Question 1

The respiratory system subsection in the CPT manual contains, but is not limited to procedure codes for the following body areas:&#10;A)Nose, mouth, and throat&#10;B)Nose, accessory sinuses, and trachea/bronchi&#10;C)Accessory sinuses, mouth, and stomach&#10;D)Lungs, pleura, and heart

Accepted Answer

The respiratory system subsection in the CPT manual contains, but is not limited to, the nose, accessory sinuses, and trachea/bronchi. Procedure codes for the mouth, throat, and stomach are located in the digestive system subsection, while procedure codes for the heart are located in the cardiovascular system subsection.

Question 2

A 32-year-old woman with repeat urinary tract infections presented to the office with painful urination. Suspecting another UTI, the physician sent a urine sample to the lab to identify the bacteria causing the infection. The physician's office billed for the laboratory service themselves, even though they sent the sample to an outside lab for the test. What modifier is appropriate in this case?

A)Modifier -99
B)Modifier -90
C)Modifier -52
D)No modifier would be necessary

Modifier -90

Accepted Answer

Modifier -90 (Outside Laboratory)is the appropriate modifier in this case. Modifier -90 is used when the physician's office bills for the laboratory service, even though they sent the lab sample to an outside laboratory. When the insurance company pays the physician for the lab sample, the physician's office reimburses the lab for the cost of the service.

Question 3

What are the two most common modifiers used in radiological services?&#10;A)-51 and -26&#10;B)- TC and -26&#10;C)S&I and -26&#10;D)- TC and -51

Accepted Answer

The two most common modifiers used in radiological services are -TC and -26. Modifier -TC is used to indicate that only the technical component of the service was performed. The technical component is used to bill for both the radiology technician's services and the machine. Modifier -26 is used to indicate professional radiological services (radiological supervision and interpretation). This modifier indicates that the physician is billing for reading the image and interpreting the results not for taking the image.

Question 4

What organizations make up the &#34;Cooperating Parties&#34; for the ICD-10-CM guidelines and who approved these guidelines?&#10;A)American Hospital Association (AHA), American Health Information Management Association (AHIMA), National Center for Health Statistics (NCHS), U.S. Federal Government's Department of Health and Human Services (DHHS)&#10;B)American Hospital Association (AHA), National Center for Health Statistics (NCHS), World Health Organization (WHO), U.S. Federal Government's Department of Health and Human Services (DHHS)&#10;C)American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS), National Center for Health Statistics (NCHS)&#10;D)American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS), National Center for Health Statistics (NCHS), World Health Organization (WHO)

Accepted Answer

The organizations that approved the ICD-10-CM guidelines and who make up the Cooperating Parties are the American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS), and the National Center for Health Statistics (NCHS).
The ICD-10-CM is based on the ICD-10, which is the statistical classification of disease that is published by the World Health Organization. The U.S. Federal Governments Department of Health and Human Services is mentioned in the official guidelines because two of its departments (CMS and NCHS) are part of the organizations that make up the Cooperating Parties for the ICD-10-CM.

Question 5

How do you locate a code in the ICD-10-CM?&#10;A)Locate it in the Alphabetic Index then verify it in the Tabular List and then submit it to insurance.&#10;B)Locate it in the Alphabetic Index and then submit it to insurance. There is no need to use the Tabular List.&#10;C)Locate it in the Tabular List and submit to insurance. There is no need to use the Alphabetic Index.&#10;D)There is no need to use either the Alphabetic Index or the Tabular List to identify the ICD-10-CM code.

Accepted Answer

The proper way to locate a code in the ICD-10-CM is to locate the code in the Alphabetic Index then flip to the Tabular List to identify any guided notations. It is essential to use both of these when locating a code.
The Alphabetic Index alone will not always give full code information and may leave out certain notations that are required for the code to be complete. The Tabular List is identified easily by locating the right code in the Alphabetic Index. Both need to be used to locate a code.

Question 6

Can you specify laterality in the ICD-10-CM codes?&#10;A)No, you cannot specify laterality with the ICD-10-CM.&#10;B)Yes, you can specify laterality for some codes. Some codes do not have &#34;bilateral&#34; listed, so in this case the code for &#34;right&#34; and &#34;left&#34; would be assigned.&#10;C)Yes, you can specify laterality in the ICD-10-CM codes when the side is not mentioned in the medical record.&#10;D)No, you cannot specify laterality even if it is mentioned in the medical record when using the ICD-10-CM codes.

Accepted Answer

Laterality is specified in the ICD-10-CM codes. Some codes have "right," "left," and "bilateral" options listed. Other codes do not have "bilateral" listed as an option, in which case you would use both the "left" and "right" codes individually to stipulate bilateral diagnoses. These codes can only be used if the laterality is mentioned in the medical record.

Question 7

Can you use signs, symptoms or unspecified codes in the ICD-10-CM instead of an actual diagnosis?&#10;A)Yes, symptom/sign codes can be used, but there are no unspecified codes in the ICD-10-CM&#10;B)No, in ICD-10-CM the purpose of added codes is to prevent the use of signs, symptoms or unspecified codes&#10;C)Yes, if a definitive diagnosis hasn't been made by the end of the patient encounter, then unspecified codes or sign/symptom codes may be used to best describe the diagnosis at the end of the encounter&#10;D)No, ICD-10-CM doesn't even have unspecified codes as an option

Accepted Answer

Both sign/symptom and unspecified codes are appropriate to use when the actual diagnosis is unable to be made. In some cases, the infecting organism needs to be identified for a specific code to be used, so in these cases when the infecting organism isn't known at the time of the patient's encounter an "unspecified" code is appropriate to be used.
ICD-10-CM does have codes for signs and symptoms or "unspecified" codes. Although they are not listed for every possible diagnosis, if they are an option they are allowed to be used based on the information available at the time of the patient's visit/encounter.

Question 8

What is sequela or &#34;late effects&#34; in the ICD-10-CM coding guidelines?&#10;A)It is the acute injury or illness right after it has happened&#10;B)It is considered to be the one-month timeframe after an acute injury or illness&#10;C)Sequela is considered to be the effect after the acute phase of the illness or injury within three months of the initial episode&#10;D)Sequela is considered to be the residual effect after the acute phase of the injury or illness without a time limit imposed on it

Accepted Answer

Sequela or "late effects" are considered the conditions or residual effects after the acute phase of the illness or injury has ended. There is no time limit. It could occur months or years after the initial encounter.

Deck 5: Coding Guidelines