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NEW QUESTION # 12
Code the following adverse effect:
Initial encounter of drug-induced tremors that was caused by Cyclosporin the patient takes for anemi a. The anemia is caused by a current diagnosis of colon cancer.
- A. D63.O, C18.9, T45.1X5A, G25.1
- B. G25.1, T45.1X5A, C18.9, D63.O
- C. C18.9, D63.O, G25.1, T45.1X5A
- D. T45.1X5A G25.1, C18.9, D63.O
Answer: B
Explanation:
The correct sequencing of the code would be as follows: side effect of the drug. medication that caused the adverse effect and the underlying condition for why the drug is being taken. In this scenario, because the anemia is caused by a malignancy, ICD-IO-CM guidelines state that the malignancy should be the principal diagnosis "followed by the appropriate code for the anemia (such as D63.0, Anemia in neoplastic disease)."
NEW QUESTION # 13
During surgery to remove a malignant melanoma from the intestinal tract, one frozen section is sent for pathological consultation to confirm an adequate excision of the margins. A second specimen is also sent, which requires frozen sections on two tissue blocks. What CPT code(s) should the pathologist report?
- A. 88331, 88331, 88332
- B. 88331, 88332, 88332
- C. 88331, 88332
- D. 88329, 88331, 88332, 88332
Answer: A
Explanation:
CPT code 88331 is used to report only a single specimen. In this scenario, there are Evo separate specimens being sent to the pathologist. The first specimen, with one frozen section, is reported with CPT code 88331. The second specimen has tv.ro tissue blocks with frozen sections, thus represented by coding 88331 for the first tissue block, followed by 88332 for the additional tissue block CPT code 88329 is inclusive to 88331 and should not be reported separately.
NEW QUESTION # 14
A patient is in labor with plans to deliver vaginally. An epidural is administered at 17:30. After several hours of pushing, the obstetrician determines that the cervix is swollen, and the baby must be delivered via a c-section. The patient consents, the baby is delivered, and both are discharged to the recovery room at 22:15. What CPT code(s) should the anesthesiologist report?
- A. 01967, 01968
- B. 01967, 01968, 99140
- C. 01967-23, 01968
- D. 01967-23, 01968, 99140
Answer: C
Explanation:
For a planned vaginal delivery with the use of an epidural, followed by a Cesarean delivery, the correct CPT codes are 10967 followed by add-on code 01968. CPT code 99140 is an add-on code portraying that the procedure was an emergency and that the patient and/or baby has a significant increase in the threat to life. The documentation gives no indication that these services were emergent Modifier 23 is reported for unusual anesthesia services. This would include-but is not limited to-the use of general anesthesia for a procedure that usually requires only a local anesthetic or none and/or a procedure extending more than 4 hours. In this case, the total procedure time was 4.75 hours, and modifier 23 is appended on the primary procedure code only.
NEW QUESTION # 15
Which is NOT part of the upper respiratory tract?
- A. Pharynx
- B. Larynx
- C. Nasal cavity
- D. Trachea
Answer: D
Explanation:
The upper respiratory tract consists of the nose, nasal cavity, pharynx, and larynx. The lower respiratory tract includes the trachea, primary bronchi, lungs, and the bronchioles and alveoli within the lungs.
NEW QUESTION # 16
A patient with right knee pain is seen in a physician's office for an x-ray. Anteroposterior and lateral views of the right knee were obtained by the technician, and images confirm right knee pain secondary to degenerative osteoarthritis. Which CPT and ICD-IO-CM code(s) should be reported?
- A. 73560-RT, MI 7.11
- B. 73560-TC-RT, MI 7.11, M25.561
- C. 73560-26-RT, MI 7.11, M25.561
- D. 73560-TC-RT, MI 7.11
Answer: A
Explanation:
The CPT crosswalk for x-ray of knee directs the coder to 73560-73580. Because two views were obtained, the correct code would be 73560 (radiologic examination, knee; I or 2 views).
Modifier TC and modifier 26 indicate only technical and professional components: however, because the x-ray was performed in a physician's office, 73560 would be reported without either because the practice provided both components. In terms of diagnosis, the knee pain would not be reported because it is a symptom of a definitive diagnosis.
NEW QUESTION # 17
A mammogram is done on a patient who has a lump on her right breast at 4 0'clock and a lump in her left breast at 6 0'clock. What CPT and ICD-IO-CM code(s) should be reported?
