Deck 16: Opthalmological Coding Certification

Question 1

The physician removed the lens of a patient with severe cataracts via the pars plana approach, without a vitrectomy. During the operative session, the physician used viscoelastic agents and enzymatic zonulysis to aid in the procedure. How should the physician code for the procedure?

A)66852
B)66840
C)66983
D)66852, 66982

Answer 1

66852

Question 2

A 38-year-old female patient presented to the office for an extended ophthalmoscopy with retinal drawing. The physician also performed interpretation and report of the findings. The physician performing the procedure also performed the anesthesia service for the patient, due to the fact that the anesthesiologist was not available. What are the correct codes for the procedure?

A)00148-47
B)92225-47
C)92225, 00148-47
D)92225-47, 00148

Answer 2

92225-47

Question 3

In an outpatient setting, what is the primary diagnosis?

A)The reason the patient came in for the visit
B)The diagnosis code that the doctor lists first
C)The problem that causes the patient the most pain
D)The diagnosis that will result in the most reimbursement

Answer 3

The reason the patient came in for the visit

Question 4

A physician can base the level of an evaluation and management service on the time spent counseling the patient and nothing else. Is this statement true or false?

Question 5

An adolescent patient's hard contact lenses were shattering when a bouncy ball that he was playing with at school bounced up at hit him in the eye. The patient was transported to the emergency department where the on-call physician removed the contact lens fragments from his cornea, using a slit lamp. What is the correct code for the procedure?

A)65205
B)65210
C)65220
D)65222

Question 6

The anterior segment of the eyeball, directly behind the cornea, is filled with a clear, salty fluid called:

A)Aqueous humor
B)Scleral fluid
C)Viscous jelly
D)Vitreous humor

Question 7

HCPCS Level II ambulance service modifiers represent:

A)The type of ambulance transport vehicle
B)The type of emergency service
C)Whether or not the patient received life support during transport
D)Where the patient was picked up and where the patient was dropped off

Question 8

What is the purpose of provider credentialing?

A)To make sure that your provider is performing the correct procedures
B)To make sure that your provider is correctly licensed to perform procedures
C)To make sure your provider pays all the necessary fees to practice medicine
D)To allow your doctor to check the credentials of private insurance companies

Question 9

According to coding conventions, NEC stands for:

A)Not Elsewhere Code able
B)Never Either Coded
C)Not Elsewhere Classifiable
D)No Other Coding

Question 10

The system that produces tears is called the:

A)Tear Duct System
B)Lacrimal System
C)Lacrimal Punta
D)Tear Glands

Question 11

When you append the HCPCS modifier -TC to a service, what are you indicating?

A)That the provider performed the professional component of the service
B)That the provider performed the technical component of the service
C)That the provider performed the entire service
D)That the service was performed by an anesthesiologist

Question 12

What is the purpose of a compliance plan?

A)It makes sure you are properly credentialed
B)It allows your office to defend itself in case of an audit
C)It helps your employees claim worker's compensation
D)It helps your office follow the correct coding and billing protocols

Question 13

Longoria, a patient with an established cataract, was displeased with his current ophthalmologist so today he was seen by a new physician. The ophthalmologist performed an ophthalmoscopy and tonometry on Mr. Longoria, as well as an external examination of both eyes and a review of the patient's interval history. What is the correct code for Mr. Longoria's ophthalmology service today?

A)92002
B)92004
C)92012
D)92014

Question 14

Which of the following steps is NOT needed before an unlisted services procedure code can be included on a claim?

A)Review the CPT manual to make sure a more appropriate code does not exist
B)Review Category II codes to make sure an appropriate code does not exist
C)Review Category III codes to make sure an appropriate code does not exist
D)Check to see if a modifier is appropriate to include with your code

Question 15

Fill in the blanks: HCPCS modifiers can be used for _________________________ but CPT modifiers cannot be used for ________________________.

A)CPT codes, CPT codes
B)CPT codes, HCPS codes
C)HCPCS Codes, procedure codes
D)HCPCS Codes, CPT Codes

Question 16

When selecting an evaluation and management code, what is the first thing that the coder needs to determine?

A)The time the provider spent with the patient
B)The appropriate category of E&M service
C)Whether the patient was new or established
D)How long the discharge took

Question 17

When you see the symbol # in front of a CPT code, what does it mean?

A)That the code is listed out of numerical order
B)That the code is listed in numerical order
C)That the code used to be listed with a different number
D)That the code description has changed

Question 18

The procedure known as blepharoplasty is performed to:

A)Correct the muscle misalignment caused by strabismus
B)Correct vision loss due to glaucoma
C)Plastic repair a droopy eyelid
D)Repair the lens of the eye caused by cataracts

Question 19

The HCPCS Level II modifier -E1 stands for:

A)Lower Right, Eyelid
B)Upper Right, Eyelid
C)Upper Left, Eyelid
D)Right Hand, Thumb

Question 20

In the CPT manual, Appendix C lists clinical examples of:

A)Surgical procedures
B)Radiological procedures
C)Dermatology procedures
D)Evaluation and management procedures

Question 21

The physician performed trichiasis on a patient with severely ingrown lower eyelashes. Utilizing forceps and biomicroscope, the physician removed four offending lower lashes and one misdirected upper eyelash. What is the correct code for the procedure?

A)67825
B)67830
C)67820-RT
D)67820-50

Question 22

The patient with severe strabismus visited the ophthalmologist clinic for a strabismus correction surgery. The ophthalmologist performed the surgery by correcting two horizontal muscles and one vertical muscle in the patient's right eye. The physician then used a transposition procedure on the superior oblique muscle in order to further correct the misalignment. What is the correct way to code for the procedure?

