Chapter 5 Test Flashcards
22-year-old has developed an abscess on his left index
finger. An incision was made over the abscess and pus and blood are drained. The wound was irrigated with sterile saline and gauzed. What CPT® code is reported for this procedure?
(A) 10060.
(B) 10061.
(C) 26010.
(D) 26115.
(C) 26010.
Look in the CPT® Index look for Abscess/Finger, directing you to codes 26010 and 26011. The abscess is on the
finger. Select the incisionand drainage code that specifies the anatomical site. Code 26010 is
reported because there is no documentation stating that this was a complicated procedure.
What is the CPT® code for trimming of nondystrophic nails?
(A) 11720.
(B) 11730.
(C) 11732.
(D) 11719.
(D) 11719.
Look in the CPT® Index for Nails/Trimming and you are referred to code 11719. Code 11720 is reported for debridement which is not the same as trimming. Code 11730 and add-on code 11732 is for avulsion of nail
plate; the removal of the nail plate. The correct code is 11719.
A 68-year-old Medicare patient presented for an annual examination and had no complaints. Her claim, billed as 99387, was denied. Was this billed correctly? If not,
what is needed to bill this encounter correctly?
(A) This was billed correctly.
(B) G0101, Q0091.
(C) G0101-GA, Q0091-GA.
(D) It will depend on the documentation.
(D) It will depend on the documentation.
The code selection is based on the documentation. CPT® code 99387 will not be paid by Medicare. Medicare uses codes G0438 for initial and G0439
for subsequent annual wellness visits. G0101 and Q0091 is billed with modifier GA if an Advanced Beneficiary Notice (ABN) was completed and documentation indicates the patient has a breast and pelvic exam with a
screening pap.
An AP and lateral chest films were performed on a patient with X-ray equipment owned by his physician in the office to rule out right pleural effusion. The physician interprets the chest films and documents the finding
in the patient’s chart. The physician bills 71046 for the X-ray. Is this billed correctly? If not, what is billed?
(A) Yes, the physician reports the code correctly.
(B) No, the physician needs to report 71046-26.
(C) No, the physician needs to report 71046-TC.
(D) No, the physician needs to report 71046-26-TC.
(A) Yes, the physician reports the code correctly.
The chest films were taken in the physician’s office by his physician who owns the equipment and who also interpreted the films. This indicates a global service was performed in which no modifiers (26 or TC) are
appended to the radiology service. Modifier 26 is reported when the physician does not own the equipment. The physician usually performs
the radiology service in a hospital or outpatient setting where only the physician supervises and interprets the service. The TC modifier is appended to a radiology service by the hospital or outpatient facility
indicating the facility owns the equipment that was used for the radiological service but a non-facility provider performed the supervision and interpretation of the service. Modifiers 26 and TC are never reported on the same claim together, only one or the other is reported.
An 18-year-old male is taken to the operating room to resolve a urethral stricture. A cystoscope was passed through the urethra and bladder and a series of urethral
dilators up to 20 French were then placed, dilating the stricture. What CPT® code is used for this procedure?
(A) 52281.
(B) 53600.
(C) 52260.
(D) 52341.
(A) 52281.
Be careful to read the code descriptions because the procedure is for the urethra not ureter. Do not report 52341. Because a cystoscope is used for the procedure, do not report code 53600. The procedure is for a urethral stricture, not for interstitial cystitis, do not report code 52260. In the CPT® Index look for Stricture/Urethra and there is a note to See Urethral Stenosis. Look for Urethral/Stenosis/Dilation referring you to 52281. Verify the code in the numerical section.
A Medicare patient presents to the ER for chest pain. An internal medicine provider is called to evaluate the patient. A comprehensive history and exam is documented. The provider orders an EKG, chest X-ray, and lab work and requests a consultation by cardiology which supports a high MDM. The internal medicine provider admits the patient. What is the correct billing?
(A) 99283, R07.9.
(B) 99223, R07.9.
(C) 99220, R07.9.
(D) 99255, R07.9.
(B) 99223, R07.9.
Internal Med is called to evaluate the patient and this does not meet the definition of a consult. The patient was seen in the ER but the provider admitted the patient, making this an initial inpatient hospital care. Code
99223, Initial Hospital Care, requires a comprehensive history, comprehensive exam and high MDM.
According to ICD-10-CM guideline, I.B.18, when a confirmed diagnosis is not available, it is appropriate to report the signs and symptoms. Look in
the ICD-10-CM Alphabetic Index for Pain/chest (central) R07.9. Verify code selection in the Tabular List.
A provider is making rounds in the Nursing Home. She visits an established patient to check on her pneumonia and UTI. She performs an expanded problem focused
interval history, an expanded problem focused exam, and moderate decision making. What E/M code is reported?
(A) 99304.
(B) 99308.
(C) 99309.
(D) 99318.
(B) 99308.
Look in the CPT Index for Evaluation and Management/Nursing Facility/Subsequent Care and you are directed to 99307-99310. Subsequent nursing facility services require two out of three key components. An expanded problem focused history and an expanded
problem focused exam make 99308 the correct code.
Codes for surgery include the performance of the surgery as well as:
(A) Local anesthesia, including digital nerve blocks.
(B) Post-operative care for 90 days.
(C) Post-operative care provided for complications associated with the surgery.
(D) All E/M codes during the post-operative period.
(A) Local anesthesia, including digital nerve blocks.
Post-operative days range from 0-90 days depending on the surgery performed. Codes for surgery includes only typical post-operative care and does not include care provided for post-operative complications as part of global care. One E/M encounter on the day of, or immediately preceding the date of surgery (unless the decision for surgery was made at that visit, in which case it may be claimed separately) is included.
