Question 1

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 2

Debbie has Type II diabetes, and has been working with her physician to develop diet and exercise techniques that help control her symptoms. Today her doctor also put her on a new medication, which may help control her blood sugar levels better. What is the correct ICD-9 code for Debbie's diabetes?
A)250.0
B)250.00
C)250.02
D)250.80

Accepted Answer

The correct ICD-9 code for Debbie's diabetes is 250.00. All diabetes codes require a fifth digit in order to make them as specific as possible. This fifth digit indicates the type of diabetes the patient has, as well as if the diabetes is considered controlled or uncontrolled. In Debbie's case, she has Type II diabetes, and even though it is poorly controlled, it is still considered controlled, so the correct diagnosis code is 250.00 (Diabetes Mellitus Without Mention of Complication, Type II, Not Stated as Uncontrolled).

Question 3

Two weeks ago, James was walking in the mountains and scratched his leg with a large branch on the edge of the trail. Yesterday, he went to the pediatrician's office because his scratch was not healing and was getting worse. Today, he is being seen again by the pediatrician, who diagnosed James with MRSA cellulitis at the site of the wound on his leg. Which of the following represents the correct code(s) for today's visit?
A)682.6, 041.12
B)686.9, 041.11
C)958.3, 041.12
D)041.12

Accepted Answer

The codes: 682.6 and 041.12 represent the correct codes for today's visit. According to ICD-9 guidelines, you must select the appropriate code for the condition, which in this case is 682.6 (Cellulitis of Leg), along with the MRSA code 041.12. Code 958.2 is incorrect because it is not used when the injury is classified as cellulitis.

Question 4

A physician performed the open excision of two deep axillary nodes in a 45-year-old female patient. What is the correct code for this procedure?
A)38500
B)38555
C)38525
D)38525 (X2)

Accepted Answer

The correct code for the procedure is 38525 (Biopsy or Excision of Lymph Node(s); Open, Deep Axillary Nodes). This code does not need to be reported with more than one unit because the code description allows for the excision of multiple nodes. Code 38555 is also incorrect because this code is used for the excision of a cystic hygroma, not a deep axillary lymph node.

Question 5

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 6

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 7

Jaime is a 9-year-old obese boy. Jaime's pediatrician suspects that he may have hypertension due to his weight, but has not come to a conclusive diagnosis yet. So far, he has had two elevated blood pressure readings, but has not been diagnosed with hypertension. Jaime saw his pediatrician today for a blood pressure reading, which was elevated. What is the correct diagnosis code for Jaime's office visit?
A)401.9
B)401.0
C)405.9
D)796.2

Accepted Answer

The correct diagnosis code for Jaime's office visit is 796.2. According to the ICD-9 manual, the code 796.2 (Elevated Blood Pressure Reading Without Diagnosis of Hypertension) should be used for an incidental elevated high blood pressure reading, or in any case where there is a high blood pressure reading without a diagnosis of hypertension. Although Jaime's blood pressure reading today was high, he has not been officially diagnosed with hypertension, therefore the correct diagnosis is 796.2.

Question 8

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 9

A pediatrician performed a routine circumcision on a newborn baby boy in a hospital setting. The physician anesthetized the area with dorsal penile block, clamped the foreskin away from the tip of the penis and excised the excess foreskin. What is the correct code for the circumcision?
A)54160
B)54150 -47
C)54150
D)54160 -47

Accepted Answer

The correct code for the circumcision is 54150 (Circumcision, Using Clamp or Other Device with Regional Dorsal penile or Ring Block). Code 54160 is not correct because it is used for a circumcision without using a clamp or other device. You should not use modifier -47 (Anesthesia by Physician) because the anesthesia was included in the procedure description. Modifier -47 guidelines state that the modifier is not to be used with local anesthesia and a penile ring block is a local anesthetic.

Question 10

Etta has been using corticosteroids for severe hay fever asthma for the last few years, and is now experiencing some eye problems. Her physician told her that she was only in the early stages of glaucoma, which could be treated to ensure her vision for the rest of her life. What is the correct code for the ICD-9 codes for Etta's condition?
A)365.31, 365.71
B)365.32, 365.71
C)365.31, 365.72
D)365.9, 365.71

Accepted Answer

The correct code for the ICD-9 codes for Etta's condition are: 365.31 and 365.71. ICD-9 coding guidelines state that for types of glaucoma, categorized to subcategories 365.1 to 365.6, an additional code from category 365.7 should be assigned to indicate the stage of glaucoma. In Etta's case, her primary glaucoma diagnosis is 365.31 (Corticosteroid-Induced Glaucoma, Glaucomatous Stage), and her physician has indicated that it is in the early stage, so the correct secondary diagnosis is 365.71.

