Prepare for the AAPC Certified Professional Coder (CPC) exam with these practice questions and answers. This guide covers ICD-10-CM, CPT coding, HCPCS, medical terminology, anatomy, and compliance.
Q: What anatomical or compartment contains all the thoracic viscera except the lungs?
Answer: Mediastinum
Q: Who is responsible for enforcing the HIPAA security rule
Answer: Office of Civil Rights (OCR)
Q: ABN
Answer: Advance Beneficiary Notice
Q: According to the OIG, internal monitoring and auditing should be performed by what means?
Answer: Periodic audits
Q: What does the abbreviation MAC stand for?
Answer: Medicare Administrative Contractor
Q: How many lobes make up the RIGHT lung?
Answer: the right has 3 lobesthe left has 2 lobes
Q: Condition in which the endometrial tissue is found outside of the uterus.
Answer: Endometriosis
Q: A thin membrane lining the chambers of the heart and valves is called the:
Answer: endocardium
Q: PHI
Answer: Protected Health Information
Q: What is the TRUE statement in reporting pressure ulcers?
Answer: Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to another stage during the admission.
Q: The acronym MMRV stands for what?
Answer: measles, mumps, rubella, and varicella
Q: Which of the following is not part of the small intestine?a. duodenumb. ileumc. jejunumd. cecum
Answer: d. cecum
Q: Healthcare providers are responsible for developing ______________ policies and procedures regarding privacy in their practices.a. Patient hotlineb. Work around proceduresc. Feesd. Notices of Privacy Practices
Answer: Notices of Privacy Practices
Q: A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the:a. testisb. scrotumc. prostated. epididymis
Answer: c. Prostate
Q: What is the Rinne test?a. Test using music as the focal pointb. test for hearing loss using a vibrating tuning fork placed at the center of the headc. test using a 2-syllable word with equal stress on each syllabled. test measuring hearing using bone conduction and air conduction
Answer: d. test measuring hearing using bone conduction and air conduction
Q: What is the difference between entropion and ectropion?A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid.B. Entropion is facial droop and ectropion is a facial spasm.C. Entropion is the outward turning of the hands and ectropion is the inward turning of the hands.D. Entropion inward turning of the feet and ectropion is the outward turning of the feet due to muscle disorder.
Answer: a. entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid.
Q: An arteriovenous anastomosis is used to increase blood flow in hemodialysis. Which one of the following describes a direct arteriovenous anastomosis?A. Insertion of a cannulaB. A section of artery and a neighboring vein are joinedC. A donor’s vein is used to connect an artery and a veinD. Radical hysterectomy not otherwise specifiedE. A synthetic vein is used to connect an artery and a vein
Answer: b. a section of the artery and a neighboring vein are joined
Q: Ventral, umbilical, spigelian and incisional are types of:A. Surgical approachesB. HerniasC. Organs found in the digestive systemD. Cardiac catheterizations
Answer: b. hernias
Q: When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located?A. FootB. Upper ArmC. Upper LegD. Hand
Answer: a. foot
Q: Which statement is TRUE when reporting pregnancy codes (O00-O9A):A. These codes can be used on the maternal and baby records.B. These codes have sequencing priority over codes from other chapters.C. Code Z33.1 should always be reported with these codes.D. The seventh character assigned to these codes only indicate a complication during the pregnancy.
Answer: B: These codes have sequencing priority over codes from other chapters
Q: Which statement is TRUE about reporting codes for diabetes mellitus?A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus.B. When a patient uses insulin, Type 1 is always reported.C. The age of the patient is a sole determining factor to report Type 1. D. When assigning codes for diabetes and its associated condition(s), the code(s) from category E08-E13 are not reported as a primary code.
Answer: a. if the type of diabetes mellitus is not documented in the medical record, the default type is E11: type 2 diabetes mellitus
Q: Which statement is TRUE for reporting external cause codes of morbidity (V00-Y99)?A. All external cause codes do not require a seventh character.B. Only report one external cause code to fully explain each cause.C. Report code Y92.9 if the place of occurrence is not stated.D. External cause codes should never be sequenced as a first-listed or primary code
Answer: d. external cause codes should never be sequenced as a first-listed or primary code
Q: What is NOT included in CPT® surgical package?A. Typical postoperative follow-up careB. One related Evaluation and Management service on the same date of the procedureC. Returning to the operating room the next day for a complication resulting from the initial procedureD. Evaluating the patient in the post-anesthesia recovery area
Answer: c. returning to the operating room the next day for a complication resulting from the initial procedure
Q: What is the term used for inflammation of the bone and bone marrow?A. ChondromatosisB. OsteochondritisC. CostochondritisD. Osteomyelitis
Answer: d. osteomyelitis
Q: The root word trich/o means:A. HairB. SebumC. EyelidD. Trachea
Answer: a. hair
Q: Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________.A. Medulla lobeB. Occipital lobeC. Middle lobeD. Inferior lobe
Answer: d. occipital lobe
Q: A patient is having pyeloplasty performed to treat an uretero-pelvic junction obstruction. What is being performed?A. Surgical repair of the bladderB. Removal of the kidneyC. Cutting into the ureterD. Surgical reconstruction of the renal pelvis
Answer: d. surgical reconstruction of the renal pelvis
Q: A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic esophageal varices. The ICD-10-CM codes are reported:A. I85.01, K74.69B. I85.11, K74.60C. K74.60, I85.11D. I85.00, K74.69
Answer: In the ICD-10-CM Alphabetic Index look for Varix/esophagus/in/cirrhosis of liver/bleeding referring you to code I85.11. This eliminates multiple choices A and D. In the Tabular List you will see an instructional note above codes I85.10 and I85.11 to Code first underlying disease. For the scenario, cirrhosis of liver (K74.60) is coded first then the esophageal varices with bleeding is coded as a secondary code. Eliminating multiple choice B.correct answer is C. K74.60, I85.11
Q: Which statement is TRUE about Z codes:A. Z codes are never reported as a primary code.B. Z codes are only reported with injury codes.C. Z codes may be used either as a primary code or a secondary code.D. Z codes are always reported as a secondary code.
Answer: c. Z codes may be used wither as a primary code or a secondary code
Q: Guidelines from which of the following code sets are included as part of the code set requirements under HIPAA?A. CPT® Category III codesB. ICD-10-CMC. HCPCS Level IID. ADA Dental Codes
Answer: ICD-10-CM guidelines are the only guidelines specifically mentioned in HIPAA. While HIPAA requires the use of the other code sets listed, there is no specific mention of the other guidelines in the law. This information is found in the ICD-10-CM Official Guidelines for Coding and Reported in you ICD-10-CM codebook: These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA).
Q: Which statement is an example in which a diabetes-related problem exists and the code for diabetes is NEVER sequenced first?A. If the patient has an underdose of insulin due to an insulin pump malfunction.B. If the patient is being treated for secondary diabetes.C. If the patient is being treated for Type 2 diabetes and uses insulin.D. If the patient is diabetic with an associated condition.
Answer: a. If the patient has an underdose of insulin due to an insulin pump malfunction.The ICD-10-CM guidelines (Section I.C.4.a.5): An underdose of insulin due to an insulin pump failure should be assigned T85.6-, as the principal or first listed code, followed by code T38.3X6-. Additional codes for the type of diabetes mellitus should also be assigned.
Q: Local Coverage Determinations (LCD) are published to give providers information on which of the following?A. Information on modifier use with procedure codesB. CPT® codes that are bundledC. Fee schedule information listed by CPT® codeD. Reasonable and necessary conditions of coverage for an item or service
Answer: d. Reasonable and necessary conditions of coverage for an item or service
Q: Which place of service code is reported on the physician’s claim for a surgical procedure performed in an ASC?A. 21B. 22C. 24D. 11
Answer: place of service codes are two digit numerical codes that define the location where the services are performed and reported on the CMS-1500 form. A complete chart of place -of-service codes are located in the front of the CPT bookC. 24
Q: If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines?A. As unspecified AMIB. As a subendocardial AMIC. As STEMID. As a NSTEMI
Answer: C. as STEMIICD-10-CM guidelines (Section I.C.9.e.1) indicate: If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI
Q: When a person has labyrinthitis what has the inflammation?A. Inner earB. BrainC. ConjunctivaD. Spine
Answer: a. inner ear
Q: An angiogram is a study to look inside:A. Female Reproductive SystemB. Urinary SystemC. Blood VesselsD. Breasts
Answer: c. blood vessels
Q: What does oligospermia mean?A. Presence of blood in the semenB. Deficiency of sperm in semenC. Having sperm in urineD. Formation of spermatozoa
Answer: b. deficiency of sperm in semenThe breakdown of this term: combining form olig/o means too few or too little and spermia refers to the condition of the sperm. The definition is too low or too few sperm. In the Alphabetic Index look for Oligospermia N46.11. In the Tabular List oligospermia is indicated as a type of male infertility.
Q: A 45-year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported?A. 14060B. 11642, 14060C. 11642, 15115D. 15574
Answer: A. 14060An adjacent tissue transfer (advancement flap) was used to repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are not separately reported. This eliminates multiple choice answer B.