What is the CPT® code for an X-ray of the humerus, 2 views?
(A) 73592.
(B) 73060.
(C) 73050.
(D) 73030.
(B) 73060.
Look in the CPT® Index for X-ray/Humerus and you are referred to 73060. Verify the code in the numerical section.
64-year-old female tripped over her walker. She lacerated her face and right arm. Her face had a 2 cm laceration and was sutured with a simple one-layer closure. Her right arm had a 2.5 cm laceration and is repaired by layered closure, 6-0 Vicryl subcutaneous sutures and prolene sutures on the skin. What CPT® codes are reported for the repairs according to CPT® guidelines?
(A) 12051, 12031-51.
(B) 12051, 12031-59.
(C) 12011, 12001-51.
(D) 12031, 12011-59.
(D) 12031, 12011-59.
The patient had a 2.5 cm laceration on her arm that was repaired by layered closures of subcutaneous skin which is an intermediate repair. Look in the CPT® Index for Skin/Wound Repair/Intermediate referring you to codes 12031-12057. The code is selected based on location and
size. Codes 12031-12037 are reported for the arm and code 12031 is reported for the 2.5 cm laceration. Her face had a 2 cm laceration repair by one-layer closure which is a simple repair. Look in the CPT® Index look for Skin/Wound Repair/Simple referring you to codes 12001-12021. Codes 12011-12018 are reported for the face and code 12011 is reported for the 2 cm laceration. CPT® guidelines indicates when more than one classification of wounds is repaired, list the more complicated as the primary procedure and less complicated as the secondary procedure, using modifier 59.
A commercial insurance claim was led and denied using 99213 with M25.519 for DOS 9/12. The patient had an arthroscopy of the left knee on 8/16 (90-day global
surgery) that is unrelated to the visit on 9/12. What error is identified for the claim for DOS 9/12?
(A) This E/M is not a billable service and should not be reported.
(B) Modifier 24 is appended to identify this as not related to the surgery.
(C) Modifier 25 is appended to identify this as separately identified.
(D) No modifier is required and contact is made with the payer to review the claim.
(B) Modifier 24 is appended to identify this as not related to the surgery.
Arthroscopy has 90 global days, however the shoulder pain is not associated with the knee procedure. Modifier 24, Unrelated E/M by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period; is appended to the claim to allow for reimbursement.
Sally is a 45-year-old female, established patient seen for an annual gynecological exam. The physician performs a comprehensive history and a detailed exam. During
the exam, a cervical polyp is seen, and the decision is made to remove the polyp with ring forceps. What code(s) are reported?
(A) 99214, 57500.
(B) 99213-25, 57500.
(C) 57500.
(D) 99396-25, 57500.
(D) 99396-25, 57500.
The polyp is an incidental finding during the preventive service. A separate problem E/M would not be reported. Look in the CPT® Index for Evaluation and Management/Preventive Services referring you to
99381-99429. Code selection is based on the age of the patient and whether the patient is new/established. The removal of the polyp is a biopsy. Look in the CPT® Index for Cervix/Biopsy and you are referred to codes 57500 and 57520. The correct code to report is 57500. Modifier 25 would be appended to the E/M code to report it is separately identifiable.
A 2-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedure code(s) to report for the ER physician?
(A) 99475-25, 36555.
(B) 99285-25, 36555, 31500, 82803.
(C) 99291-25, 36555, 31500, 82803.
(D) 99291-25, 36555, 31500.
(D) 99291-25, 36555, 31500.
According to the CPT® subsection guidelines for Inpatient Neonatal and Pediatric Critical Care: To report critical care services provided in the outpatient setting (example, emergency department or office) for
neonates and pediatric patients of any age, see the Critical Care codes 99291, 99292; do not report 99475. There is documentation in which the ER physician spent a total of 30 minutes on a critical patient; report 99291 for the critical care; do not report 99285. Blood gas (82803) is a lab procedure that is not separately reported when billing for critical care. A list of services included in reporting critical care is found in the subsection guidelines under Critical Care Services. Modifier 25 needs to be appended to 99291 because it is an evaluation and management service in which billable procedures were performed on the same date of service. Code 36556 for the catheter placement and code 31500 for the intubation are billable codes and should be reported separately.
What is the CPT® code for a diagnostic amniocentesis?
(A) 59001.
(B) 59851.
(C) 59012.
(D) 59000.
(D) 59000.
Look in the CPT® Index for Amniocentesis, Diagnostic and you are referred to 59000. Verify code in the numerical section.
A 68-year-old female with end-stage-renal disease is having a non-tunneled central venous catheter placed. Patient is placed under moderate conscious sedation and
needle punctured the internal jugular vein in which a guide wire was inserted. A catheter was inserted over the guidewire and the final catheter tip resided in the
superior vena-cava. The patient was monitored by nurse and the patient was under sedation for 30 minutes. The codes reported are 36556, 99152, 99153. Are these codes reported correctly? If not, what code(s) are used for this procedure?
(A) Yes, codes are reported correctly.
(B) No, codes reported are 36558, 99152, 99153.
(C) No, only code 36556 is reported.
(D) No, only code 36558 is reported.
(A) Yes, codes are reported correctly.
This is a non-tunneled catheter being inserted, code 36558 is for a tunneled catheter and it is not reported. In the CPT® Index look for Central Venous Catheter Placement/ Insertion/Central/Non-tunneled, leads you to 36555-36556. For the conscious sedation, look in the Index for Sedation/Moderate/with Independent Observation and you are directed to 99151-99153. Because the patient is over 5 years old, 99152 is reported for the first 15 minutes and 99153 is reported for the additional 15 minutes.
