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NEW QUESTION # 66
A urologist performs a laparoscopic adrenalectomy and excises a retroperitoneal mass in the same session. How should this be coded?
- A. 0
- B. 1
- C. 60650-22
- D. 60650, 49203-51
Answer: C
Explanation:
CPT 60650 describes a laparoscopic adrenalectomy with a biopsy but not the complete removal of a retroperitoneal mass. In contrast, adding modifier 22 indicates increased work and complexity and can be used because there is no CPT to describe a laparoscopic retroperitoneal mass resection. CPT 49329 represents an unlisted laparoscopy procedure that can be used to describe the removal of a retroperitoneal mass but would have to be used in conjunction with CPT
60650 to describe the adrenalectomy procedure. CPT 60545 describes an adrenalectomy with excision ofa retroperitoneal mass by means of an abdominal or posterior incision. CPT 49203 also does not describe the procedure because it involves an open excision of an intra-abdominal tumor.
NEW QUESTION # 67
What must the documentation for a consultation include?
- A. Which family member prompted the consultation, a written report ofthe physical findings/recommendations, and the time spent discussing the recommended treatment plan
- B. Who requested the consultation, the consulting providers, professional opinion, and awritten report that is provided to the referring physician
- C. Documentation of assumption of care, who requested the consultation, and the consultingproviders, professional opinion
- D. The reason for the consultation, the time spent discussing the recommended treatmentplan, and a medical decision-making of moderate complexity
Answer: B
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 # 68
Which term describes a procedure in which real-time moving images of an organ are displayed on a screen so that a physician can examine its function and/or structure?
- A. Computed tomography
- B. Fluoroscopy
- C. Tomography
- D. Magnetic resonance imaging
Answer: B
Explanation:
Magnetic resonance imaging (MRI) uses magnets, radio waves, and a computer to display detailed pictures of the inside of the body. Tomography uses waves of energy to create three- dimensional, computer-generated images of any internal structure. Computed tomography is cross- sectional images of the body obtained by a narrow beam of x-rays that quickly rotates around the body.
NEW QUESTION # 69
Code the following procedure note:
A selective catheter is placed into the thoracic aorta, where it is then manipulated into the left coronary artery and followed through into the right common carotid artery. Contrast injections are made, and digital imaging is performed. Upon completion, the catheter is removed, pressure is applied at the puncture site, and the patient is discharged.
- A. 36215, 36216-59
- B. 0
- C. 1
- D. 36200, 36215, 36216-59
Answer: A
Explanation:
The left coronary artery and the right common carotid artery would each be considered their own vascular family. Therefore, when the starting point of selective catheterization is the aorta, the left coronary artery would be considered first order (36215) in the vascular family and the right common carotid artery would be considered the second order (36216). Modifier 59 is appended to indicate that a different vascular family was examined in one session. Contrast materials and catheterization into the aorta are inclusive to the nvo procedures and are not to be separately coded.
NEW QUESTION # 70
Code the following note:
A 43 -year-old new female patient with a history of type I diabetes was referred to my office by Dr. White, her primary care physician. Patient complains of blurred vision that began 2 weeks ago, however, reports compliance to a strict, healthy diet and to prescribed 10 mg of dexamethasone every day for 1 month. Given that the only change appears to be the dexamethasone, I suspect the blurred vision is an adverse reaction and will decrease the dosage to 5 mg per day. Patient will follow up with me in 1 week if symptoms persist.
Total time spent on todays encounter is 30 minutes.
- A. 99204, HS3.8, ElO.9
- B. 99244, H53.8, T38.OX5A, ElO.9
- C. 99243, H53.8 ElO.39
- D. 99203, H53.8, ElO.69
Answer: A
Explanation:
When choosing between an outpatient evaluation and management code or a consultation service code, bear in mind the following four elements: request, reason, report, and intent. Although the first three elements are documented and support a consultation service, the endocrinologist is assuming immediate care of the patienYs condition. In this case, the visit is not a consultation but a new transfer of care, which is encompassed by CPT codes 99202-99205. For this visit, coding based on medical decision-making as opposed to the total time spent on the encounter that day would be more advantageous. This is because coding based on time would lead a coder to report CPT code
99203 or a low level of medical decision making, whereas the medical decision-making is actually moderate, represented by CPT code 99204.
The documentation reflects that the blurry vision is most likely due to the dexamethasone:
therefore, a causal relationship is not assumed betvveen the two conditions and should not be coded as such. Because an adverse reaction is suspected and not confirmed, it should not be coded. This general rule does not apply to inpatient encounters.
