cpc 2010 answers - Coding Certification Tips

AAPC - CPC Coding Exam 2010: The Certification Step
Final Examination-Answers
Question:1 C
The physician is taking a split-thickness skin autograft from the thigh and grafting it to the
patient’s left leg, which needs repair. In the CPT® manual look up Split/Grafts, you are referred
to 15100-15101, 15120-15121. Code 15100 is the correct code since there was less than 100 sq
cm taken from the leg (thigh). The second procedure 15002 is coded since the patient had a
hypertrophic scar on the leg and the physician is preparing the recipient’s site by excising the
scar, which left a 90 sq cm defect, to provide healthy blood vessels onto which the skin graft will
be placed.
Question:2 C
First list all lacerations by anatomical sites and/or type of wound closure. The only site that has a
layered closure is the chin of 4 cm, which is coded 12052. (Forehead) 8.6 cm + (RT and LT cheek)
9.5 cm= 18.1 cm, which is coded 13132, 13133 x 3 (13132 for the first 7.5 cm and 13133 x 3 for
the additional 10.6 cm) . The last site is the chest at 12.5 cm, which is coded 13101, 13102.
Question: 3 B
Keywords in this scenario is “actinic keratoses,” of which there are five. Code 17000 is the
correct code since the code description gives an example of what a “premalignant lesion” is in
parentheses and for the first lesion being destroyed. Code 17003 is reported for each of the four
remaining actinic keratoses lesions. Code 17110 is the correct code for the last procedure, since
it covers the destruction of the three benign lesions.
Question: 4 A
27096 is the correct code since a steroid injection (Celestone and Marcaine) is placed into the
sacroiliac (SI) joint. Code 77003 is coded since there is a parenthetical note under the code
descriptive that states: (For fluoroscopic guidance without formal arthrography, use 77003).
Modifier 26 is appended to the radiology code for the professional component, physician not
owning the equipment.
Question: 5 C
There is a diagnosis of a closed fracture of the lateral condyle. The fracture is closed since the
scenario does not mention a piece of bone has broken through the skin and is exposed. In the
ICD-9-CM manual, look up Fracture/humerus/condyle(s)/lateral (external). You are referred to
code 812.42. You have eliminated multiple choice answers A and D. The next step is to figure
out if the fracture care is opened or closed treatment. A hint is that the surgeon made “an
incision” to get to fracture site. Code 24579 is the correct code since this was an open treatment
due to the surgeon making an incision to get to fracture site along with performing an internal
fixation (two pins). Also ORIF means Open Reduction and Internal Fixation which is also an
indication an open approach is used to perform the surgery.
Q:6 C
The keyword in this op note is “disectomy,” which in this scenario is a removal of the herniated
disk in the cervical spine (neck). Eliminating multiple choice B. There is no documentation of the
vertebrae being fused together (arthrodesis), eliminating Multiple choice D. The scenario
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documents end plates were decorticated to insert an artificial disk (Kineflex-C device) to replace
the cervical disk that was removed, guiding you to code 22856.
Q: 7 D
Defibrillator is the first hint in finding this procedure code. The only codes that have
“defibrillator” in their code description are 33240 and 33249. Code 33249 is the correct code
since electrical leads were inserted for a dual chamber pacemaker defibrillator in connecting it
to a generator. Code 71090 is coded to report the fluoroscopic guidance to place the leads.
Since this procedure was performed in an outpatient hospital lab, modifier 26 is appended to
report the professional component.
Q: 8 D
For this procedure the thoracic surgeon is performing a thoracostomy, which is the puncturing
of the chest between the ribs to remove fluid and/or air from the chest cavity. This eliminates
the codes that have thoracentesis, which a needle is used to puncture the chest. The final clue is
“tube” thoracostomy which leads to the code 32551.
Q: 9 B
A surgical endoscopy is being performed since there is a removal of tissue from the sphenoid
sinus. No biopsies were performed or just a look-see (diagnostic endoscopy) for that area of the
sinus.
Q: 10 A
A sigmoidoscopy is performed for a diagnostic colorectal cancer screening since the patient has
a history of colon cancer. During the procedure the removal of three polyps are done by hot
biopsy forceps. The correct procedure is 45333. Since the patient has a history of colon cancer,
the V10.05 is coded. This is indexed in you ICD-9-CM manual, History/malignant neoplasm
(of)/colon. Code 211.3 is coded since polyps were found. According to ICD-9-CM guidelines,
when the patient is coming in for a screening exam only and a condition is discovered during the
screening then the code for the condition is assigned as an additional diagnosis. So for this
procedure, the polyps were discovered during the screening, not before, and can only be
assigned as an additional diagnosis.
Q: 11 B
The removal of the gallbladder (cholecystecomy) was begun as a laparoscopic procedure. During
the procedure, the surgeon decides that additional exposure is needed to complete the
procedure. The procedure is converted to an open approach. When a laparoscopic approach is
converted to an open approach, you code for the approach used to complete the surgery. You
cannot code for both. Modifier 22 is appropriate for the additional work involved in the case.
47001 is coded to report the needle liver biopsy that was performed during this open
procedure.
Q: 12 B
Hemorrhoids were removed by rubber band ligation, eliminating C and D. There were two
different scopes used to indentify the internal hemorrhoids. Only code 45300
(Proctosigmoidoscopy) will be billed. 46600 (Anoscopy) is a “separate procedure,” meaning this
is only coded when it is not an integral part of the another procedure performed at the same
time. For this procedure, the doctor is removing the hemorrhoids while performing the
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anoscopy, making the anoscopy an integral component (included) in the procedure code for
removal of the hemorrhoids. The 51 modifier is appended to the second procedure code since
there was an additional procedure performed in the surgery.
Q: 13 B
According to CPT® guidelines, when twins are delivered, the global code (prenatal, delivery and
post partum) is only reported once. When one twin is delivered via c-section select 59510 for
the global procedure and the vaginal delivery only (54909) for the second twin. Modifier 51 is
appended to indicate multiple procedures are performed. To code for the twin delivery in the
ICD-9-CM manual, look up Delivery/twins, you are referred to 651.0X, the fifth digit being 1
indicating a delivery. The second diagnosis is coded due to the second twin being in a transverse
lie, the reason for the cesarean. This is indexed under Delivery/ complicated /
transverse/presentation or lie, referring to 652.3X, the fifth digit being a 1.
Q: 14 B
The removal of cyst from the ovary is coded 58925. The RT modifier is appended to indicate to
the payer the ovarian cystectomy was performed on the right side. The removal of the salpingooophorectomy is coded 58720. Modifiers 51 and LT are appended to this procedure code since
the removal of the ovary and fallopian tube was done on the left side and it was an additional
procedure performed during the surgery.
Q: 15 A
Since this a 35-year-old patient getting a circumcision, that eliminates code 54160, which is for a
neonate (28 days of age or less). The patient is having the circumcision performed using a clamp
with regional block. Modifier 52 is not appended to 54150 since there is no indication in the
encounter of the physician reducing the services provided. The procedure is performed as it is
described by the CPT® code.
