TEXAS PRINCIPLES 1 EXAM PRACTICE QUESTIONS WITH ANSWERS 100% CORRECT – LATEST UPDATE 2021/, Exams of Nursing

Download TEXAS PRINCIPLES 1 EXAM PRACTICE QUESTIONS WITH ANSWERS 100% CORRECT – LATEST UPDATE 2021/ and more Exams Nursing in PDF only on Docsity! ENGLISH EN2150 EXAM ALL CORRECT/VERIFIED QUIZ & ANS LATEST UPDATE RATED • Question 1 Which part of the brain controls blood pressure, heart rate and respiration? Selected Answer: Correct Answer: Medul la Medul la • 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 Respons e Feedbac k: 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; B u rn/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 Respons e Feedbac k: Selected Answer: Correct Answer: After a denial has been received from Medicare Prior to providing a service or item to a beneficiary • Question 8 67-year-old gentleman with localized prostate cancer will be receiving brachytherapy treatment. Following 1.2 out of 1.2 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 Respons e Feedbac k: 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 9 HCPCS Level II includes code ranges which consist of what type of codes? Selected Answer: 1.2 out of 1.2 points Correct Answer: Respons e Feedbac k: Permanent national codes, miscellaneous codes, and temporary national codes. Permanent national codes, miscellaneous codes, and temporary national codes. HCPCS Level II codes consist of permanent national codes, miscellaneous codes, and temporary national codes. • Question 10 1.2 out of 1.2 points What surgical status indicator represents the Surgical Global Package for endoscopic procedures (without an incision)? Selected Answer: Correct Answer: 000 000 Respons e Feedbac k: 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 11 1.2 out of 1.2 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 Respons e Feedbac k: 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 12 1.2 out of 1.2 points An elderly female presented with increasing pain in her left dorsal foot. The patient was brought to the operating room, and placed under general anesthesia. A curvilinear incision was centered over the lesion itself. Soft tissue dissection was carried through to the ganglion. The ganglion was clearly identified as a gelatinous material. It was excised directly off the bone and sent to pathology. There was noted to be a large bony spur at the level of the head of the 1st metatarsal. Using double action rongeurs, the spur itself was removed and sequestrectomy was performed. A rasp was utilized to smooth the bone surface. The eburnated bony surface was then covered, utilizing bone wax. The wound was irrigated and closed in layers. What CPT? codes are reported? Selected Answer: Correct Answer: E y e lid Eyeli d • 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 Respons e Feedbac k: 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: 9 47140, 47146, 47147, 47135 47140, 47146, 47147, 47135  Respons e Feedbac k: 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 Respons e Feedbac k: 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: Selected Answer: Correct Answer: 10121, M79.5, Z18.10 10121, M79.5, Z18.10 Respons e Feedbac k: 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 Respons e Feedback: A n a n e sthesia 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 27 1.2 out of 1.2 points An infant is born six weeks premature in rural Arizona and the pediatrician in attendance intubates the child and administers surfactant in the ET tube while waiting in the ER for the air ambulance. During the 45 minute wait, he continues to bag the critically ill patient on 100 percent oxygen while monitoring VS, ECG, pulse oximetry and temperature. The infant is in a warming unit and an umbilical vein line was placed for fluids and in case of emergent need for medications. How is this coded? Selected Answer: Correct Answer: 99291, 31500, 36510, 94610 99291, 31500, 36510, 94610 Respons e Feedbac k: When neonatal services are provided in the outpatient setting, Inpatient Neonatal Critical Care guidelines direct the coder to use critical care codes 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes and 99292 … each additional 30 minutes (List separately in addition to code for primary service). Care is documented as lasting 45 minutes with the physician in constant attendance. The physician also administered intrapulmonary surfactant (94610), placed an umbilical vein line (36510) and intubated the patient (31500). These services can be separately billed as they are not included in 99291. • Question 28 Dr. Inez discharges Mr. Blancos from the pulmonary service after a bout of pneumococ cal pneumonia. She 1.2 out of 1.2 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 Respons e Feedbac k: 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. 