Question 1

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 2

What is the appropriate ICD-9 code for a diagnosis of a personal history of heart attacks?
A)V15.9
B)412
C)V12.50
D)V17.3

Accepted Answer

The appropriate ICD-9 code for a diagnosis of a personal history of heart attacks is 412. A heart attack is technically known as a myocardial infarction, and code 412 (Old Myocardial Infarction)is used when the patient has experienced a past myocardial infarction, but is no longer presenting any symptoms. It is also used when the patient has a healed myocardial infarction. In either case, code 412 is the appropriate code.

Question 3

Why are ICD-9 codes necessary to include on a claim?
A)They report the procedures performed on the patient
B)They are the services that are charged for on the claim
C)They indicate the medical necessity of the service
D)They indicate the code linkage on the claim

Accepted Answer

ICD-9 codes are necessary on a claim because they indicate the medical necessity for the service. CPT codes are used to report the procedures on a claim, and they are also used to code charges. Code linkage is what connects the procedures to the diagnoses on a claim. Code linkage also demonstrates the medical necessity of a service, but ICD-9 codes, by themselves, do not indicate a code linkage, as they have to be linked with a procedure code.

Question 4

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 5

Sylvia was seen in the office and was diagnosed with acute bronchitis with Chronic Obstructive Pulmonary Disease. What is the correct ICD-9 diagnosis code for her condition?
A)466.0
B)491.22
C)466.0, 491.22
D)491.21

Accepted Answer

The correct ICD-9 diagnosis code for Sylvia's condition is 491.22. According to ICD-9 coding guidelines, only code 491.22 (Obstructive Chronic Bronchitis with Acute Bronchitis) should be assigned. It is not necessary to also assign code 466.0 (Acute Bronchitis). In addition, code 491.21 (Obstructive Chronic Bronchitis with Acute Exacerbation) is inappropriate because it only indicates an exacerbation of the chronic bronchitis, not acute bronchitis.

Question 6

Tricare Prime patients typically must see physicians:
A)Whenever they feel like it
B)At their military treatment facility
C)Whenever their commander asks them to
D)At their typical private practice doctor's office

Accepted Answer

Tricare patients typically must see physicians at their military treatment facility. Depending on the Tricare plan, the patient may be able to see a physician off-base, but typically the must see the physician on-base, at his military treatment facility. A patient can see a private practice physician, if he has Tricare Prime Remote or if he has an non-availability statement that states that he has permission to see a physician off-base.

Question 7

Which of the following is a surgery section CPT code?
A)99212
B)85025
C)11000
D)70020

Accepted Answer

1100 is a surgery section CPT code because it is within the surgery section code range, 10021 to 69990. 99212 is an evaluation and management section CPT code, 85025 is a pathology and laboratory section CPT code, and 70020 is a radiology section CPT code.

Question 8

A 20-month-old with end-stage renal disease was receiving dialysis twice a week, awaiting a kidney transplant. During the last month of life, the patient received dialysis once per day. Dialysis was administered between June 1 and June 14. The patient's parents received daily face-to-face counseling regarding the patient's care and ESRD status. What is the correct code for the patient's dialysis care?
A)90968 (X14)
B)90960
C)90967 (X14)
D)90964

Accepted Answer

The correct code for the patient's dialysis care is 90967 (X14) (ESRD-related Services for Dialysis Less than an Full Month of Service, Per Day; for Patients Younger than 2 Years of Ages).Code 90967 (X14) is used because the patient only received dialysis services from June 1 to June 14. In addition, code 90967 (X14) needs to be reported with 14 units, in reference to the 14 individual days of service.

Question 9

Jones was examined after a car accident as a requirement of his car insurance claim. Which modifier is appropriate to use on the claim?
A)-22
B)-51
C)-99
D)-32

Accepted Answer

Modifier-32 is the appropriate modifier to use on the claim. Modifier-32, mandated services, is used when a procedure is performed because an official body such as a car or life insurance agency, requests it. Modifier-22 is appropriate for a unusual procedural service, Modifier-51 is used for multiple procedures, and Modifier-99 is used for multiple modifiers.

