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NEW QUESTION # 16
A 79-year-old female patient is admitted to a skilled nursing facility for continued monitoring as she completes her course of antibiotics for bronchitis. Upon admission, a nurse practitioner spends 20 minutes with the patient, performing an evaluation of recovery and rebuilding of stamin a. On day 3, the patient's physician completes an initial comprehensive assessment and determines the patient is recovering well on her current dosage of antibiotics. What CPT code should be reported on day 3?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: D
Explanation:
CPT defines an initial nursing facility service (NFS) as "the first encounter with the patient by the admitting physician to nursing facilities." Although the patient can be evaluated and treated by other medical staff in the meantime, only the physician responsible for the admission may report the initial comprehensive visit (99304-99306). If other medical personnel do provide treatment, those visits would be reported using the subsequent nursing facility care encounter codes (99307-
99310). Nursing facility care services require a medically appropriate history and/or examination, and a review of medical decision making. In this scenario, the number and complexity of problems addressed at the encounter is low (one stable, acute illness), the amount and/or complexity of data reviewed or analyzed is straightforward (minimal or none), and the risk of complications and/or morbidity or mortality of patient management is moderate (prescription drug management). After considering that the patient is established, the level of complexity for the visit is considered low and the encounter should be reported with CPT code 99304.
NEW QUESTION # 17
A complete pulmonary function test using a body plethysmograph is performed on a patient in conjunction with spirometry. After reviewing the results, a provider suspects the presence of an obstructive disease and administers a bronchodilating medicine just prior to repeating the test to reevaluate the expiratory flow rate. Which code(s) should be reported?
- A. 99212-25, 94726,94010-51, 94060-51
- B. 94726, 94060
- C. 99212-25, 94726, 94060-76
- D. 94726, 94060-51
Answer: B
Explanation:
Answers A and B can be eliminated because the complete pulmonary function test includes interpretation of the test results: therefore, the review ofthis would not be considered separately identifiable. The CPT code 94060 includes spirometry before and after a bronchodilator has been administered, so a separate spirometry code (94010) would be inappropriate. Last, a modifier is not needed because the procedures are routinely done in conjunction with each other.
NEW QUESTION # 18
A young man is triaged in the emergency room after sustaining multiple injuries in a car accident. The physician performs the following limited exams with image documentation: an abdominal and retroperitoneal ultrasound, a transthoracic echocardiography, and a chest ultrasound. He indicates in his report that all findings are normal. What charges should the provider submit to the insurance company?
- A. 93304-TC, 76700-TC, 76770-TC, 76604-TC
- B. 93308, 76705-59, 76770-59, 76604-59
- C. 93304-26, 76705-26, 76775-26, 76604-26
- D. 93308-26, 76705-26, 76775-26, 76604-26
Answer: D
Explanation:
CPT code 93304 describes an echocardiography used to evaluate a congenital defect. In this case, the provider is screening for any trauma-related injuries to the heart. Bearing in mind that the study is limited leads you to CPT 93308. Modifier 26 is used on all CPT codes because the procedures are being performed in a hospital setting. Therefore, only the professional component of the service should be billed. Modifier TC is reported by the entity providing the equipment, which in this case would be the hospital. Modifier 59 is not necessary because the procedures are routinely done in conjunction with each other.
NEW QUESTION # 19
A surgeon performs a posterior fusion on the L2-L5 of the spine due to degenerative disc disease. CPT and ICD-IOOI code(s) should be reported?
- A. 22612, 22614x 3, M51.36
- B. 22800, M51.37
- C. 22612, 22614x2, MSI.36
- D. 22533, M51.37
Answer: C
Explanation:
The code for a joint fusion using a posterior approach is 22612. In this scenario, there are three fusion levels: L2-L3, L3-L4, and L4-L5. Following the primary code, 22614 would be billed tv;ice and with no modifier because it is an add-on code. ICD-IO-CM code M51.37 is for degenerative discs in the lumbosacral region; however, L2-L5 is considered the lumbar region.
NEW QUESTION # 20
If a patient is receiving hospice care in a physician's office, which place of service code should be reported on the claim?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: A
Explanation:
Place of service (POS) codes "specify the entity where service(s) were rendered." In this case, hospice care was provided in an office, which would correspond to POS 11. POS 34 is hospice care provided in a facility, POS 71 is a public health clinic that provides ambulatory medical care, and POS 62 is an outpatient rehabilitation facility providing services that would include physical and occupational therapy.