NEW QUESTION # 71
Modifier 50 is not an appropriate modifier to append on CPT code 52000.
- A. False
- B. True
Answer: B
Explanation:
The statement is true. In general, modifier 50 is not appended on cystourethroscopies because human anatomy has only one bladder. However, if the descriptor includes "with ureteral catherization," the procedure can be performed tvvice and billed once with modifier 50 because there are two ureters. CPT 52000 does not include this descriptor.
NEW QUESTION # 72
A sternal closure using sutures is considered inclusive to CPT 33255 and should not be reported separately.
- A. False
- B. True
Answer: B
Explanation:
The statement is true. Regardless of how a sternal closure is performed, it would be considered integral to this, and any other open cardiac procedure, when a sternal approach is used as the method of exposure. If a sternal closure were performed as the only procedure to repair an injury, the closure would then be reported.
NEW QUESTION # 73
A primary care physician is requesting a second opinion to determine which strain of Ebolavirus the patient has. The specimen is sent to a pathologist, who carefully examines it.
A written report is sent promptly back to the primary care physician, confirming Zaire Ebolavirus and recommending immediate isolation and emergency care. What code should be reported by the pathologist?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: D
Explanation:
A clinical pathology consultation was rendered at the request of the primary care physician.
The consultation is considered high based on the level of medical decision making. The CDC describes Ebola disease as a "rare and often deadly illness." Therefore, the number and complexity of problems addressed is high, as is the management ofthe disease due to the decision to escalate this case to hospital level care. E/M codes can be billed only when a patient themself is evaluated by the provider. In this case, the pathologist only evaluated a specimen.
NEW QUESTION # 74
A physician performs a 6 cm midline celiotomy to remove a patient's enlarged spleen by means of cautery. Abdominal exploration was performed, and the lymph nodes surrounding the inferior mesenteric artery that were noted to be abnormal were also removed. What CPT code(s) describes the surgery performed by the physician?
- A. 0
- B. 38100, 38999-59
- C. 49000, 38102
- D. 38120, 49000-51
Answer: B
Explanation:
CPT 38120 is the removal of the spleen by means of a laparoscope. The physician performed a midline celiotomy (an abdominal incision), which is an open procedure, eliminating this option. CPT 43631 describes the removal of certain portions of the stomach and was not the procedure performed. An exploratory laparotomy (or abdominal exploration) is inclusive to a splenectomy procedure and should not be reported separately. Additionally, CPT 38102 is reported when the spleen is involved in an extensive disease such as malignancy. On the other hand, CPT
38100 fully describes the open splenectomy, and CPT 38999 is used for the removal of mesenteric lymph nodes because there is no specific code for this procedure.
NEW QUESTION # 75
Medical necessity has been established if a laboratory runs additional testing on a urine sample to determine the presence of a drug class that was not in question during confirmation testing.
- A. False
- B. True
Answer: A
Explanation:
The statement is false. To establish medical necessity, the provider/laboratory must indicate the drug class they are screening for prior to the test.
NEW QUESTION # 76
What is the difference between presumptive and definitive testing?
- A. Presumptive testing confirms the presence of a drug class; definitive testing identifies thequantity or presence of a drug.
- B. Presumptive testing is based on exhibited signs and/or symptoms; definitive testing isbased on lab results.
- C. Presumptive testing assumes a diagnosis; definitive testing confirms a diagnosis.
- D. Presumptive testing requires additional observation time; definitive testing requires ablood draw.
Answer: A
Explanation:
A presumptive test reports whether the patient is positive or negative for a specific drug. A definitive test would analyze which specific agent and/or how much of that agent is in the patients' system.
NEW QUESTION # 77
In which scenario would the modifier 53 be appended?
- A. A surgeon decides to stop a gallbladder removal procedure in the hospital operating roomafter the patient has extensive bleeding at the incision site.
- B. A patient receives an x-ray of one femur when the doctor ordered bilateral views.
- C. An IUD removal is not completed because the patient reports severe pain when thespeculum is inserted.
- D. The surgeon decides to terminate a routine colonoscopy when the patient becomeshypertensive before receiving anesthesia in the outpatient procedure room.
Answer: A
Explanation:
Modifier 53 is used to indicate that a procedure was terminated by the provider after anesthesia was given due to extenuating circumstances that affected the health of the patient.
Although option B is similar, the procedure that was discontinued was done so prior to anesthesia in the outpatient setting, in which case modifier 73 would be appended.
