Deck 7: Outpatient Coding

Question 1

Outpatient diagnostic code may utilize documented conditions of "rule out."

Answer 1

False

Question 2

ICD-9/10-CM procedure codes are required on all outpatient facility claims.

Answer 2

False

Question 3

In those instances where ICD-9-CM procedure codes are required by a carrier, when procedures are converted from laparoscopic to open, both procedures should be assigned ICD-9-CM procedure codes as appropriate.

Answer 3

False

Question 4

In some instances, the assignment of more than one ICD-9-CM procedure code will be required for one surgical procedure.

Question 5

Services assigned from Revenue Code 401 will require that a CPT/HCPCS code be assigned.

Question 6

Services assigned Revenue Code 078X require that a CPT/HCPCS code be assigned.

Question 7

Modifier 59 is not utilized in hospital outpatient facility coding.

Question 8

Modifier 51 is not utilized for hospital outpatient facility coding.

Question 9

The assignment of hospital outpatient facility acuity levels are defined by CMS in the Outpatient prospective payment system (OPPS) guidelines.

Question 10

When a patient returns to the emergency room on the same calendar date, the facility may not code for this service.

Question 11

Multiple lesions excised should be assigned multiple codes.

Question 12

When reduction of a fracture is performed, the application of the cast/splint following the reduction is included and not separately reportable.

Question 13

Disorders of the heart would be found in what code range of the ICD-9-CM code book?

A) 630-677
B) 780-799
C) 390-459
D) 800-999

Question 14

ICD-9-CM Code 042 should be assigned what conditions?

A) Exposure to AIDS
B) Positive AIDS test
C) Exposure to AIDS without/o AIDS diagnosis
D) AIDS

Question 15

When procedures are performed bilaterally, how should they be assigned for ICD-9-CM procedural code purposes?

A) Coded once with modifier 52
B) Coded once with modifier 51
C) Coded twice with modifier 50
D) Coded twice

Question 16

Which of the following services would require the assignment of a HCPCS/CPT code?

A) Chest x-ray
B) Anesthesia
C) Outpatient services
D) Dialysis services

Question 17

What modifier would be appropriate for multiple outpatient facility visits on the same day?

A) Modifier 25
B) Modifier 76
C) Modifier 27
D) Modifier 58

Question 18

Utilizing the sample acuity sheet in Table 7-3, what facility level of service would be assigned for a patient requesting a prescription refill only?

A) No acuity level
B) 99281
C) 99282
D) 99284

Question 19

Excision of a 4.0-cm lesion of the leg, a 3.0-cm lesion of the back, and a 2.0-cm lesion of the arm would be assigned how many HCPCS/CPT codes?

A) One
B) Two
C) Three
D) A minimum of three

Question 20

What codes would be assigned for the excision of a lesion with intermediate closure?

A) 11400
B) 11400, 12031
C) 11600
D) 11600, 12031

Question 21

The repair of a 2.0-cm laceration of the arm, 1.0-cm laceration of the leg, and a .0.5-cm laceration of the abdomen would be assigned how many codes?

A) One
B) Two
C) Three
D) Would vary

Question 22

An excisional biopsy of the breast that included the preoperative placement of a radiological marker and excision of the breast lesion would be assigned which codes?

A) 19101
B) 19101, 19281
C) 19125, 19281
D) 19120

Question 23

A diagnostic colonoscopy is performed; however, the physician is unable to reach the splenic flexure of the cecum. What codes would be assigned?

A) 45378
B) 45378-52
C) 45378-74
D) 45330

Question 24

A diagnostic upper gastrointestinal (GI) endoscopy was performed that identified a lesion in the gastroesophageal junction, which was biopsied. What would be the appropriate codes?

A) 43230
B) 43239
C) 43235, 43239
D) 43200, 43202

Question 25

When both IV hydration is performed as well as IV infusion of medication, what codes would be assigned?

A) 96365 only
B) 96360, 96365
C) 96365, 96361
D) 96361 only

Question 26

What coding nomenclature is utilized for ICD-9-CM/CPT outpatient coding purposes?

Question 27

What modifier code would be appropriate when multiple Emergency Department (ED) visits are performed on the same date?

Question 28

Explain how Modifier 25 is utilized for outpatient facility services.

Question 29

When a diagnostic knee arthroscopy (29870-RT) and a arthroscopic medial meniscectomy (29881-RT) are performed during the same surgical session, would both services be assigned? If not, please explain.

Question 30

When multiple chest x-rays are performed on the same calendar date, how should these be indicated?

Question 31

Excision of a 2.5-cm benign lesion of the back with .0.5-cm margins is performed with closure of the skin and dermis. What would be the correct coding assignment for this scenario?

Question 32

A 2.5-cm malignant nasal lesion was excised with a rotational flap performed for closure. What would be the appropriate coding for this scenario?

Question 33

In the outpatient setting, when a closed reduction of a fracture requires additional open procedures on the same day, are both procedures coded? How is this handled?

Question 34

When a colonoscopy with snare polypectomy is performed as well as a biopsy of an unrelated lesion, how should this be coded?

Question 35

When an extracapsular cataract extraction is performed at the same time as the insertion of an intraocular lens, what codes would be appropriate?

Question 36

When a CT of the abdomen is performed with oral contrast, what would be the appropriate code assignment?

