Response choose the cpt code completely identifying the service

Correct Answer:

Medulla

Selected Answer:

T21.31XA, T22.30XA, T24.209A, T31.32

0 out of 1.2 points

72147, C79.49

89320, N46.11

Correct Answer:

1.2 out of 1.2 points Which of the following does NOT contribute to refraction in the eye?

86817, 86821

Response Code 86817 is the correct code to report for HLA tissue typing with DR/DQ. In the CPT® Index Feedback: look under Tissue/Typing/Human Leukocyte Antigen (HLA)/Antibodies. Code 86821 is reported for the lymphocyte culture. This is indexed under Tissue/Typing/Lymphocyte Culture. Codes 86805 and 86806 are for lymphocytotoxicity, not lymphocyte mixed culture.

After a denial has been received from Medicare

Correct Answer:

Selected Answer:

55875

1.2 out of 1.2 points HCPCS Level II includes code ranges which consist of what type of codes?

1.2 out of 1.2 points

What surgical status indicator represents the Surgical Global Package for endoscopic procedures (without an incision)?

Response Per CMS Internet-only manuals (IOM) Medicare Claims Processing Manual – surgical status Feedback: 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.

70487-26

Correct Answer:

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?

Response Look in the CPT? Index for Excision/Metatarsal/Head for 28110-28114, 28122, 28140. Code Feedback: 28122 reports a partial excision or sequestrectomy of metatarsal bone. The CPT? Index for Lesion/Foot leads to 28080, 28090. Code 28090 reports the excision of the ganglion of the foot. Modifier 51 is appended to indicate multiple procedures performed during the same session.

Modifier LT is appended to indicate the procedure is performed on the left side.

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:

Eyelid

Selected Answer:

AD

1.2 out of 1.2 points

Correct Answer:

47140, 47146, 47147, 47135

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:

Abnormally high intraocular pressure

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.

Correct Answer:

10121, M79.5, Z18.10

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:

93293

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:

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

00350-P3

Correct Answer:

The patient is coming in for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and 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:

51728, 51797, 51741-51

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?

Response When neonatal services are provided in the outpatient setting, Inpatient Neonatal Critical Care Feedback: 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.

99239, 99304

Correct Answer:

1.2 out of 1.2 points

57120, N81.2

Response This surgical procedure of a colpocleisis is performed to prevent uterine prolapse. In this Feedback: 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 Surgical Global Package applies to services performed in what setting?

Selected Answer:

Correct Answer:

43220

1.2 out of 1.2 points

A gonioscopy is an examination of what part of the eye:

49402-78

Correct Answer:

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?

Response In the CPT? Index, look for Hydration, you are directed to codes 96360-96361. The hydration Feedback: 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.

Selected Answer:

71020, 74150-26

0 out of 1.2 points

86910-32, Z02.81

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.

Correct Answer:

17311, 13152-51, C44.119

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:

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).

Selected Answer:

J96.90, T42.4X1A

1.2 out of 1.2 points

A patient with metastatic bone cancer (primary site unknown) presents to the oncologist?s office for a chemotherapy treatment. On examination, the oncologist finds the patient to be severely dehydrated and cancels the chemotherapy. The patient will receive intravenous hydration in the office and reschedule the chemotherapy treatment. What ICD-10-CM codes are reported?

Response Per ICD-10-CM Guidelines, Section I.C.2.c.3, when the admission/encounter is for management Feedback: of dehydration due to the malignancy or therapy, or a combination of both, and only the dehydration is being treated (intravenous hydration); the dehydration is sequenced first, followed by the code(s) for the malignancy. When information is not available about the primary site of the cancer, the secondary site is coded first followed by code C80.1. In the Index to Diseases (Alphabetic Index), look for Dehydration E86.0. Look in the Index to Diseases (Alphabetic Index), in the Neoplasm Table for Neoplasm, neoplastic/bone. Use the code from the secondary column (C79.50). Then look in the Neoplasm Table for unknown or unspecified site and use the code from the primary column (C80.1).

31255-50, 30520-50-51

Correct Answer:

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?

Response Code 47564 is accurate for laparoscopic cholecystectomy when the exploration of the common Feedback: 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

Selected Answer:

99238

1.2 out of 1.2 points

27506-RT, 11012-51-RT, S72.301B, V03.10XA
27506-RT, 11012-51-RT, S72.301B, V03.10XA

Response This was an open femoral shaft fracture, S72.301B, thus eliminating C and D. In the ICD-10-CM Feedback: 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.

1.2 out of 1.2 points

A physician orders a quantitative FDP. What CPT® code is reported?

Response Check for unfamiliar abbreviations in the Index. Read codes closely to identify whether they are Feedback: 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.

Z38.01, P00.89

Correct Answer:

1.2 out of 1.2 points

32484, C34.10

Response A segment of the lung is removed. In the CPT? Index, look up Removal/Lung/ Single Segment. Feedback: This directs you to code 32484.

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:

1996

When an anesthesiologist is medically supervising six cases, what modifier is reported for the CRNA’s medically directed service?

Selected Answer:

1.2 out of 1.2 points

29847

Response The wrist arthroscopy and stabilization was surgically performed to provide stabilization. Look Feedback: 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

Selected Answer:

60500, E21.0

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?

Response The nuclear imaging test follows the blood as it flows to the kidneys identifying any obstruction Feedback: 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.

Correct Answer:

Production of tears

It sits within the middle ear

Correct Answer:

Selected Answer:

Z38.30, P07.03, P07.26

1.2 out of 1.2 points

12:26 am to 15:26 pm (180 minutes)

Response Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in Feedback: 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.

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:

Correct Answer:

Code both sequencing the acute first

1.2 out of 1.2 points

45-year-old established, female patient is seen today at her doctor’s office. She is complaining of severe 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?

Response This is a follow up visit indicating an established patient seen in the clinic. In the CPT® Index, Feedback: 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.

Concussion

Correct Answer:

INDICATIONS FOR SURGERY: The patient is an 82-year-old white male with biopsy-proven basal cell 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?

Response A rhomboid flap is a tissue transfer flap, coded from range 14000-14350. In the CPT? Index, see Feedback: Tissue/Transfer/Adjacent/Skin. Because the surgeon indicated the rhomboid flap extended into the lower eyelid area, you only code for the eyelid flap. The final measurement of the flap is 3.51 cm2 (1.3 x 2.7 = 3.51) directing us to CPT? 14060.

Correct Answer:

An X-ray procedure allowing the visualization of internal organs in motion

27724-LT, S82.101K

Correct Answer:

Selected Answer:

73560, M17.9

1.2 out of 1.2 points Which statement is TRUE regarding the Instruction for use of the CPT® codebook?

Selected Answer:

What ICD-10-CM codes are reported?

Selected Answer:

Correct Answer:

19125-RT

1.2 out of 1.2 points

A patient suffering from cirrhosis of the liver presents with a history of coffee ground emesis. The surgeon 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?

Response Ligation of esophageal gastric varices endoscopically is coded with CPT? code 43244.This is Feedback: 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.

Selected Answer:

non-hospital owned physician practices