Q: A 24-year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT® code is:A. 56405B. 10061C. 11004D. 11042
Answer: c. 11004The abscess had already burst, with no need to perform an incision to open it, eliminating multiple choice answers A and B. The difference between multiple choice answers C and D, is that the patient is having the debridement performed due to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of necrotized infected tissue on the external genitalia.
Q: A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to Dr. S, who his neighbor referred him, to see if Dr. S can provide another type of treatment. Dr. S documents an appropriate history and exam. Patient has had the sleep apnea for the past five months. Sleep is disrupted by frequent awakenings and getting worse due to anxiety and snoring. Current medication that he is on now is not helping him. Which E/M category is reported for this encounter?A. New Patient Office Visit (99202-99205)B. Established Patient Office Visit (99211-99215)C. Office Consultation (99241-99245)D. Observation Care (99218-99220)
Answer: c. inflammation of testisOrchitis is marked by painful swelling of the testis. It may occur without cause, or be the result of infection. The Greek root “orchis” means testicle, and – “itis” is a suffix indicating inflammation or infection. Look in the ICD-10-CM Alphabetic Index for Orchitis referring you to code N45.2. In the Tabular List this code is found under Diseases of the Male Genital Organs (N40-N53).
Q: What is orchitis?A. Inner ear imbalanceB. Lacrimal infectionC. Inflammation of testisD. Inflammation of an ilioinguinal hernia
Answer: C. Paratubal cystsParatubal cysts are benign, they are frequently found adjacent to the fallopian tubes. Pilonidal cyst develops in the deeper layers of the skin in the lower back near the upper crease of the buttocks. Myomas or leiomyomas are benign tumors of the uterus. Synovial cyst develops in any joint, for example at the back of the knee. Look in the ICD-10-CM Alphabetic Index for, Cyst/paratubal N83.8. Go to the Tabular List and the code indicates where these cysts are located.
Q: The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A laparoscopy found several small cysts in the area of the fallopian tubes. These cysts are called:A. Pilonidal cystsB. MyomasC. Paratubal cystsD. Synovial cysts
Answer: c. Newborn with pneumonia
Q: Which one of the following patients might be documented as having meconium staining?A. Woman with renal failureB. Teenage boy with sickle cell anemiaC. Newborn with pneumoniaD. Man with alcoholic cirrhosis of liver
Answer: a. nose, heart
Q: Which of the following anatomical sites have septums?A. Nose, heartB. Kidney, lungC. Sternum, coccyxD. Orbit, ovary
Answer: d.Place of service codes are reported on the claim form to identify the site of the service provided. In this case, the services are rendered in the ED which is reported with place of service (POS) 23. The place of service codes can be found in the CPT® codebook.
Q: Which place of service code is reported for fracture care performed by an orthopedic physician in the ED?A. 11B. 20C. 22D. 23
Answer: b. Reporting a biopsy and excision performed on the same skin lesion during the same encounterAnswer B is the only example of unbundling of CPT® which would result in a fraudulent claim. According to National Correct Coding Initiative (NCCI) and CPT® coding guidelines, a biopsy performed on the same lesion as an excision during the same encounter is an incidental service and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is billable. X-rays performed in a physician’s office do not require modifier 26, because the physician owns the equipment and performs the interpretation, he bills the global service. Lab panels can be reported with additional lab tests that are not listed in a lab panel.
Q: Which one of the following is an example of fraud?A. Reporting the code for ultrasound guidance when used to perform a liver biopsyB. Reporting a biopsy and excision performed on the same skin lesion during the same encounterC. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physician’s officeD. Reporting a lab panel with an additional lab test that is not included in the lab panel
Answer: D. Z02see 1.C.21.c.16
Q: Which Z code category can ONLY be reported as a first listed diagnosis code?A. Z67B. Z69C. Z58D. Z02
Answer: a. orbitA blowout fracture is a fracture of the walls or floor of the orbit. The orbit is the cavity or socket of the skull which the eye and its appendages are situated. In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/orbit/floor (blowout).
Q: While playing softball a 12-year-old boy sustains a blowout fracture. What is the anatomical location of a blowout fracture?A. OrbitB. ClavicleC. PatellaD. Femur
Answer: D. Uterus: hintThe root word metr/o or metr/i means uterus. In the ICD-10-CM Alphabetic Index look for a main term that starts with metro. You will see the main term Metrorrhexis – see Rupture, uterus.
Q: The root metr/o means:A. MenstruationB. BreastC. Mammary glandD. Uterus
Answer: d. innominate, the right common, and internal carotid
Q: According to the CPT® Appendix L, when performing a selective vascular catheterization, which vessels would you pass through to place the catheter into the right middle cerebral artery?A. Innominate, right common carotid, right exteranl carotidB. Innominate, right subclavian & axillaryC. Left common carotid, left internal carotidD. Innominate, the right common, and internal carotid
Answer: c. An ABN must be completed before delivery of items or services are providedAn ABN must include the service that may be denied, an estimated cost of the patient’s responsibility if Medicare denies the service and the response for the potential denial. Generic ABNs are not allowed. Signing of the ABN cannot be obtained during a medical emergency. The patient must be stable. The ABN must be signed prior to providing the service.
Q: Which one of the following statements regarding advanced beneficiary notices (ABN) is TRUE?A. ABN must specify only the CPT® code that Medicare is expected to deny.B. Generic ABN which states that a Medicare denial of payment is possible, or the internist is unaware whether Medicare will deny payment or not is acceptable.C. An ABN must be completed before delivery of items or services are provided.D. An ABN must be obtained from a patient even in a medical emergency when the services to be provided are not covered.
Answer: b. Minor surgery performed in a physician’s officeServices performed by physicians are covered by Medicare Part B. Inpatient services are covered by Part A. Medicare does not cover routine dental care.
Q: Which service is covered by Medicare Part B?A. Inpatient chemotherapyB. Minor surgery performed in a physician’s officeC. Routine dental careD. Assisted living facility
Answer: a. when the cancer is surgically removed with no further treatment provided and there is no evidence of any existing primary malignancy, code Z85.850ICD-10-CM guidelines (Section I.C.2.d.) indicated, when the patient has excised or eradicated the malignancy and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the site of the former malignancy. Look in the ICD-10-CM Alphabetic Index, for History/personal (of)/malignant neoplasm (of)/thyroid. Note: If a malignant cancer is removed but the patient is still receiving further treatment for that site, such as chemotherapy or radiation, you report the malignant neoplasm code not the personal history code.
Q: When coding for a patient who has had a primary malignancy of the thyroid cartilage that was completely excised a year ago, which one of the following statements is TRUE?A. When the cancer is surgically removed with no further treatment provided and there is no evidence of any existing primary malignancy, code Z85.850.B. When further treatment is provided and there is evidence of an existing metastasis, code first Z85.850 and then C32.9.C. Any mention of extension, invasion, or metastasis to another site is coded as a D49.1, Z85.850.D. When the cancer is surgically removed but the patient is receiving chemotherapy treatment report Z85.850.
Answer: E. Physician can provide services to another patient during the same times providing critical care services to a critically ill patientCritical care services can be provided at any site. If the patient is critically ill, the services provided can be coded with critical care regardless of where the services take place. A minimum of 30 minutes of critical care must be performed in order to report 99291. If less than 30 minutes, select the appropriate E/M code based on the three key components. Time spent reviewing results and discussing the critically ill patient with medical staff is included in the critical care time. Endotracheal intubation, code 31500, can be reported with critical care services. The subsection guidelines for critical care services in the CPT® codebook does give what services cannot be billed with critical care. A physician providing critical care services must devote full attention to the critically ill patient and cannot provide services to any other patient during the same period of time.
Q: In order to use the critical care codes, which statement is TRUE?A. Critical care services can be provided in an internist’s officeB. Critical care services provided for more than 15 minutes but less than 30 minutes should be billed with 99291 and modifier 52.C. Time spent reviewing laboratory test results or discussing the critically ill patient’s care with other medical staff in the unit or at the nursing station on the floor cannot be included in the determination of critical care time.D. Critical care services are never reported with endotracheal intubation (31500)E. Physician can provide services to another patient during the same time providing critical care services to a critically ill patient
Answer: b.. They should be able to obtain copies of the medical record and request corrections of errors and mistakes
Q: What is the patient’s right when it involves making changes in the personal medical record?A. Patient must work through an attorney to revise any portion of the personal medical information.B. They should be able to obtain copies of the medical record and request corrections of errors and mistakes.C. It is a violation of federal health care law to revise a patient medical record.D. Revision of the patient medical record depends solely on the facility’s compliance program policy.
Answer: d. signs and symptoms that are integral of the disease process should not be assigned additional codes, unless otherwise instructed.
Q: Which statement regarding an ICD-10-CM coding conventions is TRUE?A. If the same condition is described as both acute and chronic and separate subentries exist in the Alphabetic Index at the same indentation level, code only the acute condition.B. Sequela (Late effect) codes are reported for a current acute phase of the injury or illnessC. An ICD-10-CM code is still valid even if it has not been coded to the full number of characters required for that code.D. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed.
