CPC Chapter 17- Radiology Review Questions

Question 1

The axial plane divides the body into what sections?
A.Left and right
B.Posterior and anterior
C.Front and back
D.Superior and inferior

Answer 1

D. Superior and inferior

Rationale: The axial plane, also known as the transverse plane, slices the body horizontally and cuts the body into inferior and superior sections.

Question 2

What position is the body placed in when it is in an oblique position?
A.Lying on the back, face up
B.Lying down, face down
C.At an angle, neither frontal nor lateral
D.Lying on the side

Answer 2

C. At an angle, neither frontal nor lateral

Rationale: An oblique position is a slanted position where the patient is lying at an angle which is neither prone nor supine.

Question 3

What X-ray projection enters the front of the body and exits through the back of the body with the patient lying down on the back?
A.AP
B.PA
C.Lateral
D.Oblique

Answer 3

A. AP

Rationale: AP is the abbreviation for anteroposterior where the projection enters the front of the body and exits through the back of the body. Because the patient is lying on their back, it cannot be oblique.

Question 4

Which plane divides the body into anterior and posterior sections?
A.Sagittal
B.Axial
C.Transverse
D.Coronal

Answer 4

D. Coronal

Rationale: The coronal plane is also known as the frontal plane and divides the body into front (anterior) and back (posterior) sections.

Question 5

The path of the X-ray beam is known as?
A.Position
B.Projection
C.Plane
D.Sight of vision

Answer 5

B. Projection

Rationale: The projection is the path the X-ray beam takes through the body.

Question 6

Mary visited her family physician for a lump in the upper outer quadrant of her left breast. The physician ordered a mammogram to rule out breast cancer. The radiologist did not find any abnormal findings. What diagnosis is reported for the professional portion of the mammography?
A. C50.412
B. N63.21
C. D24.2
D. Z12.31

Answer 6

B. N63.21

Rationale: When a test is ordered for a sign or symptom, and the outcome of the test is a normal result with no confirmed diagnosis, the coder reports the sign or symptom that prompted the physician to order the test. Because the test was ordered for a lump in the breast, but the outcome is normal, the lump in the breast, N63 is reported as the diagnosis. In the ICD-10-CM Alphabetic Index, look for Lump/breast/left/upper outer quadrant which directs you to N63.21. Verify code selection in the Tabular List.

Question 7

A young boy presents to the emergency department with pain in his lower left leg after being kicked in a soccer game. The X-ray report reveals a fractured tibia and fibula. What diagnosis code(s) should the radiologist report for reading the X-ray? Do not report the external cause code(s).
A. M79.609
B. S72.8X2A
C. S82.311A
D. S82.202A, S82.402A

Answer 7

D. S82.202A, S82.402A

Rationale: The final diagnosis is available at the time of reporting and is used instead of the sign or symptom. The final diagnosis of a fracture of the tibia and fibula is reported. In the ICD-10-CM Alphabetic Index, look for Fracture, traumatic/tibia (shaft) S82.20-. Verify code selection in the Tabular List. In the Tabular List, a 6th character 2, is reported for the left side and the 7th character A, is reported for the initial encounter. Final code choice: S82.202A.

Next, look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/fibula (shaft) (styloid) S82.40-. Verify code selection in the Tabular List. In the Tabular List, 6th character 2, is reported for the left side and the 7th character A is reported for the initial encounter. Final code choice is S82.402A.

Question 8

A patient with sinusitis and left vocal cord paralysis is sent for a CT scan of the brain. The impression is vague, low-density white matter changes in the right frontal region. This is a nonspecific finding. The radiologist requests an MRI scan for further characterization. What diagnosis code(s) should the radiologist report for the reading of the CT?
A. J32.9, J38.00
B. R93.0, J32.9, J38.01
C. R93.0
D. J38.00

Answer 8

B. R93.0, J32.9, J38.01

Rationale: The findings of the CT were nonspecific and are not considered a final diagnosis. The first diagnosis reports the nonspecific findings. Because the findings were inconclusive, you also report the signs and symptoms for which the CT was ordered. In the ICD-10-CM Alphabetic Index, look for Findings, abnormal, inconclusive, without diagnosis/radiologic (X-ray)/head R93.0. Next, look in the Alphabetic Index for Sinusitis J32.9. The last code is found in the Alphabetic Index under Paralysis/vocal cords/unilateral J38.01. Verify all code selections in the Tabular List.

