 0.6 points Selected Answer: AD Correct Answer: AD Response Feedback: An anesthesiologist who is medically supervising reports anesthesia service separately from the CRNA. The anesthesia modifier for the anesthesiologist depends on the number of concurrent cases. There are six concurrent cases; therefore, the appropriate modifier to report is AD for the anesthesiologist. • Question 99 0.6 out of 0.6 points The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a piece of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it, the mass was removed. There was a capsule around this, containing what appeared to be a black- colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal, he wanted me to, so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 10121, M79.5, Z18.10 10121, M79.5, Z18.10 Response Feedback: In CPT? index, see Integumentary System/Removal/Foreign Body, you are directed to code range 10120-10121. The surgeon indicated in the note they considered this incision and removal of foreign body to be complicated leading us to code 10121. In the ICD-10-CM Index to Diseases, see Foreign body/retained/fragments/subcutaneous tissue, you are directed to M79.5. There is no mention of granuloma of the skin making L92.3 incorrect. The patient did not have an acute laceration with a foreign body in an open wound. In the Tabular List, instructions for M79.5 state to use an additional code from Z18.0 to Z18.10 to identify the foreign body. Z18.10 indicates a retained metal fragment. • Question 100 0.6 out of 0.6 points The patient presents to the office for CMG (cystometrogram). Complex CMG cystometrogram with voiding pressure studies is done, intraabdominal voiding pressure studies, and complex uroflow are also performed. What CPT? code(s) is/are reported for this service? Selected Answer: Correct Answer: 51728, 51797, 51741-51 51728, 51797, 51741-51 Response Feedback: In the CPT? Index, look for Cystometrogram directing you to 51725-51729. Code 51728 describes a Complex cystometrogram with voiding pressure studies. In the CPT? Index, look for Voiding Pressure Studies/Abdominal directing you to 51797. Add-on code 51797 is used for intra-abdominal voiding pressure studies. The parenthetical directs us to use 51797 in conjunction with 51728 or 51729. Code 51741 is used to report the complex uroflometry. The procedures were performed in the office setting, under the direct supervision of the physician and you would not use modifier 26 for the professional component. When multiple procedures are performed in the same investigative session modifier 51 should be appended. • Question 101 0.6 out of 0.6 points The physician performs an iridotomy using laser on both eyes for chronic angle closure glaucoma; procedure includes local anesthesia. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 66761-50, H40.2230 66761-50, H40.2230 Response Feedback: In the CPT? Index, look for Iridotomy/by Laser Surgery directing you to 66761. Code 66761 describes the use of laser surgery to perform an iridotomy for glaucoma. Modifier 50 would be used to identify the procedure is performed on both eyes. In ICD-10-CM Index to Diseases, look for Glaucoma/angle closure/chronic directs you to code H40.2230 and is verified in the Tabular List as Chronic angle-closure glaucoma. • Question 102 Which of the following conditions results from an injury to the head? The symptoms include headache, dizziness and vomiting. 0.6 out of 0.6 points Selected Answer: Correct Answer: Concussion Concussion • Question 103 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 should be reported? 0 out of 0.6 points Selected Answer: Correct Answer: V5140, H90.3, Z46.1 V5261, Z46.1, H90.3 • Question 104 Which statement is TRUE regarding the Instruction for use of the CPT® codebook? 0.6 out of 0.6 points Selected Answer: Correct Answer: Response Feedback: Select the name of the procedure or service that accurately identifies the service performed. Select the name of the procedure or service that accurately identifies the service performed. CPT® Instructions for the use of the CPT® codebook include “select the name of the procedure or service that accurately identifies the service performed.” • Question 105 0.6 out of 0.6 points A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This attempt was unsuccessful. The physician then dilates the esophagus transendoscopically using a balloon (25mm). What CPT? code(s) is/are reported? Selected Answer: Correct Answer: 43220 43220 Selected Answer: Correct Answer: 19318-50, 19350-59-50 19318-50, 19350-59-50 Response Feedback: With breast reduction surgery ?reduction mammaplasty? or ?mammoplasty? (both terms are used), in the CPT? Index, see Reduction/Mammoplasty, we are lead to CPT? 19318. Because this is a unilateral code per CPT?, append modifier 50. Additionally, the operative report indicates because so much breast tissue was removed the surgeon had to create free nipple grafts to recreate the nipple. In the CPT? see Reconstruction/Breast/Nipple, you are directed to code range 19350-19355. 