Q: 16 C
55700 is the correct code since only needle biopsies were performed, without mapping the
prostate under a template guide through a transperineal route. There are parenthetical notes
under code 55700, which one states: (If imaging guidance is performed, use 76942). Since
ultrasonic guidance (imaging guidance) was used, you would need to code 76942. Appending
modifier 26 indicates the professional component; the procedure was done in an outpatient
surgical center where the physician does not own equipment.
Q: 17 B
This procedure is being performed in the lumbar which eliminates “C” for the cervical or
thoracic. 62311 is the correct procedure code since the patient is getting the meds injected by a
syringe not a continuous infusion by a catheter. 77003 is coded since fluoroscopic guidance was
used to place the needle for the therapeutic injection. Modifier 26 is appended for the
professional component, physician not owning the equipment.
Q: 18 B
The key word in this scenario is “ectropion”, which eliminates D for one who has entropion. One
of the eyelids had an excision of the tarsal wedge coded with 67916 and modifier E4 is
appended to indicate the procedure was performed on the right lower lid. The other eyelid had
a suture repair coded with 67914 and modifier E2 is appended to indicate the repair was done
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on the left lower lid. A different procedure was performed on each eyelid. Modifier 50 would
not be appended to the codes since both lids did not have the same procedure performed.
Q: 19 B
The key word in this encounter is “injection” which eliminates the spinal puncture procedure
codes. 62273 is the correct code for the patient’s blood is injected to plug the wound that is
causing the CSF leak (blood patch). This is the only code to bill for this visit, since the lumbar
puncture was performed three days ago.
Question:20. B
Code 67145 is the correct procedure code since the patient had a retinal tear (retinal break) and
the physician uses a laser light (photocoagulation) to seal the retina back into place. Code 92004
is coded to report the evaluation of the complete visual field. The patient is new patient. An
evaluation of the eye was performed in addition to performing the procedure. Modifier 25 is
appended to the evaluation code.
Q: 21 D
According to CPT® guidelines: Final hospital care for discharge of a patient includes final
examination of the patient, discussion of the hospital stay, instructions for continuing care, and
preparation of discharge records.(Final day of a multiple day stay) This code includes all the E/M
services provided on the day of discharge. No other E/M code is reported with discharge codes.
The patient for this encounter was admitted on one date of service and got discharged a few
days after.
Q: 22 B
The patient was not referred by another physician for a second opinion for his sleep apnea, so
this is not a consultation visit. The patient decided to go on his own to get the opinion from
another doctor. According to CPT® guidelines: If a "consultation" is requested by a patient
and/or family and not requested by a physician (self-referral), an office visit code may be used
to report this service The doctor is seeing the patient for the first time, making him a new
patient. In the CPT® index, look up Evaluation and Management/Office or Outpatient. You are
referred to 99201-99215. Review the codes to choose the appropriate level of service. 99204 is
the correct code. Comprehensive History (Extended HPI, Complete ROS, and Complete PFSH) +
Comprehensive Exam + Moderate MDM (New patient to examiner; 1 data point; moderate risk)
= 99204.
Q: 23 D
For this encounter the established patient is coming into a doctor’s office to get an evaluation
before he goes in for surgery. In the CPT® book, look up Evaluation and Management/Office and
Other Outpatient. You are referred to 99201-99215. Review codes to choose the appropriate
level of service. Two out of three key components are required. The provider performs a
detailed exam and moderate MDM. 99214 is the correct code. After the evaluation the patient
needs the physician to address questions and concerns he has regarding the liver transplant
surgery. According to CPT® guidelines: 99354-99355 are used to report the total duration of
face-to-face time spent by a physician beyond the usual service in either the inpatient or
outpatient setting. The prolonged service includes the time he spent in face-to-face contact with
the patient when he was not performing the history, physical examination, and medical decision
making related to the level of E/M service he reported. In the CPT® index, look up Prolonged
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Services. You are referred 99354-99357, 99360. 99354 is the correct code since 30 minutes was
spent face-to-face.
Q: 24 B
There is no indication that one lung ventilation is used. The correct anesthesia code for this
procedure is 00540. The anesthesiologist reports the anesthesia with modifier QK to identify
medical direction. The CRNA uses modifier QX to indicate it is a medically directed service.
Q: 25 C
The block is reported because it is done for postoperative pain management and not the mode
of anesthesia. The block is reported with 64417. The procedure is reported with 64721, which
crosswalks to 01810. In the CPT® manual look up anesthesia/wrist. The anesthesia is reported
with 01810. Modifier 59 is appended because these services are bundled.
Q: 26 D
From the CPT® index, look up anesthesia/thyroid. You are referred to 00320-00322. The
procedure performed is a thyroid needle biopsy, which is reported with 00322. Anesthesia time
starts when the anesthesiology provider begins to prepare the patient and ends when they are
no longer in personal attendance. In this case the anesthesia time starts at 0900 and ends at
1000 which is one hour.
Q: 27 B
The key words for this encounter are “dual energy”, which eliminates C and D. 77081 is the
correct code since an example is given in parentheses what an “appendicular skeleton” is. The
foot is in the same category as the wrist or heel which is considered peripheral bones.
Q: 28 D
When a selective catheter placement is performed, it includes the procedure to gain access. In
this case the femoral access is to the aorta. From the aorta the physician selectively catheterizes
the right renal artery which is considered a first order branch from the aorta reported with
36245. 36200 is included with 36245 and cannot be coded separately. Refer to Appendix L in the
CPT® manual. The renal artery is considered a first order branch. Two imaging services are
performed. The aortography (75625) is bundled with the renal angiography (75722). Only the
renal angiography is reported. Modifier 26 is appended to report the professional component
was performed by the physician for the radiology services.
Question: 29 A
The patient receives seven radiation treatments, which is reported with 77427. In the coding
guidelines for this section it states, “ Code 77427 is also reported if there are three or four
fractions beyond a multiple of five at the end of a course of treatment; one or two fractions
beyond a multiple of five at the end of a course of treatment are not reported separately.”
Q: 30 B
The encounter mentions that a specimen was removed from the proximal jejunum, which is part
of the small intestines, during a resection for cancer. Code 88309 is the only lab code that covers
the small intestine resection of a tumor.
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Q: 31 C
The first three labs (HDL -87318, total serum, cholesterol-82465 and triglycerides-84478) are
part of the lipid panel for code 80061. That leaves the lab, quantitative glucose, to be added
with code 82947.
Q: 32 A
This is a therapeutic drug test, since the patient is taking gold for rheumatoid arthritis, and this
type of drug test is found between codes 80150 – 80299. 80172 is the correct code since the
physician wants to measure the level of gold found in the blood stream.
Q: 33 B
Although the patient is scheduled for chemotherapy, only hydration therapy is performed.
Hydration therapy codes are selected based on time. The total time for this procedure is one
hour and 10 minutes. There is a parenthetical note following code 96361 which states “Report
96361 for infusion intervals greater than 30 minutes beyond one hour increments. Because
there are only 10 additional minutes beyond the first hour, only 96360 is reported.
Q: 34 A
Injection, catheterization, angiography and supervision and interpretation are included in 93458
itself. It is not necessary to code separately.
Q: 35 C
OMT stands for “osteopathic manipulative treatment”. This was performed on three body
regions (cervical, thoracic and sacral) which leads you to code 98926.