Answer: b. GAAn Advance Beneficiary Notice (ABN) is a waiver of liability. When a patient has been informed a service that is otherwise covered by Medicare but might not be covered in a particular instance an ABN is signed by the patient prior to receiving the service. To inform Medicare the ABN has been signed, append modifier GA. If an ABN is signed, the claim is the patient’s responsibility if the claim is denied. This modifier is listed in the HCPCS Level II codebook.
Q: Which modifier is appended to a CPT®, for which the provider had a patient sign an Advance Beneficiary Notice (ABN) form because there is a possibility the service may be denied because the patient’s diagnosis might not meet medical necessity for the covered service?A. GJB. GAC. GBD. GY
Answer: b. Initial hospital inpatient E/M code and office visit E/M coe with modifier 25According to CPT® subsection guidelines for Initial Hospital Care: When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in another site of service (eg, hospital emergency department, office, nursing facility), the services in the initial site may be separately reported. Modifier 25 may be added to the other evaluation and management service to indicate a significant, separately identifiable service by the same physician or other qualified health care professional was performed on the same date.
Q: 15-year-old male is seen by the pediatrician in his office for having excessive thirst and frequent urination. A urine dip is performed showing +3 sugar and with some ketones. Glucometer reading is done showing a blood sugar range of 500-600. Physician sends the patient with his father to the hospital for emergency admission and insulin drip. The pediatrician meets the patient at the hospital and performs a medically appropriate history andexam continuing treatment for the patient. How should the pediatrician code the E/M service for this visit?A. Office visit E/M code onlyB. Initial Hospital Inpatient E/M code and Office Visit E/M code with modifier 25C. Initial Hospital Inpatient E/M code onlyD. Subsequent Hospital Inpatient E/M code
Answer: b. genitourinaryCKD is the abbreviation for Chronic Kidney Disease. The abbreviation is found in the ICD-10-CM Tabular List for category code N18 which falls under the Genitourinary System.
Q: CKD is a disease of which system?A. CirculatoryB. GenitourinaryC. DigestiveD. Musculoskeletal
Answer: d. kidney
Q: A person who has nephritis has inflammation in what location?A. GallbladderB. NerveC. UterusD. Kidney
Answer: a. fluid int he abdomenIn ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically caused by cirrhosis, malignancy, or heart failure. It is usually managed medically but may be treated with paracentesis. Look in the ICD-10-CM Alphabetic Index for Ascites (abdominal) referring you to code R18.8. In the Tabular List under category code R18 the includes note indicates: Fluid in peritoneal cavity.
Q: What is ascites?A. Fluid in the abdomenB. Enlarged liver and spleenC. Abdominal malignancyD. Abdominal tenderness
Answer: d. Bell’s palsy
Q: Which one of the following is a disorder in causing paralysis of the facial nerve?A. ExotropiaB. Tarsal tunnel syndromeC. Brachial plexus lesionsD. Bell’s palsy
Answer: a. TricuspidTricuspid is the first heart valve that blood encounters as it enters into the heart. Superior Vena Cava is a vein that returns blood to the heart from the head, neck and both upper extremities. Carotid is a major artery located in the front of the neck. Atrium is one of the two upper receiving chambers of the heart. An illustration of the heart is found in the Professional Edition of the CPT® codebook in the Cardiovascular System Table of Contents or look in the CPT® Index for Valve and you will note a complete valve listing.
Q: Complete this series: Pulmonary, Aortic, Mitral, and ________are valves of the heart.A. TricuspidB. Superior Vena CavaC. CarotidD. Atrium
Answer: c. hypernatremiahint:In the ICD-10-CM Alphabetic Index look for each of the listed terms. Cross reference each code in the Tabular List to note a brief definition. Hypernatremia is the when one has too much sodium in the system. Hypernatremia is indexed to code E87.0.
Q: Which term is one who has an overload of sodium?A. HyperkalemiaB. HyperpotassemiaC. HypernatremiaD. Hypercalcemi
Answer: a. procedure performed to drain fluid that has accumulated in the abdominal cavity
Q: The term paracentesis found in CPT® code 49082 means:A. A procedure performed to drain fluid that has accumulated in the abdominal cavityB. Biopsy of an abdominal massC. Removal of tissue samples from the abdominal cavity by an open approach D. Removal of a cyst located in the abdominal cavity
Answer: d. 12034, 12002-59The two face lacerations were closed with steri-strips (adhesive strips). When adhesive strips are the only repair material used to close an open wound a repair code is not reported. According to CPT® subsection guidelines for Repair (Closure), when wound closure uses adhesive strips as the only repair material it should be coded using the appropriate E/M service. Code 12011 is inappropriate to report for this scenario, eliminating multiple choices A and B. The repairs for the wounds on the arm and leg are intermediate closures. According to CPT® subsection guidelines for Repair (Closure), single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair. This eliminates multiple choice C. To report multiple wounds that are repaired in the same classification and from the anatomic sites that are grouped together into the same code descriptor, add the length of the wounds. The subsection guidelines also indicates when more than one classification of wounds is repaired, append modifier 59 to the least complicated repair(s).
Q: A 7-year-old riding his bike struck a tree stump throwing him off his bike. He received multiple lacerations. He had a 3 cm dermis laceration on his scalp with two 0.5 cm lacerations on his face. His right arm had a 5 cm laceration and right leg has a 5 cm laceration. The physician stapled the laceration for the scalp. Physician used steri-strips (adhesive strips) to close the wounds on the face. The legs and arms were cleaned by heavily irrigating them with normal saline and removal of embedded debris performed on both wounds, followed with a single-layer closure. Select the repair codes to report.A. 12032, 12032-59, 12011-59, 12002-59B. 12002, 12002-59, 12011-59, 12002-59C. 12005, 11042-59D. 12034, 12002-59
Answer: a. 11644, 12052-51, C44.319You need to first find out if this lesion is benign or malignant. For this scenario the patient has a basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as they deal with benign lesions. Now you need to find out where the lesion is located and the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm + .3 cm = 3.6 cm, leading you to code 11644. CPT® subsection guidelines for Excision-Malignant Lesions state: For excision of malignant lesion(s) requiring intermediate or complex closures should be reported separately. For this scenario the wound was closed in two layers qualifying the closure to be coded with an intermediate repair of the chin (4 cm), 12052. The diagnosis, basal cell carcinoma of the chin, look in the ICD-10-CM Table of Neoplasms, for Neoplasm, neoplastic/skin NOS/face NOS/basal cell carcinoma C44.31-. In the Tabular List complete the code with the 6th character 9.
Q: Procedure Diagnosis: Basal cell carcinoma, left chin.Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell carcinoma of the left chin with a 4 cm closure.Procedure: The patient’s left chin was examined. The site of intended excision was marked out. The site was then prepped. The patient was then prepped and draped in the usual fashion. A 15 blade scalpel was then used to make an incision in the previously marked site. It was carried down to the subcuticular fat. The lesion was then sharply dissected off underlying tissue bed using a 15-blade scalpel. It was tagged for pathologic orientation. The hyfrecator was used for hemostasis. The wound was then closed by advancing the tissue surrounding the lesion and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin. The skin closure was in a running subcuticular fashion. Steri-Strips were then applied. What are the procedure and diagnosis codes?A. 11644, 12052-51, C44.319B. 11643, 12013-51, C44.319C. 11444, 12052-51, D49.2D. 11443, 12013-51, D49.2
Answer: a. 27724, S82.102NThe selection of the code is based on the anatomic location and method of repair. Codes are 27758 and 27759 are not reported with this scenario because the fracture is not an acute traumatic fracture. The physician is repairing a nonunion tibia fracture (failure of two ends of a fracture to completely heal). Eliminating multiple choices B and D. To select the correct choice you need to find out what type of graft was used. Your hints are “bone grafting” and “iliac crest,” which leads you to the code 27724. The bone graft was harvested from the iliac crest, and then the graft is placed at the fracture site of the tibia compressing it for desired position and alignment and the screws were used to stabilize the fracture.In the ICD-10-CM Alphabetic Index, look for Nonunion/fracture-see Fracture, by site. Look for Fracture, traumatic/tibia/upper end referring you to code S82.10-. Compete code in the Tabular List, S82.102N. ICD-10-CM Coding Guideline, I.C.19.c.1, indicates Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N) or subsequent care with malunion (P, Q, R).
Q: A 47-year-old patient was previously treated with external fixation for a type IIIA open left tibia fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Interfragmentary compression was applied and three screws and the harvested bone graft were packed into the fracture site. What are the correct codes for this diagnosis and procedure?A. 27724, S82.102NB. 27758, S82.202SC. 27722, S82.202PD. 27759, S82.102N
Answer: c. 33228-78, T82.111AOne way to choose the correct choice is by the modifiers. The patient is still in a post-op period from an initial cardiac procedure and is having an unplanned return to the operating room due to a malfunctioning pacemaker battery that is going to be replaced (modifier 78). In the ICD-10-CM Alphabetic Index look for Malfunction/cardiac electronic device/pulse generator referring you to code T82.111-. Go to the Tabular List to complete the code, T82.111A.The selection of the pacemaker code is based on which system part of the system is being inserted or replaced and the number of leads for the unit. Code 33228 is the removal of the pulse generator or battery on a dual lead system with replacement.
