Question 1

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 2

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 3

A physician performed the following trigger point injections: Two injections into the flexor carpi muscle
One injection into the extensor carpi muscle
Three injections into the triceps brachii
One injection into the biceps brachii
What is the correct code for these injections?
A)20553 (X7)
B)20553
C)20552 (X2), 20553 (X5)
D)20552, 77021

Accepted Answer

The correct code for these injections is with 20553 (Injection(s); Single or Multiple Trigger Point(s), 3 or More Muscle(s)).20553 is the only code that needs to be reported because it allows for the multiple injections of each muscle and it allows (for three or more muscles). There were four muscles injected, two of which were injected multiple times.

Question 4

A physician performed craniotomy on a patient with a severe head trauma and intracerebral hematoma. Due to the patient's condition the procedure was extremely difficult, requiring a significant amount of extra time and effort. What is the correct code for this procedure?
A)61315
B)61313
C)61313 -22
D)61315 -23

Accepted Answer

The correct code for the procedure is 61313 (Craniectomy or Craniotomy for Evacuation of Hematoma, Supratentorial; Intracerebral) combined with modifier -22 to indicate that the procedure was an increased procedural service. Code 61315 is inappropriate because it is used for an infratentorial, intracerebellar hematoma.

Question 5

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 6

A physician biopsied the skin on a 30-year-old woman's upper eyelid, with a possible fungal infection. Three sites were biopsied. How should the physician code for this procedure?
A)11100, 11101 (X2)
B)11100 (X3)
C)11100, 67810
D)67810

Accepted Answer

The physician should code for this procedure using codes: 11000 (Biopsy of Skin, Subcutaneous Tissue and/or Mucous Membrane) and 11001 (X2) (Each Additional Lesion).The physician biopsied three sites, therefore three biopsy codes should be listed on the claim. Code 67810 (Incisional Biopsy of the Eyelid Skin including Lid Margin) is not the correct code because the biopsy is for the skin of the eyelid, instead of an incisional biopsy of the eyelid.

Question 7

A pediatric patient presented to the office with a severe asthma attack. The pediatrician ordered a pulse oximetry to check the patient's blood oxygen saturation level and a spirometry to evaluate her lung capacity. The physician interpreted the results and ordered an albuterol nebulizer treatment and a post-spirometry to check the patient's responsiveness to the albuterol treatment. What are the correct codes for this office visit?
A)99214, 94060, 94760, 94640, A7015, A4616, J7630
B)99214, 94010 (X2), 94760, 94640, A7015, A4616, J7630
C)99214, 94060, 94640, A7015, A4616, J7630
D)99214, 94010, 94760, 94640, A7015, A4616, J7630

Accepted Answer

The correct codes for this office visit are: 99214 (E&M service), 94060 (Bronchodilation Responsiveness, Spirometry), 94010 (Pre and Post Bronchodilator Administration), 94760 (Pulse Oximetry Reading) and 94640 (Nebulizer Treatment). Codes A7015, A4616, and J7630 are nebulizer treatment supply codes. Code 94010 is incorrect because it does not include both the before and after nebulizer treatment spirometry.

Question 8

Medical billing fraud is:
A)Billing for services at a reduced level
B)Billing correctly for services performed
C)Billing for services that are not medically necessary
D)Billing for services that were not performed

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 9

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 10

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 11

A physician excised the head of the humeral bone and replaced it with the appropriate implant. What is the correct code for this procedure?
A)23195
B)23470
C)23195, 23470
D)23472

Accepted Answer

The correct code for the procedure is23470 (Arthroplasty, Glenohumeral Joint; Hemiarthroplasty). Notes under code 23195 (Resection, Humeral Head) state that the appropriate way to report replacement of the humeral head with implant is with code 23470 only.

Question 12

A physician performed a complex repair of the scalp measuring 7.2 cm and an intermediate repair of the arm measuring 3.4 cm. The repairs are different complexities, so they would be reported with separate repair codes, but you would need to add a modifier to indicate that they are two separate procedures performed on the same date of service. Which modifier would you use?
A)-59
B)-51
C)-25
D)-24

Accepted Answer

The modifier that you would use to indicate that they were two separate procedures performed on the same date of service would be -59 (Distinct Procedural Service). In the description of modifier -59, it states that it is used to report two services that were performed on "different site or organ system[s]," and as such, it is used to report a repair done on the same date, on two separate body areas (the scalp and arm).

