Question 1

Excision of simple internal and external hemorrhoids

Accepted Answer

Code 46255 specifically describes the excision of internal hemorrhoids, whereas code 46945 is used for excision of internal and external hemorrhoids with removal of subcutaneous tissue. Code 46221 is for a hemorrhoidectomy with a fissurectomy, and code 46260 is for a stapled hemorrhoidectomy. Therefore, the most appropriate code for the given scenario is 46255, Excision of single internal and external hemorrhoid(s).

Question 2

Patient complains of frequent temporal headaches and the physician suspects temporal arteritis. Patient underwent temporal artery biopsy.

Accepted Answer

Temporal arteritis is coded with 446.5, and the procedure code for temporal artery biopsy is 37609. The only option with both codes is B.

Question 3

Tracheostoma revision with flap rotation

Accepted Answer

The answer of Tracheostoma revision with flap rotation 
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Question 4

Ureterolithotomy completed laparoscopically

Accepted Answer

The answer of Ureterolithotomy completed laparoscopically 
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Question 5

Tonsillectomy on a 14-year-old

Accepted Answer

The answer of Tonsillectomy on a 14-year-old 
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Question 6

Facelift utilizing the SMAS flap technique

Accepted Answer

The code for facelift utilizing the SMAS flap technique is 15829. All of the other codes are either not specific to this technique or do not include all the necessary components for this specific procedure.

Question 7

Patient presents to the operating room for fulguration of bladder tumors. The cystoscope was inserted and entered the urethra which was normal. Bladder tumors measuring approximately 1.5 cm were removed.

Accepted Answer

The procedure performed is fulguration of bladder tumors, which involves the removal of tumor(s) using electrocautery. The correct code for this procedure is 52234. Codes B, C, and D are not appropriate for this specific procedure.

Question 8

Excision of Cowper's gland

Accepted Answer

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Question 9

Blood transfusion of three units of packed red blood cells

Accepted Answer

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Question 10

Patient presents to the operating room for a secondary Achilles tendon repair.

Accepted Answer

The correct code for secondary Achilles tendon repair is 27654. 27599 is an unlisted procedure code which may cause issues with reimbursement. 27650 is for repair of primary Achilles tendon rupture and 27698 is for repair of ankle ligament, not appropriate for this procedure.

Question 11

The patient is on vacation and presents to a physician's office with a lacerated finger. The physician repairs the laceration and gives a prescription for pain control and has the patient follow up with his primary physician when he returns home. The physician fills out the superbill as a problem-focused history and examination with straightforward medical decision making. Also checked is a laceration repair for a 1.5 cm finger wound.

Accepted Answer

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Question 12

Patient undergoes partial nephrectomy for carcinoma of the kidney.

Accepted Answer

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Question 13

Two-year-old patient returns to the hospital for cleft palate repair where a secondary lengthening procedure takes place.

Accepted Answer

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Question 14

A 69-year-old established female patient presents to the office with chronic obstructive lung disease, congestive heart failure, and hypertension. The physician conducts a comprehensive history and physical examination and makes a medical decision of moderate complexity. Physician admits the patient from the office to the hospital for acute exacerbation of CHF.

Accepted Answer

The patient presents with chronic obstructive lung disease, congestive heart failure, and hypertension, which are all chronic conditions. The acute exacerbation of CHF requires admission to the hospital. The appropriate ICD-10 code for CHF exacerbation is 428.0. The appropriate CPT code for a hospital admission with a moderate complexity medical decision is 99222. The appropriate ICD-10 codes for the patient's chronic conditions are hypertension (401.9) and COPD (496).

Question 15

A physician orders a lipid panel on a 54-year-old male with hypercholesterolemia, hypertension, and a family history of heart disease. The lab employee in his office performs and reports the total cholesterol and HDL cholesterol only.

Accepted Answer

The physician ordered a lipid panel which includes total cholesterol, HDL, LDL, and triglycerides. Even though the lab employee only reported total cholesterol and HDL, it is still appropriate to report a more comprehensive lipid panel with additional codes (82465 and 83718). The diagnosis codes of 272.0 (hypercholesterolemia) and V17.49 (family history of cardiovascular disease) should also be reported. The hypertension code (401.9) is not necessary to report for this particular lab result.

Question 16

Patient presents to the operating room where the physician performed, using imaging guidance, a percutaneous breast biopsy utilizing a rotating biopsy device.

Accepted Answer

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Question 17

Laparoscopic repair of umbilical hernia

Accepted Answer

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Question 18

Chronic nontraumatic rotator cuff tear. Arthroscopic subacromial decompression with mini-open rotator cuff repair.

Accepted Answer

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Question 19

Established 42-year-old patient comes into your office to obtain vaccines required for his trip to Sri Lanka. The nurse injects intramuscularly the following vaccines: hepatitis A and B vaccines, cholera vaccine, and yellow fever vaccine. As the coding specialist, what would you report on the CMS 1500 form?

Accepted Answer

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Question 20

Patient presents to the emergency room complaining of right forearm/elbow pain after racquetball last night. Patient states that he did not fall, but overworked his arm. Past medical history is negative and the physical examination reveals the patient is unable to supinate. A fourlview x-ray of the right elbow is performed and is negative. The physician signs the patient out with right elbow sprain. Prescription of Motrin is given to the patient.

Accepted Answer

The answer of Patient presents to the emergency room complaining...

Exam 1: Registered Health Information Administrator