Question 9

Mr. Davis has his yearly preventive medicine exam. The physician orders a chest X-ray as a part of the preventive exam. What diagnosis is reported for the chest X-ray?
A. Z01.811
B. Z00.01
C. Z00.00
D. Z02.9

Answer 9

C. Z00.00

Rationale: For encounters for routine radiology testing in the absence of any signs, symptoms, or associated diagnosis, assign Z00.00. Because there were no signs or symptoms for the chest X-ray, and it was routinely performed as part of a preventive medicine exam, ICD-10-CM Z00.00 is reported. In the ICD-10-CM Alphabetic Index, look for Examination/annual (adult) or Examination/radiological (as part of a general medical examination) Z00.00. In the Tabular List, the note under subcategory code Z00.0 indicates the code is for an, “Encounter for adult periodic examination (annual) (physical) and any associated laboratory and radiologic examinations.”

Question 10

A 63-year-old female is having a hip arthroplasty due to severe rheumatoid arthritis in the hip. During her pre-operative exam, a chest X-ray is taken. What diagnosis is reported for the chest X-ray?
A. M06.9
B. Z01.810
C. Z01.811
D. Z01.818

Answer 10

D. Z01.818

Rationale: The pre-operative exam is a general preoperative exam. When an X-ray is performed as part of a general preoperative exam, ICD-10-CM code Z01.818 is reported. In the ICD-10-CM Alphabetic Index, look for Examination/pre-operative - see Examination, pre-procedural. Examination/pre-procedural/specified NEC Z01.818. Verify code selection in the Tabular List.

Question 11

A contrast radiograph of the salivary glands and ducts is performed, resulting in a diagnosis of salivary fistula. What are the CPT® and ICD-10-CM codes for the supervision and interpretation of this procedure?
A. 70380-26, K11.5
B. 70380-26, K11.3
C. 70390-26, K11.5
D. 70390-26, K11.4

Answer 11

D. 70390-26, K11.4

Rationale: Contrast radiography of the salivary gland and ducts is considered sialography. Code 70390 describes sialography supervision and interpretation. Look in the CPT® Index for Salivary Glands/X-ray/with contrast. The patient is diagnosed with a salivary fistula, which is found in the ICD-10-CM Alphabetic Index under Fistula/salivary duct or gland K11.4. Verify code selection in the Tabular List.

Question 12

CT images of the abdomen and pelvis were obtained without IV contrast as a follow up to a splenic injury. Code the CT scan.
A. 74019
B. 72170
C. 74176
D. 74170, 72194

Answer 12

C. 74176

Rationale: Both CT of the abdomen and of the pelvis were obtained. There is one code to report for both anatomical areas taken at the same time. The “without contrast” codes are used. Look in the CPT® Index for CT Scan/without Contrast/Abdomen or Pelvis.

Question 13

A parent brings a child to the Emergency Department after realizing the child swallowed a metal jack. A radiological exam from the nose to the rectum is performed. Code this service.
A. 70160-26, 70370-26, 71045-26, 74240-26, 74248-26
B. 76010-26
C. 70160-26, 70360-26, 71046-26, 74240-26, 74248-26
D. 70160-26, 70370-26, 74240-26, 74248-26

Answer 13

B. 76010-26

Rationale: Look in the CPT® Index for X-ray/Nose to Rectum/Foreign Body 76010. Turning to 76010 in the numeric section, this code is applicable to a child for a single view.

Question 14

A patient presents to her physician with right eye pain, nasal airway obstruction, and deformity 48 hours after an assault. The physician orders an X-ray of the facial bones with a Waters view, Caldwell view, and a lateral view. What is the CPT® code for the X-ray?
A. 70486
B. 70220
C. 70150
D. 70140

Answer 14

C. 70150

Rationale: Three views of the facial bones (Waters’ view, Caldwell view, and lateral view) were ordered. Look in the CPT® Index for X-ray/Facial Bones, 70140-70150. Code 70150 is for a complete, minimum of three views X-ray of the facial bones.

