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NEW QUESTION # 42
Which form is used to make a patient aware of the potential monetary liability they will have if their procedure is not likely to be covered by Medicare?
- A. Advance Beneficiary Notice
- B. National Coverage Determination
- C. Health Insurance Portability and Accountability Act (HIPAA) Release
- D. Payment Plan Contract
Answer: A
Explanation:
National Coverage Determination is a reference guide for physicians to determine which services are covered by Medicare. The HIPAA Release is a form that must be signed by the patient prior to release of medical records and can be revoked at any time. The HIPAA Privacy Rule is in place to protect the patien& health information.
NEW QUESTION # 43
Which service is NOT included in the central nervous system assessment?
- A. Clinical dementia rating
- B. Prescription for an opioid
- C. Review of an advance care plan
- D. Discussion of suicidal intentions
Answer: B
Explanation:
A central nervous system assessment is comprised of multiple screenings that are reported with CPT codes 96105-96146 and includes, but is not limited to, the following elements: use of standardized instruments for staging and rating clinical dementia: evaluation for behavioral symptoms using standardized screening instruments; and development, updating, revision, and/or review of an Advance Care Plan. A review of high-risk medications is also included in the central nervous system assessment; however, if in the same encounter a prescription is issued, the clinician should document and report the treatment with an appropriate E/M.
NEW QUESTION # 44
A diaphragm resection and repair are done using a biologic mesh to reduce the formation of adhesions. Which procedure code should be reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: C
Explanation:
A diaphragm resection is reported with CPT codes 39560-39561. The use ofa biologic mesh makes the repair complex, whereas a simple repair would implement only internal sutures.
NEW QUESTION # 45
A 45-year-old female patient with urinary incontinence is treated by means of a Burch procedure. The patient is morbidly obese. What CPT and ICD-IO-CM codes should be reported by the surgeon?
- A. 51840, R32, E66.8
- B. 51841, R32, E66.8
- C. 51840, R32
- D. 51841, R32
Answer: B
Explanation:
When choosing betvteen CPT 51840 and 51841, consider that obesity reduces the operative field, increases surgical time, and poses difficulties in surgical technique. It is therefore considered one of several complicating factors to this surgery because it has an abdominal approach.
Additionally, although the obesity is not the reason for the surgical encounter, it nevertheless should be coded due to the impact it has on the procedure.
NEW QUESTION # 46
Under the oversight of the pediatrician, a nurse reviews the vaccine and allergr history of a 13-year-old established patient just prior to administering a live varicella virus vaccine subcutaneously. What procedure code(s) should be reported?
- A. 90716, 90471
- B. 90716, 90460
- C. 99211-25, 90716, 90471
- D. 99211-25, 90716, 90460
Answer: A
Explanation:
Although CPT 99211 can be reported for limited assessments performed by nonphysician staff members, the vaccine and allergy history intake is considered vaccine related and not separately reportable. CPT 90460 is reported when a physician provides counseling about the benefits and risks associated with the vaccine and signs and symptoms that would indicate an adverse reaction.
Because the physician did not document seeing the patient at this encounter, report CPT 90471 for the administration of the immunization.
NEW QUESTION # 47
A patient is referred to a radiology clinic with a diagnosis of chest bruising. A radiologist who works for the clinic performs a 3-view x-ray on the patient's ribcage bilaterally. The radiologist interprets images and determines that there is a right-sided stress fracture to one rib. Which ICD-IO-CM and CPT codes should be reported for this encounter?
- A. 71110, S22.31Y.4
- B. 71110-26, S22.31Y.A
- C. 71110-26, M84.48XA
- D. 71110, M84.48XA
Answer: D
Explanation:
Modifier 26, indicating only a professional component ofthe study, would be inappropriate because the radiologist who obtained the images and interpreted the results works for the clinic that owns the x-ray machines, By reporting the procedure without a modifier, the clinic is requesting 100% reimbursement of the study, which includes the technical and professional components. When searching the index in the ICD-IO-CM book a stress fracture is related to fatigue and is coded as a bone disorder as opposed to an injury.