- A. 77067, D48.61, D48.62
- B. 77066, N63.14, N63.25
- C. 77067, D49.3
- D. 77065-50, N63.13, N63.20
Answer: B
Explanation:
CPT code 77067 is a screening mammogram. In this case, the mammogram would be diagnostic because the purpose is to rule out and/or make a diagnosis based on physical exam findings. Code 77065-50 is an inappropriate use of the modifier because there exists a bilateral procedure code. A breast lump should only be coded to "mass" and not as a neoplasm unless specifically stated in the diagnosis. When deciphering the location of the mass, 12 0'clock is at the top of each breast, and the point of movement is clockwise. Therefore, 4 0'clock in the right breast is equivalent to the lower-inner quadrant, and 6 0'clock in the left breast is in the middle ofthe t".vo lower quadrants.
NEW QUESTION # 18
Age, gender, height, and race are the four key factors in calculating a person's forced vital lung capacity (FVC). If FVC is calculated to be 3.00 L and anything under 80% is abnormal, what would be the cutoff value to a normal FVC?
- A. 3.2 L
- B. 2.4 L
- C. 2.0 L
- D. 2.8 L
Answer: B
Explanation:
A forced vital capacity test is the maximum amount of air that can be exhaled from the lungs and is used to determine whether there is an obstruction in the lungs. To calculate the abnormality, take 0.8 (80%), and multiply it by 3.00 (liters). Anything less than 2.4 L would be considered an abnormal result in this scenario.
NEW QUESTION # 19
A patient is seen in the emergency room with a thermal burn to the left thigh because of a fire. The patient denies feelings of hypothermi a. Vitals are obtained, and a physical examination reveals that approximately 4% of the body is affected by second-degree burns, and nonviable tissue needs to be removed to avoid the risk of infection. After consent is obtained, the physician debrides the wound, cleanses the area, and applies a gauze. The patient is discharged and told to follow up with their primary care physician in 2 days. What CPT code(s) should be reported for this encounter?
- A. 16020, 99282
- B. 0
- C. 99282-25, 16020
- D. 99283-25, 16020
Answer: D
Explanation:
When billing for physician services in the emergency room, it is appropriate to report a standalone E/M when the documentation supports its necessity in determining the need for appropriate treatment. Modifier 25 is necessary to the E/M code when being billed alongside a procedure and/or surgery to indicate a separately billable service. In this case, the documentation supports decision-making of moderate complexity. CPT code 99283 meets these criteria, whereas CPT code 99282 reflects a medical decision-making of low complexity and does not accurately portray the services rendered. The emergency room visit is always the first listed code, followed by the procedure and/or surgery performed.
NEW QUESTION # 20
CPT code 11102 is a column 2 code that has an NCCI edit of 1 when paired with CPT code 11402. How would this be interpreted?
- A. If being billed together, only report one unit of each.
- B. The two codes are exclusive of each other and can never be billed together.
- C. The two codes are inclusive of each other and can never be billed together.
- D. The two codes can be billed together with an appropriate modifier.
Answer: D
Explanation:
NCCI stands for National Correct Coding Initiative and was created by CMS to prevent unbundling and prevent incorrect payments. Column one represents a correct code when listed next to column two. There are three edits listed with the combination of the two columns: 0, 1, and
9. Edit 0 means that the two codes should never, under any circumstance, be reported together. Edit
1 means that the procedures may be coded together with the use of a modifier. Edit 9 means that the edit does nota I .
NEW QUESTION # 21
Code the following surgical note:
Patient is seen for an epidural injection into the following three levels: L3-L4, L4-L5 and L5-S1.
A 22 -gauge spinal needle is inserted into the zygapophyseal joint using fluoroscopic guidance. After confirming the needles placement at L3-L4 on the left side, 0.5 cc of a local anesthetic is injected into the joint. The whole process is repeated on the left side at the other two levels. The procedure was completed without any complications.
- A. 64493-LT, 64494-LT, 64495-LT
- B. 0
- C. 64493-LT, 64494-59-LT, 64495-59u
- D. 0216T-LT, 0217T-LT, 0218T-LT
Answer: A
Explanation:
64493 is used for the initial injection of an anesthetic, followed by 64494 and 64495 as add-on codes for the other Two levels. Because there are two sides of a facet joint, modifier LT would be amended to show the carrier that the procedure occurred on the left side of the spine.