Q: 36 D
The key to this encounter is time and monitoring of the cerebral seizures. 95950 is the correct
code since it covers an eight channel EEG (electroencephalogrpahy) to measure and record the
brain’s electrical activity, monitoring a 24-hour period evaluating her cerebral seizure.
Q: 37 C
Orchitis is marked by painful swelling of the testis. It may occur without cause, or be the result
of infection. The Greek root orchis means testicle, and –itis is a suffix indicating inflammation or
infection.
Q: 38 C
Debridement is the removal of foreign materials and dead tissue from a wound so that clean,
vital tissue is all that remains. Debridement can be surgical, with dissection of nonvital tissue, or
it can be a manual process.
Q: 39 C
Meconium is fetal stool, composed of materials ingested in utero. It is odorless and tarlike.
Meconium is usually expelled in a neonate’s first bowel movements, but during stress before or
during birth, may be expelled into the amniotic fluid. It can be inhaled into the fetal lung and
cause pneumonia at birth. Meconium staining refers to discoloration of the amniotic fluid, or of
the neonate (for example, meconium staining of fingernails).
Q: 40 A
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Both the heart and the nose have a septum, defined as a wall dividing two chambers. The nasal
septum separates the two nostrils. A septum also divides the right and left atriums and right and
left ventricles of the heart.
Q: 41 A
Lordosis is a spinal deformity in which the anterior curvature of the lumbar spine is excessive. It
is also called a “sway back.” Lordosis may be caused by tight lower back muscles, obesity, or
pregnancy. It can lead to lower back pain. The answer to this question is easily found by looking
in the ICD-9-CM Index.
Q: 42 B
Congenital herpes is a bit tricky in the index. It isn’t listed under Herpes/herpetic. Instead, look
under Infection/herpes/congenital to be directed to 771.2. By the process of elimination, the
other codes are inappropriate: 054.9 and 054.0 are unacceptable based on an exclusion note at
the beginning of category 054. Code 646.92 is incorrect because it is a maternal code, not a code
for an infant, and because a fifth-digit 2 is not acceptable with 646.9x, based on the bracketed
information presented under the code in the tabular section.
Q: 43 C
Congestive heart failure has many codes, but without more information, we must choose 428.0
(Failure/heart/congestive). The heart failure is an adverse effect of the drug trastuzumab, an
antineoplastic antibiotic agent. The adverse affect in therapeutic use is reported with E930.7 (in
therapeutic use), according to the table of drugs and chemicals. Finally, report the breast
cancer, as suspension of therapy for the breast cancer will need to be addressed at some point
in this patient’s plan of care. We don’t have enough information on the breast cancer to report
anything but 174.9. Because the patient is still being treated with trastumumab and the
physician notes that treatment is being discontinued for contraindications, she is still considered
to have active cancer, and a history code would be inappropriate. Note that separate codes exist
for antineoplastic drugs vs antineoplastic antibiotics. Answers B and D mix up the two types of
drugs and are therefore in error. Only answer C captures the clinical situation correctly.
Q: 44 B
Always pause to consider the meaning of “history” when you see it in a note. Physician
documentation does not always dovetail with the language of ICD-9-CM. History is a good
example of this. A physician may document that the patient has a history of a disease, and this
usually will mean that the disease has been eradicated. But it may mean that the disease is not a
diagnosis new at this encounter, but something ongoing in the patient’s care. It may also mean
that this is a problem that the patient has had and resolved in the past, and that it has recurred.
In the case of “history of symptomatic HIV,” we all know this is not a disease that resolves. Once
a patient has symptomatic HIV, the patient whether they have symptoms at the time of the
service or not, the diagnosis is coded as 042. According to the Official Guidelines, once a patient
with HIV develops symptoms or an opportunistic disease, report code 042.
Q: 45 C
Codes from V27 are reserved for the mother’s chart, so we can automatically eliminate A and D
as options. Guidelines tell us that a code from 765.2 should be assigned in addition to a code
from 764, and this code was omitted from B. Further, B listed as a diagnosis 763.4, indicating the
patient was adversely affected by the C-section, and no adverse affects were documented.
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Q: 46 B
When a patient is covered by Medicare, HCPCS Level II codes are reported over CPT® codes with
the same description. Since two different procedures were performed in two different
compartments of the knee, 29881 is reported for the meniscectomy and G0289 is reported for
the removal of loose bodies.
Q: 47 D
In the Official ICD-9-CM Coding Guidelines, there is a listed of V codes that can be reported as a
first listed diagnosis code. The current version of the guidelines is available at
http://djk9qtinkh46n.cloudfront.net/ppdf/icdguide091.pdf
Q: 48 B
The description for code 61535 is indented which means the description from 61533 up to the
semicolon is the beginning of the full description for 61535.
Q: 49 D
Place of service codes are reported on the claim form to identify the site of the service provided.
In this case, the services are rendered in the emergency department which is reported with POS
23. The place of service codes can be found on in the CPT® manual.
Q: 50 B
Answer b is the only example of unbundling of CPT® which would result is a fraudulent claim.
According to NCCI (National Correct Coding Initiative) and CPT® coding guidelines, a biopsy
performed on the same lesion as an excision during the same encounter is an incidental service
and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is
billable. X-rays performed in a physician’s office does not require modifier 26. Since the
physician owns the equipment and performs the interpretation, he bills the global service.
Modifier 57 is appended to the EM service the day prior or day of a major surgery, not a minor
surgery.
Q: 51 C
To first tackle this scenario, you need to find out what type of graft was used on this patient. It
was a porcine graft, which is a type of xenograft, so multiple choice A is eliminated. There are
two ways to start eliminating choices to get to the correct answer. One way is to look at the
remaining choices, B, C, and D. The only one out of those three choices that has an extra code is
C, code 15040 (Harvest of skin for tissue skin autograft, 100 sq cm or less). This was performed
when a split thickness skin graft was harvested using dermatome (skin harvesting) from a
separate donor site (autograft). The other way is to add the group body areas together with
their total sq cm. The first group to add is: Face, scalp, neck 500 cm + hands & feet 300 cm = 800
cm coded, 15420, 15421 x7. Your next group is the trunk 950 cm + arms & legs 725 = 1675 cm
coded, 15400, 15401 x 16. Those took care of the xenograft codes. The next set of codes deal
with the excision of the burn eschar to provide healthy skin onto which the skin graft will be
placed. You would use the same sq cm totals that are grouped in the same body areas that you
used for the xenograft codes. Face, scalp, neck, hand, and feet are coded 15004, 15005 x 7.
Trunk, legs and arms are coded 15002, 15003 x 16.
Q: 52 A
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One way to get to the correct answer is by the diagnosis. This patient is having the procedure
performed due to a breast mass. The only two choices that have the ICD-9-CM code for breast
mass are A and B. The diagnosis is indexed in the ICD-9-CM manual under Mass/breast. Now to
find the procedure code, your key term is “excision” of the mass, which leads you to codes
19120 and 19125. 19120 is the correct answer since radiological markers were not used to
identify the breast tissue that needed to be excised. Neither a biopsy of the breast was
performed (19101) nor was a malignant tumor with part of the breast removed (19301).
