Question 1

A physician sutured 3 digital nerves in the left hand, the common sensory nerve in the left foot and two common sensory nerves in the right foot. What codes need to be reported?

Accepted Answer

The codes that need to be reported are: 64831 (Suture of Digital Nerve, Hand or Foot; 1 Nerve) and 64832 (Suture of Digital Nerve, Hand or Foot; Each Additional Digital Nerve) with two units. These codes include all three sutures for the digital nerves in the left hand. The other codes that need to be reported are 64834 (Suture of 1 Nerve; Hand or Foot, Common Sensory Nerve) and 64837 (Suture of Each Additional Nerve, Hand or Foot) with two units. This accounts for the three additional common sensory nerves that were sutured in the feet.

Question 2

The physician performed an annual examination on a 47-year-old male new patient with a history of congenital heart disease. What is the correct E&M code?

Accepted Answer

The correct E&M code is 99386 (Periodic Comprehensive Preventive Medicine, New Patient, 40-64 Years of Age). The patient is new to the physician, so the codes: 99396 and 99397 are incorrect.99396 and 99397 are used for established patients. Furthermore, code 99387 is used for patients at least 65 years old.

Question 3

A physician performed a right lumbar hemilaminectomy with decompression of nerve root, including the excision of two herniated intervertebral discs for three vertebral interspaces. How should the physician code for this service?

Accepted Answer

The physician should code for this service with codes 63030 (Laminotomy (Hemilaminectomy), with Decompression or Nerve Root(s), Including Facetectomy, Foraminotomy and/or Excision of herniated Intervertebral Disc; 1 Interspace, Lumbar) with the add-on code 63035 (Each Additional Interspace, Cervical or Lumbar). Although there were only two herniated discs removed, there were three interspaces involved in the procedure therefore the correct number of units for the add-on code 63035 is two.

Question 4

A pediatric patient with a history of asthma and pneumonia presented to the office with severe respiratory distress. The pediatrician performed a detailed history and comprehensive examination, and diagnosed the patient with status asthmaticus. A pulse oxygen level was taken and it was determined that the patient's blood oxygen level was at 88%. The patient was started on a nebulizer treatment at 0950 hours, which lasted until 1015 hours. The physician then re-checked the patient and determined that the patient's breathing had only slightly improved. A pulse oxygen level was taken again and it was determined that the patient was at 92%. The physician then ordered another nebulizer treatment, which was started at 1032 and continued until 1054. After this second breathing treatment, an additional pulse oxygen level was taken and the patient's blood oxygen level had risen to 97%. The pediatrician then determined that the patient needed to be sent for chest x-rays to determine whether or not pneumonia was present in the lungs. Due to the resulting amount of data and risk, the pediatrician considered the MDM of high complexity. The total time spent with the patient was 1 hour 45 minutes.
What E&M codes would you use to code for the office visit?

Accepted Answer

You would report this office visit with the E&M codes: 99215 (Established Patient Office Visit, Level Five), and 99354 and 99355 (X2) (Prolonged Services). Code 99215 is established by the detailed history, comprehensive examination, and the MDM of high complexity. The appropriate prolonged services codes are: 99354 (First 30-74 minutes Over), which represents the time spent beyond what is allowed for the 99215 code and the 99355 (X2) (Rest of the Time Spent with the Patient), which in this case is a total of 1 hour and 45 minutes. If the physician spent 1 hour and 44 minutes, then the correct number of units for 99355 would be 1, but that is not the case.

Question 5

ICD-9-CM diagnosis codes for laboratory services are limited to:

Accepted Answer

ICD-9-CM diagnosis codes for laboratory services are not limited to any chapter in the ICD-9-CM manual. In other words, any chapter may be used. Pathology and laboratory tests can sample many different types of specimens for many different conditions therefore almost any code from the ICD-9-CM manual may be appropriate. The reasons for these tests include, but are not limited to: identification of infectious organisms, the morphology of neoplasms, quantities of substances in the body and hormonal changes and imbalances, such as pregnancy status.