19350 is the correct code. Normally, with reduction mammaplasty the patient?s nipple is moved into place after removal of the breast tissue. The Nipple reconstruction is normally bundled into the reduction surgery making it necessary to append modifier 59. • Question 111 Myocardial Perfusion Imaging—Office Based Test Indications: Chest pain. 0.6 out of 0.6 points Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous cardiolite. At peak exercise, 30 mCi of intravenous cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion. Findings: This is a technically fair study. There were no stress induced electrocardiographic changes noted. There are no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%. Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. What CPT® code(s) is/are reported? Selected Answer: Correct Answer: 78451, A9500 78451, A9500 Response Feedback: Tomographic myocardial perfusion imaging was performed. In this procedure the patient receives an intravenous injection of a radionuclide, which localizes in nonischemic tissue. SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. In the CPT® Index, look for Heart/Myocardium/Perfusion Study 78451-78454. A single study SPECT was performed, 78451. This was performed in the office; therefore, report the cardiolite. Using your HCPCS codebook go to the Table of Drugs and Biologicals and look for Cardiolite A9500. The code A9500 reports the dose per study • Question 112 0.6 out of 0.6 points The surgeon performed an insertion of an intraocular lens prosthesis discussed with the patient before the six- week earlier cataract removal (by the same surgeon). What CPT? code is reported? Selected Answer: Correct Answer: 66985-58 66985-58 Response Feedback: 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. • Question 113 What does “non-facility” describe when calculating Physician Fee Schedule payments? 0.6 out of 0.6 points Selected Answer: Correct Answer: non-hospital owned physician practices non-hospital owned physician practices Response Feedback: “Non-facility” location calculations are for private practices or non-hospital-owned physician practices. Reimbursement is higher for private practices because the practice incurs the full expense of providing the service. • Question 114 CPT® Category III codes are reimbursable at what level of reimbursement? 0.6 out of 0.6 points Selected Answer: Correct Answer: Response Feedback: Reimbursement, if any, is determined by the payer Reimbursement, if any, is determined by the payer Per AMA, no relative value units (RVUs) are assigned to these codes. Payment for these services or procedures is based on the policies of payers. • Question 115 0.6 out of 0.6 points A female patient fell on the floor as she got out of bed. She has no known head trauma. She noticed some slight stiffness in her joints and weakness in her lower extremity muscles, with slight stiffness in her arm joints. The physician decided to test for possible multiple sclerosis (MS). She was sent to a clinic providing somatosensory studies. The testing included upper and lower limbs. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 95938, M62.81, M25.60 95938, M62.81, M25.60 Response Feedback: In the CPT? Index, look for Somatosensory Testing. Studies are reported based on location. In this case the upper limbs and lower limbs were performed guiding you to code 95938. Since MS has not been confirmed, the weakness in her muscles (M62.81) and stiffness of the joints (M25.60) should be reported. In the Index to Diseases, look for Weakness/muscle (generalized). Also, look for Stiffness, joint/multiple sites. • Question 116 0.6 out of 0.6 points 66-year-old female is admitted to the hospital with a diagnosis of stomach cancer. The surgeon performs a total gastrectomy with formation of an intestinal pouch. Due to the spread of the disease, the physician also performs a total en bloc splenectomy. What CPT? codes are reported? Selected Answer: Correct Answer: a 43622, 38102 43622, 38102 Response Feedback: In the CPT® Index, look for Anesthesia/Spinal Instrumentation. An anesthesiologist who is medically directing care reports their service separately from the CRNA, depending on the number of concurrent cases. Since there was only one case, the appropriate modifiers to report are QY for the physician and QX for the CRNA. A QZ modifier would indicate the case was performed by a non-medically directed CRNA. • Question 123 0.6 out of 0.6 points 55-year-old male has had several episodes of tightness in the chest. His physician ordered a PTCA (percutaneous transluminal coronary angioplasty) of the left anterior descending coronary artery. The procedure revealed atherosclerosis in the native vessel. It was determined a stent would be required to keep the artery open. The stent was inserted during the procedure. Selected Answer: Correct Answer: 92928-LD, I25.10 92928-LD, I25.10 Response Feedback: PTCA is a percutaneous transluminal coronary angioplasty. In the CPT? Index, look for Transcatheter/Placement/Intravascular Stents directing you to 92928-92929. In this case, the angioplasty was followed by stent placement in the LD. Only one procedure can be performed in each of the coronary vessels (LC, LD, and RC). The hierarchy beginning with the lowest is angioplasty, stent, atherectomy, atherectomy & stent placement. Only the stent placement (92928) is reported. Modifier LD indicates the left anterior descending coronary