Q: 53 B
This procedure is being performed on a sacral decubitus ulcer or pressure ulcer, which
eliminates multiple choice answer A. Code 15937 was performed due to the ulcer being
removed by debridement along with the removal of part of the coccyx (ostectomy) to prepare
for the split-thickness skin graft closure. Code 15100 is coded since the split-thickness graft is
being used to repair the defect left from removing the ulcer and coccyx (25 sq cm).
Q: 54 B
The key term is “long leg walking cast,” which is found in the code description of procedure code
29355. Code 29345 does have long leg cast in its description, but it does not include a walker
type of a long leg cast. This patient did not have a fracture, eliminating choice C; neither did the
patient have a long leg cast brace, eliminating choice A. The diagnosis is indexed in the ICD-9-CM
manual under Sprain/knee.
Q: 55 D
Trigger point is your key term in this scenario, eliminating choice B. Trigger points are coded by
the number of muscles that the injections are performed on, not by the number of trigger point
injections. The scenario tells you that six trigger points were injected into four muscle groups
which lead you to the procedure code 20553.
Q: 56 B
One way to start finding the correct answer is to look up the diagnosis in the ICD-9-CM manual.
It is indexed under Fracture/femur/shaft/open which refers you to code 821.11, eliminating
codes C and D. The only difference between choices A and B are the second procedure codes.
Code 11012 is the correct code since extensive debridement was performed all the way to the
bone on an open fracture.
Q: 57 A
The multiple choice answers are between a rhinoplasty and septoplasty for which you will need
to know the difference. Rhinoplasties are performed on patients that are having cosmetic
surgery, restorative, or reconstruction on the nose. This patient is coming in to correct a
deviated septum, which falls under a septoplasty which is removing a portion of the deviated
septum and straightening the septum to correct airway obstruction. You eliminate multiple
choice answers B and D. C is incorrect since the patient is not coming in for a dermatoplasty,
which is surgical replacement of destroyed skin.
Q: 58 D
With these codes you need to know what type of catheter was inserted in this patient, which
was a PICC line. This eliminates multiple choice answers A, B, and C. The ultrasound guidance is
reported with 76942. Modifier 26 is appended to indicate the professional component was
performed.
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Q: 59 A
This is a direct laryngoscopy with “injection into vocal cords,” which eliminates multiple choice
codes B and D. You would not code 69990, Operating Microscope, since 31571 has operating
microscope already in its code descriptive.
Q: 60 C
This scenario is on a patient having a coronary artery bypass graft (CABG) involving three venous
grafts, which eliminates multiple choice answer A. Code 33508 is an add-on code, which does
not need a modifier 51 appended to the procedure, eliminating multiple choice answer D. 33254
is the correct code since a modified maze was performed on the patient.
Q: 61 D
43257 is the correct procedure for the Upper GI Endoscopy delivering thermal energy,
eliminating multiple choice answer B. Modifier 73 and 74 are reported for the facility codes
which eliminates answers A and C. The correct modifier for the physician’s service is 53. For the
diagnosis codes GERD is indexed in the ICD-9-CM manual under Reflux/Gastroesophageal, you
are referred to code 530.81. 458.29 is indexed under Hypotension/postoperative. V64.1 is
reported to indicate the surgery was not carried out.
Q: 62 A
This colonoscopy involved polyps being removed by hot biopsy forceps which leads to code
45384. This is only coded once regardless of the number of polyps that was removed with this
one technique.
Q: 63 D
You first need to look at the approach of the surgery, which is the physician incising the chest
(thoracotomy) to expose the esophagus, eliminating multiple choice answer C. The physician is
not removing a lesion from the esophagus; the physician is removing the esophagus
(esophagectomy) and replacing it with the stomach, eliminating multiple choice answer A. The
next key term to help you choose between procedure code 43112 and 43117 is “cervical”.
43112 is the correct code since the stomach is pulled through the middle of the chest into the
neck and the stomach is connected to the stump of the esophagus in the neck (cervical).
Q: 64 B
Radiological guidance was used for this procedure; there are parenthetical notes that inform
you for each of these ECRP procedure codes to use 74328 or 74329 for radiological supervision
and interpretation, eliminating multiple choice answer C. Since the surgery is being performed in
an outpatient hospital, the physician does not own the equipment so modifier 26 needs to be
appended to radiology code eliminating multiple choice answer D. 43264 is the correct code
since there was a removal of a calculus (stone) from the common bile duct.
Q: 65 B
One way to get to the correct answer is to code for the diagnosis first. The procedure is being
performed due to the patient having vaginal lesions. In the ICD-9-CM index, look up
Lesion(s)/vagina. You eliminate multiple choice answers C and D. 57065 is the correct code since
the scenario states that the laser surgery was used to destroy “extensive” number of vaginal
lesions.
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Q: 66 B
The physician performs a cervical cerclage. We know the patient is pregnant so 57700 is an
incorrect code. We know the approach for this procedure is vaginally because the scenario
states that a speculum is used to access the vagina to view the cervix. From the index look up
cerclage/vaginal. You are referred to 59320. The patient is diagnosed with an incompetent
cervix. In the ICD-9-CM index, look up incompetent/cervix/in pregnancy. The patient is pregnant
so the fifth digit is “3”.
Q: 67 C
52000 is a separate procedure, which indicates that only a cystourethroscopy is performed for
diagnostic (examination) purposes only with no other procedure being performed at this time.
For this scenario a surgical procedure was performed with the cystourethroscopy, eliminating
multiple choice answers A and B. 52204 is not coded because biopsies were not taken from the
bladder, leaving multiple choice answer C as the correct choice since a 7 cm bladder tumor was
removed with fulguration.
Q: 68 A
The keywords for narrowing your search to the correct code is “carpal tunnel” and “median
nerve,” which is found in the code descriptive of 64721. RT is appended to indicate the surgery
is performed on the right side.
Q: 69 C
There was an anesthetic agent injected in the “cervical plexus,” eliminating codes A and B.
Although three injections are performed, only one nerve is involved. It is inappropriate to report
multiple units unless the procedure is performed bilaterally, which in this case it is not.
Q: 70 D
A tympanostomy was performed eliminating multiple choice answers A and B. The patient was
under general anesthesia which leads you to procedure code 69436.
Q: 71 A
The patient is in the hospital for 3 days being seen by the physician for subsequent hospital care.
In the CPT® index, look up Hospital Services/Inpatient Services/Subsequent Hospital Care. You
are referred to 99231-99233. Review codes to choose appropriate level of service. 99231 is the
correct code. Two out of three key components are needed for subsequent hospital care codes.
The physician documented a problem focused exam (1 system) + Low MDM (Established
problem to examiner; stable, 2 data points, low level of risk) =99231.
Q: 72 C
The E/M service is at the request of the ED physician to render an opinion on whether the
patient needs surgery. A written report of the findings is documented in the ED chart. According
to CPT® coding guidelines, the requirements for a consultation have been met. The service is
provided in the ED, which is an outpatient setting. The plastic surgery performs a detailed
history (extended HPI, extended ROS and pertinent PFSH), a detailed exam (extended 4 body
area/organ system exam) and moderate MDM (New problem to examiner no additional workup
planned and need for major surgery). For an outpatient consultation three of the three key
components are required. 99243 is the appropriate code. During this encounter, the physician
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made the decision to perform a major surgery, which is scheduled for the next day. Modifier 57
is appended to the E/M service.