NEW QUESTION # 21
Assign the appropriate CPT codes for the following surgical note: A 15-year-old patient is being treated for obstructive sleep apnea and adenoid tissue hypertrophy. After being placed under general anesthesia, a dental mirror is placed in the oropharynx to allow visualization of the nasopharynx. Suction electrocautery is used to remove the adenoid tissue that regrew after the initial adenoidectomy. Attention is then turned to the tonsils. The plane of tissue between the tonsillar capsule and the underlying muscles are cauterized, and the tonsils are removed. Bleeding is controlled by silver nitrate and gauze packing. Procedure is completed without complications, and patient is discharged to recovery.
- A. 42826, 42836-51, 135.2, G47.33
- B. 42826, 42831-59, 135.2, G47.33
- C. 42999, 647.33, 135.2
- D. 42821, G47.33, 135.2
Answer: D
Explanation:
An adenoidectomy and a tonsillectomy were performed in this surgical encounter (the root word -ectomy literally means the surgical removal of an anatomical structure). The adenoidectomy was done first and, if coded alone, would fall under one of Evo categories: primary (CPT 42830-
42831) or secondary (CPT 42835-42836). A primary adenoidectomy refers to the initial removal of the adenoid, whereas a secondary adenoidectomy occurs when adenoid tissue that was once removed has grown back. Because the documentation states that "the adenoid tissue ... regrew after the initial adenoidectomy," a coder can infer that this procedure is secondary. However, distinguishing betvveen the two procedures is not necessary when done in conjunction with a tonsillectomy because the procedures are bundled into two nonspecific CPT codes (42820 and
42821). Billing for an adenoidectomy and a tonsillectomy separately, as shown in answers A and C, is considered unbundling and is not allowed under the Correct Coding Initiative (CCI) edits.
Regarding the sequencing of the diagnoses, ICD-IO-CM guidelines state that when V,vo conditions meet the definition for principal diagnosis, either can be sequenced first In this scenario, J 35.2 or G47.33 could have been first listed because the procedures were to resolve both conditions in the same encounter.
NEW QUESTION # 22
A provider places a catheter on the right side of the heart chamber via an incision made on the lower left side of the patient's chest while performing a transcatheter mitral valve replacement. How should this encounter be coded?
- A. 0484T
- B. 0483T, 93451
- C. 0
- D. 0484T, 93451-59
Answer: A
Explanation:
0484T describes a transcatheter mitral valve replacement via a thoracic approach. CPT code
33430 describes a mitral valve replacement in which cardiopulmonary bypass is initiated. CPT code
0483T describes a transcatheter mitral valve replacement with a percutaneous approach: however, the documentation identifies a transthoracic incision. Catheterization is bundled into the procedure and is not separately identifiable unless the provider documents extenuating circumstances (i.e. no prior study available, inadequate visualization, etc.).
NEW QUESTION # 23
Code the excision of a large goiter extending into the chest cavity using a transthoracic approach.
- A. 0
- B. 1
- C. 2
- D. 3
Answer: A
Explanation:
A goiter is an abnormal enlargement of the thyroid gland. The removal of that gland is a thyroidectomy, represented by CPT codes 60240-60271. CPT 60270 is selected based on the approach used. CPT codes 21602 and 32900 are obtained by using the coding crosswalk for resection ofthe chest wall and describe the removal of a tumor and one or more ribs. CPT 32140 is a thoracotomy, which involves pulling apart the ribs to reach and remove a lung cyst.
NEW QUESTION # 24
Which of the four chambers in the heart receives deoxygenated blood from the body through the vena cava?
- A. Left atrium
- B. Right ventricle
- C. Right atrium
- D. Left ventricle
Answer: C
Explanation:
After receiving deoxygenated blood from the body through the vena cava, the right atrium pumps blood into the right ventricle. The right ventricle sends the blood to the lungs to be oxygenated. The left atrium receives blood from the lungs through the pulmonary veins and pumps it into the left ventricle via the mitral valve. The left ventricle then distributes oxygenated blood to tissues throughout the body.
NEW QUESTION # 25
A low-risk obstetrical patient is told to come in for weekly ultrasounds in her first trimester. This is an example of what?
- A. Fraud
- B. Abuse
- C. Waste
- D. Misuse
Answer: C
Explanation:
In this case, the patient is not at risk, and most organs either are not developed and/or cannot be visualized in the first trimester. Thus, this would constitute as waste due to the provider overutilizing services that result in unnecessary cost. AAPC defines fraud as purposely billing "for services that were never given or to bill for a service that has a higher reimbursement than the service provided." Abuse is payment for services "that are billed by mistake by providers."