NEW QUESTION # 48
A laboratory receives a pap smear as a screening for a patient's annual gmecological exam. A thin-layer preparation screened by an automated system with manual rescreening is performed. A pathologist interprets the results and confirms a diagnosis of high-grade squamous intraepithelial lesion. What should the laboratory report?
- A. G0148, R87.610
- B. 88175, Z12.4
- C. 88175, 88141, ZOI.419,R87.613
- D. G0148, G0141, Z12.4 R8.613
Answer: C
Explanation:
The CPT codes for cytopathologv smears are dependent on the payer and the method used to test the specimen. HCPC II G0148 does accurately describe the test method; however, this code is used for Medicare payers only. As the documentation does not specify that this is the case, it should be assumed that the carrier is non-Medicare. The appropriate non-Medicare CPT for this test method is 88175. CPT 88141 is always reported as a secondary code for the associated physician interpretation. Regarding the diagnosis, the primary ICD-IO-CM code should be synonymous with the reason for the encounter, which in this scenario would be the Omecological exam (ZOI.419).
Although Z12.4 does describe a screening of the cervix, it specifically is excluded from the diagnosis list "when the screening is part of general gynecological examination (ZOI.4-ZOI.42)." Any abnormal findings are reported as secondary and/or tertiary.
NEW QUESTION # 49
If the dermatologist removes 17 skin tags from a patient's lumbar using local anesthesia and a sharp blade, which CPT code(s) should be reported?
- A. 11200, 11201-51, 00300
- B. 0
- C. 11200, 11201, 00300
- D. 11200, 11201
Answer: D
Explanation:
The CPT code 11201 is an add-on code and would not receive a modifier. Local anesthesia is included in the primary procedure code and would not be reported separately with CPT 00300.
NEW QUESTION # 50
A 22-year-old patient presents with a 5.5 cm gaping laceration on the right forearm and a
2 cm superficial laceration on the right wrist caused by a table saw. A local anesthetic is injected around both laceration sites. The physician irrigates the laceration on the wrist before closing the wound with a tissue adhesive and then performs an extensive cleaning and single-layer closure with sutures on the forearm. What should be coded for this encounter?
- A. 12032, S41.111A, S61.411A,W31.2kX.A
- B. 12032, 97597, G0168, S41.111A, S61.411A W31.2XXA
- C. 12001, 12032-59, S61.411AS41.111A W31.2XXA
- D. 12032, 12001-59, S41.111A S61.411A W31.2XXA
Answer: D
Explanation:
A "gaping" injury and/or "single-layer closure" is indicative of an intermediate repair and a
"superficial" injury and/or use of a "tissue adhesive" is indicative ofa simple repair. Because the repairs are not in the same classification, each repair is reported in a single code, sequenced from the most to the least severe (eliminating answers B and D), with modifier 59 appended to the less complicated procedure(s). Local anesthesia is included in these procedures, as is debridement unless the provider specifically indicates that it is extensive. In answer A, an HCPC's code for tissue adhesive would be reported only if the patient had Medicare.
NEW QUESTION # 51
A patient with right knee pain is seen in a physician's office for an x-ray. Anteroposterior and lateral views of the right knee were obtained by the technician, and images confirm right knee pain secondary to degenerative osteoarthritis. Which CPT and ICD-IO-CM code(s) should be reported?
- A. 73560-RT, MI 7.11
- B. 73560-TC-RT, MI 7.11
- C. 73560-26-RT, MI 7.11, M25.561
- D. 73560-TC-RT, MI 7.11, M25.561
Answer: A
Explanation:
The CPT crosswalk for x-ray of knee directs the coder to 73560-73580. Because two views were obtained, the correct code would be 73560 (radiologic examination, knee; I or 2 views).
Modifier TC and modifier 26 indicate only technical and professional components: however, because the x-ray was performed in a physician's office, 73560 would be reported without either because the practice provided both components. In terms of diagnosis, the knee pain would not be reported because it is a symptom of a definitive diagnosis.
NEW QUESTION # 52
An established female patient presents to a video conference with her internist with complaints of a nonproductive cough. She receives 15 minutes of counseling about the symptoms of COVID-19 and is directed to an unaffiliated testing site. What CPT and ICD-IO-CM codes should be reported?