Q: 73 D
During this encounter, the physician performs resuscitation, endotracheal intubation, and
inserts an umbilical line. According to CPT® coding guidelines, “procedures that are performed
as a necessary part of the resuscitation are reported separately in addition to 99465”. Code
99464 cannot be reported with 99465. The critically ill neonate is admitted to critical care.
According to CPT® coding guidelines, 99468 can be reported with 99465. The guidelines also
state “other procedures performed as a necessary part of the resuscitation are also reported
separately when performed as part of the pre-admission delivery room care". In this scenario
the intubation (31500) and the umbilical line (36510) were performed pre-admission for
resuscitation so they are both reported. Modifier 59 is required because both services are
bundled with 99468 when performed during after admission. Modifier 25 is reported to indicate
a separate and significant E/M service.
Q: 74 D
The patient received a neuraxial epidural for labor for a planned vaginal delivery, which is
reported with 01967. During the course of labor the patient requires a caesarean section. The
patient begins to hemorrhage requiring a hysterectomy. The add-on code 01969 is used to
report the anesthesia for the caesarean and hysterectomy.
Q: 75 C
From the index, look up anesthesia/ heart/ coronary artery bypass/grafting. You are referred to
00566 and 00567. In the scenario it states that cardiopulmonary bypass is used, which indicates
that the code that includes pump oxygenator is the correct answer. The patient has COPD,
which is a severe systemic disease, but there is no indication that is a threat to the patient’s life.
Append physical status indicator P3.
Q: 76 C
Anesthesia is performed for cleft lip repair. From the index, look up anesthesia/cleft lip repair.
You are referred to 00102. Refer to the code description to verify accuracy. The patient is
healthy, which means P1 is the correct physical status modifier. 99100 is reported because the
patient is under one year of age and the patient’s age is not included in the CPT® code for the
anesthesia service.
Q: 77 C
Codes for MRI are determined by anatomical site and whether contrast is used. In this case, the
MRI is of the lumbar spine. From the index, look up magnetic resonance imaging/spine/lumbar.
You are referred to 72148-72158. Option A is an X-ray so it is not the correct answer. 72148 is
without contrast, which is the correct code. According to ICD-9-CM Official Coding Guidelines,
do not report signs and symptoms of a definitive diagnosis. In this case the patient complains of
lower back pain and leg pain. He is diagnosed with lumbar spinal stenosis. The symptoms he
presents with are symptoms associated with his diagnosis and should not be reported. From the
index, look up stenosis/spinal/lumbar. You are referred to 724.02. Verify the code accuracy in
the tabular section.
Q: 78 D
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The patient presents for a ureteral catheter exchange via the ileal conduit. 50398 is not correct
because it is for a nephrostomy tube which is in the kidney. 50393 is performed using a
percutaneous approach, which is not used in this case. 50385 is performed using a transurethral
approach, which is not correct. The exchange is performed via the ileal conduit, which is
reported with 50688. Imaging is performed. There is a parenthetical note under 50688 that
states that imaging is reported with 75984.
Q: 79 D
In the beginning of the obstetric ultrasound subsection in CPT®, there are descriptions of what is
required for the OB ultrasound codes. In this case the ultrasound is limited because only two
elements are examined the fetal heart rate and fetal position. This type of ultrasound is
reported with 76815. In the code description it states “1 or more” which means the code is only
reported once whether it is a single fetus or multiple fetuses.
Q: 80 C
In this scenario, three CPK enzyme levels are performed. Modifier 91 is appended to the second,
and third CPK CPT® to indicate the services were repeat clinical diagnostic tests. Since each of
the CPK enzymes were elevated, the isoenzymes were also tested, which is reported with
82552. Modifier 91 is appended to the second and third test to indicate the tests are repeat
clinical diagnostic tests.
Q: 81 A
In the panel section of the laboratory tests, look up each of the codes to determine the tests are
included in the panel. 80061 is the only test that does not include chloride. 80050 includes a
comprehensive metabolic panel (80053) which includes chloride.
Q: 82 B
First the physician performs a UA dipstick with no indication of a microscopic test. This test is
reported with 81002. The urine culture is performed with identification for each isolate, which is
reported with 87088. 87086 is a quantitative test for a colony which is incorrect.
Q: 83 C
Unbundling is reporting components of a code separately that can be reported with one code. In
this case 80061 includes 83718 and 84478. It is unbundling to report components of a panel
separately.
Q: 84 C
The site of service indicates the code to select. The physician is overseeing the home ventilator
management care plan. There is one code for home ventilator care which is 94005. This code
requires a minimum of 30 minutes. This physician has performed 45 minutes of care.
Q: 85 D
We know this patient is established because she is seeing “her pediatrician.” The well check up
is coded as a preventive service. The patient is two-months-old. The proper code is 99391.
According to NCCI, modifier 25 is appended when a significant and separately identifiable E/M
service is performed with other services at the same encounter. In this case vaccinations are
performed. A vaccine administration for each is coded as well as the vaccine itself. In this case
three vaccines are performed; rotavirus (90680), combination vaccine DTap-Hib (90721) and
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Pneumococcal (90669). The physician counsels the patient’s mother regarding the vaccinations.
90465is reported for the initial vaccine and 90466 is reported for the second and third vaccine.
Q: 86 A
In this case the patient presents for allergen immune therapy for food allergies. The injections
are prepared and provided by the physician, which is reported with 95125 for two injections.
The therapy is not for an insect which makes 95131 and 95146 incorrect answers. 95117 does
not include the provision of the extract so it is also incorrect.
Q: 87 A
Angi- is a Greek combine form for “a vessel” and the suffix graphy refers to writing or a graph. In
angiography, an imaging technique is used to allow the visualization of the inside of blood
vessels. An opaque contrast agent is usually injected and X-ray performed so the veins and
arteries can be reviewed.
Q: 88 C
Meatus is a Latin word meaning passage, and describes any of numerous passages within the
body that have external openings: acoustic meatus (ear canal); urinary meatus (urethra); and
middle, inferior, or superior nasal meatus (nasal openings into the sinus).
Q: 89 D
The first three bones listed are all long bones. The calcaneus is a triangular shaped bone in the
foot – not a long bone. A long bone has a shaft and two heads, and they provide structure,
mobility and strength to the body. Long bones contain yellow bone marrow and red bone
marrow, whereas the calcaneus has a hard outer shell and a spongy bone center.
Q: 90 D
The esophagus lies between the trachea and the spine. The trachea carries air into the lungs and
the esophagus carries nutrients into the stomach. The esophagus of an adult is about 25 cm
long, and is lined with muscles that contract to push food into the stomach. Glands along the
lining of the esophagus produce mucus to facilitate the movement of food along its pathway.
Q: 91 C
This is a straightforward lookup from the index, under Tritanopia, and reports a form of color
blindness involving blue and yellow. What’s important to remember here is that congenital
conditions are not limited to the congenital chapter of ICD-9-CM, but appear throughout the
code set.
Q: 92 A
The reason for this encounter is pain management, pain in neoplastic disease (338.3) should be
the first listed diagnosis. The patient has metastatic cancer of the lung, which is reported with
197.0 as a secondary diagnosis.