A)67311 (X2), 67320
B)67312, 67314, 67320
C)67312, 67314, 67318
D)67312, 67314, 67320-51

Question 23

Which of the following is NOT typically included in a global package?

A)The surgical procedure
B)Follow-up appointments related to the procedure, within the global period
C)Appointments for problems that are not related to the procedure
D)Appointments for problems that are related to the procedure

Question 24

HCPCS Level II codes are updated every quarter by:

A)CMS
B)Medicaid
C)Tricare
D)Commercial payers

Question 25

When a CPT code has the words "separate procedure" in parenthesis after the code description, you:

A)Do not use this code if it is listed as a separate procedure
B)Code for all other elements of the procedure except this one
C)Only code for this procedure if it was the only thing performed
D)Code for this procedure, even if it was not performed

Question 26

When using the table of drugs in the HCPCS Level II manual, you must know the drug's administration route. The abbreviation "VAR" stands for which of the following?

A)Various Routes
B)Variable Routes
C)A Variety of Routes
D)None of the Above

Question 27

Unbundling a code is:

A)Unwrapping a code to open a new code
B)Listing multiple procedures, services and supplies with their own separate, distinct codes
C)Using one code to report a variety of services
D)Using a new code to report previous services

Question 28

When you include an unlisted service procedure code on a claim, what else must you also include on the claim?

A)A Category III code
B)A Category II code
C)A special report
D)All diagnostic studies

Question 29

What is the purpose of temporary national codes in the HCPCS Level II manual?

A)They are for procedures that are considered temporary
B)There are no temporary codes, only permanent codes
C)They allow the establishment of codes prior to the January 1st annual update
D)They allow the deletion of codes prior to the January 1st annual update

Question 30

Why are ICD-9 codes necessary to include on a claim?

A)They report the procedures performed on the patient
B)They are the services that are charged for on the claim
C)They indicate the medical necessity of the service
D)They indicate the code linkage on the claim

Question 31

When you are searching for a diagnosis code in the ICD-9 manual:

A)You must first locate the diagnosis code description in the index and then verify the correct code selection in the tabular list
B)You must locate the diagnosis code in the index and then assign the appropriate code
C)You must determine which procedure you will bill for first, and then find out which diagnosis codes match the procedure
D)You must first locate the diagnosis code description in the index and then verify the code in Volume III

Question 32

Tricare Prime patients typically must see physicians:

A)Whenever they feel like it
B)At their military treatment facility
C)Whenever their commander asks them to
D)At their typical private practice doctor's office

Question 33

The HCPCS manual includes codes for:

A)Procedures that are also found in the CPT coding manual
B)Supplies, services, and procedures that are not found in the CPT manual
C)Only supplies that you cannot find in the CPT manual
D)All services performed in the office, except for procedures

Question 34

Medical billing fraud is:

A)Billing for services at a reduced level
B)Billing correctly for services performed
C)Billing for services that are not medically necessary
D)Billing for services that were not performed

Question 35

What is the purpose of an internal audit?

A)It allows an outside agency to see your records to make sure that the patients were billed correctly
B)It allows the coders and billers in your office to make sure your claims were billed correctly
C)It allows Medicare to go through your charges to make sure that they are reasonable
D)It allows patients to make sure they were not overcharged for their office visit co pays

Question 36

What types of codes are located in the V0000 through V5999 section of the HCPCS manual?

A)Pathology and Laboratory Services
B)Vision and Hearing Services
C)Dental Procedures
D)Transportation Services

Question 37

Which of the following is the best, most effective way to locate the correct code for a service or supply in the HCPCS manual?

A)Look in the Index for the name of the service or supply, and it will direct you to the correct code or range of codes
B)Go directly to Appendix 1 to check the name of the supply, and then find out the route of administration
C)Flip through the sections of the book until you find the correct service or supply and then assign the best code
D)Go directly to the code in the book, and assign the code that looks right

Question 38

Which of the following is always the payer of last resort?

A)Medicare
B)Medicaid
C)Worker's Compensation Insurance
D)Commercial Insurance

Question 39

HCPCS J-Codes are used to represent:

A)Drugs administered by methods other than the oral method
B)Durable medical equipment
C)Dental procedures not found in the CPT manual
D)Temporary national codes for Medicare

Question 40

Appendix 1 in the HCPCS Level II manual contains:

A)An alphabetized list of HCPCS modifiers
B)A table of drugs
C)A list of changes, additions, and deletions
D)A short list of CPT codes to use with HCPCS codes

Question 41

In order for a physician to appropriately code for a consultation service, three things must be documented. What are those three things?

A)The referral or request from the PCP, the rendering of the opinion by the specialist or consultant, and the written report or findings sent from the specialist to the PCP
B)The rendering of the specialty service to the patient, the referral of the patient from the specialist to an additional specialist, and the written report of the findings provided to the specialist
C)The specialist request of a second opinion regarding the patient, the PCP's advice regarding which second specialist the patient should see, and the second specialist's report or findings
D)The referral from the PCP to the specialist, an additional referral from the specialist to another specialist, and the written report or findings sent from the specialist to the PCP

Question 42

When listing both CPT and HCPCS modifiers on a claim, you:

A)List the HCPCS modifier first
B)Do not list the HCPCS modifier at all
C)Only list the CPT modifier
D)List the CPT modifier first

Question 43

In the RBRVS calculation, the GPCI takes into account:

A)The geographic location of a practice or provider
B)The type of provider specialty
C)The malpractice risk of a procedure
D)The overhead cost of the practice

Question 44

HIPAA was created to:

A)Protect patient privacy
B)Enact ways to uncover fraud and abuse
C)Create standards of electronic transactions
D)All of the above
E)Only options A and B