Q: Patient had a dual chamber pacemaker put in two days ago. He is having problems with the battery and the cardiologist found that it is malfunctioning. He is taken to the operating suite to replace the pacemaker battery. What CPT® and ICD-10-CM codes are reported?A. 33226-76, T82.111AB. 33235-52, T82.110AC. 33228-78, T82.111AD. 33213-58, T82.119A
Answer: c. 36557The selection of the central venous codes are based on the technique of placement, if there is a use of port or pump, and the age of the patient. Procedure performed is for placement of a central venous catheter eliminating multiple choice A. An access device is not inserted eliminating multiple choice D. The documentation supports that a subcutaneous tunnel is created to place the catheter guiding you to code 36557.
Q: A 2-year-old male requires a central venous catheter. Using xylocaine local anesthesia a percutaneous approach is used in the neck and venous access is achieved. A subcutaneous tunnel is created from the anterior chest wall to the venotomy site and the catheter passed through the tunnel. The CV catheter is then placed at the superior vena cava and sutured in position. Which procedure code is reported?A. 36568B. 36555C. 36557D. 36560
Answer: d. 50688, 75984-26The patient presents for a ureteral catheter exchange via the ileal conduit. 50435 is not correct because it is an exchange of the catheter percutaneously. 50693 is performed using a percutaneous approach for placement of a ureteral stent, which is not performed in this case. 50385 is performed using a transurethral approach, which is not correct. The exchange is performed via the ileal conduit, which is reported with 50688. Monitoring contrast imaging is performed. There is a parenthetical note under 50688 that states that imaging is reported with 75984.
Q: A 46-year-old female with history of cervical carcinoma underwent placement of an ileal conduit, with subsequent development of left hydronephrosis. A retrograde ureteral catheter was recently placed. She returns today for catheter exchange. Patient was placed in the supine on the operating table. The ileal conduit was accessed. The existing catheter was removed over a guidewire and replaced with a similar 10 French 50 cm long locking pigtail catheter. Contrast was injected for monitoring, confirming good position of the catheter placement. Interpretation and report is in the record. IMPRESSION: Left retrograde ureteral catheter exchange via the ileal conduit. How is this reported?A. 50435B. 50693C. 50385D. 50688, 75984-26
Answer: b. 57240, 57282The colporrhaphy codes are based on the surgical approach and type of herniation. The operative note indicates the patient had an anterior approach in correcting a grade IV cystocele (herniation of the bladder causing the anterior vaginal wall to bulge downwards). The colpopexy codes are also coded by approach. Colpopexy is suturing a prolapsed vagina to its surrounding structures for vaginal fixation. Operative note documents a sacrospinous ligament fixation. Correct codes are 57240 and 57282.
Q: A 70-year-old with significant pelvic prolapse and grade IV cystocele who has failed previous primary repair and is status post hysterectomy. She presents for anterior repair and colpopexy. Procedure: Patient placed in the dorsal lithotomy position and general anesthetic was induced without problems. A midline incision is made from just above the bladder neck to the vaginal cuff. She is noted to have a grade IV cystocele. Vaginal flaps were dissected to the level of the pubocervical fascia. Her vaginal mucosa was in good condition but near the urethra and bladder neck it was a little thinner. There is significant scarring on the left side from previous procedures. Ishcial spine is identified and swept fiber fatty tissue off of the sacrospinous ligament bilaterally. No scarring or adhesions in this area. Anterior needles were passed into place on the elevate mesh and these were fixed in a manner similar to the MiniArc. They were passed along just below the bladder neck toward the obturator foramen and fixed in place. An anterior support was created without tension at the vesicourethral junction. Apical needles were then used to pass the apical arms into place. There were gently fixed into place along the sacrospinous ligament approximately 2cm away from the ischial spine. This was done bilaterally. They passed in a single pass and were fixed in place confirmed by gentle tugging on both arms. Three Vicryl sutures had been placed and the vaginal apex were then passed over into the mesh and tied down. The apical arms were placed through the eyelets of the mesh and passed down toward the sacrospinous ligament bilaterally to create good apical support. Eyelet fasteners placed bilaterally and mesh arms trimmed providing excellent apical and anterior support. Vaginal mucosa was closed and vaginal packed placed. No complications. What CPT® code(s) describe(s) this procedure?A. 57250, 57280B. 57240, 57282C. 57240, 57283D. 57250, 57283View Rationale
Answer: d. 0216T-50, 0217T X 2 (found in CPT code book category IIIWhen coding for facet joint or facet joint nerve injections, you report each level that is injected. In this case, the joints for L4-L5 and L5-S1 were injected. A parenthetical note states: If ultrasound guidance is used, report 0213T-0218T. The codes for facet joint and facet joint nerve injections are unilateral. The procedure was performed bilaterally at each level, therefore modifier 50 is reported on code 0216T. A parenthetical note is given for add-on code 0127T that indicates to report it twice when performed bilaterally, not with modifier 50. The ultrasound guidance is not reported separately, eliminating answer choice A.
Q: PROCEDURE: Bilateral lumbar medial branch block under ultrasound guidance for the L3, L4, L5 medial branches injecting the L4-L5, L5-S1 facets for diagnostic and therapeutic purposes.PROCEDURE: The patient was placed in the prone position and automated blood pressure cuff and pulse oximeter applied. The skin entry points for approaching the anatomic target points of the bilateral segmental medial branches or dorsal ramus of L3, L4, L5 were identified with a 22.5 degree from an ultrasound view and marked. Following thorough Chloraprep preparation of the skin and draping and 1% lidocaine infiltration of the skin entry points and subcutaneous tissues, a 22 gauge 6″ spinal needle was placed under ultrasound guidance for the L4-L5 and L5-S1 facet joints. At each joint 1 mL consisting of 0.5% bupivacaine and Depo-Medrol was injected. A total of 80 mg of Depo-Medrol was given in both sides. Which CPT® codes are reported?A. 0216T-50, 0217T x 2, 0218T x 2, 76942-26B. 64493-50, 64494-50, 64495-50C. 64493-50, 64494-50, 76942-26D. 0216T-50, 0217T x 2
Answer: Using the AMA CPT® E/M Service Guidelines for Medical Decision Making:· High for number and complexity of problem addressed at the encounter – 1 acute or chronic illness or injury that poses a threat to life or bodily function· Moderate for amount /or complexity of data to be reviewed and analyzed – ordering of 3 unique tests (EKG, CBC, and X-ray).· High risk of complication and/or morbidity or mortality of patient management – Decision regarding hospitalization.To qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is low reporting 99215.
Q: CC: Shortness of breathHistory: A 62-year-old female returns to a family practice having shortness of breath for the last week. It has been two years since her last visit to the practice. She also has nausea, diaphoresis, chest pressure.Past History: Celebrex® for her arthritis.Hysterectomy 1 year ago.Social History: Smoker-No Alcohol-NoAllergies: PenicillinPHYSICAL EXAMVital Signs: BP 195/95 sitting, left armGeneral/Constitutional: Mild distress. Some diaphoresis.Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions.Neck/Thyroid: Supple, without adenopathy or enlarged thyroid.Respiratory: Shallow breathing, no wheezing.Cardiovascular: Unequal pulses in both arms. Abnormal heart sounds heard.EKG ordered.Assessment/PlanSevere exacerbation of congestive heart failurePatient is sent to the hospital to be admitted. Will send hospital orders to start her on IV, order chest X-ray and CBC.A. 99202 B. 99215 C. 99204 D. 99214
Answer: c. 99234According to the Initial Observation Care guidelines it states: For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236. Code 99222 is not reported. Code 99238 are not reported with code range 99234-99236.
Q: This morning a 48-year-old is placed in observation status with severe diarrhea and extreme thirst. The physician performs a medically appropriate history, and examination and determines the patient is suffering from dehydration. The physician places the patient on IV saline 500 ml and conducts normal saline hydration for a couple hours. Patient is discharged home in the late evening on the same day and is told to return if symptoms occur again. The E/M service(s) for this encounter is:A. 99234, 99238B. 99222, 99238C. 99234D. 99222
Answer: b. 01382-AA-QSIn this case MAC is performed, which requires modifier QS. This eliminates answer options A and C. The selection of the code is based on the procedure being diagnostic or surgical. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was performed, eliminating choice D. Because the service was provided by an anesthesiologist, modifier AA is appended to the anesthesia code. Anesthesia modifiers are found in your HCPCS Level II codebook.
Q: The anesthesiologist performed MAC (monitored anesthesia care) for a patient undergoing an arthroscopy of the right knee. Code the anesthesia service.A. 01382-AAB. 01382-AA-QSC. 01400-AAD. 01400-AA-QS
Answer: c. 00326
Q: General anesthesia is administered to a 9-month-old undergoing a tracheostomy. Code the anesthesia service.A. 00320, 99100B. 00320C. 00326D. 00326, 99100
Answer: b. 77435, Z51.0, C78.02Documentation supports stereotactic body radiation therapy, treatment management. This eliminates multiple choices A and D. According to ICD-10-CM guidelines (Section I.C.2.e.2): If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy, assign code Z51.0 (radiation), Z51.11 (chemotherapy), or Z51.12 (immunotherapy) as the first listed or principal diagnosis, and the diagnosis or problem for which the service is being performed as a secondary diagnosis. For the metastasized or secondary neoplasm in the left upper lobe lung, look in the Table of Neoplasm for Neoplasm/lung/upper lobe/Malignant Secondary referring you to code C78.0-. Complete code in the Tabular List, C78.02.