Question 13

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?
A)You bill Blue-Cross Blue-Shield first and Medicaid second
B)You bill Medicaid only
C)You bill Blue-Cross Blue-Shield only
D)You bill Medicaid first and Blue-Cross Blue-Shield second

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 14

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?
A)969.00, 787.01, 780.4, E939.0
B)969.01, 787.01, E854.0
C)969.00, 780.4, 787.01
D)969.09, 787.01, 780.4, E950.3

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 15

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 16

Alma is a 32-weeks pregnant, Type I diabetic, who was diagnosed at 10-years-old. She has taken insulin continuously since her diagnosis. So far, Alma' diabetes has not significantly affected her pregnancy, but Alma and her physicians have closely monitored her pregnancy and diabetes. What are the correct ICD-9 diagnosis codes for Alma's condition?
A)648.80, V58.67
B)648.00, 250.00
C)648.00, 250.01, V58.67
D)648.80, 250.01, V58.67

Accepted Answer

The correct diagnosis codes for Alma's condition are: 648.00, 250.01 and V58.67. According to ICD-9 coding guidelines, a pregnant woman with diabetes, like Alma, should be assigned the 648.00 (Diabetes Complicating Pregnancy Code). In addition, they should be assigned the appropriate diabetes code. Alma has Type I diabetes, so the correct code is 250.01. She is also on insulin so the appropriate code is also V58.67 (Long-Term Use of Insulin).

Question 17

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 18

The patient is a 20-month-old with end-stage renal disease receiving dialysis twice a week, awaiting a kidney transplant. The patient's parents receive weekly face-to-face counseling services regarding the patient's care and ESRD status. What is the correct code for the patient's dialysis care?
A)90951 (X4)
B)90951
C)90952
D)90954 (X4)

Accepted Answer

The correct code for the patient's dialysis care is 90951 (ESRD-Related Services Monthly, for Patients Younger than 2 Years of Age to Include Monitoring of the Adequacy of Nutrition, Assessment of Growth and Development, and Counseling of Parents; with 4 or More Face-to-Face Visits by the Physician Per Month).This code is used because it includes 4 or more visits by the physician. Code 90951 only needs to be reported once.

Question 19

Level 1 studies in the surgical pathology section of the Laboratory and Pathology chapter of the CPT manual describe:
A)Gross and Microscopic Examination
B)Quantitative Examination
C)Qualitative Examination
D)Gross Examination Only

Accepted Answer

Level 1 studies in the surgical pathology section of the Laboratory and Pathology chapter of the CPT manual describe gross examination only. A gross examination is an inspection of the entire surgical specimen without dividing it into blocks for microscopic examination. A gross examination is performed by the naked eye. Level 1 surgical pathology codes are the only codes that include a gross examination; the other five levels all include a microscopic examination at increasingly complicated levels.
Category: Pathology and Laboratory

Question 20

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.

Quiz 1: Free Coding Specialist

A physician performed the following trigger point injections: Two injections into the flexor carpi muscle One injection into the extensor carpi muscle Three injections into the triceps brachii One injection into the biceps brachii What is the correct code for these injections?

A physician performed craniotomy on a patient with a severe head trauma and intracerebral hematoma. Due to the patient's condition the procedure was extremely difficult, requiring a significant amount of extra time and effort. What is the correct code for this procedure?

HIPAA was created to:

A physician biopsied the skin on a 30-year-old woman's upper eyelid, with a possible fungal infection. Three sites were biopsied. How should the physician code for this procedure?

Medical billing fraud is:

Tricare Prime patients typically must see physicians:

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

A physician excised the head of the humeral bone and replaced it with the appropriate implant. What is the correct code for this procedure?

What is the purpose of an internal audit?

In the RBRVS calculation, the GPCI takes into account:

The patient is a 20-month-old with end-stage renal disease receiving dialysis twice a week, awaiting a kidney transplant. The patient's parents receive weekly face-to-face counseling services regarding the patient's care and ESRD status. What is the correct code for the patient's dialysis care?

Level 1 studies in the surgical pathology section of the Laboratory and Pathology chapter of the CPT manual describe:

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?