Question 11

A 30-year-old woman with high-risk pregnancy suffered a splenic rupture due to a car accident. What is the correct ICD-9-CM diagnosis code for the mother's injury?
A)767.8
B)865.04
C)867.9
D)289.59

Accepted Answer

The correct ICD-9-CM diagnosis code for the mother's injury is 865.04, Injury to spleen, without mention of open wound into cavity. Code 767.8 is incorrect because it is used for the rupture of the spleen of an infant during childbirth. Code 867.9 is also incorrect because it is used for an injury to an unspecified pelvic organ. Furthermore, code 289.59 is incorrect because it is used for a disease of the spleen, such as a splenic cyst or splenitis.

Question 12

Mr. 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 13

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 14

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 15

The external ear contains the:
A)Auricle and Auditory Canal, leading up to the Tympanic Membrane
B)Incus, Stapes, and Malleus
C)Cochlea, Semicircular Canals, and Eustachian Tube
D)Branches of the Vestibulocochlear Nerve and Tympanic Membrane

Accepted Answer

The external ear contains the auricle and external auditory canal, which leads up to the tympanic membrane. The tympanic membrane separates the outer ear canal from the middle and inner ear. The middle ear includes the incus, stapes, and malleus. The inner ear contains the cochlea, semicircular canals and Eustachian tube. This is where sounds waves are converted into nerve impulses, which are read by the brain.

Question 16

The HCPCS manual includes codes for:
A)Procedures that are also found in the CPT coding manual
B)Supplies, services, and procedures that are not found in the CPT manual
C)Only supplies that you cannot find in the CPT manual
D)All services performed in the office, except for procedures

Accepted Answer

The HCPCS manual includes codes for supplies, services, and procedures that are not found in the CPT manual. Although some procedures found in the HCPCS manual are also found in the CPT manual, the most appropriate answer is B because HCPCS codes also include supplies and services not found in the CPT manual.

Question 17

There are four different classifications of a vulvectomy (the removal of the vulva). What classification should be used for a vulvectomy with the removal of skin and deep subcutaneous tissues?
A)Simple Vulvectomy
B)Radical Vulvectomy
C)Partial Vulvectomy
D)Complete Vulvectomy

Accepted Answer

The classification that should be used for a vulvectomy with the removal of skin and deep subcutaneous tissues is a radical vulvectomy. A simple vulvectomy is the removal of skin and superficial subcutaneous tissue not deep subcutaneous tissues. A partial vulvectomy is the removal of less than 80% of the vulvar area, and a complete vulvectomy is the removal of more than 80% of the vulvar area.

Question 18

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 19

When listing both CPT and HCPCS modifiers on a claim, you:
A)List the HCPCS modifier first
B)Do not list the HCPCS modifier at all
C)Only list the CPT modifier
D)List the CPT modifier first

Accepted Answer

When listing both CPT and HCPCS modifiers on a claim, you list the CPT modifier first. When you report a procedure code with more than one modifier, you must list the modifier that will affect the payment first on the claim. Typically, CPT modifiers will affect the payment of a claim, but HCPCS modifiers may not.

Question 20

When you are searching for a diagnosis code in the ICD-9 manual:
A)You must first locate the diagnosis code description in the index and then verify the correct code selection in the tabular list
B)You must locate the diagnosis code in the index and then assign the appropriate code
C)You must determine which procedure you will bill for first, and then find out which diagnosis codes match the procedure
D)You must first locate the diagnosis code description in the index and then verify the code in Volume III

Accepted Answer

When you are searching for a diagnosis code in the ICD-9 manual, you must first locate the diagnosis code description in the index and then verify the correct code selection in the tabular list. It is an incorrect coding practice to code directly from the index. Once you locate your code in the index, it is important to verify the code in the tabular list to make sure it is the correct code.

Quiz 1: Free Coding Specialist

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?

Debbie has Type II diabetes, and has been working with her physician to develop diet and exercise techniques that help control her symptoms. Today her doctor also put her on a new medication, which may help control her blood sugar levels better. What is the correct ICD-9 code for Debbie's diabetes?

A physician performed the open excision of two deep axillary nodes in a 45-year-old female patient. What is the correct code for this procedure?

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

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 pediatrician performed a routine circumcision on a newborn baby boy in a hospital setting. The physician anesthetized the area with dorsal penile block, clamped the foreskin away from the tip of the penis and excised the excess foreskin. What is the correct code for the circumcision?

A 30-year-old woman with high-risk pregnancy suffered a splenic rupture due to a car accident. What is the correct ICD-9-CM diagnosis code for the mother's injury?

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

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

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?

The external ear contains the:

The HCPCS manual includes codes for:

There are four different classifications of a vulvectomy (the removal of the vulva) . What classification should be used for a vulvectomy with the removal of skin and deep subcutaneous tissues?

The HCPCS Level II modifier -E1 stands for:

When listing both CPT and HCPCS modifiers on a claim, you:

When you are searching for a diagnosis code in the ICD-9 manual: