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NEW QUESTION # 80
A surgeon performs a craniectomy to excise a meningioma located above the tentorium cerebelli. During the procedure, an extradural hematoma is noted and removed via the same craniectomy site. How should the surgeon report the procedure?
- A. 61312-22
- B. 61512, 61312-59
- C. 0
- D. 61519, 61314-51
Answer: C
Explanation:
Surgical procedures on the nervous system are identified by where inside the skull they occur. A meningioma is being excised from above the tentorium cerebelli, otherwise known as supratentorial (CPT 61512). The removal of an extradural hematoma is inclusive to the primary craniectomy code because the finding is incidental and the same surgical site is used for its removal.
If the surgeon had to create a separate incision to access the extradural hematoma, that excision could be reported separately with modifier 59.
NEW QUESTION # 81
Which of the four chambers in the heart receives deoxygenated blood from the body through the vena cava?
- A. Left atrium
- B. Left ventricle
- C. Right atrium
- D. Right 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 # 82
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. The two codes are exclusive of each other and can never be billed together.
- B. The two codes can be billed together with an appropriate modifier.
- C. If being billed together, only report one unit of each.
- D. The two codes are inclusive of each other and can never be billed together.
Answer: B
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 # 83
Under the oversight of the pediatrician, a nurse reviews the vaccine and allergr history of a 13-year-old established patient just prior to administering a live varicella virus vaccine subcutaneously. What procedure code(s) should be reported?
- A. 99211-25, 90716, 90471
- B. 90716, 90471
- C. 90716, 90460
- D. 99211-25, 90716, 90460
Answer: B
Explanation:
Although CPT 99211 can be reported for limited assessments performed by nonphysician staff members, the vaccine and allergy history intake is considered vaccine related and not separately reportable. CPT 90460 is reported when a physician provides counseling about the benefits and risks associated with the vaccine and signs and symptoms that would indicate an adverse reaction.
Because the physician did not document seeing the patient at this encounter, report CPT 90471 for the administration of the immunization.
NEW QUESTION # 84
A patient relocates after receiving treatment for an arm fracture. The patient schedules an appointment with a new orthopedist to remove the cast. The orthopedic office should report the fracture diagnosis code with the seventh character A to indicate active treatment.
- A. False
- B. True
Answer: A
Explanation:
The statement is false. When a patient is in the healing and/or recovery phase of an injury, the seventh character would be D to indicate that the care is subsequent-whether the provider has treated the patient in the past or not.
NEW QUESTION # 85
An extracapsular cataract extraction procedure was performed on a patient with a clouded and discolored lens. The physician uses iris hooks in the right pupil to ensure safe and controlled access to the cataract and blue staining dye to visualize the capsulorhexis. Using suction, the existing lens capsule is removed, and an intraocular lens is inserted. What should the physician report?
- A. 66982-RT, Q12.8
- B. 66984-RT, H18.891
- C. 66984-RT, H26.8
- D. 66982-RT, H27.8
Answer: D
Explanation:
When deciding between a routine extracapsular cataract removal and a complex extracapsular cataract removal, bear in mind the code descriptor for a complex procedure involves
"devices or techniques not generally used in a routine cataract surgery (e.g., iris expansion device)." Because iris hooks were used, the procedure is complex (CPT 66982). When it comes to the diagnosis, do not get confused with the anatomy of the eye. Although the cornea works with the lens to help refract light, they are anatomically separate, thus eliminating answer B as an acceptable choice. A congenital condition is one that is genetic and/or present from birth. The documentation does not specifiy the origin, nor does it indicate when the lens abnormality began. Symptoms of a cataract include clouded and discolored lenses but should not be reported unless the physician clearly identifies this as the diagnosis. Coding crosswalk for diseases of the lens leads a coder to H27.8 (other specified disorders of lens).
NEW QUESTION # 86
Which service would NOT be covered under Medicare part A?
- A. Home health care
- B. Hospice care
- C. Observation hospital care
- D. Inpatient hospital care
Answer: C
Explanation:
Observation hospital care is provided to patients who are not sick enough to be admitted.
Therefore, it is considered an outpatient service and is covered under Medicare part B.
