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NEW QUESTION # 43
Consultation codes 99242-99245 have been deemed as not medically necessary and are no longer reimbursed by Medicare. This decision would fall under which term?
- A. Governed Coding Determination
- B. Local Coding Determination
- C. National Coding Determination
- D. Carrier Coding Determination
Answer: C
Explanation:
Decisions regarding coverage are made through evidence-based processes and public opinion. National Coding Determination (NCD) is specific to Medicare coverage nationwide, whereas Local Coding Determination (LDC) is contractor and commercial specific. Carrier and Governed Coding Determinations do not exist.
NEW QUESTION # 44
A gastroenterologist performs a gastric bypass surgery on an obese patient with a body mass index of 52. During the procedure, the size of the stomach is reduced by 77%; the intestine is bypassed from the duodenum and then attached to the ileum. The pylorus is preserved and left intact. Which CPT code best describes the surgery performed?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: C
Explanation:
In this scenario, the gastroenterologist performed a procedure known as a biliopancreatic diversion with duodenal switch (BPD/DS). A BPD/DS removes a portion of the stomach and transfers parts of the duodenum and small intestine to the lower end of the large intestine in an effort to limit intestinal absorption for weight loss. CPT codes 43842-43843 describe gastric restrictive procedures without gastric bypass. However, gastric bypass was done in rearranging the small intestine to connect to the ileum.
NEW QUESTION # 45
The physician suspects malignancy and decides to remove two lesions from the patient's back to confirm. The size of the first lesion has a diameter of 0.5 cm, and the excised diameter is 1.0 cm. The size of the second lesion has a diameter of 0.3 cm, and the excised diameter is 1.5 cm. Which CPT code(s) should be reported?
- A. 11600, 11600-51
- B. 11402, 11401-59
- C. 11401, 11402-51
- D. 11401, 11402-59
Answer: B
Explanation:
Without a patholoy report to confirm malignancy, the excision code assumes that the lesion is benign. Code selection is based on the excision size, not the size of the lesion, and the more complex code takes priority in sequence, eliminating answer C. Answers A and B can be incorrect choices due to CPT guidelines outlining that when coding more than one excision, the appropriate modifier would be 59 on each additional procedure.
NEW QUESTION # 46
What would NOT be included in a global obstetrical package?
- A. Contraception following delivery is discussed at length.
- B. A patient complains of flu-like symptoms and is prescribed an antibiotic.
- C. Sutures are removed from a first-degree perineal laceration during the delivery.
- D. A patient with anemia comes in to check hemoglobin levels.
Answer: B
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 # 47
The appendix is removed through an abdominal incision due to metastatic colon malignancy. How should this be reported?
- A. 44970, C78.5
- B. 44970, C18.9, C78.5
- C. 44950, C78.5, C18.9
- D. 44950, C78.5
Answer: C
Explanation:
An open appendectomy procedure is reported with CPT 44950. A metastatic colon malignancy is a cancer that began in the colon but has spread to other areas. In this scenario, that means that the primary malignancy is the colon, and the secondary malignancy is the appendix.
Additionally, ICD-IO-CM guidelines state that when "treatment is directed toward the metastatic site only, the metastatic site is designated as the principal/first-listed diagnosis. The primary malignancy is coded as an additional code." The malignancy codes do not specifically state
"appendix," but the ICD-IO-CM coding crosswalk in the neoplasm table assigns this diagnosis as C78.5 secondary malignant neoplasm of large intestine and rectum.
NEW QUESTION # 48
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: B
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 # 49
A radiation oncologist reviews the port films, dose delivery, and treatment parameters of a 52-year-old female patient who has received external beam therapy three times in the current week He also spends 15 minutes examining the patient and collecting an intake of her response to the treatment program. Which CPT code(s) should the physician report?
- A. 0
- B. 77435, 99213-25
- C. 99213-25, 77401x3units
- D. 1
Answer: A
Explanation:
Treatment management of a patient undergoing radiation therapy is reimbursed by reporting CPT codes 77427-77470. Treatment management includes a review ofthe port films, dosimetry, dose delivery, treatment parameters, a physical examination, and related counseling. It would therefore not be appropriate to bill for a separate evaluation and management. CPT 77435 describes treatment management for a course of stereotactic body radiation therapy (SBRT), which the patient is not receiving. CPT 77401 describes the actual radiation and not the evaluation from the physician. CPT 77431 is reported when the entire course of therapy consists of one or nvo treatment sessions: however, a coder can infer from the documentation that the patient in this scenario has or will receive multiple sessions over the course of one or more weeks. Additionally, CPT guidelines advise that only three treatment sessions must occur to support the face-to-face encounter described in CPT 77427.