Question 15

A patient presents to the physician with stiffness and numbness in the neck, shoulders, and arms. The physician orders an MRI of the cervical spine, without and with contrast, to rule out cervical spinal stenosis. Code the MRI.
A. 72020
B. 72127
C. 72141, 72142
D. 72156

Answer 15

D. 72156

Rationale: Look in the CPT® Index for Magnetic Resonance Imaging (MRI)/Diagnostic/Spine/Cervical, 72141-72142, and 72156. Because both without contrast and with contrast were used for this cervical MRI, CPT® code 72156 is selected.

Question 16

During a physical examination hepatomegaly is revealed. The physician orders an ultrasound of the liver to evaluate the hepatomegaly. What CPT® code is reported?
A. 74018
B. 76705
C. 74022
D. 76700

Answer 16

B. 76705

Rationale: Ultrasound of the abdomen includes the liver, gallbladder, common bile duct, pancreas, spleen, kidneys, and the upper abdominal aorta and inferior vena cava. Because the ultrasound was of only the liver, it is considered a limited abdominal ultrasound. Look in the CPT® Index for Ultrasound/Abdomen.

Question 17

A patient 20 weeks pregnant with twins goes to her OB/GYN for an ultrasound to check the position of both fetuses. Code the ultrasound.
A. 76805, 76810
B. 76816
C. 76816, 76810
D. 76815

Answer 17

D. 76815

Rationale: The ultrasound is limited because the position of the fetuses is all that the ultrasound is verifying. Look in the CPT® Index for Ultrasound/Obstetrical/Pregnant Uterus. The description of 76815 includes one or more fetuses and the code is reported once only.

Question 18

A complete B-scan ultrasound without duplex Doppler of the kidney is performed in the physician’s office on a patient following a kidney transplant. What is the CPT® code for the ultrasound?
A. 76705
B. 76775
C. 76776
D. 76811

Answer 18

B. 76775

Rationale: Look in the CPT® Index for Ultrasound/Kidney, 76770-76776. CPT® code 76776 is an ultrasound for a transplanted kidney, including real-time and duplex Doppler with image documentation. A duplex Doppler of the kidney is not performed. The parenthetical instruction under CPT® 76776 indicates to report 76775 for an ultrasound of transplanted kidney without duplex Doppler. The correct code is 76775.

Question 19

A patient with left breast pain and a lump in the breast visits her physician. After examination, the physician orders a mammogram of the left breast. The mammography is performed using computer-aided detection software. Code the mammography.
A. 77066
B. 77067
C. 77065
D. 77061

Answer 19

C. 77065

Rationale: The physician ordered a unilateral diagnostic mammogram with computer-aided detection (CAD). Code 77065 describes a diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.

Question 20

The use of ultrasound to examine and measure internal structures of the skull and to diagnose abnormalities and disease is echoencephalography. What is the code for echoencephalography and/or real time with image documentation, including A-mode encephalography as a secondary component where indicated?
A. 76506
B. 76510
C. 76511
D. 76512

Answer 20

A. 76506

Rationale: An echoencephalography is performed to identify any abnormalities or disease(s). Look in the CPT®Index for Echoencephalography/Intracranial, code 76506.

Question 21

A patient receives complex radiation oncology treatments two times a day for three days. Code this series of clinical management fractions.
A. 77427 x 3, 77431 x 3
B. 77427
C. 77525 x 3, 77523 x 3
D. 77427, 77431

Answer 21

B. 77427

Rationale: Radiation therapy management is based on the number of fractions. Each time the patient receives the radiation is considered a fraction. If the patient receives radiation two times in one day, it is considered two fractions. This patient had a total of 6 fractions of radiation. Code 77427 indicates five fractions. According to the radiation treatment management guidelines, when a patient has one or two fractions left at the end of a course of treatment, it is not separately billable. Code 77431 is used when the entire course of treatment consists of only 1 or 2 fractions. The correct code to report for the management is 77427. Look in the CPT® Index for Radiation Therapy/Treatment Management/Weekly.