Q: A 52-year-old male has a 3.2 cm metastasized lung cancer in his left upper lobe. The tumor cannot be removed by surgery due to the patient having severe respiratory conditions. He will be receiving stereotactic body radiation therapy management under image guidance. There is a delivery of 25 Gy for four fractions under direct supervision of the radiation oncologist. The patient’s treatment set up is assessed to manage the execution of the treatment to make any adjustments needed for accuracy and safety. The oncologist reviews and approves all the images used to locate the tumor and images of fields arranged to deliver the dose. What CPT® and ICD-10-CM codes should be reported?A. 77373, Z51.0, C34.92B. 77435, Z51.0, C78.02C. 77435, C78.02, Z51.0D. 77402, C34.92, Z51.0
Answer: d. 52005-RT, 74420-26Patent had a retrograde pyelogram eliminating multiple choices B and C. A cystoscope is passed through the urethra into the bladder. Then a French catheter was passed into the right ureter (ureteral catheterization) to introduce the contrast for radiologic study of the renal pelvis and ureter, eliminates code 52000. Note in the code description for code 52005 that it states: exclusive of radiologic service. This is an indication that radiology will be coded if performed.
Q: Preoperative Diagnosis: Right hydronephrosis Postoperative Diagnosis: Right hydronephrosisProcedure: Cystoscopy and right retrograde pyelogram Procedure Description: Patient prepped and draped in the dorsolithotomy position. Placed under general anesthesia a 23 French cystoscope was passed into the bladder. No tumors were visualized. Urine from the bladder was sent for urine cytology. Then a 6 French access catheter was passed into the right ureteral orifice. Contrast was injected and there were no filling defects noted. There was no fixed tumor and no stone. There was mild hydroureteral nephrosis against the bladder. There was a narrowing at the UVJ no abnormalities. Renal pelvis barbotaged with saline and renal pelvis urine sent to pathology for urine cytology. After the retrograde pyelogram was performed the access catheter was removed. Interpretation and report are in the medical record. What CPT® codes are reported?A. 52000-RT, 74420-26B. 52281-RT, 74425-26C. 52007-RT, 74400-26D. 52005-RT, 74420-26
Answer: Medicare Part B
Q: The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer<
Answer: 32
Q: What modifier do you append to a CPT code if a commercial insurance company requires the patient to acquire a medical consultation from a second physician?
Answer: A CCM id not allowed and will not bypass the edits.
Q: The National Correct Coding Initiative (NCCI) files contain a Correct Coding Modififer (CCM) indicator. What does the CCM indicator 0 mean?
Answer: 24, 25, 57
Q: Which modifiers are appended to E/M codes to report services within the global package?
Answer: Preoperative visits, intraoperative, postsurgical pain management
Q: What services are included in the surgical global package?
Answer: quarterly
Q: How often can HCPCS temporary Codes be undated?
Answer: G codes
Q: What set of HCPCS Level II codes are considered temporary codes assigned by CMS and reviewed by AMA for inclusion in the CPT
Answer: NU
Q: Which HCPCS Level II modifier should you append for a new wheelchair purchase?
Answer: The code that represents the condition most commonly associated with the main term
Q: What is a default code? Refer to ICD-10-CM guideline I.A.18.
Answer: NCHS and CMS
Q: Who are the parties responsible for providing the ICD-10-CM?
Answer: International Classification of Diseases, 10th Revision, Clinical Modification
Q: What does ICD-10-CM stand for>
Answer: Ischemia
Q: Restriction of blood supply, commonly due to factors in the blood vessel, that can result in damage or dysfunction of tissue is known as:
Answer: endocardium
Q: A thin membrane lining the chambers of the heart and valves is called the:
Answer: Section IV
Q: What section of the ICD-10-CM guidelines contains instructions on how to code for a patient receiving diagnostic services only in an outpatient setting?
Answer: Paget’s diseaseRationale: An eponym is a word derived from someone’s name. Paget’s disease is a disorder that involves abnormal bone destruction and regrowth which results in deformity. It was described by surgeon and pathologist Sir James Paget.
Q: What is an example of an eponym?
Answer: October
Q: What month does the new ICD-10-CM code book take effect each year?
Answer: Official Coding guidelines
Q: What do the instructions and conventions of the classifications take precedence over?
Answer: The residual condition is coded first, and the codes for the cause of the late effect are coded secondary.
Q: What is the sequencing order when coding a sequela?
Answer: Use code in brackets in addition to the disease or condition to identify an associated manifestation.
Q: What do brackets {} indicate in the ICD-10-CM Alphabetic index?
Answer: Code the post operative diagnosis because it is the most definitiveFor ambulatory surgery, if the postoperative diagnosis is known to be different from the preoperative diagnosis is confirmed, select the postoperative diagnosis for coding because it is the most definitive
Q: When coding for an ambulatory surgical procedure, how is the diagnosis determined?
Answer: b. work plan
Q: The OIG releases a __________ outlining its priorities for the fiscal year ahead and beyond.a. Compliance planb. Self-referral lawc. Work Pland. CIA yearly review
Answer: c. efficiencyIf shall be the responsibility of every AAPC member, as a condition of continued membership, to conduct themselves in all professional activities in a manner consistent with ALL of the following ethical principles of professional conduct:+ Integrity+ Respect+ Commitment+ Competence+ Fairness+ Responsibility
Q: According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?a. Integrityb. Responsibilityc. Efficiencyd. Commitment
Answer: c. a chronic condition characterized by red, dry, elevated lesions covered by silvery scales
Q: Which one of the following best describes psoriasis?a. An inflammatory condition characterized by redness pustular and vesicular lesions, crusts, and scalesb. A contagious infection of skin generally caused by staphylococcus bacteriumc. A chronic condition characterized by red, dry, elevated lesions, covered by silvery scales.d. An allergic reaction characterized by wheals and generally accompanied by pruritus.
Answer: d. Thickens the endometrium for implantation and is necessary to sustain pregnancy
Q: The corpus luteum secretes progesterone. What is an effect of this secretion?a. Enlargement and development of the organs of the female reproductive systemb. Deposition of fat beneath the skinc. Closure of the epiphyseal in long bonesd. Thickens the endometrium for implantation and is necessary to sustain pregnancy
Answer: d. cryptorchidism
Q: What condition results from failure of the testis to descend into the scrotum?a. epididymitisb. cryptorchidismc. orchitisd. priapism
Answer: a. G47.00, K30ICD-10-CM guidelines I.B.11 states to reference the ICD-10-CM Alphabetic Index to determine if the condition has a subentry for impending or threatened and reference main term entries for Impending and Threatened. If the subterms are listed, assign the given code. If the subterms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatening. Look in the Alphabetic Index for Impending. There is not a subterm for menopause; therefore, the symptoms are coded.
Q: A 50 year old female presents to her provider with symptoms of insomnia and upset stomach. The provider suspects she is in premenopausal. She is diagnosed with impending menopause. What diagnosis coed (s) should be reported?a. G47.00, K30b. N95.9c. N95.9, G47.00, K30d. E28.319
Answer: The malignancy is reported first, followed by the code fro anemia
Q: According to ICD-10-CM guidelines, when a patient is seen for management of anemia due to malignancy, how is it reported?
Answer: a. M54.50Per ICD-10-CM guideline I.C.6.b.1 if the pain is not specified as acute or chronic, do no assign codes from category G89, except for post thoracotomy pain, post operative pain, neoplasm related pain, or central pain syndrome.
Q: A patient returns to the provider for an injection to relieve low back pain from a car accident. What ICD-10-CM code(s) is/are reported?a. M54.50b. G89.11, M54.50c. M54.50, G89.11d. G89.21, M54.50
Answer: b. I11.0, I50.1According to ICD-10-CMS guideline I.C.9.a. there is a presumed causal relationship between hypertension and heart involvement. IN this case, the patient has hypertension and LEFT heart failure. In the ICD-10-CM Alphabetic Index look for hypertension, hypertensive/heart/with heart failure I11.0. Verify the code in the tabular list. There is an instructional note under core I11.0 that tells us to use an additional code to identify the type of heart failure. The additional code is sequenced second. The patient has LEFT heart failure. Look in the ICD-10-CMS alphabetic index for failure/heart/left (ventricular) and you are directed to see failure, ventricular, left which directs you to code I50.1. Verify the code in the tabular list. Under code selection I50 there is an instructional note telling us to code heart failure due to hypertension. This confirms our sequencing.
Q: What codes, according to ICD-10-CM guidelines, describe a patient that has hypertension with left heart failure?a. I10, I50.1b. I11.0, I50.1c. I11.9, I50.1d. I50.1, I11.0
Answer: b. H52.202, H54.52A2Look in the ICD-10-CM Alphabetic Index for Impaired (function)/vision NEC referring you to H54.7. In the Tabular list category H54 has a note to see the definition of visual impairment categories. Category 2 is considered low vision. Looking through codes, low vision in the LEFT eye is reported with H54.52 A2 is assigned as 6th and 7th character to identify Category 2. Or, you can look in the Alphabetic Index for Low/vision/one eye/LEFT (normal vision on RIGHT) referring you to H54.52. It is important to read the instructional notes in the Tabular List that are associated with categories before selecting your code.Category H54 also has a note to code first any cause of the blindness. In this care the low vision is due to the astigmatism. Look in the Alphabetic Index for Astigmatism referring you to H52.20. In the Tabular List, H52.202 is reported for the LEFT eye
Q: The patient has a significant visual impairment (category 2) due to astigmatism in the left eye. It is corrected with glasses. The right eye has normal vision. What ICD-10-CM code(s) is/are reported?a. H54.7, H52.202b. H52.202, H54.52A2c. H54.7d. H52.212
Answer: c. C25.1, E08.11, Z79.4The patient’s diabetes is due to the pancreatic cancer as an underlying condition. In the ICD-10-CM Alphabetic index look for diabetes, diabetic (mellitus) (sugar)/ due to underlying condition/with ketoacidosis/with coma E08.11. In the tabular list under category code E08 an instructional note indicated to code the underlying condition first. In the table of neoplasms look for neoplasm, neoplastic/pancreas/body and select the code guidance under category code E08 to use additional code for patients who routinely use insulin. Report code Z79.4 which is found in the alphabetic index under long term (current) (prophylactic) drug therapy (use of) insulin directing you to code Z79.4. Verify code selection in the tabular list.
Q: A patient is being treated for ketoacidosis and diabetic coma due to malignant neoplasm of the pancreatic body. The patient uses insulin routinely. What ICD-10-CM codes are reported?a. E13.11, C25.1b. E10.11, C25.2, Z79.4c. C25.1, E08.11, Z79.4d. C25.9, E08.11
Answer: c. M79.5, S01.82XS, Z18.10ICD-10-CM Coding guidelines I.B.10 indicated: a sequela is the residual effect (condition produced) after the acute phase of an illness or injury has been terminated. Coding sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second. IN the ICD-10-CM alphabetic index look for foreign body/in/soft tissue (residual) referring you to M79.5. Look for laceration/forehead/foreign body referring you to S01.82- The 6th character is X and the 7th character is S for sequela. Next, report the type of foreign body. Look for foreign body/retained (old) (nonmagnetic) (in)/fragments and you are directed to see Retained, foreign body fragments (type of). In the alphabetic index look for retained/foreign body fragments (type of)/metal directing you to Z18.10. Verify code selection in the tabular list. There is no mention of whether the metal is magnetic or not. The patient did not have an acute laceration with a foreign body in an open wound; therefore code S01.82XA is not reported.
Q: The patient has a mass on his forehead; he says it is from a piece of sheet metal from an injury to his forehead months ago. He has an X-ray showing a foreign body is in the mass. After obtaining consent, the metal fragment foreign body is removed from the subcutaneous tissue. What ICD-10-CM code(s) is/are reported?ma. S01.82XAb. L92.3c. M79.5, S01.82XS, Z18.10d. Z18.10, S01.82XA
Answer: 32
Q: When procedures are “mandated” by third party payers, what modifier would you use?
Answer: annually
Q: How often are HCPCS Level II permanent national codes updated?
Answer: cornea
Q: What is the transparent part of the eye?
Answer: c. QX
Q: An anesthesiologist is medically supervising six cases. What modifier is reported fro the CRNA’s medically directed service?a. ADb. QKc. QXd. QZ
Answer: b. 36200, 75630-26The patient is having abdominal aortography, which is radiographic visualization of the aorta and its branches. It was performed by injecting contrast medium through a catheter to see if there is an aneurysm, atherosclerotic disease or trauma to the aorta. The non-selective catheterization of the aorta is found in the CPT index under catheterization/aorta. Code 36200 is correct for the introduction of the aorta. IN the CPT index look for Serialography/aorta. A review of the codes in the numeric section code 75630 is correct because it includes Serialography abdomen plus bilateral ileofemeral lower extremity.
Q: A patient who may have a stricture of the artery is undergoing an aortogram in which the left femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta. Contrast medium was injected and films taken by Serialography showing the aortoiliac inflow vessels were widely patent. The bilateral common femoral arteries appear normal. What CPT® codes are reported for the professional component?a. 36200, 75625-26b. 36200, 753630-26c. 36200, 75635-26d. 36200, 75808-26
Answer: Presumptive identification identifies microorganisms like viruses by observing growth patterns and other characteristics
Q: A virus is identified by observing growth patterns on cultured media. What is this type of identification is called?a. definitiveb. qualitativec. quantitatived. presumptive
Answer: c. nursing facility services
Q: What category of codes should be used to report an evaluation and management service provided to a patient in a psychiatric residential treatment center?a. hospital inpatient servicesb. office and other outpatient servicesc. nursing facility servicesd. emergency department
Answer: c. Mucosa, submucosa, muscle, serosa
Q: In order, starting with the innermost layer, what are the for walls of the digestive tract?a. Muscle, submucosa, mucosa, serosab. Mucosa, submucosa, serosa, musclec. Mucosa, submucosa, muscle, serosad. Serosa, mucosa, submucosa, muscle
Answer: b. polysomnography
Q: A diagnostic tool in sleep medicine is:a. electroencephalographyb. polysomnographyc. electromyographyd. electrocorticography
Answer: methicillin-resistant staphylococcus aureus
Q: What does MRSA stand for?
Answer: c. 000For endoscopic procedures (except procedures requiring an incision), there is not postoperative period. Surgical status indicator 000 is for endoscopies or minor surgical procedures with no preoperative or postoperative period. Any related services on the day of the procedure are generally included in the fee schedule payment and not pain separately; including evaluation and management services on the day of procedure.
Q: What surgical status indicator represents the Surgical Global Package for endoscopic procedures (without an incision)?a. XXXb. 010c. 000d. 090
Answer: d. They identify ambulance place of origin and destinationRationale: Transportation (ambulance) services utilize modifiers made up of two letters identifying the origin and the destination according to the HCPCS Level II guidelines at the beginning of section A, Transportation Services Including Ambulance A0021-A0999.hint: information is found in the HCPCS Level II guidelines at the beginning to section A
Q: How are ambulance modifiers used?a. They identify mileage traveled during the encounter.b. They identify emergency or non emergency transport typesc. They identify the time elements of the ambulanced. They identify ambulance place of origin and destination
Answer: BasalRationale: Scattered throughout the basal layer of the epidermis are cells called melanocytes, which produce the pigment melanin, one of the main contributors to skin color.
Q: Melanin is found in what layer of the epidermis?
Answer: a. T80.89XA, J81.1, Y63.0In the ICD-10-CM Alphabetic Index look for Complication/infusion (procedure)/specified type NEC directing you to T80.89. In the Tubular list subcategory code requires 7 characters. T80.89XA is the correct code choice. Next look for edema/lung directing you to J81.1. Because the edema is due to the fluid overload that is associated with an infusion given during the patient’s medical care look in the ICD-10-CM External Cause of Injuries Index for Misadventure (s) to patient(s) during surgical or medical care/excessive amount of blood or other fluid during transfusion or infusion directing you to Y63.0
Q: What ICD-10-CM codes are reported for postoperative pulmonary edema due to fluid overload from an infusion?a. T80.89XA, J81.1, Y63.0b. J95.89, E87.70, Y63.1c. J81.0, E87.70, Y63.1d. T81.9XXA, J81.1, Y63.0
Answer: d. J44.0, J20.9COPD stands for Chronic Obstructive Pulmonary Disease. In the ICD-10-CM Alphabetic Index, look for disease/lung/obstructive (chronic) with/acute bronchitis referring you to J44.0 Verification in the Tabular list confirms code selection and gives additional instruction to code also identify the infection. The infection is reported with a code from category code J20 Acute Bronchitis. Because there is no indication of the infectious agent for the acute bronchitis, an unspecified code is used. Bronchitis/acute or subacute refers you to J20.9. There is also an Excludes2 note that lists category code J44-, which indicated that a code from that category can be coded with J20.9
Q: What ICD-10-CM code is reported for COPD with acute bronchitis?a. J44.9, J22b. J44.1c. J40d. J44.0, J20.9
Answer: b. 32551In the CPT Index for thoracostomy/tube referring you to code 32551. The ED provider would not be performing the surgery for other injuries so we would not bundle the tube insertion into any of those procedures.
Q: A patient presents to the emergency department with a sucking chest wound. The ED provider on duty performs an immediate tube thoracostomy in order to restore normal breathing to the patient before rushing him to surgery for another provider to address other injuries. What CPT code is reported by the ED provider?a. 31500b. 32551c. 31603d. It is not coded, as it will be bundled with any procedures performed during surgery.
Answer: d. One code is used to report both the pneumonia and the cytomegaloviral disease.
Q: Which option is TRUE regarding reporting codes for cytomegaloviral pneumonitis in ICD-10-CM?a. Pneumonia is reported first; the underlying disease is reported second.b. The underlying disease is reported first; pneumonia is reported secondc. Only the pneumonia is reported, it is not necessary to report the underlying diseasesd. One code is used to report both the pneumonia and the cytomegaloviral disease.