Question 6

Sheila took her 5-year-old daughter to the pediatrician's office for an annual well-child exam. She has a commercial Blue-Cross Blue-Shield insurance plan, through her work, which covers her daughter. Sheila also has Medicaid coverage on her daughter, due to her low-income status. Which one of her insurances is billed for the well-child exam?

Accepted Answer

You bill Blue-Cross Blue-Shield first as the primary payer, and send a secondary claim to Medicaid, once the primary insurance has paid. Medicaid is always the payer of last resort, and as such is always billed after a commercial insurance processes the claim.

Question 7

The patient was seen in the emergency department for a severe laceration to the right forearm, following a work injury. The on-call physician performed an expanded problem-focused history assessment and examination, and then sutured the complicated wound using 25-0 vicryl sutures in three subcutaneous layers. The patient was prescribed prophylactic antibiotics and released from the emergency department. The patient was instructed to return to his PCP in one week for a follow-up appointment. The MDM was moderate. What is the correct level of E&M service?

Accepted Answer

The correct level of E&M service is 99283 (Emergency Department Visit, Level Three). Code 99291 is not correct because it represents critical care services, not emergency department services. The note states that both the history assessment and examination were expanded problem-focused, and that the MDM was of moderate complexity. In the emergency services category, these three factors make up a level three visit, which should be reported using the code 99283.

Question 8

Unbundling a code is:

Accepted Answer

Unbundling a code occurs when multiple procedures, services and supplies are listed with their own separate, distinct codes. Many surgical procedures consist of multiple elements such as: gaining access to an organ by performing an open incision, completing the surgery, and closing the wound. The primary surgical code includes all of these elements. In other words, it is a bundled code. Unbundling the code would consist of listing the incision, surgical procedure, and surgical closure codes separately.

Question 9

Debbie has Type II diabetes, and has been working with her physician to develop diet and exercise techniques that help control her symptoms. Today her doctor also put her on a new medication, which may help control her blood sugar levels better. What is the correct ICD-9 code for Debbie's diabetes?

Accepted Answer

The correct ICD-9 code for Debbie's diabetes is 250.00. All diabetes codes require a fifth digit in order to make them as specific as possible. This fifth digit indicates the type of diabetes the patient has, as well as if the diabetes is considered controlled or uncontrolled. In Debbie's case, she has Type II diabetes, and even though it is poorly controlled, it is still considered controlled, so the correct diagnosis code is 250.00 (Diabetes Mellitus Without Mention of Complication, Type II, Not Stated as Uncontrolled).

Question 10

The physician saw the disabled patient during a home visit. The patient recently moved to be closer to her family therefore she is considered a new patient. The physician performs a detailed history and an expanded problem-focused examination. Due to the lack of risk and small amount of data to be analyzed, the MDM is of low complexity. What is the correct evaluation and management service code?

Accepted Answer

The correct evaluation and management code is 99342 (Home Visit For New Patient, Level Two). Codes 99348 and 99349 are not correct, because the patient is new to the physician. Code 99343 is also not correct. Although the patient's history places her at the 99343 level, the examination and MDM are at a lower level, which results in a code of 99342.

Question 11

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

Accepted Answer

When you include an unlisted service procedure code on a claim, you must also include a special report. This special report needs to include a precise description of the service or procedure and the nature of and need for the service. The special report should also include the time, effort, and equipment used to complete the service.

Question 12

The nurse practitioner returned a phone call from a concerned daughter regarding her ailing mother's health. She spent 20 minutes counseling the daughter on how to provide hospice care during the last stages of her mother's life. It had been three weeks since the patient had been seen in the office, and her next scheduled appointment was in two weeks. What E&M service can be reported for this phone call?

Accepted Answer

The E&M service that can be reported for this phone call is 99442 (Telephone E&M Service Provided by a Qualified Non-Physician Health Care Professional; 11-20 Minutes of Medical Discussion). The phone call did not originate from a previous visit (within the last 7 days) and it also did not occur in response to an upcoming doctor's visit (within the next 24 hours), therefore you can code for this service. In addition, code 99442 is more appropriate than 98967 because a nurse practitioner qualifies as a non-physician health care professional.

Question 13

The diaphragm is the major muscle that controls breathing. Is this muscle voluntary or involuntary?