Question 22

A DXA body composition study is performed on a patient. Code the scan.
A. 77080, 77081
B. 77080
C. 77086
D. 76499

Answer 22

D. 76499

Rationale: Dual energy X-ray absorptiometry (DXA) studies are indexed under Dual X-ray Absorptiometry (DXA) in the code range 77080-77086. Under 77081 is a parenthetical instruction stating to use 76499 for a DXA body composition study.

Question 23

A male patient being treated for prostate cancer receives brachytherapy treatment. Twelve radioactive seeds are interstitially applied within the prostate. What is the CPT® code for the radiological component?
A. 0395T
B. 77778
C. 77771
D. 77789

Answer 23

B. 77778

Rationale: In this case, brachytherapy is performed using interstitial application of radiation seeds. According to the Radiology Guidelines, a complex application has greater than 10 sources, which is reported with code 77778. Review the CPT® coding guidelines for the definition of simple, intermediate, and complex for clinical brachytherapy. Look in the CPT® Index for Brachytherapy/Interstitial Application 0395T, 77778.

Question 24

Patient is in the orthopedist office with an injured ankle. The orthopedist thinks it is only a sprained ankle but decides to take an ankle X-ray to rule out a fracture. A two-view ankle X-ray is taken in the physician’s office. The orthopedist reviews the ankle X-ray and it is negative for a fracture. The report is placed in the medical record. How is the X-ray reported by the orthopedist?
A. 73600-26
B. 73600-TC
C. 73600-26-TC
D. 73600

Answer 24

D. 73600

Rationale: In this case, no modifiers are reported with the CPT® code; you report the global procedure. Because the ankle X-ray was taken in the physician’s office (meaning the office owns the equipment) and the physician reads the X-ray and provides a report, the CPT® code is reported without a modifier. The global service 73600 includes both the professional and technical components.

Question 25

A patient with osteoporosis reports to her physician’s office for a DXA bone density study of her spine to monitor the severity of her condition. What is the correct CPT® code for the DXA scan?
A. 77080
B. 77081
C. 77086
D. 77081-52

Answer 25

A. 77080

Rationale: DXA is dual-energy X-ray absorption. The site is of the spine, which is part of the axial skeleton. In the CPT® Index, look for DXA and you are directed to see Dual X-ray Absorptiometry (DXA); Dual X-ray Absorptiometry (DXA)/Axial Skeleton. In this case, one site (spine) is involved in the study. The correct code is 77080.

Question 26

Which anatomic position has the patient lying at an angle instead of lying flat or directly on their side?
A. Lateral
B. Supine
C. Oblique
D. Prone

Answer 26

B. Oblique

Rationale: The oblique position is a slanted position where the patient is lying at an angle that is neither prone nor supine.

Question 27

A patient arrives at the urgent care facility with a swollen ankle. Anteroposterior and lateral view X-rays of the ankle are taken to determine whether the patient has a fractured ankle. What CPT® code(s) is/are reported?
A. 73610
B. 73600, 73610
C. 73600 x2
D. 73600

Answer 27

D. 73600

Rationale: In the CPT® Index look for X-ray/Ankle and you are guided to range 73600-73610. There were two views taken (anteroposterior and lateral views), so CPT® code 73600 is correct.

Question 28

AP and Lateral chest X-rays were performed for a cough. What CPT® and ICD-10-CM codes are reported?
A. 71046, R05.9
B. 71045, R05.9
C. 71045, F45.8
D. 71046, F45.8

Answer 28

A. 71046, R05.9

Rationale: In the CPT® Index look for X-ray/Chest and you are guided to code range 71045-71048. In looking at the descriptions, this is a 2-view chest X-ray. In the AP (Anteroposterior) position the X-ray beam enters the front of the body and exits through the back. In the lateral position, the X-ray beam enters through the side of the body. This is reported with 71046. Look in the ICD-10-CM Alphabetic Index for cough and you are directed to R05.9.