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 y o u t o c o d e 3 0 5 2 0 . T h e f r a c t u r i n g of the turbinates is inclusive to the procedures and not reported separately, since the physician is fracturing the turbinates to perform the ethmoidectomy. Modifier 50 indicates these procedures were both performed bilaterally and modifier 51 is reported with code 30520 to indicate multiple procedures performed at same session, for maximum reimbursement. • Question 42 1.2 out of 1.2 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 Respons e Feedbac k: 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 43 1.2 out of 1.2 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 Respons e Feedbac k: 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 44 1.2 out of 1.2 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 Selected Answer: Correct Answer: Z38.01, P00.89 Z38.01, P00.89 Respons e Feedbac k: 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 Respons e Feedbac k: 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 u p p er 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 Respons e Feedbac k: 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: Respons e Feedbac k: 1996 1996 HIPAA was adopted into law in 1996 • Question 50 When an anesthesiol 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 5 6 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? C o d e both sequencing the acute first Code both sequencing the acute first Response According to the ICD-10-CM Section 1.B.10 coding guidelines, if the same condition is Feedback: 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 60 45-year-old established, female patient is seen today at her doctor’s office. She is complaining of severe 1.2 out of 1.2 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 Respons e Feedbac k: 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 61 Which of the following conditions results from an injury to the head? The symptoms include headache, dizziness and vomiting. 1.2 out of 1.2 points Selected Answer: Correct Answer: Concussi on Concussi on • Question 62 INDICATIONS FOR SURGERY: The patient is an 82-year-old white male with biopsy-proven basal cell 1.2 out of 1.2 points carcinoma of his right lower eyelid and cheek laterally. I marked the area for rhomboidal excision and I drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the surgery and agreed on the location and we proceeded. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was achieved using Bovie cautery. Modified Mohs analysis showed the margin to be clear. I incised the rhomboid flap as drawn and elevated the flap with a full- thickness of subcutaneous fat. Hemostasis was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap was rotated into the defect. The donor site was closed and flap inset in layers using 5-0 Monocryl and 6-0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm What CPT? code(s) should be reported? Selected Answer: Correct Answer: 14060 14060 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: Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 0 out of 1.2 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: [None Given] Correct Answer: 20526, J3301 x 4 • Question 72 0 out of 1.2 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: [None Given] Correct Answer: 00560 • Question 73 0 out of 1.2 points Patient has returned to the operating room to aspirate a seroma that has developed from a surgical procedure that was performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported? Selected Answer: [None Given] Correct Answer: 10160-78, T88.8XXA • Question 74 A CRNA is personally performing a case, with medical direction from an anesthesiologist. What modifier is appropriately reported for the CRNA services? Selected Answer: [None Given] Correct Answer: 0 out of 1.2 points QX • Question 75 0 out of 1.2 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? 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 D o c u m e n tation describes physician direction of the paramedics (99288) In the CPT® Index, look for Physician Services/Direction, Advanced Life Support. He spends another hour stabilizing the patient, reported with critical care code 99291. In the CPT® Index, look for Critical Care Services. CPR is not a service included in the critical care codes and may be reported separately with 92950.In the CPT® Index, look for CPR (Cardiopulmonary Resuscitation). See the CPT® guidelines under Critical Care Services. • Question 9 Operative Report PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp. POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp. PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin-Yang flap repair ANESTHESIA: Local, using 4 cc of 1% lidocaine with epinephrine. COMPLICATIONS: None. ESTIMATED BLOOD LOSS: Less than 5 cc. SPECIMENS: Squamous cell carcinoma, scalp sutured at 12 o?clock, anterior tip 0.6 out of 0.6 points INDICATIONS FOR SURGERY: The patient is a 43-year-old white man with a biopsy- proven basosquamous cell carcinoma of his scalp measuring 2.1 cm. I marked the area for excision with gross normal margins of 4 mm and I drew my planned Yin-Yang flap closure. The patient observed these markings in two mirrors, so he can understand the surgery and agreed on the location and we proceeded. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The patient was placed prone, his scalp and face were prepped and draped in sterile fashion. I excised the lesion as drawn to include the galea. Hemostasis was achieved with the Bovie cautery. Pathologic analysis showed the margins to be clear. I incised the Yin-Yang flaps and elevated them with the underlying galea. Hemostasis was achieved in the donor site using Bovie cautery. The flap rotated into the defect with total measurements of 2.9 cm x 3.2 cm. The donor sites were closed and the flaps inset in layers using 4-0 Monocryl and the skin stapler. Loupe magnification was used. The patient tolerated the procedure well. What CPT? and ICD-10-CM codes are reported? Selected Answer: Correct Answer: 14020, C44.42 14020, C44.42 Response In the CPT? codebook, Yin-Yang flap repair falls under Adjacent Tissue Transfer codes. Look in 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 Respons e Feedbac k: 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 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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: @ Medulla  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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 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 Respons e Feedbac k: 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  Respons e Feedbac k: As noted in ICD-10-CM Tabular List, a comminuted fracture is a closed fracture; therefore, a comminuted lateral condyle fracture is listed as S42.451. In the ICD-10-CM Index to Diseases, look up Fracture/humerus/external condyle directing you to S42.451. The fracture procedure code is found in the CPT? Index for Fracture/Humerus/Condyle/Open Treatment 24579. The manipulation is included in 24579. The application of the first cast is always bundled with the 24579 and not reported separately. • Question 25 HIPAA was made into law in what year? 0.6 out of 0.6 points Selected Answer: Correct Answer: Respons e Feedbac k: 1996 1996 HIPAA was adopted into law in 1996 • Question 26 Wire placement in the lower outer aspect of the right breast was done by a radiologist the day prior to this 0.6 out of 0.6 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? Respons e Feedbac k: 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 for the procedure. 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. Anesthesia start time (12:26) and the anesthesia end time (15:26) calculates as three hours or one hundred eighty (180) minutes of total anesthesia time. • Question 29 A couple with inability to conceive has fertility testing. The semen specimen is tested for volume, count, 0.6 out of 0.6 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 Respons e Feedbac k: 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 Semen Analysis directing you to code range 89300-89322. Code 89320 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 30 0.6 out of 0.6 points 28-year-old female patient is returning to her physician?s office with complaints of RLQ pain and heartburn with a temperature of 100.2. The physician performs a detailed history, detailed exam and determines the patient has mild appendicitis. The physician prescribes antibiotics to treat the appendicitis in hopes of avoiding an appendectomy. What are the correct CPT? and ICD-10-CM codes for this encounter? Selected Answer: Correct Answer: 99214, K37 , R12 99214, K37 , R12 Respons e Feedbac k: This is an established patient E/M level of service due to the indication she returning to her physician for the visit. Code 99214 is appropriate with the key components met or exceeded for this level of service and this is an established patient. According to the ICD-10-CM Official Coding Guidelines Section I.B.6- 8, if a definitive diagnosis is established we will code it reporting code K37. Look in the ICD-10-CM Index to Diseases for Appendicitis K37. Any signs or symptoms that would be an integral part of that definitive diagnosis/disease process would not be separately reported. Heartburn is not a symptom commonly seen with appendicitis so we can report this as an additional code. Look in the Index to Diseases for Heartburn R12. • Question 31 Which cells produce hormones to regulate blood sugar? 0.6 out of 0.6 points Selected Answer: Correct Answer: P a n creatic islets Pancreatic islets • Question 32 0.6 out of 0.6 points A l t hough 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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 Respons e Feedbac k: 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