Q: 93 B
The patient is being counseled regarding his obesity, which would be reported with 278.01 and
V85.41. The comorbidities of the patient, his bad knees, and diabetes contribute to the decision
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for surgery and should be included. There are no complications of diabetes noted, so 250.00 is
the correct code for his condition. The arthritis is a complication of his obesity, not his diabetes.
Q: 94 C
Keep in mind that codes describing symptoms and signs, as opposed to diagnoses, are
acceptable for reporting purposes when a diagnosis has not been confirmed by the physician.
Coders should select an ICD-9-CM code to describe the diagnosis, symptom, complaint,
condition, or problem, indicating why the service was performed if a final diagnosis is not
available. In this case, the angina was ruled out by the physician, so 413.9 is incorrect. The
costochondritis, 733.6, has not been confirmed. The guidelines tell us we cannot report “rule
out” or “probable” diagnoses in an outpatient setting. Therefore, all we can code is the
precordial pain, 786.51. Code 786.50 is unspecified, and since we know the pain is behind the
sternum, 786.51 is a better choice. See Pain/substernal, which takes us to 786.51.
Q: 95 B
Look up the description for each code. G0168 reports a wound closure using tissue adhesives.
Q: 96 C
In this scenario we are selecting a code to report the refill of insulin pump. J1815 reports insulin
but not for a pump. J1817 is insulin through a pump which is the correct code. J1817 reports 50
units. Two units are reported to account for 100 units of the insulin.
Q: 97 A
According to ICD-9-CM Official Coding Guidelines, when the patient has completed treatment
for cancer and there is not an existing malignancy, select a personal history of malignancy by
site. From the index, look up history/malignant neoplasm (of)/thyroid.
Q: 98 A
Critical care services can be provided at any site. If the patient is critically ill, the services
provided can be coded with critical care regardless of where the services take place. A minimum
of 30 minutes of critical care must be performed in order to report 99291. If less than 30
minutes, select the appropriate E/M code based on the three key components. Time spent
reviewing results and discussing the critically ill patient with medical staff is included in the
critical care time.
Q: 99 C
An ABN must include the service that may be denied, an estimated cost of the patient’s
responsibility if Medicare denies the service and the response for the potential denial. Generic
ABNs are not allowed. Signing of the ABN cannot be obtained during a medical emergency. The
patient must be stable. The ABN must be signed prior to providing the service.
Q: 100 B
Services performed by physicians are covered by Medicare Part B. Inpatient services are covered
by Part A. Medicare does not cover routine dental care.
Q: 101 D
To narrow down to the correct reconstruction code, your hint is “TRAM flap,” which is found in
the code description in 19367.
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Q: 102 B
This patient is coming in to have an in-grown toe nail removed, eliminating multiple choice
answer D (Evacuation of Subungual Hematoma), which is evacuating blood from under the nail.
You are now left with choices A, B, and C that involves the removal of an ingrown toenail. Code
11752 is not correct. The scenario does not mention an amputation. The clue to help you
narrow down between the codes 11765 and 11750 is that the lateral border of the nail was
incised and “excised in total”. Those words lead you to the code description in 11750.
Q: 103 A
You need to first find out if this lesion is benign or malignant. For this scenario the patient has a
basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C
and D as they deal with benign lesions. Now you need to find out where the lesion is located and
the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm =
.3 cm = 3.6 cm, leading you to code 11644. CPT® guidelines state: For excision of malignant
lesion(s) requiring intermediate or complex closures should be reported separately. For this
scenario the wound was closed in two layers qualifying the closure to be coded with an
intermediate repair of the chin (4 cm), 12052. The diagnosis, basal cell carcinoma of the chin, is
indexed in the ICD-9-CM manual in the Neoplasm Table, under Skin/chin/malignant (column),
referring you to code 173.3
Q: 104 D
For narrowing down to the correct procedure code for the Mohs micrographic surgery, you
should find out where on the body the tumor was removed. For this scenario, it is the neck;
eliminating multiple choice codes B and C, which involve the trunk, arms or legs. The tissue
block removals were performed in two stages, coding 17311 and 17312. Code 17315 is not
coded for this scenario, since the physician would have to remove more than five tissue blocks
in any stage. There were only four tissue blocks removed in the first stage and two tissue blocks
removed in the second stage, both falling short of six or more tissue blocks removed in either
stage.
Q: 105 A
This patient is having a mass removed from the shoulder area, eliminating multiple choices B,
which is biopsy and D, which is incision and drainage of an abscess. The size of the mass that
was excised was 4.5 cm, which leads you to code 23076.
Q: 106 A
This surgery is being performed by arthroscopy, eliminating multiple choice answer C, which is
an open procedure code without using any type of scope. Our next clue is that a “subacromial
decompression” was performed, which leads you to code 29826. The scenario does not mention
that the physician lyses and resects adhesions, eliminating multiple choice answers B and D.
29824 is performed when the physician opens the AC (acromioclavicular) joint to the
anterosuperior portal grounding of 10 mm of “distal clavicle” then totally grounding it out due
to a cyst.
Q: 107 B
One way to narrow down the choices is to code for the diagnosis first, which is a medial
meniscus tear of the left knee. In the ICD-9-CM index, look up Tear/meniscus/medial; you are
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referred to code 836.0. You eliminated choices C and D. 29881 (medial OR lateral) is the correct
procedure code, since the menisectomy (removing torn fragments) was performed on the
medial meniscus only.
Q: 108 A
The physician is repairing a nonunion tibia fracture (failure of two ends of a fracture to
completely heal). Next you need to find out what type of graft was used. Your hints are “bone
grafting” and “iliac crest,” which leads you to the code 27724, eliminating multiple choice codes
B and C. The bone graft was harvested from the iliac crest, and then the graft is placed at the
fracture site of the tibia compressing it for desired position and alignment and the screws were
used to stabilize the fracture. In the ICD-9-CM index, look up Fracture/nonunion referring you to
code 733.82. The late effect code is also appropriate in this case.
Q: 109 C
This three year old had a “tracheostomy” done due to acute respiratory distress. This eliminates
choices B and D where a bronchoscopy is performed. Then a laryngoscope was used to remove
the coin, coded 31530. To assign the ICD-9-CM code for the swallowed coin, in the index, look
up Foreign Body/trachea. Code 934.0 falls under the injury codes, which indicates that E codes
would need to be coded to provide the cause of injury and be used as an additional code for
more detailed analysis. In Section 3 of the alphabetic index (right after the Drug Table); look up
Foreign body/air passage/with asphyxia, obstruction, suffocation. You are referred to code
E912. The next E code is to show the place of occurrence of the injury. In Section 3, look up,
Accident/occurring (at) (in)/home (private) (residential), you are referred to E849.0. Verify all
codes in the tabular section for accuracy.
Q: 110 C
The key term to narrow down your choices is “diagnostic” maxillary sinusoscopy, which is found
in the code description of 31233.
Q: 111 B
To narrow down your choices, you can start with coding the diagnosis first. The patient is having
the procedure done due to a lung mass. A specimen was sent to pathology and came back
indicating that the lung mass is cancerous. In the ICD-9-CM index, look up in the Neoplasm Table
lung/malignant/primary column. You are referred to code 162.9, eliminating multiple choice
answers A and D. You would not code 31622 since this is a separate procedure. A diagnostic
procedure is not coded if performed at the same session as a surgical procedure in the same
area. A surgical procedure (biopsy) was performed with the bronchoscopy.