- A. 99213-95, R05.9, Z20.828
- B. 99442, R05.9
- C. 99442, R05.9, Z20.828
- D. 99213-95, R05.9
Answer: D
Explanation:
When coding a telehealth encounter for an outpatient practice that occurs over audio-video technology (e.g. Skype), the appropriate office visit E/M would be reported with modifier 95. The patient must initiate the telehealth encounter. Although similar, CPT code 99442 is billed when a patient initiates communication with a provider through an online patient portal. ICD-IO-CM Z20.828 is reported only when a patient does not exhibit any symptoms of a disease the patient is suspected to have been exposed to.
NEW QUESTION # 53
A primary care physician is requesting a second opinion to determine which strain of Ebolavirus the patient has. The specimen is sent to a pathologist, who carefully examines it.
A written report is sent promptly back to the primary care physician, confirming Zaire Ebolavirus and recommending immediate isolation and emergency care. What code should be reported by the pathologist?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: C
Explanation:
A clinical pathology consultation was rendered at the request of the primary care physician.
The consultation is considered high based on the level of medical decision making. The CDC describes Ebola disease as a "rare and often deadly illness." Therefore, the number and complexity of problems addressed is high, as is the management ofthe disease due to the decision to escalate this case to hospital level care. E/M codes can be billed only when a patient themself is evaluated by the provider. In this case, the pathologist only evaluated a specimen.
NEW QUESTION # 54
An extracapsular cataract extraction procedure was performed on a patient with a clouded and discolored lens. The physician uses iris hooks in the right pupil to ensure safe and controlled access to the cataract and blue staining dye to visualize the capsulorhexis. Using suction, the existing lens capsule is removed, and an intraocular lens is inserted. What should the physician report?
- A. 66984-RT, H26.8
- B. 66982-RT, H27.8
- C. 66984-RT, H18.891
- D. 66982-RT, Q12.8
Answer: B
Explanation:
When deciding between a routine extracapsular cataract removal and a complex extracapsular cataract removal, bear in mind the code descriptor for a complex procedure involves
"devices or techniques not generally used in a routine cataract surgery (e.g., iris expansion device)." Because iris hooks were used, the procedure is complex (CPT 66982). When it comes to the diagnosis, do not get confused with the anatomy of the eye. Although the cornea works with the lens to help refract light, they are anatomically separate, thus eliminating answer B as an acceptable choice. A congenital condition is one that is genetic and/or present from birth. The documentation does not specifiy the origin, nor does it indicate when the lens abnormality began. Symptoms of a cataract include clouded and discolored lenses but should not be reported unless the physician clearly identifies this as the diagnosis. Coding crosswalk for diseases of the lens leads a coder to H27.8 (other specified disorders of lens).
NEW QUESTION # 55
An established patient presents complaining of clumpy, white discharge for 3 days. A vaginal exam reveals an old tampon, which is removed. Diflucan is sent to the pharmacy, instructions given, and the patient is told to follow up in I week. How would the provider code the visit?
- A. 99213,N89.8, T19.2LXA
- B. 57415, T19.2XXA, N89.8
- C. 99213, T19.2XXA, N89.8
- D. 57415, 99212-25, T19.2kVA
Answer: C
Explanation:
Although a foreign body was removed, 57415 in answers A and B cannot be reported because anesthesia was not used. The documentation supports low-level medical decision making, so the appropriate E/M would be 99213. VVhen comparing answers C and D, bear in mind that ICD-IO-CM requires sequencing "the underlying condition first, followed by the manifestation."
NEW QUESTION # 56
A 74-year-old male patient recently had a bone marrow transplant due to aplastic anemi a. At his follow-up visit with the doctor, his blood is drawn and sent to the laboratory to determine if the engraftment was successful. The laboratory evaluates the immature reticulocyte fraction (IRF) using an automated cell counter and total reticulocyte by way of a manual count. What codes should the laboratory report?