In answer B, CPT codes 0216T-0218T exclude fluoroscopic guidance and refer the biller to codes
64490-64495. In general, modifier 59 would not be used on add-on codes, so answer C can be eliminated. Answer D describes an injection in the interlaminar epidural or subarachnoid space and is not the correct procedure code for this circumstance.
NEW QUESTION # 22
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 # 23
Which healthcare professional may NOT report medical nutrition therapy?
- A. Endocrinologist
- B. Dietician
- C. Nutritionist
- D. Registered nurse
Answer: A
Explanation:
Medical nutrition therapy describes nutritional assessments and interventions in a face-to- face or group patient setting and is reported with CPT codes 97802-97804. These codes are used by nonphysician healthcare professionals only. When a physician provides nutritional advice, a preventative service or evaluation and management code should be reported.
NEW QUESTION # 24
A radiation oncologist reviews the port films, dose delivery, and treatment parameters of a 52-year-old female patient who has received external beam therapy three times in the current week He also spends 15 minutes examining the patient and collecting an intake of her response to the treatment program. Which CPT code(s) should the physician report?
- A. 99213-25, 77401x3units
- B. 0
- C. 1
- D. 77435, 99213-25
Answer: C
Explanation:
Treatment management of a patient undergoing radiation therapy is reimbursed by reporting CPT codes 77427-77470. Treatment management includes a review ofthe port films, dosimetry, dose delivery, treatment parameters, a physical examination, and related counseling. It would therefore not be appropriate to bill for a separate evaluation and management. CPT 77435 describes treatment management for a course of stereotactic body radiation therapy (SBRT), which the patient is not receiving. CPT 77401 describes the actual radiation and not the evaluation from the physician. CPT 77431 is reported when the entire course of therapy consists of one or nvo treatment sessions: however, a coder can infer from the documentation that the patient in this scenario has or will receive multiple sessions over the course of one or more weeks. Additionally, CPT guidelines advise that only three treatment sessions must occur to support the face-to-face encounter described in CPT 77427.
NEW QUESTION # 25
The appendix is removed through an abdominal incision due to metastatic colon malignancy. How should this be reported?
- A. 44950, C78.5
- B. 44950, C78.5, C18.9
- C. 44970, C18.9, C78.5
- D. 44970, C78.5
Answer: B
Explanation:
An open appendectomy procedure is reported with CPT 44950. A metastatic colon malignancy is a cancer that began in the colon but has spread to other areas. In this scenario, that means that the primary malignancy is the colon, and the secondary malignancy is the appendix.
Additionally, ICD-IO-CM guidelines state that when "treatment is directed toward the metastatic site only, the metastatic site is designated as the principal/first-listed diagnosis. The primary malignancy is coded as an additional code." The malignancy codes do not specifically state
"appendix," but the ICD-IO-CM coding crosswalk in the neoplasm table assigns this diagnosis as C78.5 secondary malignant neoplasm of large intestine and rectum.
NEW QUESTION # 26
A female patient presents to her obstetrical office 32 -weeks pregnant for a bi-weekly ultrasound. Code the following technician's report:
Fetal views obtained via transabdominal ultrasound as follows:
BPD: 32 mm
Femur Length: 63 mm
Head Circumference: 288 mm
Abdominal Circumference: 270 mm
BPP 8/8
NST from 11:15 to 12:17, showing 160 BPM and positive movement activity Doppler shows adequate systolic and diastolic flow velocities of the fetal umbilical artery.
- A. 76816-TC, 76816-TC, 76820-TC
- B. 76816, 76818, 76820
- C. 76815-TC, 76819-TC, 76820-TC
- D. 76815, 78819, 76820
Answer: B
Explanation:
CPT 76815 is a limited ultrasound, in which only the fetal heartbeat, position, placental location, and/or volume of amniotic fluid are evaluated. In this scenario, much more was done than a limited study. The ultrasound technician documented age-appropriate fetal measurements, which are supported by CPT 76816. A biophysical profile (BPP) was also done, which monitors the fetus's movements, tone, and breathing as well as evaluates the volume of amniotic fluid. Each of these elements counts as 2 units of grading to evaluate the general well-being ofthe fetus. The desired score of a BPP is 8/8. Because a fetal nonstress test (NST) was completed in conjunction with a BPP, report CPT 76818 instead of CPT 76819. Modifier TC is used to reflect that only a technical component of the procedure was completed. However, because the patient received these services in an obstetrical office that employs the physicians providing prenatal care and owns the ultrasound equipment the code should be submitted without modifiers TC or 26 to receive 100% reimbursement.