Q: 112 A
To start narrowing down your choices, you need to identify the type of hernia. The operative
note indicates that it is an inguinal hernia. Next does the op not mention if the hernia is
incarcerated or strangulated? No, so this eliminates multiple choice answers C and D. Code
49568 (Mesh) would not be coded. According to CPT® guidelines the mesh is only coded for
incisional hernia repairs. This statement is found in the subsection above the hernia repair
codes. In the ICD-9-CM index, look up, Hernia/inguinal referring you to 550.9X. Your fifth digit is
“0” since there is no indication in the op note that the hernia is recurrent or bilateral.
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Q: 113 D
One way to narrow down your choices is by looking up the diagnosis first. In the ICD-9-CM index,
look up Adenoiditis/with chronic tonsillitis, referring you to code 474.02. This eliminates
multiple choice answers A and C. The patient is having a tonsillectomy and an adenoidectomy,
which leads to code 42821.
Q: 114 B
Patient is having an Upper GI endoscopy, eliminating multiple choice answers C and D, which
report esophagoscopy. Your key terms to look for are “balloon dilation” which is in code
description 43249.
Q: 115 D
The hint to narrow down your choices is a D&C (dilation and curettage) for a blighted ovum. This
eliminates multiple choice answers A (there is no indication this was a hydatidiform molar
pregnancy) and B (there is no indication that this is a missed abortion). 58120 is not the correct
D&C, since this is an obstetrical (pregnancy) reason for the procedure. Blight ovum is indexed in
the ICD-9-CM under Mole/pregnancy.
Q: 116 A
This patient is having a stent removed, eliminating multiple choice answers B and D, which
should be used for insertion of a stent. You would not code 52000 since this is a separate
procedure, which means that this code is only billed for diagnostic or examination purposes
only, with no other procedures being performed at that time. A surgical procedure (removal of
the stent) was done at the same time of the cystoscopy. Code 74420 is coded for the use of a
retrograde ureterogram (urography). Modifier 26 is appended to report the professional
component was performed.
Q: 117 D
You can narrow down your choices by first coding the diagnosis. The patient had testicular
cancer; in the ICD-9-CM index go to the Neoplasm Table testis,testes/malignant/primary column
where you are referred to code 186.9. This eliminates codes A, B, and C. 54690 is the correct
procedure code since a laparoscopy was performed to remove the left testicle (orchiectomy).
Q: 118 C
The key terms for this scenario are “Corneal foreign body” removal with a “slit lamp”. This
procedure is reported with 65222. RT is appended to indicate the procedure is performed on the
right eye.
Q: 119 C
The patient is having a “thyroid lobectomy,” eliminating multiple choice answers A and D, which
is a thyroidectomy (removal of the thyroid). 60220 is the correct code since the scenario
indicates that a small thyroid lobe (total lobe) is dissected free; it does not indicate that part of
the lobe was removed.
Q: 120 D
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When coding for facet joint or facet joint nerve injections, you report each level that is injected.
In this case, the joints for L4-L5 and L5-S1 were injected. The codes for facet joint and facet joint
nerve injections are unilateral. The procedure was performed bilaterally at each level, therefore
modifier 50 should be reported. In the coding guidelines for facet joint injections, it states that
fluoroscopic guidance is included. This service should not be reported separately.
Q: 121 B
In the CPT® book, look up Evaluation and Management/Office or Outpatient. You are referred to
99201-99215. Review the codes to choose the appropriate level of service. 99204 is the correct
code. Patient is a “new patient” since this is an initial visit. Comprehensive HPI (Extended HPI,
Complete ROS, and Complete PFSH) + Comprehensive Exam (eight system exam) + Moderate
MDM (New problem to examiner with additional work up planned, 1 data point (radiology),
moderate level of risk (prescription) = 99204.
Q: 122 B
In this case, the ED physician performed an E/M service and moderate conscious sedation so the
orthopedic surgeon could provide fracture care. The services are performed in the ED setting,
which is reported with codes 99281-99285. This category requires three of three key
components for the E/M code. The physician performs a detailed history (extended HPI,
extended ROS and complete PFSH), detailed exam (extended six system exam), and moderate
MDM (New problem to the examiner, no additional workup planned, 1 data point, moderate
risk). The documentation supports a 99284. Modifier 25 is appended to the E/M service because
a significant and separately identifiable E/M service is performed during the same encounter as
a procedure which is the moderate conscious sedation. When coding for MCS, you need to
know the age of the patient, the amount of time and whether the physician providing MCS is the
same physician performing the diagnostic or therapeutic procedure for which the patient
requires MCS. In this case, the ED physician is providing the MCS. He is not performing the
fracture care service. The proper code is within range 99148-99150. This eliminates answer
options C and D. The patient is four-years-old and the MCS is provided for 30 minutes. The
correct code is 99148.
Q: 123 C
Dr. X is performing a follow-up consultation in a nursing facility. According to CPT® guidelines,
“Follow-up consultations that are performed in order to complete the initial consultation (eg,
certain tests results previously not available are now ready) provided in the nursing facility
setting, the subsequent nursing facility care codes (99307-99310) should be reported”. In the
CPT® book, look up Nursing Facility Services/Subsequent Care. You are referred to 99307-99310.
Review the codes to choose appropriate level of service. In this case the physician performed a
problem focused history, expanded problem focused exam (limited exam of two systems) and
low MDM (Established problem stable, 3 data points (labs, EKG, consult) and low risk). In this
category two of the three key components are required, 99308 is the correct code.
Q: 124 C
According to CPT® guidelines, “Critical care is the care of the unstable critically ill or unstable
critically injured patient who requires constant physician attendance (the physician need not be
constantly at bedside per se but is engaged in physician work directly related to the individual
patient's care). The critical care codes may be reported wherever critical care services are
provided. It is important to recognize that the critical care codes are reported based upon the
type of care rendered not the location of where the care is rendered. The critical care codes are
19
used to report the total duration of time spent by a physician providing constant attention to an
unstable critically ill or unstable critically injured patient even if the time spent by the physician
providing critical care services on that date is not continuous.” For this encounter the physician
was called to the floor to evaluate a critically ill patient. The keywords to look for are the
statement “total critical care time,” to indicate a critical care service. In the CPT® book, look up
Evaluation Management/Critical Care. You are referred to codes 99291-99292. Review codes to
choose appropriate level of service. The physician documents 48 minutes of critical care time
which is reported with 99291.
Q: 125 B
In this case MAC is performed, which requires modifier QS. This eliminates answer options A and
C. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was
performed. Because the service was provided by an anesthesiologist, modifier AA is appended
to the anesthesia code.
Q: 126 C
The patient receives anesthesia for a tracheostomy. From the CPT® index, look up
anesthesia/trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-old
which eliminates answer options A and B. There is a parenthetical note under code 00326 which
states “Do not report 00326 in conjunction with 99100”.
