Question 1

An forensic pathologist performed a gross post=mortem examination on a stillborn infant. The exam included the infant's brain, but did not include the infant's spinal cord. How should the pathologist code for this service?

Accepted Answer

The pathologist should code for this service using code 88014 (Necropsy, Gross Examination Only; Stillborn or Newborn with Brain). Code 88025 is not correct because it refers to gross and microscopic examinations, whereas, in this case, the pathologist only performed a gross examination. Codes 88005 and 88012 are also incorrect because they do not refer to the examination of a stillborn infant.

Question 2

A radiographic image of the colon's interior is referred to as which of the following?

Accepted Answer

A radiographic image of the colon's interior is referred to as a colonography. A colonoscopy occurs when an endoscope is passed into the colon for visualization, while a duodenoscopy occurs when the endoscope is passed from the colon into the duodenum. A cholangiography is a radiographic image of the bile duct.

Question 3

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 4

HOSPITAL CHARGE SHEET PATIENT: Carson, Cason
AGE: 10
DATE OF ADMISSION: 01/02/2014
DIAGNOSIS: Coccidiomycosis Meningitis
DATE OF DISCHARGE: 01/08/2014
The patient was admitted on 01/02/2014 complaining of a severe headache and hyperpyrexia. An lumbar puncture determined on 01/02/2014 that the patient was suffering from coccidiomycosis meningitis. The patient was administered antibiotics and admitted to the hospital for observation and management of the condition. The patient's condition improved slowly with a regression on 01/05/2014, at which time the antibiotics were changed. After the change in medication, the patient's condition rapidly improved and by 01/07/2014, the patient no longer developed a fever or headache when not on pain medications. On 01/08/2012, the physician spent 20 minutes managing patient discharge, with instructions to continue antibiotics and pain medications, as needed.
What E&M service codes would be reported for this service?

Accepted Answer

The E&M service codes that would be reported for this service are: 99222 (Initial Hospital Care Admission). This code only needs to be reported once per admission. The next code would be 99232 (X3) (Hospital Stay). This code is used to report daily visits by the hospital physician. In this case, the hospital stay would be reported as three units to represent the three days (an extended amount of time) that the physician spent caring for the patient. The next code would be 99231 (Inpatient Stay). This code would be reported as two units to represent the last two days before discharge, at a less complicated level of care, in response to an improved patient condition. The last code would be 99238 (Discharge). This code would be used to report the time it took to discharge the patient, which in this case, took less than 30 minutes.

Question 5

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 6

Diaphragmatic hernia repair codes are divided based upon what?

Accepted Answer

Diaphragmatic hernia repair codes are divided based upon the age of the patient and whether or not the hernia is acute or chronic. There are only three hernia codes, 39503 (Neonatal Diaphragmatic Hernia Repair) and codes 39540 and 39541 (Diaphragmatic Hernia Repair for Other than an Neonate). The codes 39540 and 39541 are divided into traumatic acute and traumatic chronic hernias.

Question 7

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 8

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 9

A 47-year-old male patient with advanced cancer of the lower left mandible presented to the hospital for surgical removal of the lower left jawbone with secondary insertion of mandibular prosthesis. In order to perform surgery, the patient had to be intubated through a tracheostomy. After anesthesia, the surgeon performed the tracheostomy by incising the cricothyroid membrane horizontally along the trachea and inserting the intubation device. The surgeon completed the primary surgical procedure on the patient's mandible. What is the correct code for the intubation?

Accepted Answer

No code should be used for the intubation procedure. The correct code in this case is 31600 (Tracheostomy, Planned (Separate Procedure)).This code is designated as a separate procedure, so it should only be reported if it was the only procedure performed during a surgical session. The primary procedure performed was the mandibular excision and reconstruction; therefore the tracheostomy should be bundled into the major procedure. The intubation should not be reported separately.

Question 10

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 11

What is the difference between anterior nasal packing versus posterior nasal packing procedure codes?

Accepted Answer

The difference between anterior nasal packing versus posterior nasal packing procedure codes is that anterior packing applies pressure and gauze to the front of the nose, and posterior packing inserts a balloon into the back of the nasal cavity. Posterior packing includes packing the nose with gauze and applying pressure to the posterior aspect of the nasal cavity. This can include inserting a balloon to the back of the throat, which is inflated to block blood from draining into the back of the throat.

Question 12

Larry works at a cola bottling company and as one of his job duties, he is required to lift heavy boxes of syrup onto pallets. He is also required, by the safety department, to wear a back brace and hernia belt. Larry was lifting a large box of syrup on to a pallet when he suffered a severe abdominal hernia. Will worker's compensation insurance cover his medical costs?

Accepted Answer

Worker's compensation insurance will only cover his medical costs if Larry was wearing the back brace and hernia belt as he was lifting the box because that is one of his safety requirements. The safety requirement states that Larry must wear the proper safety equipment when performing his job duties. If he is injured while not wearing the proper safety equipment, then worker's compensation insurance is not liable for his injury.

Question 13

What is the purpose of provider credentialing?

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 14

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 15

What is the purpose of a compliance plan?

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 16

In order for a physician to appropriately code for a consultation service, three things must be documented. What are those three things?

Accepted Answer

In order for a physician to appropriately code for a consultation service, three things must be documented. These three things are: the referral or request from the PCP, the rendering of the opinion by the specialist or consultant, and the written report or findings sent from the specialist to the PCP. These three things can be easily remembered by the "Three R's:" "Referral to Specialist," "Rendering of Service" and "Report to PCP."

Question 17

A new patient was seen in the office complaining of ear pain, headache and a mild fever. The physician performed a problem-focused history assessment and an expanded problem-focused examination on the patient. The physician diagnosed the patient with an acute inner ear infection. This medical diagnosis was considered to be of low complexity. What is the correct E&M code for the service?

Accepted Answer

The correct E&M service is 99202. The patient was new so the codes: 99212 and 99211 would be inappropriate. Code 99201, for a new patient, requires a problem-focused history assessment, problem-focused examination, and a straightforward MDM, but in this case, the examination and MDM levels are higher, allowing us to code for a higher level of service. The correct E&M code for this case is 99202.

Question 18

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

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 19

Mr. Beck was recently seen in the hospital by Dr. Johnson, who is his PCP. Dr. Johnson usually treats Mr. Beck for his stomach issues, but he has not had any problems in the last four years, so he has not scheduled any follow-up appointments. Mr. Beck was recently weed-eating in his backyard when a rock flew up and hit him in the eye. Dr. Johnson was the on-call physician, who treated Mr. Beck for his eye injury. He recommended that Mr. Beck schedule a follow-up visit the next week. Will Dr. Johnson bill the follow-up visit as a new patient or as an established patient?

Accepted Answer

Dr. Johnson will bill the follow-up visit as an established patient. New v. established rules state that if a patient has not seen the doctor within three years, he is considered a new patient, but in this case, Mr. Beck saw his physician twice within a week. Although Mr. Beck did not schedule any follow-up visits with Dr. Johnson for four year, he did see Dr. Johnson that week in the ER, and as such he is once again an established patient.

Question 20

A physician can base the level of an evaluation and management service on the time spent counseling the patient and nothing else.

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.

Quiz 1: Free Coding Specialist