artery. In ICD-10-CM Index to Diseases, look for atherosclerosis and you are directed to see arteriosclerosis. Under Arteriosclerosis/coronary/native artery, you are directed to I25.10. Verification in the Tabular List confirms code selection. • Question 124 0.6 out of 0.6 points The code for sweat collection by iontophoresis can be found in what section of the Pathology Chapter of CPT®? Selected Answer: Correct Answer: Other Procedures Other Procedures Response Feedback: The Other Procedures section includes codes for a number of miscellaneous procedures. Many of them are for analysis of substances found in other body substances and tissues. There are also a number of tests for specific conditions and diseases. In the CPT® Index, look for Iontophoresis/Sweat Collection referring you to 89230. Code 89230 is under the heading, Other Procedures. • Question 125 A gonioscopy is an examination of what part of the eye: 0.6 out of 0.6 points Selected Answer: Correct Answer: Anterior chamber of the eye Anterior chamber of the eye • Question 126 45-year-old established, female patient is seen today at her doctor’s office. She is complaining of severe 0.6 out of 0.6 points dizziness and feels like the room is spinning. She has had palpitations on and off for the past 12 months. For the ROS, she reports chest tightness and dyspnea but denies nausea, edema, or arm pain. She drinks two cups of coffee per day. Her sister has WPW (Wolff-Parkinson-White) syndrome. An extended exam of five organ systems are performed. This is a new problem. An EKG is ordered and labs are drawn, and the physician documents a moderate complexity MDM. What CPT® code should be reported for this visit? Selected Answer: Correct Answer: 99214 99214 Response Feedback: This is a follow up visit indicating an established patient seen in the clinic. In the CPT® Index, look for Established Patient/Office Visit. The code range to select from is 99211-99215. For this code range, two of three key components must be met. History Detailed (HPI-Extended; ROS- Extended, PFSH-Complete), Exam – Detailed, MDM Moderate. 99214 is the level of visit supported. • Question 127 0.6 out of 0.6 points Code 00350 Anesthesia for procedures on the major vessels of the neck; not otherwise specified has a base value of ten (10) units. The patient is a P3 status, which allows one (1) extra base unit. Anesthesia start time is reported as 11:02 am, and the surgery began at 11:14 am. The surgery finished at 12:34 am and the patient was turned over to PACU at 12:47 am, which was reported as the ending anesthesia time. Using fifteen-minute time increments and a conversion factor of $100, what is the correct anesthesia charge? Selected Answer: Correct Answer: $1,800.00 $1,800.00 Response Feedback: Determining the base value is the first step in calculating anesthesia charges and payment expected. Time reporting is the second step. Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in either the operating room or an equivalent area. Anesthesia time ends when the anesthesiologist is no longer in personal attendance. Ending time is generally reported when the patient is safely placed under postoperative supervision, usually in the Post Anesthesia Care Unit (PACU) or equivalent area. Physical status modifiers and/or qualifying circumstances may also be added to the charge. In the scenario above, Base units equal ten (10) plus one (1) physical status modifier unit (Base 10 + PS 1 = 11 units). Seven (7) time units, in fifteen minute increments, is calculated by taking the anesthesia start time (11:02) and the anesthesia end time (12:47) and determining one hour 45 minutes (105/15 = 7) of total anesthesia time. Eighteen units (11 + 7 = 18) are then multiplied by the $100 conversion factor (18 X $100 = $1,800.00). • Question 128 0.6 out of 0.6 points A patient has partial removal of his lung. The surgeon also biopsies several lymph nodes in the patient’s chest which are examined intraoperatively by frozen section and sent with the lung tissue for Pathologic examination. The pathologist also performs a trichrome stain. What CPT® codes are reported for the lab tests performed? Selected Answer: Correct Answer: 88309, 88305, 88313, 88331 88309, 88305, 88313, 88331 Response Feedback: Separately code for each, the lung examination (all lung specimens are 88309), the lymph node biopsy (88305), the frozen section (first specimen 88331), and for the special trichrome stain (88313). In the CPT® Index, see Pathology/Surgical/Level IV and Level VI. Also, see Surgical Pathology//Consultation/Intraoperative directing you to code range 88329-88334. Response Feedback: Presumptive identification identifies microorganisms like viruses by observing growth patterns and other characteristics. • Question 136 0.6 out of 0.6 points A Grade I, high velocity open right femur shaft fracture was incurred when a 15-year-old female pedestrian was hit by a car. 