Question 10

Theodore is an elderly 90-year-old man, who has been unable to leave his bed for the last six months. During his last check-up, the physician noticed a pressure ulcer on the back of his calf muscle. The ulcer was already at an elevated stage, with partial thickness skin loss involving the epidermis of the back of the calf. His physician recommended that Theodore be moved to an upright position to relieve the pressure on his calf muscle and prevent infection. If the pressure ulcer persists, Theodore's physician may recommend using a healing chamber as a way to treat the wound before it gets any worse. What is the appropriate way to code Theodore's pressure ulcer?
A)707.09
B)707.06, 707.20
C)707.09, 707.22
D)707.21, 707.22

Accepted Answer

The appropriate codes for Theodore's pressure ulcer are: 707.09 and 707.22. According to ICD-9 coding guidelines, pressure ulcers need at least two codes to report them correctly. The first code should represent the pressure ulcer, which in this case is707.09 (Pressure Ulcer of Other Sit) and the second code should represent which stage the pressure ulcer is in, which in this case is 707.22 (Pressure Ulcer Stage II).

Question 11

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 12

Which of the following is NOT typically included in a global package?
A)The surgical procedure
B)Follow-up appointments related to the procedure, within the global period
C)Appointments for problems that are not related to the procedure
D)Appointments for problems that are related to the procedure

Accepted Answer

Appointments for problems that are not related to the procedure are not typically included in a global package. Global packages include: all aspects of a surgical service, including, but not limited to the surgical procedure itself, any follow-up appointments within the global period, and appointments for problems related to the surgical procedure. Appointments for problems that are not related to the surgery are always separate charges, regardless of whether they occur within the global period or not.

Question 13

When a CPT code has the words "separate procedure" in parenthesis after the code description, you:
A)Do not use this code if it is listed as a separate procedure
B)Code for all other elements of the procedure except this one
C)Only code for this procedure if it was the only thing performed
D)Code for this procedure, even if it was not performed

Accepted Answer

When a CPT code has the words "separate procedure" in parenthesis after the code description, you only code for this procedure if it was the only thing performed. Codes that are designated as "separate procedures" should only be coded if they are the only procedures performed on that part of the body on the specified day. If any other procedure was performed on that part of the body, another procedure code should be used and this "separate procedure" code is considered bundled into the major procedure.

Question 14

A 76-year-old woman visited her dermatologist's office in response to a large suspicious nevus on her back. The dermatologist excised the nevus and sent it to the pathology lab for examination. The patient experienced pain excision site, due to its large size and was prescribed pain medication. What two part of Medicare insurance will the patient need to pay for the dermatologist's office visit and the prescription charges?
A)Medicare Parts A and B
B)Medicare Parts B and C
C)Medicare Parts B and D
D)Medicare Parts D and E

Accepted Answer

The two parts of Medicare insurance that the patient will need to have to pay for the charges are: Medicare Parts B and D. Medicare Part B covers outpatient office visits, which in this case, would cover the dermatologist's office visit charges, while Medicare Part D covers pharmacy or prescription charges, which in this case, would cover the patient's pain medication charges. Medicare Part A only covers inpatient services, such as inpatient hospital or hospice services, while Medicare Part C is a combination program that combines Medicare A and B services.

Question 15

In the RBRVS calculation, the GPCI takes into account:
A)The geographic location of a practice or provider
B)The type of provider specialty
C)The malpractice risk of a procedure
D)The overhead cost of the practice

Accepted Answer

In the RBRVS calculation, the GPCI takes into account the geographic location of a practice or provider. GPCI stands for Geographic Practice Cost Index, and it takes into account the relative price differences in geographical location. The GPCI is a part of the RBRVS (Resource Based Relative Value Scale), which calculates a reasonable fee for procedures.

Question 16

PROCEDURAL NOTE PATIENT: Trohoske, Janine
AGE: 62
DATE: 01/13/2017
PREOPERATIVE DIAGNOSIS: Degenerative Disc Disease
POSTOPERATIVE DIAGNOSIS: Degenerative Disc Disease
PROCEDURE: Arthrodesis of L4-L2 utilizing autogenous bone graft
An anesthetized patient was placed in the prone position on the operating table and draped in the usual manner. An incision was made along the spinal column, from the area of the L1 to L5, and skin and subcutaneous tissues were pinned back to allow access to the L4-L2 vertebral spaces. A separate fascial incision was made to obtain morselized bone graft segments for arthrodesis procedure. Posterior arthrodesis was then performed along the L4-L2 vertebrae. No additional fixation or instrumentation was placed. Incision was then closed, stapled together, and dressed with a sterile dressing. What is the appropriate code for this procedure?
A)22612, 20937
B)22612, 22614
C)22612, 22614 (X2), 20937
D)22612, 22614 (X2), 20936

Accepted Answer

The appropriate codes for this procedure are 22612 (Arthrodesis, Posterior or Posteriolateral Technique, Single Level; Lumbar) and add-on code 22614 (X2) (Additional Level of Arthrodesis). There were three levels of arthrodesis, L4, L3, and L2, so each level needs to be reported, which can be accomplished by using one 22612 and two 22614 codes. The additional code 20937 needs to be included on the claim to account for the morselized fascial bone graft performed at the same time as the primary procedure.