Answer: A. ThreeRationale: An artery has three layers: an outer layer of tissue, a muscular middle, and an inner layer of epithelial cells.
Q: How many layers of tissue does an artery have?
Answer: b. 36245-Lt, 37236The LEFT renal artery is a first order vessel as noted in Appendix L in the CPT book. To locate the selective catheterization, look in the CPT book for artery/abdomen/catheterization referring you to 36245-36248. 36245 is the correct code for the selective catheterization. Angiography of the LEFT vessel was performed, however, there is not mention in the report of the results of the angiography. This is not a diagnostic angiography, rather it is an angiography for mapping (checking out known stenosis). The stent was deployed (37236) in the LEFT renal artery; this code also includes the radiologic supervision and interpretation. In the CPT index book look for angioplasty/with intravascular stent. Placement referring you to 37215-37218, 37236-37239 or you can look for artery/stent/placement/carotid. Follow up renal angiography is bundled with the stent procedure.
Q: The cardiologist advances a 6 French catheter into the LEFT renal artery via a RIGHT common femoral puncture. It is selectively catheterized and angiographic films are taken. The catheter was then removed and a diagnostic guiding type, RDC catheter was used and the LEFT renal artery was selectively engaged. A 0.014 Supracore wire was used and the lesion was crossed. A 6.0 X 18 mm balloon expandable Racer stent was introduced. This was expanded around 8 atmospheres of pressure which is normal. Angiography revealed excellent results with no residual stenosis. What CPT codes are reported?a. 36245-Lt, 75625-26, 37236b. 36245-Lt, 37236c. 36245- Lt, 36251, 37236d. 36246-Lt, 37236
Answer: d. 71046, 74150-26Look in the CPT index for x-ray/chest. Code 71046 is the correct code for 2 views. The chest x-ray was taken in the doctor’s office and interpreted. This means the doctor’s office can bill the code without appending a modifier. Next look in the CPT book for CT/scan/without contrast/abdomen. The correct code for the CT scan is 74150. Modifier 26 is appended to the CT scan code, as it was performed at another site and the doctor only interpreted the image
Q: A 41 year old male is in his doctor’s office for a follow up of an abnormality which was noted on an abdominal CT scan. He also had a chest x-ray (PA and lateral views) performed in the office due to chest tightness. He states he otherwise feels well and is here to go over the results of his chest x-ray performed in the office, and the CT scan performed at the diagnostic center. The results of the chest x-ray were normal. CT scan of the abdomen showed a small mass in his RIGHT upper quadrant. What CPT codes are reported for the doctor’s office radiological services?a. 71046-26, 74150-26b. 71046,74150c. 71046-26, 74150d. 71046, 74150-26
Answer: Medicare Part B
Q: The Medicare program is made up of several parts. Which part is most significant to coders working in physician offices and covers physician fees without the use of a private insurer?a. Part Ab. Part Bc. Part Cd. Part D
Answer: c. Part CAccurate and thorough diagnosis is important for Medicare Advantage (Part C) claims because reimbursement is impacted by the patient’s health status. The CMS-HCC risk adjustment model provides adjusted payments based on a patient’s disease and demographic factors. If a coder does not include all pertinent diagnoses and comorbidities, there may be a loss of additional reimbursements to which the provider is entitled.
Q: The Medicare program is made up of several parts. Which part is affected by the Centers for Medicare & Medicaid Services-Hierarchical Condition Categories?a. Part Ab. Part Bc. Part Cd. Part D
Answer: It explains CMS policies on when Medicare will pay for items and services
Q: What is the purpose of National Coverage Determinations?
Answer: 1996
Q: In what year did HIPAA become a law?
Answer: b. patients
Q: A covered entity does NOT includea. healthcare providersb. patientsc. clearinghousesd. Health plans
Answer: d. Covered entities taking reasonable steps to limit use or disclosure of PHI
Q: The minimum necessary rule applies toa. Disclosures to or requests by a health care provider for treatment purposesb. Disclosures to the individual who is the subject of the imformationc. Uses or disclosures that are required by lawd. Covered entities taking reasonable steps to limit use or disclosure of PHI
Answer: It states what will be paid and why any changes to charges were made
Q: What is the value of a remittance advise?
Answer: 1988
Q: In what year was AAPC founded?
Answer: C. It lies on top of the dermis and has aaccess to rich supply of blood
Q: Which one of the following is TRUE of the stratum germinativum?a. It is composed of about 30 layers of dead, flattened, keratinized cells.b. It is composed of dense fibrous connective tissue.c. It lies on top of the dermis and has access to rich supply of blood.d. It is the surface layer of the epidermis.
Answer: c. tendons, aponeurosis and directly to bone
Q: Muscle is attached to bone by what method?a. tendons, ligaments, and directly to boneb. tendons and cartilagec. tendons, aponeurosis and directly to boned. ligaments, aponeurosis, and directly to bone
Answer: LEFT ventricle
Q: Which chamber of the heart is considered the one working the hardest?
Answer: Lymph nodes, lymphatic vessels, spleen, thoracic duct
Q: Which best describes constituent components of the human lymphatic system?
Answer: cecumascending colontransverse colondescending colonsigmoid colonrectumanus
Q: Upon leaving the last portion of the small intestine, nutrients move through the large intestine in what order?
Answer: The transverse and descending colon
Q: The splenic (LEFT colic) flexure lies in the upper quadrant, between what 2 portions of the large intestines?
Answer: vas deferens
Q: The structure of the male anatomy carrying sperm out of the epididymis is called?
Answer: Helps lubricate the urethra
Q: What is the function of the Cowper’s glands?
Answer: Prostate
Q: A part of the male genital system sitting below the urinary bladder surrounding the urethra is called the:
Answer: Medulla
Q: Which part of the brain controls blood pressure, heart rate, and respiration?
Answer: b. Macula
Q: Which does NOT contribute to refraction in the eye?a. aqueousb. Maculac. cornead. lens
Answer: b. It separates the external each from the middle ear
Q: Which one of the following is TRUE about the tympanic membrane?a. It separates the middle ear from the inner earb. It separates the external ear from the middle earc. It sits within the middle eard. It sits within the inner ear
Answer: C. It helps with sound only
Q: Which one of the following is TRUE about the function of the cochlea?a. It helps with balance and sound transmissionb. It helps with balance onlyc. It helps with sound onlyd. Its function is to excrete cerumen to help keep ear clean
Answer: d. stapes and incus
Q: Which of the following are auditory ossicles?a. incus and pinnab. stapes and mastoidc. tragus and malleusd. stapes and incus
Answer: Under the toenail/fingernail
Q: Where would a subungual hematoma be located?
Answer: suturing a wound of the spleen
Q: Splenorraphy is:
Answer: Imbrication
Q: The operation overlapping of tissue to repair a defect in the diaphragm is called?
Answer: Stomat/o
Q: The root word for mouth is:
Answer: Cryptorchidism
Q: What condition results from failure of the testis to descend into the scrotum?
Answer: Thyrotoxicosis
Q: A condition where the thyroid is overactive is called?
Answer: excision of a lacrimal sac
Q: A dacryocystectomy is an ?
Answer: Unequal vision in the two eyes
Q: The meaning of heteropsia (or anisometropia) is:
Answer: X ray procedure allowing the visualization of internal organs in motion
Q: The radiology term fluoroscopy is an:
Answer: salivary glands
Q: Sialography is an X-ray of:
Answer: Cryopreservation
Q: The process of preserving cells or whole tissues at extremely low temperatures is known as:
Answer: anterior chamber of the eye
Q: A gonioscopy is an examination of what part of the eye?
Answer: Section IV
Q: What section of the ICD-10-CM guidelines contains instructions on how to code for a patient receiving diagnostic services only in an outpatient setting?
Answer: d. K40.90, A49.02, Z53.09ICD-10-CM guideline for outpatient services IV.A.1 states to report reason for the surgery as the first listed diagnosis even if the surgery is canceled due to a contraindication.
Q: A 22 year old is in an outpatient facility for an inguinal hernia repair. Just before surgery, the surgeon discovers the patient is positive for MRSA and the surgery is canceled. Which ICD-10-CM code(s) shoudl be reported for the outpatient service?a. A49.02b. A49.01, K40.90, Z53.09c. Z53.09d. K40.90, A49.02, Z53.09
Answer: Rationale: ICD-10-CM guideline I.B.11 states to reference the ICD-10-CM alphabetic index to determine if the condition has a subentry for impending or threatened and reference main term entries for Impending and Threatened. If the subterms are listed, assign the given code. If the subterms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatened. Look in sthe alphabetic index for impending. There is not a subterm for menopause; therefore, the symptoms are coded. Look for Insomnia (organic) which directs the coder to G47.0. Next look for upset/stomach which directs the coder to K30.
Q: A 50 year old female presents to her provider with symptoms of insomnia and upset stomach. The provider suspects she is premenopausal. She is diagnosed with impending menopause. What diagnosis code(s) should be reported.a. G47.00, K30b. N95.9c. N95.9, G47.00, K30d. E28.319
Answer: c. Z01.810, K80.20, I10When a patient is receiving a preoperative evaluation only, A Z code from subcategory code Z01.81- is reported first. Then assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Next code any findings related to the preoperative evaluation.