NEW QUESTION # 87
Code the following procedure note:
A 45-year-old female was referred for a urodynamics study due to complaints of bladder pain and weak urination. The provider places a rectal catheter simultaneously with a urethral catheter and begins to fill the bladder with water.
Using calibrated equipment, cytometry was done with a medium fill rate of 40 cc/ minute. A strong desire to void occurred at 84 cc. and the patient is instructed to void. The provider determines that the maximum urinary flow rate is 12 cc per second with a voiding time of 45 seconds and a voided volume of 102 cc. She voided with a sustained detrusor pressure. An abdominal pressure measurement was also taken, indicating no urinary leaking with abdominal straining. EMG patches were placed on the anal sphincter and found to be elevated with increased intra- abdominal pressure. All catheters and EMG patches were removed, and the procedure was completed without complications. A report will be forwarded to the referring provider, who will provide the interpretation of the results to the patient.
- A. 51726-TC, 51784-51-TC, 51797-51-TC
- B. 51726-TC, 51784-59-TC, 51797-59-TC, 51741-59-TC
- C. 51728-TC, 51784-TC, 51797-TC, 51741-TC
- D. 51728-TC, 51784-TC, 51797-TC
Answer: C
Explanation:
A urodynamics study is a diagnostic test to evaluate the function of the bladder. When performed using calibrated equipment, it becomes known as a complex cystometrogram (51726-
51729). In CPT code 51728, a complex cystometrogram is performed in conjunction with voiding pressure studies. In the provider's documentation, the bladder is filled with water, and voiding times and volume are recorded, thus fulfilling the requirements for this code. CPT code 51726 in answers A and B only describe a complex cystometrogram without the voiding pressure studies.
Electromyography (EMG) studies were performed without a needle to evaluate pelvic floor activity and are represented by 51784. An intraabdominal voiding pressure study (51797) can be inferred in that the provider had earlier inserted a rectal catheter and, after instructing the patient to cough, obtained an abdominal pressure measurement. A complex urinary flow study (51741) was performed in obtaining the maximum urinary flow rate through calibrated equipment. This procedure is missing in answers B and C. Modifier TC (indicating only a technical component) is amended on all the procedures because the provider is not interpreting the results to the patient.
Modifiers 51 and/or 59 is not amended on any procedure (A and B) because these are routinely billed together.
NEW QUESTION # 88
What would NOT be included in a global obstetrical package?
- A. A patient with anemia comes in to check hemoglobin levels.
- B. A patient complains of flu-like symptoms and is prescribed an antibiotic.
- C. Contraception following delivery is discussed at length.
- D. Sutures are removed from a first-degree perineal laceration during the delivery.
Answer: B
Explanation:
The treatment of flu-like symptoms is considered a non-obstetric service, and a separate E/M can be billed for reimbursement. All other answer choices would be included in the global obstetrical package as routine care.
NEW QUESTION # 89
A patient tests positive for coronavirus (SARS-CoV-2) and bronchitis after presenting with a cough. What diagnosis code(s) should be reported?
- A. U07.1,J40, Z20.828
- B. J40,B97.29, Z20.828
- C. U07.1,J40
- D. 140, 897.29, R05.9
Answer: C
Explanation:
The underlying condition should always be first listed, which in this case would be the SARS- COV-2 infection (U07.1). The description of the code then prompts the biller to list the manifestations, which would be the unspecified bronchitis 040). In answer A. cough would not be coded as a symptom because the patients illness is confirmed. Answers C and D, which include a suspected exposure code, can also be eliminated because this code is used only when the existence ofthe illness in the patient is unknown or negative.
NEW QUESTION # 90
A laboratory receives a pap smear as a screening for a patient's annual gmecological exam. A thin-layer preparation screened by an automated system with manual rescreening is performed. A pathologist interprets the results and confirms a diagnosis of high-grade squamous intraepithelial lesion. What should the laboratory report?
