Chapter 5 Practical Flashcards
A patient comes into the office for follow up of neck pain. The provider documents a medically appropriate history and exam. The medical decision making was of low complexity. What E/M code is reported for this visit?
(A) 99213.
(B) 99212.
(C) 99202.
(D) 99203.
(A) 99213.
The patient is seen in the office and is being seen for follow-up of neck pain making it an established patient. For an established patient, the criteria of the E/M visit is based on the 2021 E/M Guidelines. The provider documented a medically appropriate history and exam. The medical decision making was of low
complexity making this a 99213.
A patient sees his primary care doctor for calluses on his feet. The provider uses a scalpel to pare down six calluses (benign hyperkeratotic lesions) on his feet. How is this reported?
(A) 11057 x 6.
(B) 11055 x 6.
(C) 11055, 11056, 11057 x 4.
(D) 11057.
(D) 11057.
Look in the CPT Index for Paring/Skin Lesion/Benign
Hyperkeratotic 11055-11057. In the Integumentary Section, the codes are determined based on the number of lesions removed. 11057 reports more than four lesions. This code is only reported once anytime more than 4 lesions are removed by paring or cutting.
A 5 year-old fell on broken glass and required suturing of a laceration. Due to the age and combative behavior of the patient, the provider utilized moderate sedation while repairing the laceration. The provider gave the
child 50 mg of Ketamine IM. A nurse monitored the patient during the procedure which took 30 minutes. What CPT® code is reported for moderate sedation?
(A) 99152.
(B) 99152, 99153.
(C) 99156.
(D) 99156, 99157.
(B) 99152, 99153.
Moderate sedation is often used for pediatric patients in
situations not normally requiring sedation. In this case, the
provider administered sedation with a nurse assisting in
monitoring the patient. In the CPT® Index look for
Sedation/Moderate/with Independent Observation and you are directed to code range 99151-99153. Code selection is based on age of the patient and the length of time. Code 99152 describes an encounter using moderate sedation, and the physician or other qualified healthcare professional rendering the diagnostic or therapeutic service also manages the sedation. This code is
specific for the age of the patient and up to 15 minutes of time. Add-on 99153 is for each additional 15 minutes of intraservice time.
A child with suspected sleep apnea was given an apnea monitoring device to use over the next month. The device was capable of recording and storing data relative to heart and respiratory rate and pattern. The pediatric
pulmonologist reviewed the data and reported to the child’s primary pediatrician. What CPT® code(s) is/are reported for the monitor attachment, download of data, provider review, interpretation and report?
(A) 95806.
(B) 94775, 94776, 94777.
(C) 95800.
(D) 94774.
(D) 94774.
In the CPT® Index look for Monitoring/Pediatric Apnea and you are directed to code range 94774-94777. Code selection is based on the components of the test performed. In this case, code 94774 describes the data storage capability, including the provider or other qualified health care professional interpretation
and report. The code is to be reported each 30-day period.
When tissue glue is used to close a wound involving the epidermis layer how is it reported?
(A) As a simple closure.
(B) As a complex closure.
(C) 99211.
(D) It is not billable.
(A) As a simple closure.
The Guidelines for Repair (Closure) include tissue
adhesive along with sutures and staples, either singly or in combination with each other can be reported with the repair codes. In this case the tissue glue (adhesive) is a one-layer closure and can be reported with a simple repair code. Wound closure utilizing adhesive strips as the sole repair material is coded using the appropriate E/M code.
Mr. Bowen is having a pre-employment physical (screening). His doctor ordered the following serum blood tests: CBC, automated, comprehensive metabolic panel and a thyroid stimulating hormone (TSH) assay. Code the
services for these labs.
(A) 80048.
(B) 80050-26.
(C) 80053, 84443.
(D) 80050.
(D) 80050.
Organ or Disease-Oriented Panels guidelines preceding the panel codes indicate, “The tests listed with each panel identify the defined components of that panel.” In addition to the tests listed under the Comprehensive metabolic panel, a CBC and TSH are part of 80050 General health panel and are not coded separately.
In the CPT® Index, look for Blood Tests/Panels/General Health directing you to 80050.
A 56 year-old patient who has been admitted requires a tunneled CV catheter insertion. The physician uses ultrasound guidance to perform the insertion. The physician documented vessel patency and that permanent recordings are in the patient’s record. What CPT® codes are reported for the physician’s services?
(A) 36558, 76937-26.
(B) 36558, 76000-26.
(C) 36558, 77001-26.
(D) 36556, 76937-26.
A) 36558, 76937-26.
The physician inserts a tunneled CV catheter (central venous). The patient is 56 years-old and there is no indication that a port or pump is involved. In the CPT® Index look for Central Venous Catheter Placement/Insertion/Central/Tunneled without Port or Pump 36557-36558, 36565. The correct code is 36558. The physician uses ultrasound guidance, which is reported with 76937. In the coding guidelines for Central Venous Access Procedures, it states that imaging can be reported separately. The codes you are referred to are 76937 and 77001. Because the imaging used is ultrasound, report with 76937. Note that 76937 is an add-on code and it can only be reported if the physician documents selected vessel patency and permanent ultrasound recordings are in the patient’s record. Modifier 26 is appended to report the professional component.
A 6 year-old female with prominent ears undergoes a bilateral otoplasty. Surgeon makes an incision just behind the ear in the natural fold where the ear is joined to the head exposing the cartilage. Cartilage is trimmed and shaped and the incision is closed. Temporary sutures are placed to secure the ear until healing is accomplished. The procedure is repeated on the other
ear. What CPT® code is reported?
(A) 69310-50.
(B) 69300 x 2.
(C) 69300-50.
(D) 69120-22.
(C) 69300-50.
In the CPT® Index look for Otoplasty which directs
you to code 69300, Auditory System numeric section. The parenthetical note beneath 69300 instructs us to report the code with modifier 50 for a bilateral procedure.
Vasectomy reversal is performed, bilaterally, using the operating microscope. Choose the procedure code(s).
(A) 55250.
(B) 55400-50, 69990.
(C) 55250-50, 69990.
(D) 55400.
(B) 55400-50, 69990.
In the CPT® Index look for Vasectomy/Reversal
which refers you to see Vasovasorrhaphy - code 55400. There are two parenthetical instructions beneath the code instructing us to use modifier 50 for a bilateral procedure and to use 69990 when
an operating microscope is used.
A patient presents for epicardial lead placement via median sternotomy to the right atrium and right ventricle. A dual pacemaker generator is then inserted subcutaneously. The patient has bundle branch block and sinoatrial node dysfunction. What CPT® code(s) are reported?
(A) 33214.
(B) 33203, 33213-51.
(C) 33208, 33213-51.
(D) 33202, 33213-51.
(D) 33202, 33213-51.
Because leads were placed on the right atrium and
right ventricle, it is a dual chamber system. Two codes are
necessary to report placement of an epicardial system. The parenthetical note under 33203 directs the coder to report codes 33202 and 33203 with 33212, 33213, 33221, 33230, 33231, and 33240. Look in the CPT® Index for Pacemaker, Heart/Insertion/Pulse Generator Only. You are referred to 33212, 33213, and 33221. For the placement of the epicardial electrodes look in the CPT® Index for Pacemaker, Heart/Insertion/Electrode, and you are referred to 33202-33203.
