Question 1

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?
A)New
B)Established
C)Not enough information provided to determine patient status

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 2

HIPAA was created to:
A)Protect patient privacy
B)Enact ways to uncover fraud and abuse
C)Create standards of electronic transactions
D)All of the above
E)Only options A and B

Accepted Answer

All of the above, HIPAA was created to protect patient privacy, enact ways to uncover fraud and abuse, and to create standards of electronic transactions. HIPAA protects patient privacy through its strict standards of confidentiality, allows organizations like the OIG to uncover fraud and abuse, and gives these organizations the power to investigate and prosecute suspected fraud and abuse cases. HIPAA also creates standards of electronic transactions, such as the ANSI 5010 update and requires encryption and passwords on websites that contain patient data.

Question 3

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.

Question 4

Steve gets tested regularly for HIV at his local health clinic because he is part of a high-risk group. So far, Steve has not had any positive HIV test results, but his last test came back as inconclusive. What diagnosis code(s) would be assigned for Steve?
A)042
B)795.71, V69.8
C)V73.89, V65.44
D)V08

Accepted Answer

The diagnoses: 795.71 and V69.8 would be assigned for Steve. According to ICD-9 guidelines, patients with inconclusive HIV serology, but without any definite manifestations of the illness, are assigned the code 795.71 (Inconclusive Serologic Test for Human Immunodeficiency Virus). We can also assign the code V69.8 because Steve is in a high-risk group, which is why he is tested regularly. A secondary diagnosis related to lifestyle can also be coded.

Question 5

What are the three major components of an intestinal transplant?
A)Cadaver Enterectomy, Backbench Work, and Biopsy of Lesion
B)Living Donor Enterectomy, Preparation of the Intestine, and Transplantation with Enterectomy
C)Cadaver Enterectomy, Biopsy of Intestinal Wall, and Allotransplantation
D)Cadaver Anastomosis, Backbench Work, and Recipient Allotransplantation

Accepted Answer

The three major components of an intestinal transplant are: the living donor enterectomy, preparation of the intestine, and transplantation with enterectomy. As with all major organ transplants, there are three distinct phases of work that need to be performed. The first is the removal of the organ from a living or cadaver donor. The second is the preparation of the organ for transplant (backbench work). The third is the transplantation of the organ into the recipient, which can be performed with or without recipient enterectomy.

Question 6

Jenny is on dialysis three times a week, 4 hours a day, due to her End-Stage Renal Disease. Yesterday she went into her primary care office and they diagnosed her with anemia, as a side-effect of her ESRD. What are the correct ICD-9 codes for her visit?
A)285.22, 585.1
B)285.21, 585.9
C)585.6, 282.21
D)285.21, 585.6

Accepted Answer

The correct codes from her visit are: 285.21 and 585.6. According to ICD-9 coding guidelines, when a patient develops anemia as a result of chronic kidney disease, the anemia is sequenced first and the kidney disease second. In this case, the code 285.21 (Anemia in Chronic Kidney Disease) is sequenced first and code585.6 (End-Stage Renal Disease) is sequenced second.

Question 7

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?
A)Yes
B)No
C)Only if he was wearing the back brace and hernia belt while he was lifting the box
D)Only if he was clocked in and lifting the box as one of his job duties

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 8

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 9

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 10

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?
A)99212
B)99202
C)99201
D)99211

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 11

Two weeks ago, a 32-year-old male suffered a thumb injury at work. He was using a belt grinder on a small piece of steel when the belt caught the tip of his left thumb in the grinder. His thumb was ground down to the tip, his thumb nail was removed and a small piece of his anterior phalange bone was broken off. The patient has an appointment scheduled today to see if his nail bed on his left thumb can be reconstructed using a graft from his left great toe. What is code for this procedure?
A)11760-LT
B)11765
C)11762-LT
D)11730, 11732

Accepted Answer

The appropriate code for this procedure is 11762-LT (Reconstruction of the Nail Bed with Graft). The physician is planning on using a graft of the nail bed from the left great toe, therefore the code 11760-LT would not be correct because it only applies to the unspecified repair of the nail bed not a repair performed with a graft.

Question 12

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 13

Walt has metastatic lung cancer. He also has skin melanoma, which is the primary neoplasm. Today he is being seen for treatment and evaluation of his lung cancer. Which of the following is the correct way to code his diagnoses for today's visit?
A)172.8, 197.0
B)162.9, 172.8
C)197.0, 172.8
D)197.0

Accepted Answer

197.0 and 172.8 are the correct codes for today's visit. ICD-9 coding guidelines state that if the patient is being seen for treatment directed at the secondary site, the secondary neoplasm is sequenced first, even though the primary neoplasm still exists. In this case, code 197.0 (Secondary Malignant Neoplasm of the Lung) is the correct code because the neoplasm is being treated and 172.8 (Malignant Melanoma of Skin, NEC,) is the correct code because of the primary neoplasm.