Q: A 65 year old is seen by her cardiologist for preoperative evaluation for clearance for removal of her gallbladder due to gallstones. The cardiologist notes that she has hypertension. Medication is given to control her hypertension. What diagnosis are reported?a. Z01.810, K80.21, I10b. I10, K80.20, Z01.810c. Z01.810, K80.20, I10d. K80.20, I10, Z01.810
Answer: a. 54.50Per ICD-10-CM guideline I.C.6.b.1, if the pain is not specified as acute or chronic, do not assign codes from category G89, except for post-thoracotomy pain, postoperative pain, neoplasm related pain, or central pain syndrome. Look in the ICD-10-CM alphabetic index for pain/low back which directs the coder to M54.50.
Q: A patient returns to the provider for an injection to relieve low back pain from a car accident. What ICD-10-CM code(s) is/are reported?a. M54.50b. G89.11, M54.50c. M54.50, G89.11d. G89.21, M54.50
Answer: b. H52.202, H54.52A2Look in the ICD-10-CM Alphabetic index for impaired, impairment (function)/vision NEC referring you to H54.7. In the tabular list category H54 has a note to see the definition of visual impairment categories. Category 2 is considered low vision. Looking through the codes, low vision in the LEFT eye, is reported with H54.52-. A2 is assigned as 6th and 7th character to identify Category 2. Or, you can look in the alphabetic index for low/vision/one eye/left (normal vision on RIGHT) referring you to H54.52. It is important to read the instructional noted in the tabular list that are associated with categories before selecting your code.Category H54 also has a note to first code first any cause of the blindness. IN this case, the low vision is due to the astigmatism, Look, in the alphabetic index for astigmatism referring you to H52.20- In the tabular list, H52.202 is reported for the LEFT eye.
Q: The patient has a significant visual impairment (category 2) due to astigmatism in the LEFT eye. It is corrected with glasses. The RIGHT eye has normal vision. What ICD-10-CM code(s) is/are reported?a. H54.7, H52.202b. H52.202, H54.52A2c. H54.7d. H52.212
Answer: B. E86.0, C79.51, C80.1Per ICD-10-CM guideline I.C.2.c.3 when the admission/encounter is for management for 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. The treatment is directed at the bonce cancer or the metastatic site. In the ICD-10-CM alphabetic index look for dehydration E86.0 in the ICD-10-CM table of neoplasms look for neoplasm, neoplastic/bone. Use the code from the malignant secondary column directing you to code C79.51. Also in the table of neoplasms look for unknown or unspecified site and use the code from malignant primary column which directs the coder to C80.1.
Q: A patient with metastatic bone cancer (primary sit 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 receives intravenous hydration in the office and reschedules, the chemotherapy treatment. What ICD-10-CM codes are reported?a. C40.30, E86.0, C79.51b. E86.0, C79.51, C80.1c. C79.51, E86.0d. E86.0, C80.1, C79.51
Answer: Colp/o is the combining form referring to the vagina.
Q: What does the root word colp/o stand for
Answer: N18.6according to the ICD-10-CM guideline I.C.14.a.1 when both a stage of CKD and ESRD are documented, you assign only code N18.6.
Q: The provider documents CKD stage 5 and ESRD. What ICD-10-CM code(s) is/are reported?a. N18.5b. N18.4, N18.6c. N18.6, N18.5d. N18.6
Answer: d. S60.452AIN the ICD-10-Cm alphabetic index look for splinter-see foreign body, superficial, by site. The alphabetic index entry at foreign body/superficial, without open wound/finger(s)/middle guides you to subcategory S60.45-. In the tabular list seven characters are needed to complete the code. The 6th character 2 indicates the RIGHT middle finger and the 7th character A indicates the initial encounter. There was no mention of laceration or puncture wound so the other codes are incorrect.tip for CPC exam: write in splinter by S60.45-
Q: A child has a splinter under the right middle fingernail. What ICD-10-CM code is reported?\a. S61.227Ab. S61.242Ac. S61.222Ad. S60.452A
Answer: c. L91.0, T22.332SA keloid is a type of scar resulting from granulation tissue at the site of a healed skin injury. This would be considered a sequela (late effect) after the acute phase of the burn. Per ICD-10-CM guideline I.B.10, coding of sequela generally requires 2 codes sequenced in the following order: the condition or nature of the sequela is sequenced first (keloid scar). The sequela code is sequenced second.
Q: A 24 year old woman developed a keloid scar as a result of a third degree burn son the LEFT upper arm. What ICD-10-Cm code(s) is/are reports?a. L91.0b. T22.332Dc. L91.0, T22.332Sd. T22.332A, L91.0
Answer: c. Z12.11, K63.5According to the ICD-10-CM guideline I.C.21.c.5 indicates, A screening code may be first listed if the reason for the visit is specifically the screening exam. Should a condition be discovered during the screening the code for the condition may be assigned as an additional diagnosis.
Q: Patient is in the facility here today for a screening colonoscopy. During the procedure, a polyp is found and removed with a hot biopsy technique. How would this be reported?a. K63.5, Z12.11b. K63.5c. Z12.11, K63.5d. Z12.11
Answer: c. S42.301B, S82.202AThis is a traumatic fracture since the patient was in an accident. In the ICD-10-CM alphabetic index look for fracture, traumatic/humerus/shaft, which refers you to subcategory code S42.30-. IN the tabular list, the code needs seven characters. The 6th characters 1 indicates the RIGHT humerus. The 7th character B indicates that this is an initial encounter for an open fracture. The resulting code is S42.301B. The simple fracture is classified as a closed fracture. Look in the alphabetic index for fracture, traumatic/tibia (shaft) which refers you to S82.20-. Verification in the tabular list shows the 6th character 2 for LEFT tibia and 7th character A for initial encounter for closed fracture. ICD-10-CM guidelines I.C.19.C.2 states multiple fractures are sequenced in accordance with the severity of the fracture. For the ATV accident, refer to the ICD-10-CM external cause of injuries index. Look for accident/transport/all-terrain vehicle occupant (non-traffic)/specified type NEC directing you to subcategory V86.99-. The tabular list show this code needs 7 characters. A placeholder X is used fore the 6th character , and the 7th character is A for initial encounter. The complete code is V86.99XA
Q: A patient is admitted to surgery to treat an open fracture to the shaft of the RIGHT humerus and a simple closed fracture of the LEFT tibia following an ATV accident. What ICD-10-CM codes are reported?a. S42.311A, S82.201A, V86.99XAb. S42.301B, S82.202B, V86.99XAc. S42.301B, S82.202A,d. S42.301A, S82.202A, V86.99XA
Answer: c. T42.4X1A, J96.00Poisoning codes are sequenced by 1) the poison code, and 2) the condition or manifestation. ICD-10-CM guideline I.C.19.e.5.b.i states examples of poisoning include “errors made in the drug prescription, or in the administration of the drug by provider, nurse, patient, or other person. In the ICD-10-CM table of drugs and chemicals, find valium and use the code from poisoning, accidental (unintentional) column which is T42.4X1. In the tabular list the code requires a 7th character and in this case the A is used for the initial encounter. The manifestation is respiratory failure, which is J96.90. Per ICD-10-CM guideline, I.C.19.e no additional external cause code is required for poisoning, toxic effects, adverse effects, and underdosing codes
Q: The diagnostic statement indicates respiratory failure due to administering incorrect medication. Valium was administered instead of Xanax. What ICD-10-CM codes are reported?a. T42.4X5A, J96.00b. J96.90, T42.4X1Ac. T42.4X1A, J96.90d. T42.4X4B, J96.00
Answer: A. T79.2XXA, S02.2XXAThe patient is seen for the second time in the ED for continued care of a nasal fracture. Look in the ICD-10-CM alphabetic index for hemorrhage, hemorrhagic/traumatic/recurring or secondary (following initial hemorrhage at the time of injury) which guides you to T79.2-. Next look for fracture, traumatic/nasal (bones) which guides you to code S02.2. Per ICD-10-CM guideline I.C.19.a.7, 7th character A for initial encounter is used for each encounter when the patient is receiving active treatment. Examples are of active treatment are surgical treatment, emergency department encounter, and evaluation and continued treatment by the same or different provider. Because the patient is seen for the second time inthe ED for continued care of the fracture, 7th character A is used for each code. Placeholder X is needed for the 5th and 6th characters.
Q: A patient was treated in the emergency department for a nasal fracture. Bleeding was controlled, a splint applied, and the patient sent home. He returned to the ED several hours later with new bleeding from both nares due to the fracture. The ED provider has to repack the nose and insert new splints to stabilize the fracture. What ICD-10-CM code(s) is/are reported for the second ED visit?a. T79.2XXA, S02.2XXAb. S02.2XXSc. R04.0d. S02.2XXD, T79.2XXD
Answer: c. L27.0, R11.0, T42.75XAPer ICD-10-CM guideline I.C.19.e.5.a when the drug was correctly prescribed and properly administered, drug toxicity is considered an adverse effect. Code the nature of the adverse effect (nausea and rash), followed by appropriate code for the adverse effect of the drug (T36-T50). We don’t use rash R21 code because L27.0 is a more specific code.