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

Accepted Answer

The physician should code the procedure using the code 66852 only (Removal of Lens Material; Pars Plana Approach, With or Without Vitrectomy). Codes: 66983 and 66982 are used for the removal and implantation of a lens, but this procedure does not include the implantation of a lens, only the removal. Code 66840 is also inappropriate because it is used to report the removal of the lens via an aspiration technique.

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

Accepted Answer

The correct code is 92225-47, (Ophthalmoscopy, extended, with retinal drawing, with interpretation and report). Modifier -47, (Anesthesia by Surgeon) must be appended to indicate that the anesthesia service was performed by the physician performing the procedure. According to modifier guidelines, modifier -47 is not to be used on the anesthesia procedure code, but rather appended to the basic service code which in this case is 92225. The anesthesia service code, 00148, should not be reported.

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

Accepted Answer

In an outpatient setting, the primary diagnosis is the reason the patient came in for the visit, and received services on that day. The primary diagnosis will not always be the code that the doctor lists first, as the doctor may not know the coding guidelines. The problem that causes the patient the most pain will only be the primary diagnosis if it is the reason the patient receives services, but not all diagnoses cause pain. Diagnosis codes also do not have any effect on reimbursement, only procedure codes do.

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?

Accepted Answer

This statement is true. Under certain circumstances, an evaluation and management service can be based solely on the face-to-face time spent with the patient. There are seven components of an E&M service with time being one of them. E&M coding guidelines state that time shall be the key factor when counseling dominates (more than 50%) of a patient encounter.

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

Accepted Answer

The correct code for the procedure is 65222 (Removal of Foreign Body, External Eye; Corneal, with Slit Lamp). Code 65220 is inappropriate because it does not include the use of the slit lamp, and codes: 65205 and 65210 are inappropriate because they do not include the removal of a foreign body from the cornea. Furthermore, codes: 65205 and 65210 do not include the use of a slit lamp. A slit lamp is a small lamp that consists of a high-intensity light source. This lamp can be used to aid surgeons in the removal of small foreign bodies.

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

Accepted Answer

The anterior segment of the eyeball, directly behind the cornea, is filled with a clear salty fluid called the aqueous humor. Light from the aqueous humor enters a convex disc suspended behind the iris, which is called the crystalline lens. After the light passes through the crystalline lens, it enters the vitreous humor, which is the jelly-like substance that fills the posterior chamber of the eyeball.

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

Accepted Answer

HCPCS Level II ambulance service modifiers represent where the patient was picked up and where the patient was dropped off. They are two letters, like all other HCPCS Level II modifiers, but the first letter represents where the patient was picked up and the second letter represents where the patient was transported to or dropped off. The locations and letters are found at the beginning of the A-section of the HCPCS manual.

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

Accepted Answer

The purpose of provider credentialing is to make sure that your provider is correctly licensed to perform procedures. In the credentialing process, insurance companies check a provider's credentials, to make sure he is legal and valid. This process is required as part of the provider's contract with the insurance company.

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

Accepted Answer

According to coding conventions, NEC stands for "Not Elsewhere Classifiable." This common acronym is used to indicate that your diagnosis code is more specific than what is available in the ICD-9 manual. Using an NEC code means that the doctor was more specific about the diagnosis code than the ICD-9 manual allows.

Question 10

The system that produces tears is called the:
A)Tear Duct System
B)Lacrimal System
C)Lacrimal Punta
D)Tear Glands

Accepted Answer

The system that produces tears is called the lacrimal system. This is a system of glands that produce tears behind the eyebrows, which flow into the eyes and drain out through the lacrimal punta, into the nose. A common ailment of babies is lacrimal ductal stenosis, a condition that occurs when the lacrimal ducts become clogged, causing a buildup in the inner corners of the eyes.