NEW QUESTION # 50
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. 73560-26-RT, MI 7.11, M25.561
- B. 73560-RT, MI 7.11
- C. 73560-TC-RT, MI 7.11, M25.561
- D. 73560-TC-RT, MI 7.11
Answer: B
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 # 51
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. 0
- B. 11200, 11201, 00300
- C. 11200, 11201
- D. 11200, 11201-51, 00300
Answer: C
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 # 52
Which is NOT a violation of Health Insurance Portability and Accountability Act (HIPAA)?
- A. A hospital with a multilayered cybersecurity defense experiences a data breach by acybercriminal.
- B. An encrypted laptop is stolen from a physician,s vehicle.
- C. An office does not perform a risk assessment of electronic health information.
- D. An employee drops off patient records on a physician,s porch.
Answer: A
Explanation:
HIPAA is in place to reduce the level of risk associated with a potential violation and/or breach. In answer C, even though a breach has occurred, the hospital has appropriate preventative measures in place and is not in violation of HIPAA. Leaving a laptop in an unattended vehicle or medical records outside is high-risk behavior that gives opportunity for an unauthorized person to access protected health information (PHI) and/or electronic protected health. In answer D, a medical practice is required to perform a risk analysis to PHI and/or ePHI and recti$ any failures within a timely manner.
NEW QUESTION # 53
If all the following statements were documented by the anesthesiologist in one record, which would be chosen as the start time for anesthesia services?
- A. Request for services is received for an operation that begins in 1 hour.
- B. Propofol is administered to the patient intravenously.
- C. Medical history and vital signs for the patient are obtained prior to the surgery.
- D. A pulse oximeter is attached to the patient,s finger while in the operating room.
Answer: D
Explanation:
Anesthesia time begins when the provider begins to prepare the patient for anesthesia services. This usually will take place in the operating room or an equivalent area. Although answer B would not be incorrect as a chosen starting point, answer C is more accurate according to the anesthesia time definition. Preoperative evaluations of the patient, such as a history intake, cannot be counted as anesthesia time.
NEW QUESTION # 54
A patient is in labor with plans to deliver vaginally. An epidural is administered at 17:30. After several hours of pushing, the obstetrician determines that the cervix is swollen, and the baby must be delivered via a c-section. The patient consents, the baby is delivered, and both are discharged to the recovery room at 22:15. What CPT code(s) should the anesthesiologist report?
- A. 01967-23, 01968
- B. 01967, 01968
- C. 01967-23, 01968, 99140
- D. 01967, 01968, 99140
Answer: A
Explanation:
For a planned vaginal delivery with the use of an epidural, followed by a Cesarean delivery, the correct CPT codes are 10967 followed by add-on code 01968. CPT code 99140 is an add-on code portraying that the procedure was an emergency and that the patient and/or baby has a significant increase in the threat to life. The documentation gives no indication that these services were emergent Modifier 23 is reported for unusual anesthesia services. This would include-but is not limited to-the use of general anesthesia for a procedure that usually requires only a local anesthetic or none and/or a procedure extending more than 4 hours. In this case, the total procedure time was 4.75 hours, and modifier 23 is appended on the primary procedure code only.
NEW QUESTION # 55
A patient presents to urgent care with complaints of a sore throat, a temperature of 100.2, and pain while urinating. The provider examines the patient and collects a throat swab and urine sample. The following codes are then entered on the patient's claim: R30.9, R07.O, R50.9, N39.O, J03.8, and B95.3. What code(s) should be removed?
- A. N39.O, 103.00
- B. 395.3
- C. R30.9, 102.9 and R50.9
- D. R30.9, J02.9
Answer: C
Explanation:
Pain while urinating 830.9) is a symptom of a urinary tract infection (N39.O), and a sore throat (R07.0) and fever 850.9) are symptoms of acute tonsillitis caused by Streptococcus (103.00).
Neither ofthese three codes should be reported because ICD-IO-CM guidelines stipulate that when a definitive diagnosis is present, signs and/or symptoms should not be additionally listed on the claim.
NEW QUESTION # 56
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. Z08, Z85.038
- C. C18.9
- D. Z48.3, C18.9
Answer: B
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 # 57
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. K63.5, Z12.11
- B. Z12.11, K63.5
- C. Z12.11
- D. K63.5
Answer: B
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 # 58
Diagnostic endoscopy is always inclusive to a surgical endoscopy.
- A. False
- B. True
Answer: B
Explanation:
The statement is true. When multiple endoscopic procedures are performed in the same session, only the most extensive service should be reported. In this case, it would be the surgical endoscopy because it has a higher revenue value.
NEW QUESTION # 59
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