NEW QUESTION # 26
Assign the CPT codes for the following surgical note:
A patient who is confirmed to have lymphoma is placed under general anesthesi a. A flexible bronchoscope is first inserted through the oral cavity to determine if the primary carcinoma has spread to the lung tissue. No lesions are observed in the bronchus, and the bronchoscope is removed. An incision is then made in the parasternal second left intercostal space, thus exposing the anterior mediastinal lymph nodes. Tissue samples from the lymph nodes are removed without complication. The incision is closed with sutures, and the patient is discharged to recovery.
- A. 39402, 31622-51
- B. 39010, 31622-51
- C. 39402, 31623-51
- D. 39010, 31623-51
Answer: B
Explanation:
The first procedure documented is a bronchoscopy, reported with CPT codes 31622-31654.
Because the procedure was specifically aimed at confirming a diagnosis based off a previously confirmed malignancy, the bronchoscopy would be considered diagnostic (CPT 31622). The second procedure performed is a mediastinotomy with removal of cancerous tissue. An incision made into the parasternal intercostal space is considered transthoracic, making the correct procedure code
39010. Sequencing is based off the highest RVU value, and modifier 51 is appended to the bronchoscopy procedure code to indicate that multiple procedures were performed in the same session.
NEW QUESTION # 27
A 22-year-old patient presents with a 5.5 cm gaping laceration on the right forearm and a
2 cm superficial laceration on the right wrist caused by a table saw. A local anesthetic is injected around both laceration sites. The physician irrigates the laceration on the wrist before closing the wound with a tissue adhesive and then performs an extensive cleaning and single-layer closure with sutures on the forearm. What should be coded for this encounter?
- A. 12032, S41.111A, S61.411A,W31.2kX.A
- B. 12032, 97597, G0168, S41.111A, S61.411A W31.2XXA
- C. 12001, 12032-59, S61.411AS41.111A W31.2XXA
- D. 12032, 12001-59, S41.111A S61.411A W31.2XXA
Answer: D
Explanation:
A "gaping" injury and/or "single-layer closure" is indicative of an intermediate repair and a
"superficial" injury and/or use of a "tissue adhesive" is indicative ofa simple repair. Because the repairs are not in the same classification, each repair is reported in a single code, sequenced from the most to the least severe (eliminating answers B and D), with modifier 59 appended to the less complicated procedure(s). Local anesthesia is included in these procedures, as is debridement unless the provider specifically indicates that it is extensive. In answer A, an HCPC's code for tissue adhesive would be reported only if the patient had Medicare.
NEW QUESTION # 28
A 39-year-old female patient has developed a diaphragmatic hernia after an episode of domestic violence. The surgeon repairs the hernia through an incision into the abdomen. The patient is later discharged with no complications. How should this encounter be reported?
- A. 39541, K44.O, T74.11YA Y07.9
- B. 39540, K44.9, T74.11XA Y07.9
- C. 39540,K44.9, T 76.1 IXA
- D. 39541, K44.O, T76.1 IXA
Answer: B
Explanation:
Acute trauma results from a single incident, whereas chronic trauma is repeated, usually over the course of months or years. In this scenario, the documentation does not specify, so the coder should assume acute trauma. There is no mention of obstruction, so ICD-IO-CM code selection is K44.9, followed by the cause of the hernia. Vvhen an exam shows evidence of abuse, the abuse is no longer considered suspected but confirmed.
NEW QUESTION # 29
Which type of anesthesia is NOT separately reportable?
- A. Monitored anesthesia care
- B. Spinal anesthesia
- C. Metacarpal blocks
- D. Regional anesthesia
Answer: C
Explanation:
CPT surgery guidelines uphold that local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia is always included in the surgical package. Under monitored anesthesia care (MAC), a patient is sedated but typically still aware, and the presence of qualified anesthesia personnel is required. Spinal and regional anesthesia is used for a variety of different procedures and is also separately reportable.
NEW QUESTION # 30
A male patient with cancerous cells in his right bronchus is given 150 mg of porfimer sodium via a single and slow intravenous injection and told to return to the office in 3 days.
Upon his return, the physician enters the right bronchus by means of a bronchoscope and activates LED for a total of 38 minutes to destroy the cancer cells. What should the physician report?