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? Selected Answer: 27506-RT, 11012-51-RT, S72.301B, V03.10XA 27506-RT, 11012-51-RT, S72.301B, V03.10XA Correct Answer: 27506-RT, 11012-51-RT, S72.301B, V03.10XA 27506-RT, 11012-51-RT, S72.301B, V03.10XA Response Feedback: This was an open femoral shaft fracture, S72.301B, thus eliminating C and D. In the ICD-10- CM Index to Diseases, look up Fracture/femur/shaft/open directing you to S72.301B. The E code is indexed in the Index to External Causes under Collision/motor vehicle/and/pedestrian (conveyance) referring you to subcategory code V03.10XA. For the first procedure code, look in the CPT? Index under Fracture/Open Treatment directing you to several codes. In reviewing the codes, 27506 is the correct choice. The debridement prior to the intramedullary rodding is reported with 11012 which is found in the CPT? Index under Debridement/Bone/with Open Fracture and/or Dislocation which eliminates choice A. Modifier RT is appended to indicate the procedure is performed on the right side. • Question 137 A woman with a long history of rectocele and perineal scarring from multiple episiotomies develops a 0.6 out of 0.6 points rectovaginal fistula with perineal body relaxation. She has transperineal repair with perineal body reconstruction and plication of the levator muscles. What are the CPT? and ICD-10-CM codes reported for this procedure? Selected Answer: Correct Answer: 57308, N82.3, N81.89 57308, N82.3, N81.89 Response Feedback: The physician is closing a rectovaginal fistula (abnormal passage between the rectum and vagina). The repair is performed by a transperineal approach by reconstructing the perineal body (pertaining to the vulva and anus area between the thighs) by using a levator muscle plication. In the CPT? Index, look for Fistula/Closure/Rectovaginal giving you codes 57300, 57305, 57307- 57308. Code 57308 is closure of rectovaginal fistula transperineal approach, with perineal body reconstruction, with or without levator plication. Two diagnoses are reported for this scenario. The first diagnosis is rectovaginal fistula. This is indexed in the ICD-10-CM Index to Diseases under, Fistula/rectovaginal guiding you to code N82.3. Your second diagnosis is perineal scarring. This is indexed under, Scarring/labia guiding you to code N81.89. • Question 138 0.6 out of 0.6 points A physician extracts a tumor, using a frontal approach, from the lacrimal gland of a 14-year-old patient. What CPT? and ICD-10-CM codes are reported? Selected Answer: 68540, D49.89 Correct Answer: 68540, D49.89 Response Feedback: In the CPT? Index, look for Lacrimal Gland/Tumor/Excision/Frontal Approach directs you to 68540. This code is used to describe the excision for a lacrimal gland tumor using the frontal approach. In ICD-10-CM Index to Diseases, look for Tumor directing you to see also Neoplasm, by site, unspecified nature. In the Neoplasm table locate lacrimal gland and select the code from the Unspecified column. Verify code D49.89 in the Tabular List. • Question 139 0.6 out of 0.6 points A patient with hypertensive heart disease is now experiencing accelerated hypertension due to papillary muscle dysfunction. What ICD-10-CM code(s) should be reported? Selected Answer: Correct Answer: I11.9 I11.9 Response Feedback: Per ICD-10-CM guidelines, Heart conditions are assigned from category I11 when a casual relationship is stated (due to hypertension or implied (hypertensive). The same heart conditions with hypertension, but without a stated causal relationship, are coded separately. In the Index to Diseases (Alphabetic Index), look for Hypertension/accelerated (See also Hypertension, by type, malignant); Hypertension/heart/malignant guides you to code I11.9. This will be the only code to report since there is a casual relationship between the hypertension and the heart disease. • Question 140 The radiology term “fluoroscopy” is described as: 0.6 out of 0.6 points Selected Answer: Correct Answer: An X-ray procedure allowing the visualization of internal organs in motion An X-ray procedure allowing the visualization of internal organs in motion • Question 141 0 out of 0.6 points 64-year-old patient came to the emergency department complaining of chest pressure. The physician evaluated the patient and ordered a 12 lead EKG. Findings included signs of acute cardiac damage. Appropriate initial management was continued by the ED physician who contacted the cardiologist on call in the hospital. Admission to the cardiac unit was ordered. No beds were available in the cardiac unit and the patient was held in the ED. The cardiologist left the ED after completing the evaluation of the patient. Several hours passed and the patient was still in the ED. During an 80-minute period, the patient experienced acute breathing difficulty, increased chest pain, arrhythmias, and cardiac arrest. The patient was managed by the ED physician during this 80-minute period. Included in the physician management were a new 12 lead EKG, endotracheal intubation and efforts to restore the patient’s breathing and circulation for 20 minutes. CPR was unsuccessful, the patient was pronounced dead after a total of 44 minutes critical care time, exclusive of other separately billable services. What CPT® codes are reported by the physician? Selected Answer: Correct Answer: 99291-25, 31500, 93000, 92950 99291-25, 31500, 92950 • Question 142 A young child is taken to the OR to reduce a meconium plug bowel obstruction. A therapeutic enema is 0.6 out of 0.6 points 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?