Q: 127 C
The type of biopsy performed is a percutaneous needle core biopsy, which is reported with
19102. 10022 is not correct because an aspiration of a cyst is not performed. 19101 is an
incisional biopsy, which is also not correct for this scenario. Modifier RT is appended to indicate
the procedure is performed on the right breast. There is a parenthetical note following 19102,
which states to report the imaging guidance performed. In this case, ultrasound guidance is
used, which is reported with 76942. Because the service is performed in the physician’s office,
modifier 26 is not appropriate.
Q: 128 C
Ultrasound codes are selected by anatomic site. The liver is an organ in the abdomen. Because
the ultrasound is performed on one organ, it is reported as limited. Please note in the
parentheses following code 76705 it states “one organ.” 76970 is not appropriate because this is
an initial ultrasound and not a follow-up.
Q: 129 A
From the CPT® index, look CT scan/heart/evaluation/for coronary calcium. You are referred to
75571. Verify the code description. Codes 75572 and 75574 are performed with contrast so
answer options B and C are not correct. 75557 is an MRI which is also incorrect.
Q: 130 B
The physician inserts the needle through the skin which indicates this is a percutaneous
approach and not an open procedure. Answer options A and C can be eliminated. Fluoroscopic
guidance was used, which is reported with 77002 for this type of procedure.
Q: 131 B
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The identification of ooctyes in the follicular fluid is performed. The stage in this scenario does
not include the culture or preparation of the oocyte, only the identification of them. This service
is reported with 89254.
Q: 132 B
The appropriate code is determined by the type of specimen. In this case the specimen is a bone
marrow biopsy. Under each code in this section of CPT® is a list of specimens for each code. For
this scenario, the correct answer is 88305 because it is specific for bone marrow. 88304 is
reported for bone fragments which is not correct. 88307 is reported for a bone biopsy. 88309 is
reported for bone resection.
Q: 133 A
The pathologist services are not reported with E/M codes, which eliminates answer option B.
80502 is clinical consultation requested by an attending physician for the pathologist medical
interpretive judgment, which is not described in this scenario. The service is not performed
during surgery, which eliminates D as a correct answer. The code description for 88325 matches
the scenario in the question making it the correct answer.
Q: 134 C
The photodynamic therapy is performed externally in this case which eliminates option A.
Photochemotherapy is not used, which eliminates option D. The code description for 96567
reports the services provided for this patient.
Q: 135 C
A nurse visit (99211) is not supported in this case. The patient presents for a scheduled
injection, which is the only service performed. Injections are coded by route. In this case, the
injection is given intramuscularly which is reported with 96372. The 1000 mcg of vitamin B12 is
reported with J3420. The substance injected is not a chemotherapy medication; 96401 is an
incorrect answer.
Q: 136 B
The services are provided in an inpatient setting which eliminates 90804. The physician
performs 30 minutes of psychotherapy, which is reported with 90816. A diagnostic interview is
not performed nor is psychoanalysis.
Q: 137 B
Percutaneous transluminal coronary angioplasty mechanically widens narrowed blood vessels in
the heart. The approach is transluminal, meaning a catheter is threaded through the skin and
into a blood vessel, then carried into the heart artery where it will make the repair. Narrowed
vessels in the heart can deprive cardiac tissue of the blood supply it needs to do its work
effectively.
Q: 138 D
Contra is derived from a Latin root meaning against, and lateral, from a Latin form meaning side.
Contralateral means occurring on the opposite side. The opposite of contralateral is ipsilateral,
meaning occurring on the same side.
Q: 139 A
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In ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically caused by
cirrhosis, malignancy, or heart failure. It is usually managed medically but may be treated with
paracentesis. Ascites is indexed in ICD-9-CM, and this answer could have been found by
reviewing the tabular entry, which notes, “Fluid in peritoneal cavity.”
Q: 140 D
Exotropia is an outward deviation of the eye. The muscles of the eye are controlled by the
fourth cranial nerve. The facial nerve is the seventh cranial nerve. This distinction can be found
in illustrations and written information within your ICD-9 and CPT® code books. Tarsal tunnel
syndrome is nerve impingement in the foot, and brachial plexis lesions refer to a complex of
nerves found between the neck and armpit. Bell’s palsy, is a common disorder of the facial
nerve, and causes an inability to control facial muscles of expression. It may be caused by a brain
tumor, stroke, or Lyme disease, but can be idiopathic and transient.
Q: 141 A
The lymphatic system has three main functions: To collect interstitial fluid to help maintain the
fluid balance in the body; to produce lymphocytes for fighting disease; and to absorb fats from
the intestine and transport them to the blood. The lymphatic system is composed of the lymph
nodes, spleen, thymus, bone marrow, lymph nodes, and ducts.
Q: 142 C
The islets of Langerhans produce hormones, most notably insulin, within the pancreas. Insulin
causes cells to take up glucose from the blood. If the production of insulin stops or becomes
inefficient, the patient will develop diabetes.
Q: 143 A
Hyperlipidemia occurs when too many fats are circulating in the blood and can lead to the
buildup of fatty plaque in the blood vessels. This fatty plaque is also known as atherosclerosis.
Q: 144 D
The reason for this encounter is for radiation therapy. The ICD-9-CM Coding Guidelines instruct
us that V58.0 is to be “first listed, followed by the diagnosis code when a patient’s encounter is
solely to receive radiation therapy or chemotherapy for the treatment of a neoplasm.” In this
case, 174.1 would be sequenced secondarily. Because the cancer is still being treated, a history
code would be inappropriate.
Q: 145 D
Barrett’s esophagus describes changes at the cellular level in the epithelium of the esophagus, a
precursor to cancer. It is usually caused by gastrointestinal reflux disease (GERD, 530.81). This
patient has a narrowing of the esophagus (530.3) that caused food to be lodged in her throat. A
biopsy during that encounter found Barrett’s changes (530.85). For the current encounter, the
FB (935.1) has been resolved, and so would not be reported. Because we know her condition
more precisely, V41.6 would be inappropriate. Proper coding would be for the Barrett’s, the
stenosis, and the GERD, or D.
Q: 146 B
The only code provided as an option that describes an event recorder is C1764. The other code
options are for generators, pacemakers, or cardioverter-defibrillators.
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Q: 147 C
To select the correct code for casting supplies, you need to know the type, material and age of
the patient. In this case the patient is a 12-year-old, which eliminates Q4011 and Q4012. The
cast is made of fiberglass, which makes Q4010 the correct answer.
Q: 148 D
According to the ICD-9-CM Official Coding Guidelines, do not report signs and symptoms that
are integral to a definitive diagnosis. When the same condition is diagnosed as acute and
chronic and there is a separate code for both, report both codes. An ICD-9-CM code is not valid
unless it is coded to the highest level of specificity. Combination code instructions are also in the
tabular section. Do not rely solely on the alphabetic index to select the correct code.
Q: 149 B
An ABN is a waiver of liability. When a patient has been informed a service that is otherwise
covered by Medicare but might not be covered in a particular instance an ABN is signed by the
patient prior to receiving the service. To inform Medicare the ABN has been signed, append
modifier GA. If an ABN is signed, the claim is the patient’s responsibility if the claim is denied.
Q: 150 B
Under HIPAA regulations, patients have the right to receive a copy of their medical record and
request that errors are corrected.
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