Question 37

When excision of a skin lesion is performed and five separate biopsies are obtained and placed in one surgical specimen jar, what would be the appropriate codes for this scenario?

Question 38

Assign CPT codes for the following injection/infusion scenario:

Question 39

ICD-10
In those instances where ICD-10 PCS procedure codes are required by a carrier, when procedures are converted from laparoscopic to open, both procedures should be assigned ICD-10 PCS procedure codes as appropriate?

Question 40

ICD-10
In some instances, the assignment of more than one ICD-10 PCS procedure code will be required for one surgical procedure?

Question 41

ICD-10
Disorders of the heart would be found in what code range of the ICD-10-CM code book:

A) H90-H95
B) H80-H89
C) I00-I99
D) J00-J99

Question 42

ICD-10
Code B20 should be assigned for what conditions?

A) Exposure to AIDS
B) Positive AIDS test
C) Exposure to AIDS without AIDS diagnosis
D) AIDS

Question 43

ICD-10
When procedures are performed bilaterally, how should they be assigned for ICD-10 PCS procedure code purposes?

A) Coded once with modifier 52
B) Coded once with modifier 51
C) Coded twice with modifier 50
D) Coded twice when no bilateral code is available

Question 44

ICD-10
What coding nomenclature is utilized for ICD-10/CPT outpatient coding pur​poses?

Question 45

ICD-9-CM and CPT
​
Assign the appropriate ICD-9-CM diagnostic codes and CPT codes for the following:
​
Patient brought to the endoscopy suite and video endoscope was introduced and advanced into the gastric fundus. The duodenum was difficult to intubate but appeared normal. Biopsy was taken for Helicobacter pylori. There was minimal bleeding and the patient tolerated the procedure well.
​
IMPRESSION:
Reflux esophagitis
Moderate hiatal hernia
Antral gastritis, biopsy pending
​
​

Question 46

ICD-10-CM and CPT
​
Assign the appropriate ICD-10-CM diagnostic codes and CPT codes for the following:
​
Patient brought to the endoscopy suite and video endoscope was introduced and advanced into the gastric fundus. The duodenum was difficult to intubate but appeared normal. Biopsy was taken for Helicobacter pylori. There was minimal bleeding and the patient tolerated the procedure well.
​
IMPRESSION:
Reflux esophagitis
Moderate hiatal hernia
Antral gastritis, biopsy pending
​
​

Question 47

ICD-9-CM and CPT
​
Assign the appropriate ICD-9-CM diagnostic codes and CPT codes for the following:
​
Left breast needle localization/excisional biopsy
​
Incision made through the subcutaneous tissue and the guide wire and breast lesion were grasped with hemostat. The wire and lesion were removed in toto. The patient tolerated the procedure well.
​
​

Question 48

ICD-10-CM and CPT
​
Assign the appropriate ICD-10-CM diagnostic codes and CPT code(s) for the following:
​
Left breast needle localization/excisional biopsy
​
Incision made through the subcutaneous tissue and the guide wire and breast lesion were grasped with hemostat. The wire and lesion were removed in toto. The patient tolerated the procedure well.
​
​

Question 49

ICD-9 and CPT
​
Assign the appropriate ICD-9-CM codes and CPT codes for the following:
​
Preoperative diagnosis: Acalculus cholecystitis
Postoperative diagnosis: Same
​
​
Patient brought to the operating room (OR) and a supraumbilical incision made and the Veress needle introduced followed by laparoscope. Additional instruments and trocars were introduced. The gallbladder was grasped, removed from the liver bed, and brought out through the subxyphoid incision. No calculi were noted on the gallbladder during the procedure or pathologically.
​
​

Question 50

ICD-10-CM and CPT
​
Assign the appropriate ICD-10-CM codes and CPT codes for the following:
​
Preoperative diagnosis: Acalculus cholecystitis
Postoperative diagnosis: Same
​
​
Patient brought to the OR and a supraumbilical incision made and the Veress needle introduced followed by laparoscope. Additional instruments and trocars were introduced. The gallbladder was grasped, removed from the liver bed and brought out through the subxyphoid incision. No calculi were noted on the gallbladder during the procedure or pathologically.
​
​

Question 51

ICD-9-CM and CPT
​
Assign the appropriate ICD-9-CM diagnostic codes and CPT codes for the following:
​
Preoperative/Postoperative Diagnosis: Metastatic pancreatic cancer
​
The right side of the neck was prepped and raped and percutaneous access to the right internal jugular was obtained. Percutaneous access was obtained to the right subclavian, and a J wire was advanced through the needle without difficulty. The tract of the J wire was enlarged by passing a dilator over the J wire. All three ports were aspirated and flushed, and the catheter was then sutured to the skin in two places.
​
​

Question 52

ICD-10-CM and CPT
​
Assign the appropriate ICD-10-CM diagnostic codes and CPT codes for the following:
​
Preoperative/Postoperative Diagnosis: Metastatic pancreatic cancer
​
The right side of the neck was prepped and raped and percutaneous access to the right internal jugular was obtained. Percutaneous access was obtained to the right subclavian, and a J wire was advanced through the needle without difficulty. The tract of the J wire was enlarged by passing a dilator over the J wire. All three ports were aspirated and flushed, and the catheter was then sutured to the skin in two places.
​
​