Question 17

The physician performed a right and left heart catheterization with a left ventriculography on 58-year-old male patient. During catheterization, the patient participated in a physiologic exercise study in the form of a bicycle ergometry. How should you code for this service?
A)93531, 93464
B)93451, 93452, 93464
C)93453, 93464
D)93453

Accepted Answer

The correct codes for this service are 93453 (Combined Right and Left Heart Catheterization including Intraprocedural Injections(s) for Left Ventriculography, Imaging Supervision and Interpretation, when Performed) and 93464 (Physiologic Exercise Study (e.g. Bicycle or Arm Ergometry).Code 93531 is only reported when the combined catheterization is performed for congenital cardiac anomalies and codes 93451 and 93452 are only used for either a right or left heart catheterization.

Question 18

What is the purpose of an internal audit?
A)It allows an outside agency to see your records to make sure that the patients were billed correctly
B)It allows the coders and billers in your office to make sure your claims were billed correctly
C)It allows Medicare to go through your charges to make sure that they are reasonable
D)It allows patients to make sure they were not overcharged for their office visit co pays

Accepted Answer

The purpose of an internal audit is to allow the coders and billers in your office to make sure your claims were billed correctly. There are two types of internal audits: prospective, which are completed before claims are sent out and retrospective, which are performed after claims are sent and paid. Both internal audits are conducted to make sure your office is coding and billing correctly.

Question 19

The patient presents to the laboratory for suspected heavy metal poisoning. The actual amounts of metals detected were not indicated. What laboratory code(s) are appropriate?
A)83018
B)83015
C)82175, 83825, 83885
D)80050

Accepted Answer

Code 83015 (Chemistry Screening for Heavy Metal (e.g., Arsenic, Barium, Beryllium, Bismuth, Antimony, Mercury Screen) is the most appropriate in this case. Code 83018 is not correct because it used when a qualitative test is performed for each heavy metal detected in the patient. Code 80050 is also incorrect because it is used for a general health panel, not a screening for heavy metals.
Category: Pathology and Laboratory

Question 20

What is the difference between biopsy codes located in the integumentary section and those found in the musculoskeletal section?
A)The biopsy codes found in the integumentary section are only for codes related to malignant neoplasms
B)There are no biopsy codes found in the musculoskeletal section
C)The codes in the musculoskeletal system include biopsies for bone only, whereas the biopsy codes found in the integumentary section include codes for biopsies of subcutaneous structures including bone
D)The biopsy codes found in the integumentary section are for biopsies of the skin and subcutaneous structures whereas the biopsy codes found in the musculoskeletal section are for deeper structures

Accepted Answer

The difference between biopsy codes located in the integumentary section and those found in the musculoskeletal section is that the biopsy codes found in the integumentary section are for biopsies of the skin and subcutaneous structures whereas the biopsy codes found in the musculoskeletal section are for deeper structures. Both of the sections include codes for biopsies, but all of the codes in the musculoskeletal section are for deeper structures underlying skin and subcutaneous structures such as muscles and bones.

Quiz 1: Medical Coding

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

What is the appropriate ICD-9 code for a diagnosis of a personal history of heart attacks?

Why are ICD-9 codes necessary to include on a claim?

In an outpatient setting, what is the primary diagnosis?

Sylvia was seen in the office and was diagnosed with acute bronchitis with Chronic Obstructive Pulmonary Disease. What is the correct ICD-9 diagnosis code for her condition?

Tricare Prime patients typically must see physicians:

Which of the following is a surgery section CPT code?

Jones was examined after a car accident as a requirement of his car insurance claim. Which modifier is appropriate to use on the claim?

What is the purpose of a compliance plan?

Which of the following is NOT typically included in a global package?

When a CPT code has the words "separate procedure" in parenthesis after the code description, you:

In the RBRVS calculation, the GPCI takes into account:

The physician performed a right and left heart catheterization with a left ventriculography on 58-year-old male patient. During catheterization, the patient participated in a physiologic exercise study in the form of a bicycle ergometry. How should you code for this service?

What is the purpose of an internal audit?

The patient presents to the laboratory for suspected heavy metal poisoning. The actual amounts of metals detected were not indicated. What laboratory code(s) are appropriate?

What is the difference between biopsy codes located in the integumentary section and those found in the musculoskeletal section?