NEW QUESTION # 27
A physician performs a thyroidectomy on a 26-year-old female patient with thyroid cancer. A radical neck dissection with a partial parathyroidectomy and autotransplantation of two parathyroid glands is also completed in the same session. W'hat CPT code(s) should the physician report?
- A. 60254, 60512-52
- B. 0
- C. 60254, 60500-51, 60512-51
- D. 60254, 60500-51, 60512
Answer: A
Explanation:
The CPT code for a thyroidectomy with a radical neck dissection is 60254 and sequenced first because it is the primary procedure with the highest RVU. CPT 60500, which describes a parathyroidectomy, is bundled into a thyroidectomy. Therefore, the two procedures should never be reported together. Parathyroid autotransplantation (CPT 60512) involves the removal of all four parathyroid glands. If not all four glands are removed, report the code with modifier 52 to indicate reduced services. As this is an add-on code, do not append modifier 51.
NEW QUESTION # 28
In the Current Procedural Terminology book, how is the icon "Excludes" meant to be interpreted?
- A. An additional code should be reported to fully describe a condition.
- B. It may include services that are bundled and cannot be separately billed.
- C. It may identify services that are not bundled and may lead the user to a more appropriatecode.
- D. Acausal relationship should be presumed between the tvo conditions.
Answer: C
Explanation:
The "Excludes" note identifies services that are not bundled into a procedure and may be reported in addition to the primary code. It may also lead the user to another code that would be more appropriate for the procedure being reported. Answer B describes "with." Answer C describes the icon "Includes." Answer D describes the "code also" note attached to a diagnosis.
NEW QUESTION # 29
A physician provides a GIPO 39-weeks twin gestational patient with antepartum care, delivery, and postpartum care. Baby A was delivered vaginally without complications, and Baby B was delivered by Cesarean due to fetal tachycardi a. Assign the correct ICD-IO-CM and CPT codes.
- A. 59410, Z37.2 and 59510-51, 076, Z37.2
- B. 59510, 076, Z3A39, Z37.o and 59409-51, Z3A39, Z37.o
- C. 59400, Z37.o and 59510-51, 036.8332, Z37.o
- D. 59409, Z3A.39, Z37.o and 59510-51, 076, Z3A39, Z37.o
Answer: B
Explanation:
The Cesarean delivery (59510) would be sequenced first because this code has the highest RVU and would include the antepartum and postpartum care. The vaginal delivery by itself (59409), without antepartum and postpartum care, would be reported secondary because the charges for the antepartum and postpartum care of the mother have already been included in the Cesarean delivery code.
NEW QUESTION # 30
If a physician administers cyclophosphamide over 154 minutes, irinotecan over 72 minutes, and panitumumab over 15 minutes intravenously to a patient with pancreatic cancer, how should this be reported?
- A. 96413, 96413-59, 9641512, 96417
- B. 96413, 96415x3, 96417x2
- C. 94613, 96415x2, 96417x2
- D. 96413, 96413-59x2, 96415, 96417
Answer: B
Explanation:
Unless a separate IV site is established for a secondary or tertiary administration, CPT
96413 should be reported only once to represent the initial drug infusion. In this case, it is the cyclophosphamide. The remaining 94 minutes are reported with Ovo units of add-on CPT 96415, which may be reported ifthe time spent beyond the first hour is between 31 and 60 minutes. CPT
96417 is reported only once per subsequent infusion of a different drug up to the first hour.
Consequently, the 72 minutes of irinotecan is reported with a single unit of CPT 96417, and the 15 minutes of panitumumab is also reported with one unit ofthat same CPT code.
NEW QUESTION # 31
A 59-year-old male patient presents for a routine colonoscopy. During the procedure, a polyp is discovered. What is the proper ICD- 10-CM coding for this encounter?
- A. Z12.11
- B. K63.5
- C. Z12.11, K63.5
- D. K63.5, Z12.11
Answer: C
Explanation:
Because the reason for the visit was a routine colonoscopy, the "encounter for screening for malignant neoplasm of colon" (Zl 2.11) would be the first-listed code. ICD-IO-CM guidelines advise that if there is a finding during a screening, the finding may be used as an additional code. In this example, the colon polyp (K63.5) is a physical finding and would be listed as the secondary diagnosis.
NEW QUESTION # 32
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