- A. 88175, 88141, ZOI.419,R87.613
- B. G0148, G0141, Z12.4 R8.613
- C. G0148, R87.610
- D. 88175, Z12.4
Answer: A
Explanation:
The CPT codes for cytopathologv smears are dependent on the payer and the method used to test the specimen. HCPC II G0148 does accurately describe the test method; however, this code is used for Medicare payers only. As the documentation does not specify that this is the case, it should be assumed that the carrier is non-Medicare. The appropriate non-Medicare CPT for this test method is 88175. CPT 88141 is always reported as a secondary code for the associated physician interpretation. Regarding the diagnosis, the primary ICD-IO-CM code should be synonymous with the reason for the encounter, which in this scenario would be the Omecological exam (ZOI.419).
Although Z12.4 does describe a screening of the cervix, it specifically is excluded from the diagnosis list "when the screening is part of general gynecological examination (ZOI.4-ZOI.42)." Any abnormal findings are reported as secondary and/or tertiary.
NEW QUESTION # 91
Which healthcare professional may NOT report medical nutrition therapy?
- A. Nutritionist
- B. Registered nurse
- C. Endocrinologist
- D. Dietician
Answer: C
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 # 92
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-TC-RT, MI 7.11
- B. 73560-RT, MI 7.11
- C. 73560-TC-RT, MI 7.11, M25.561
- D. 73560-26-RT, MI 7.11, M25.561
Answer: B
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 # 93
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. 39010, 31622-51
- B. 39010, 31623-51
- C. 39402, 31622-51
- D. 39402, 31623-51
Answer: A
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 # 94
Which patient is receiving critical care services?
- A. A 67 -year-old female receives chronic ventilator therapy after a cerebral infarction thatcaused hemorrhage in the brain.
- B. A 60-year-old male is admitted with an acute chronic heart failure exacerbation causinghypoxic respiratory failure. The patient is intubated, sedated, and started on 50 mg ofertapenem for a potential lung infection.
- C. A 47 -year-old female with a history of unrepaired chronic heart disease and anemia has anoxygen saturation level of 80. She is put on a nasal cannula and given a blood transfusion toimprove her oxygen-carrying capacity and oxygen saturation level.
- D. A 93 -year-old male is admitted to the intensive care unit for monitoring after a coronaryangioplasty procedure that was performed to relieve symptoms of atherosclerosis.
Answer: B
Explanation:
CPT guidelines define critical care as an illness or injury that acutely impairs one or more vital organ systems, where there is a high probability of imminent or life-threatening deterioration in the patients condition. Additionally, to report a critical care service, the documentation should provide evidence of high-complexity medical decision-making (e.gendotracheal tube insertion, defibrillation, fluid administration for shock, Narcan, etc.). Answer B is the only option listed that contains documentation to support critical care services.
This male patient has Vyvo life-threatening conditions, in which emergent intervention is provided to prevent further deterioration. In ansvver A the female patient may have a life-threatening condition: however, administering oxygen via a nasal cannula and/or transfusing blood does not qualify as critical care. Management of a patient who receives chronic ventilator therapy is also not considered critical care because the medical decision-making involved in the therapy is quite low.
The care a patient receives after having surgery would be considered routine and postoperative, regardless of where they are sent, unless a complication arises in which one or more of the vital organ systems begins to deteriorate in a fashion that poses a threat to life.
NEW QUESTION # 95
What must the documentation for a consultation include?
- A. Who requested the consultation, the consulting providers, professional opinion, and awritten report that is provided to the referring physician
- B. Documentation of assumption of care, who requested the consultation, and the consultingproviders, professional opinion
- C. Which family member prompted the consultation, a written report ofthe physical findings/recommendations, and the time spent discussing the recommended treatment plan
- D. The reason for the consultation, the time spent discussing the recommended treatmentplan, and a medical decision-making of moderate complexity
Answer: A
Explanation:
Per CPT guidelines, the Office of Inspector General, and Medicare, a consultation must include who requested the consultation, the consulting provider's professional opinion, and a written report of the findings, which is provided to the referring physician. Time can be used to select the level of E/M; however, it is not required if all three components of the documentation are met (history, exam, and medical decision-making). Additionally, once the provider assumes care, a subsequent code appropriate for that place of service would be reported (e.g., 99211-99215) and not a consultation code.
NEW QUESTION # 96
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