Question 29

The patient presents for a screening CT colonography. What CPT® code(s) is/are reported?
A. 74150, 74263
B. 74261
C. G0121
D. 74263

Answer 29

D. 74263

Rationale: The patient presents for a colonography. In the CPT® Index look for Colonography/CT Scan/Screening. You are referred to 74263. Refer to the code descriptions to confirm selection of the correct code. The purpose of the test is for a screening. 74263 is the correct code.

Question 30

A patient on estrogen replacement therapy (ERT) receives a DXA study of the hips. What is the CPT® code reported for the bone density study?
A. 77080
B. 77078
C. 77077
D. 77081

Answer 30

A. 77080

Rationale: In the CPT® Index look under Bone Density Study/Axial Skeleton/Dual Energy X-ray Absorptiometry (DXA) referring you to 77080, 77081, 77085. Review in the numeric section shows 77080 for axial skeleton is the correct code for reporting DXA study of the hips.

Question 31

A patient needing scoliosis measurements is coming in to have standing anteroposterior and lateral views of his entire thoracic and lumbar spine. What CPT® code(s) is/are reported for radiology?
A. 72082
B. 72084
C. 72083
D. 72040, 72070, 72100

Answer 31

A. 72082

Rationale: X-rays of the thoracic and lumbar (thoracolumbar) spine are being taken. In the CPT® Index look for X-ray/Spine/Thoracolumbar. Reviewing the code range in the Radiology Section, because anteroposterior and lateral, two views, of the spine are done for scoliosis, guides you to code 72082.

Question 32

A 25-year-old female in her last trimester of her pregnancy comes into her obstetrician’s office for a fetal biophysical profile (BPP). An ultrasound is used to first monitor the fetus’ movements showing three movements of the legs and arms (normal). There are two breathing movements lasting 30 seconds (normal). Non-stress test (NST) of 30 minutes showed the heartbeat at 120 beats per minute that increased with movement (normal or reactive). Arms and legs were flexed with fetus’ head on its chest, opening and closing of a hand. Two pockets of amniotic fluid at 3 cm were seen in the uterine cavity (normal). Biophysical profile scored 9 out of 10 points (normal or reassuring). What CPT® code is reported by the obstetrician?
A. 76819
B. 76815
C. 76818
D. 59025, 76818

Answer 32

C. 76818

Rationale: A biophysical test (BPP) measures the health of the fetus during pregnancy. Points are given (0, 1 or 2) in five areas (fetal movement, tone, heart rate, breathing, amniotic fluid volume). This is found in the CPT® Index by looking for Fetal Biophysical Profile directing you to 76818, 76819. A non-stress test (NST) monitors the baby’s heart rate over a period of 20 minutes or more looking for accelerations with the baby’s movements. Because fetal non-stress testing is included in code 76818, code 59025 is not reported separately.

Question 33

A 66-year-old male with a history of anemia presents for a liver core biopsy to evaluate for possible cirrhosis. The patient was brought to the CAT scan suite in which limited CT images of the upper abdomen were performed for biopsy needle placement. The appropriate site for the liver core biopsy was chosen. The patient’s skin was then marked with the computer coordinates. An 18-gauge needle was advanced into the appropriate site and a sample was obtained. What CPT® codes are reported?
A. 47100, 76942-26
B. 47000, 77002-26
C. 47000, 77012-26
D. 47100, 74150-26

Answer 33

C. 47000, 77012-26

Rationale: Biopsy of the liver is taken by a needle (percutaneous) under computed tomography guidance (CT). In the CPT® Index look for Biopsy/Liver. Code 47000 describes a percutaneous needle biopsy of the liver. Below CPT code 47000 you are given codes for imaging guidance. Code 77012 describes the CT guidance for needle placement. Modifier 26 is appended to indicate the professional service.