- A. 85046, D61.9
- B. 85046, 85044, D61.9
- C. 85046, D61.9, Z79.89
- D. 85046, 85044, D61.9, Z94.81
Answer: A
Explanation:
When a hematologr procedure that could be billed alone is encompassed in another code, only the most complex of the tvo should be reported. Because CPT 85046 includes the reticulocyte count billing CPT 85044 as secondary despite using a different method would be considered an unbundling of services. Per ICD-IO-CM guidelines, an organ or tissue transplant status code is for use "only if there are no complications or malfunctions of the organ or tissue replaced." As the testing is to determine whether the engraftment was successful, a bone marrow transplant status code would not be appropriate until deemed by the provider.
NEW QUESTION # 57
What would NOT be included in a global obstetrical package?
- A. Sutures are removed from a first-degree perineal laceration during the delivery.
- B. Contraception following delivery is discussed at length.
- C. A patient with anemia comes in to check hemoglobin levels.
- D. A patient complains of flu-like symptoms and is prescribed an antibiotic.
Answer: D
Explanation:
The treatment of flu-like symptoms is considered a non-obstetric service, and a separate E/M can be billed for reimbursement. All other answer choices would be included in the global obstetrical package as routine care.
NEW QUESTION # 58
What must the documentation for a consultation include?
- A. Documentation of assumption of care, who requested the consultation, and the consultingproviders, professional opinion
- B. The reason for the consultation, the time spent discussing the recommended treatmentplan, and a medical decision-making of moderate complexity
- C. Who requested the consultation, the consulting providers, professional opinion, and awritten report that is provided to the referring physician
- D. Which family member prompted the consultation, a written report ofthe physical findings/recommendations, and the time spent discussing the recommended treatment plan
Answer: C
Explanation:
Per CPT guidelines, the Office of Inspector General, and Medicare, a consultation must include who requested the consultation, the consulting provider's professional opinion, and a written report of the findings, which is provided to the referring physician. Time can be used to select the level of E/M; however, it is not required if all three components of the documentation are met (history, exam, and medical decision-making). Additionally, once the provider assumes care, a subsequent code appropriate for that place of service would be reported (e.g., 99211-99215) and not a consultation code.
NEW QUESTION # 59
A female patient with type II diabetes, asthma, and hypertension is admitted with complaints of chest pain. Testing rules out heart attack and other underlying conditions as the cause. Which diagnosis codes should be listed on the discharge note?
- A. R07.9, Ell.9, J45.909, 110
- B. R07.9
- C. Z03.89
- D. Z03.89
Answer: A
Explanation:
The primary diagnosis on an inpatient record would be the primary reason the patient was admitted. In this case, because a definitive diagnosis could not be confirmed, the symptom of chest pain would be selected instead. The previously confirmed chronic conditions would also be coded because they affect the management of inpatient care. Diabetes would be coded to an unspecified code because the term "with" implies a causal relationship between the conditions that is not implicitly documented. Per ICD-IO-CM guidelines, a rule-out code is not assigned when "any signs or symptoms related to the suspected condition are present."
NEW QUESTION # 60
A patient is admitted for chemical burns caused by a leaky car battery. The physician diagnoses the patient with second- and third-degree burns on the right hand and second- degree burns on the left hand. The physician follows up with the patient 3 days later and performs a detailed examination. His findings include an infection that has developed on the right hand as a result of the burn. The patient is started on antibiotics. Code this encounter.
- A. 99231, T23.201A, T23.361A T23.301A, T23.202A T54.2X4A L08.9
- B. 99232, L08.9, T23.201S, T23.361S, T23.301S, T23.202A T54.2X4A
- C. 99232, T23.701A, T23.662A T54.2XIA, L08.9
- D. 99231, L08.9, T23.701S, T23.662A T54.2XIS
Answer: C
Explanation:
The physician's level of medical decision-making was moderate in complexity due to the acute, complicated injury/ illness, the minimal amount and complexity of data reviewed, and the issuance of a prescription drug. Because the patient has already been receiving care in a hospital setting for 3 days, the visit would be considered subsequent hospital care, making the level of inpatient service a 99232 and eliminating answers B and D. A burn caused by a chemical would be considered a corrosion because it is not caused by heat, electricity, and/or radiation, thus eliminating the remaining choice of A. Additionally, when multiple burns on the same anatomic location and laterality are being treated, identify and code only the highest degree of burn recorded in the diagnosis. In this case, only the third-degree burns on the right hand and the second-degree burns on the left hand would be reported. Although the skin infection is a sequela, the seventh character in the corrosion code would remain "A" and sequenced first to indicate that the patient is still receiving active treatment for the reason of admission.