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

Accepted Answer

When you append modifier -TC to a service, you are indicating that the provider only performed the technical component of the service. Some CPT codes have two components to them, such as radiology services. The professional component of the service is the supervision and interpretation of the x-ray results, whereas the technical component is actually taking the x-ray picture. Sometimes it is necessary to indicate that the physician only performed one or the other part of the service.

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

Accepted Answer

The purpose of a compliance plan is to help your office follow the correct coding and billing protocols. A compliance plan is a document, or multiple documents, that describes the HIPAA requirements that your office is required to follow and uphold. Among other things, the compliance plan outlines how often your office should conduct audits, how your employees should be trained in regards to confidentiality, and how you should select a compliance manager to ensure that all components of the compliance plan are carried out.

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

Accepted Answer

The correct code for Mr. Longoria's ophthalmology service today is with 92002, (Ophthalmological Services; Medical Examination and Evaluation with Initiation of Diagnostic and Treatment Program; Intermediate, New Patient. Codes 92012 and 92014 are incorrect because they are used for established patients. In this case, the patient is new to this physician and the correct level of evaluation is intermediate because the patient has an established (known) cataract. The patient's cataract is not newly diagnosed. Furthermore, the patient did not receive a comprehensive examination.

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

Accepted Answer

Before you include an unlisted services procedure code on a claim, you do NOT have to review Category II codes to make sure an appropriate code does not exist. In order to assign an unlisted procedures code, you first must review all of the CPT codes in that section to make sure a more appropriate code does not exist. You must also check to see a modifier is available to include on the claim. Lastly, before assigning an unlisted procedure code, you must check if a Category III code is more appropriate.

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

Accepted Answer

HCPCS modifiers can be used for CPT codes, but CPT modifiers cannot be used to HCPCS codes. CPT modifiers can only be used with CPT codes, whereas HCPCS modifiers can be used with HCPCS and 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

Accepted Answer

When selecting an evaluation and management code, the first thing that the coder needs to determine is the appropriate category of E&M service. This means that the coder needs to determine where the service was provided (i.e., hospital inpatient, office/outpatient, hospital observation, etc.). Whether the patient was new or established would only be a question in certain categories. In addition, the time spent with the patient is only a determining factor in certain categories.

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

Accepted Answer

When you see the symbol # in front of a CPT code, it means that the code is listed out of numerical order. Throughout the CPT book, whenever you see the # symbol in front of a numerical CPT code, it means that the code has been re-sequenced so that it is not listed in numerical order with the rest of the CPT codes within that section.

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

Accepted Answer

The procedure known as blepharoplasty is performed to plastic repair a droopy eyelid. The prefix "blephar/o" means "eyelid," and as such, a "blepharoplasty" would be performed to repair the skin of the eyelid. A blepharoplasty is commonly performed to correct a droopy eyelid, a condition also known as ptosis. Codes for blepharoplasty can be found in both the Eye and Ocular Adnexa subsection as well as the Integumentary subsection of the surgery Chapter in the CPT manual.

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

Accepted Answer

The HCPCS Level II modifier -E1 stands for Upper Right, Eyelid. Many HCPCS modifiers indicate anatomical locations, such as the -E series modifiers for eyelids. Other HCPCS modifiers indicate a section of the vertebral column, and digits of the hands or feet.

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

Accepted Answer

In the CPT manual, Appendix C lists clinical examples of evaluation and management procedures. In Appendix C, you will find multiple examples of each level of evaluation and management procedures. Reviewing these examples will not only help you determine which specific levels of codes should be used in each coding situation, it will also help you make sure the right code is assigned.

Quiz 16: Opthalmological Coding Certification

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?

In an outpatient setting, what is the primary diagnosis?

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?

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

HCPCS Level II ambulance service modifiers represent:

What is the purpose of provider credentialing?

According to coding conventions, NEC stands for:

The system that produces tears is called the:

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

What is the purpose of a compliance plan?

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

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

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

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

The procedure known as blepharoplasty is performed to:

The HCPCS Level II modifier -E1 stands for:

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