- A. 96573, J9600x2
- B. 31641, 96570, 96571, 96409,J9600x2
- C. 31641, 96570, 96571, J9600x2
- D. 96573, 96409, J9600x2
Answer: C
Explanation:
Photodynamic therapy applies a photosensitizing agent by either an external or endoscopic application. An external application is applied directly onto a patient's lesions, whereas an endoscopic application is an injection into the bloodstream, where it is absorbed by cells all over the body. Based on this differentiation, the documentation supports only an endoscopic application.
The code notes for CPT 96570 and 96571 indicate they are add-on codes to the bronchoscopy procedure, which is represented by CPT 31641. Any drug administration is inclusive to photodynamic therapy, making CPT 96409 not separately billable.
NEW QUESTION # 31
The physician suspects malignancy and decides to remove two lesions from the patient's back to confirm. The size of the first lesion has a diameter of 0.5 cm, and the excised diameter is 1.0 cm. The size of the second lesion has a diameter of 0.3 cm, and the excised diameter is 1.5 cm. Which CPT code(s) should be reported?
- A. 11401, 11402-51
- B. 11402, 11401-59
- C. 11401, 11402-59
- D. 11600, 11600-51
Answer: B
Explanation:
Without a patholoy report to confirm malignancy, the excision code assumes that the lesion is benign. Code selection is based on the excision size, not the size of the lesion, and the more complex code takes priority in sequence, eliminating answer C. Answers A and B can be incorrect choices due to CPT guidelines outlining that when coding more than one excision, the appropriate modifier would be 59 on each additional procedure.
NEW QUESTION # 32
A patient is having difficulties breast-feeding and receives a lactation consultation by a certified lactation consultant under the general supervision of a mid-level practitioner. How should this service be reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: B
Explanation:
CPT 98960 is used by nonphysician healthcare professionals who provide education to patients that enable them to self-manage established conditions. CPT 99078 could also be used to report lactation services, but these are specifically rendered in a group setting. CPT 98966 is used for healthcare management via the telephone, and CPT 99211 is not considered the most appropriate descriptor for services rendered in this instance.
NEW QUESTION # 33
A patient is admitted for chemical burns caused by a leaky car battery. The physician diagnoses the patient with second- and third-degree burns on the right hand and second- degree burns on the left hand. The physician follows up with the patient 3 days later and performs a detailed examination. His findings include an infection that has developed on the right hand as a result of the burn. The patient is started on antibiotics. Code this encounter.
- A. 99232, L08.9, T23.201S, T23.361S, T23.301S, T23.202A T54.2X4A
- B. 99231, L08.9, T23.701S, T23.662A T54.2XIS
- C. 99231, T23.201A, T23.361A T23.301A, T23.202A T54.2X4A L08.9
- D. 99232, T23.701A, T23.662A T54.2XIA, L08.9
Answer: D
Explanation:
The physician's level of medical decision-making was moderate in complexity due to the acute, complicated injury/ illness, the minimal amount and complexity of data reviewed, and the issuance of a prescription drug. Because the patient has already been receiving care in a hospital setting for 3 days, the visit would be considered subsequent hospital care, making the level of inpatient service a 99232 and eliminating answers B and D. A burn caused by a chemical would be considered a corrosion because it is not caused by heat, electricity, and/or radiation, thus eliminating the remaining choice of A. Additionally, when multiple burns on the same anatomic location and laterality are being treated, identify and code only the highest degree of burn recorded in the diagnosis. In this case, only the third-degree burns on the right hand and the second-degree burns on the left hand would be reported. Although the skin infection is a sequela, the seventh character in the corrosion code would remain "A" and sequenced first to indicate that the patient is still receiving active treatment for the reason of admission.
NEW QUESTION # 34
Dr. Black orders a hepatitis panel for a patient who has recently returned from traveling abroad and is now experiencing lower abdominal pain. The laboratory completed a hepatitis A antibody test, hepatitis B core antibody test, and a hepatitis C antibody test. Select the CPT and the ICD-IO-CM codes that the laboratory will report.
- A. 86709, 86705, 86803, RIO.30
- B. 80074, RIO.30
- C. 80074-52, RIO.30
- D. 86709, 86705, 86803, RIO.31, RIO.32
Answer: A
Explanation:
The hepatitis B surface antigen test was not performed, so the actual panel code in answer A was not completed, leaving each test to be reported separately. It would not be appropriate to add modifier 52 to 80074 in answer B. Because the provider did not specify which side the lower abdominal pain was on, it would be reported as unspecified with RIO.30, eliminating answer C.
NEW QUESTION # 35
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