Accepted Answer

The diaphragm is voluntary and involuntary. It is involuntary because you do not have to consciously think about taking a breath every time you inhale or exhale. This is illustrated when you hiccup involuntarily. It is also voluntary because you can change the way you breathe, for instance when you hold your breath.

Question 14

What is the correct code for a complete chest x-ray?

Accepted Answer

The correct code for a complete chest x-ray is 71030 (Radiologic Examination, Chest, Complete, Minimum of 4 Views).71034is the only code that needs to be included because the procedure description does not mention fluoroscopic guidance. Code 71020 only allows for 2 views of the chest, while codes 71021, 71022, and 71023 include other specifications that are not included in the procedure description.

Question 15

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

Accepted Answer

Medicaid is always the payer of last resort. This means that if a patient has more than one type of insurance coverage, and one of the insurances is Medicaid, then the biller must bill the other insurance first and Medicaid second. Medicaid will never pay first, if the patient has more than one type of insurance coverage.

Question 16

PREOPERATIVE DIAGNOSIS: Cyst of Mediastinal Wall POSTOPERATIVE DIAGNOSIS: Tumor of Mediastinal Wall
A physician removed 1.5 cm mass from mediastinal wall, along with appropriate margins. The tumor was sent to pathology to determine the malignancy status.
What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 39220 (Resection of Mediastinal Tumor). There are only two codes for the removal or resection of a mediastinal mass. Code 39200 is for the removal of a mediastinal cyst, whereas code 39220 is for the removal of a tumor. The postoperative diagnosis states that the mass is a tumor, therefore code 39220 is the most appropriate code for this service.

Question 17

Contrast material is introduced into a patient in order to better visualize the area being imaged. What are the three main ways that contrast material can be introduced?

Accepted Answer

The three main ways that contrast material can be introduced are intravascularly, intra-articulary, or intrathecally. Intravascular contrast material is injected into a vein. Intra-articular contrast material is injected into a joint. Intrathecal contrast material is injected within a sheath (within subarachnoid/spinal fluid).

Question 18

Medical billing fraud is:

Accepted Answer

Medical billing fraud is billing for services that were not performed in the office. An example would be billing for an office visit for a patient who never came into the office. Medical billing abuse is billing for services that were not medically necessary. An example of medical billing abuse would be billing a high-level E&M service when only a low-level E&M service was performed.

Question 19

Devonne recently experienced a death in her family and has been severely depressed. She went to her psychiatrist and he prescribed a new anti-depressant drug. After Devonne started taking the anti-depressant, she experienced nausea, vomiting, and dizziness. She called her physician, who advised her to stop taking the anti-depressant and come into the clinic so that he could examine her and prescribe a new anti-depressant. What are the appropriate ICD-9 diagnosis codes for Devonne's reaction to the anti-depressant?

Accepted Answer

The appropriate ICD-9 diagnosis codes for Devonne's reaction to the anti-depressant are: 969.00, 787.01, 780.4 and E939.0. In order to code for a poisoning or toxic effect correctly, you must first code the poisoning, which in this case is 969.00 (Poisoning by Anti-Depressant, Unspecified). The patient experienced adverse effects to the medication, therefore the next codes should be 787.01 (Nausea and Vomiting) and 780.4 (Dizziness). The last code is the (External Cause Effect) or the reason for the poisoning. Although Devonne was depressed, this was not a suicide attempt and she took the medication as prescribed by her physician, so the correct code is E939.0 (Therapeutic Use).

Question 20

A physician performed a cystourethroscopy with an ejaculatory duct catheterization and irrigation. Duct radiography was also performed to visualize ejaculatory duct system. What CPT codes should be reported?

Accepted Answer

The CPT codes that should be reported are 52010 (Cystourethroscopy, with Ejaculatory Duct Catheterization, with or without Irrigation, Instillation, or Duct Radiography, Exclusive of Radiologic Service) and 74440 (Vasography, Vesiculography, or Epidemiography, Radiological Supervision and Interpretation) Duct radiography was performed, therefore the radiological S&I also needs to be reported. In parenthesis under code 52010, it directs the coder to code 74440, the appropriate radiological S&I code.

Quiz 1: Medical Coding