NEW QUESTION # 61
An obstetrical patient carrying twins is seen. The physician performs a fetal non stress test on each fetus. How should the CPT code(s) be reported?
- A. 59025-76
- B. 0
- C. 59025, 59025-59
- D. 59025-22
Answer: C
Explanation:
Modifier 76 is used to identify a repeated procedure, but the test was performed on a separate fetus. Modifier 22 indicates increased procedural services: however, the services were not increased. Rather, a separate, identifiable test was rendered, and the modifier 59 would therefore apply to the second fetal nonstress test.
NEW QUESTION # 62
Which healthcare professional may NOT report medical nutrition therapy?
- A. Registered nurse
- B. Endocrinologist
- C. Nutritionist
- D. Dietician
Answer: B
Explanation:
Medical nutrition therapy describes nutritional assessments and interventions in a face-to- face or group patient setting and is reported with CPT codes 97802-97804. These codes are used by nonphysician healthcare professionals only. When a physician provides nutritional advice, a preventative service or evaluation and management code should be reported.
NEW QUESTION # 63
A patient with a history of colon cancer was treated with radiation therapy. CT scans and blood tests show the malignancy has been eradicated. The patient is directed to take 81 mg of aspirin daily over the course of the next year to help prevent reoccurrence of the malignancy. What ICD-IO-CM code(s) should be reported by the provider on subsequent visits related to this patient's condition?
- A. Z85.038
- B. C18.9
- C. Z08, Z85.038
- D. Z48.3, C18.9
Answer: C
Explanation:
Regarding Z08, ICD-IO-CM guidelines state: "The follow-up codes are used to explain continuing surveillance following completed treatment of a disease. They imply that the condition has been fully treated and no longer exists." When using a follow-up code as the primary reason for an encounter, a history code indicating what condition the patient originally had should be assigned as secondary. Aftercare codes are used to describe the continued treatment of a disease. In this case, the malignancy has been eradicated, the disease no longer exists, and aspirin is being used merely as a preventative measure. History codes can never be reported as first listed; rather, a follow-up code or other current disease and/or condition should precede it.
NEW QUESTION # 64
What is NOT a function of the kidneys?
- A. Remove waste
- B. Filter blood
- C. Regulate blood pressure
- D. Propel urine
Answer: D
Explanation:
The role ofthe kidneys is to filter blood before it is transported back to the heart, remove waste materials from food and medication, and regulate blood pressure by excreting excess sodium.
The ureters propel urine from the kidneys into the bladder.
NEW QUESTION # 65
What is NOT a condition related to the thyroid gland?
- A. Hashimoto,s disease
- B. Toxic adenoma
- C. Acosta disease
- D. Graves, disease
Answer: C
Explanation:
Toxic adenoma E05.2- is a thyroid nodule that may secrete hormones into the body that results in an overactive thyroid. Graves' disease E05.0- is an autoimmune disorder that attacks the thyroid, resulting in overactivity. Hashimoto's disease E06.3 is also an autoimmune disorder:
however, it usually results in an underactive thyroid. Acosta disease T 70.29- is altitude sickness.
Even if a coder is unfamiliar with these terms, by locating the ICD-IO-CM code that correlates to the condition, a coder can infer which body system a diagnosis relates to.
NEW QUESTION # 66
A 59-year-old male patient presents for a routine colonoscopy. During the procedure, a polyp is discovered. What is the proper ICD- 10-CM coding for this encounter?
- A. Z12.11, K63.5
- B. Z12.11
- C. K63.5
- D. K63.5, Z12.11
Answer: A
Explanation:
Because the reason for the visit was a routine colonoscopy, the "encounter for screening for malignant neoplasm of colon" (Zl 2.11) would be the first-listed code. ICD-IO-CM guidelines advise that if there is a finding during a screening, the finding may be used as an additional code. In this example, the colon polyp (K63.5) is a physical finding and would be listed as the secondary diagnosis.
NEW QUESTION # 67
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