Question 14

The ICD-9-CM and CPT manuals recognize three abortions. They are spontaneous, _____________, and missed.
A)Miscarriage
B)Legal
C)Induced
D)Fatality

Accepted Answer

The three types of abortions recognized by the ICD-9-CM and CPT manuals are spontaneous, induced, and missed. Spontaneous abortions (miscarriages) occur when the body naturally and spontaneously rejects the pregnancy. Missed abortions occur when the fetus dies before the completion of 22 weeks of conception, but the products of conception are retained. Induced abortions are caused by a deliberate procedure to end the pregnancy.

Question 15

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.

Question 16

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 17

A 27-year-old woman in labor presented to the emergency room. Upon admission and evaluation, it was determined that the fetus was in breech position. Due to the severity of the mother's contractions, the OB decided that tocolysis was necessary in order to delay the contractions to allow for an external cephalic version procedure. The OB and the delivery team of nurses carefully performed the external cephalic version and successfully turned the fetus into the appropriate delivery position, at which time the tocolysis was ceased and the patient was given Pitocin to begin contractions again. The baby was successfully delivered vaginally after three additional hours of labor.
How should the OB code for the procedure?
A)59400
B)59412
C)59400 -22
D)59400, 59412 -51

Accepted Answer

The OB should code for the procedure with codes 59400, for the vaginal delivery. No additional modifier is necessary for this code. Code 59412 needs to be reported in addition to the delivery code, to indicate the additional service that was performed, in this case the external cephalic version procedure with tocolysis. Guidelines in the CPT manual after code 59412 indicate that it should be reported in addition to the code for the delivery. Modifier -51 and code 59412 should also be included on the claim to indicate that there were multiple procedures performed on the same date of service.

Question 18

In order for a physician to appropriately code for a consultation service, three things must be documented. What are those three things?
A)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
B)The rendering of the specialty service to the patient, the referral of the patient from the specialist to an additional specialist, and the written report of the findings provided to the specialist
C)The specialist request of a second opinion regarding the patient, the PCP's advice regarding which second specialist the patient should see, and the second specialist's report or findings
D)The referral from the PCP to the specialist, an additional referral from the specialist to another specialist, and the written report or findings sent from the specialist to the PCP

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 19

The physician on duty examined the patient and determined that patient was ready for discharge. The physician spent 25 minutes on the hospital discharge of an inpatient discharge. What is the correct procedure code?
A)99238
B)99239
C)99217
D)99315

Accepted Answer

The correct procedure code is 99238 (Hospital discharge day management; 30 minutes or less). Code 99239 is used when the physician spends 30 minutes or more on the hospital discharge so that code is incorrect because the discharge note states that the physician only spent 25 minutes on the patient's hospital discharge. The discharge note also states that the discharge was for a patient in the hospital, so code 99217 (Hospital observation patient) or 99315 (Nursing home patient) would also not be appropriate.

Question 20

A physician has been treating a patient with endocarditis for the past two weeks. Due to the patient's chronic inflammation of the heart's lining, the physician sent a blood sample to the lab, which detected trace amounts of the bacteria staphylococcus. Now that the physician knows the bacterium that is causing the endocarditis, he can prescribe an appropriate antibiotic to fight the infection and treat the condition. What are the correct diagnosis codes for this patient's condition?
A)421.0, 041.10
B)041.10, 421.0
C)041.11, 421.0
D)421.0, 041.00

Accepted Answer

The correct diagnosis codes for this patient's condition are: 421.0 (Endocarditis) and 041.10 (Infectious Organism). The codes need to be sequenced in this order because there is a note under the endocarditis category 421.0 that states to "use additional code to identify an infectious organism." In this case, the infectious organism is unspecified staphylococcus, code 041.10, which needs to be sequenced after the endocarditis code.

Quiz 1: Medical Coding

HIPAA was created to:

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

Steve gets tested regularly for HIV at his local health clinic because he is part of a high-risk group. So far, Steve has not had any positive HIV test results, but his last test came back as inconclusive. What diagnosis code(s) would be assigned for Steve?

What are the three major components of an intestinal transplant?

Jenny is on dialysis three times a week, 4 hours a day, due to her End-Stage Renal Disease. Yesterday she went into her primary care office and they diagnosed her with anemia, as a side-effect of her ESRD. What are the correct ICD-9 codes for her visit?

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

What is the purpose of provider credentialing?

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

Walt has metastatic lung cancer. He also has skin melanoma, which is the primary neoplasm. Today he is being seen for treatment and evaluation of his lung cancer. Which of the following is the correct way to code his diagnoses for today's visit?

The ICD-9-CM and CPT manuals recognize three abortions. They are spontaneous, _____________, and missed.

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

According to coding conventions, NEC stands for:

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

The physician on duty examined the patient and determined that patient was ready for discharge. The physician spent 25 minutes on the hospital discharge of an inpatient discharge. What is the correct procedure code?