NEW QUESTION # 78
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. 94726, 94060-51
- B. 99212-25, 94726, 94060-76
- C. 94726, 94060
- D. 99212-25, 94726,94010-51, 94060-51
Answer: C
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 # 79
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 # 80
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, 96413-59x2, 96415, 96417
- C. 96413, 96415x3, 96417x2
- D. 94613, 96415x2, 96417x2
Answer: C
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 # 81
A male patient is admitted with symptoms of a persistent cough and temperature of 101.2. A skin test reveals that the patient has tuberculosis. His medical history is positive for HIV. Assign the appropriate diagnosis codes for this patient.
- A. A18.4, R05.8, R50.9, B20
- B. A18.4, Z21
- C. B20,A15.9
- D. A15.9,
Answer: C
Explanation:
Tuberculosis (TB) can usually spread from the lungs to another site via the bloodstream.
Because the documentation does not specify whether the TB is primary or secondary, the coder would default to A15.9, as TB unspecified. A cough and fever are symptoms of an underlying illness and would not be coded because a definitive diagnosis of TB is present. Because TB is an HIV- related illness, B20 would be the first listed code.
NEW QUESTION # 82
CPT code 99135 is an example of a qualifying circumstance.
- A. False
- B. True
Answer: B
Explanation:
The statement is true. When it comes to reporting anesthesia services, qualifying circumstances are factors that put a patient at an unusually high health risk. A qualifring circumstance is reported with CPT codes 99100-99140, which are listed separately, in addition to the primary anesthesia code. If reporting one of these add-on codes, documentation must be submitted to support the necessity of such services.
NEW QUESTION # 83
The laboratory collected blood to test the patient's carbon dioxide, chloride, potassium, sodium, and glucose levels. Select the CPT codes that the laboratory will report.
- A. 80053-52
- B. 80051, 82947-59
- C. 80051, 80053
- D. 80051, 82947
Answer: D
Explanation:
It would not be appropriate to add modifier 52 to 80053 in answer A In answer C, 80051 and
80053 would not be reported together because CPT guidelines state that "when or more panel codes include the same tests, report the panel with the highest number of tests in common." Because the glucose test is not included in 80051, 82947 would be added to 80051, with no modifier 59, because the procedures are routinely billed together, thus eliminating answer D.
NEW QUESTION # 84
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 can be billed together with an appropriate modifier.
- B. The two codes are inclusive of each other and can never be billed together.
- C. If being billed together, only report one unit of each.
- D. The two codes are exclusive of each other and can never be billed together.
Answer: A
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 # 85
Which service would NOT be covered under Medicare part A?
- A. Hospice care
- B. Inpatient hospital care
- C. Observation hospital care
- D. Home health 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 # 86
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. 0483T, 93451
- B. 0484T, 93451-59
- C. 0484T
- D. 0
Answer: C
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 # 87
A physician documents a comprehensive electrophysiologic evaluation with an unsuccessful attempted induction of arrhythmi a. Upon review, the bundle-of-His recording is missing. What code(s) should be reported?
- A. 93610, 93602, 93612, 93603, 93618
- B. 0
- C. 93619-52
- D. 93620-52
Answer: A
Explanation:
To bill a comprehensive electrophysiologic evaluation (93619-93622), the following five components must be documented: right atrial pacing (93610), right atrial recording (93602), right ventricular pacing (93612), right ventricular recording (93603), and bundle-of-His recording (93600). If the documentation does not support all five components, each study must be reported separately, as opposed to billing the procedure with a "reduced services" modifier. The exception to this rule would be if an add-on procedure were performed and required to be reported in addition to the comprehensive electrophysiologic evaluation. In this case, however, the attempted induction arrhythmia (93618) is not an add-on code and can be reported in addition to the primary procedures.
NEW QUESTION # 88
Which service is NOT included in the central nervous system assessment?
- A. Clinical dementia rating
- B. Discussion of suicidal intentions
- C. Review of an advance care plan
- D. Prescription for an opioid
Answer: D
Explanation:
A central nervous system assessment is comprised of multiple screenings that are reported with CPT codes 96105-96146 and includes, but is not limited to, the following elements: use of standardized instruments for staging and rating clinical dementia: evaluation for behavioral symptoms using standardized screening instruments; and development, updating, revision, and/or review of an Advance Care Plan. A review of high-risk medications is also included in the central nervous system assessment; however, if in the same encounter a prescription is issued, the clinician should document and report the treatment with an appropriate E/M.
NEW QUESTION # 89
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