Question 34

A patient with hydronephrosis has a left nephrostomy and he has agreed to a pyelography (IVP) to rule out a right renal obstruction. The patient was placed prone on the X-ray table one hour after IV infusion of contrast. Contrast flowed from the left and right renal pelvis, down the ureters into the bladder where a Foley catheter was positioned. The IVP showed no obstruction or abnormalities in the urinary tract aside from the left hydronephrosis of the pelvis. The right kidney and ureter showed no obstruction. Bladder appeared within normal limits. What CPT® code is reported for the radiological services?
A. 74420-26
B. 74400-26
C. 74415-26
D. 74425-26

Answer 34

B. 74400-26

Rationale: A radiographic exam of the urinary tract is performed with IV injection of contrast medium and radiographs are taken. This is performed to assess the anatomy and function of the kidneys, bladder, and ureters. In the CPT® Index look for X-ray/with Contrast/Urinary Tract or Urography/Intravenous. Reviewing the codes in the numeric section leads you to report 74400 for an intravenous pyelography. Modifier 26 is appended to indicate the professional service.

Question 35

A patient 14 weeks pregnant is coming back to her obstetrician’s office for a repeat transabdominal ultrasound to measure fetal size and to confirm abnormalities seen in a previous scan. The obstetrician documented the ultrasound results in the medical record. What CPT® code is reported by the obstetrician?
A. 76805
B. 76805-26
C. 76816-26
D. 76816

Answer 35

D. 76816

Rationale: The patient is coming back for a follow-up (repeat) ultrasound to re-evaluate conditions affecting the fetus seen on the last ultrasound scan. In the CPT® Index look for Ultrasound/Obstetrical/Pregnant Uterus. The correct code for a follow-up ultrasound is 76816. No modifier 26 is needed because the ultrasound and the interpretation of the results were performed in the obstetrician’s office.

Question 36

What ICD-10-CM codes are reported for a radiotherapy session?
A. Z51.12
B. Z51.11
C. Z51.5
D. Z51.0

Answer 36

D. Z51.0

Rationale: Look in the ICD-10-CM Alphabetic Index for Radiotherapy session which refers you to Z51.0. Verify code selection in the Tabular List.

Question 37

What ICD-10-CM code is reported for a routine screening mammogram?
A. Z12.39
B. C50.919
C. C50.929
D. Z12.31

Answer 37

D. Z12.31

Rationale: Look in the ICD-10-CM Alphabetic Index for Screening/neoplasm (malignant) (of)/breast/routine mammogram which refers you to Z12.31. ICD-10-CM only has one code to report a screening mammogram. Verify code selection in the Tabular List.

Question 38

A patient is seen in the clinic with sharp abdominal pain, vomiting and nausea, and a history of cholelithiasis. An ultrasound of the gallbladder is performed revealing she has stones in the gallbladder. What CPT® code is reported?
A. 74018
B. 76705
C. 76975
D. 76700

Answer 38

B. 76705

Rationale: The patient has a limited ultrasound performed because only a single organ (gallbladder) was examined. A complete ultrasound of the abdomen is defined in the subsection guidelines under the heading of Abdomen and Retroperitoneum. This is found in the CPT® Index by looking for Ultrasound/Abdomen directing you to 76700-76706. Pay close attention to the guidelines throughout the ultrasound codes to determine what must be examined and documented to be considered a complete exam.

Question 39

A 32-year-old patient is coming into an outpatient facility to have a catheterization performed of the uterus with saline infusion sonohysterography due to dysfunctional uterine bleeding. A previous scan showed suspected endometrial polyps. What CPT® and ICD-10-CM codes are reported?
A. 51700, 58340, 76831-26, N93.9
B. 51701, 58340, 74740-26, N92.5, N84.0
C. 58340, 76831-26, N93.8, N84.0
D. 58340, 76831-26, N93.8

Answer 39

D. 58340, 76831-26, N93.8

Rationale: The uterus is being catheterized not the bladder. Look in the CPT® Index for Catheterization/Uterus/Radiology or look for Sonohysterography directing you to 58340. The catheterization is included in the code description for 58340. A parenthetical note under this code states “For radiological supervision and interpretation of saline infusion, use 76831.” Modifier 26 is reported for the professional service. The diagnosis to report is the dysfunctional uterine bleeding, which is found in the ICD-10-CM Alphabetic Index by looking for Bleeding/uterus, uterine NEC/dysfunctional of functional which guides you to code N93.8. According to ICD-10-CM guideline IV.H you do not code for a condition documented as suspected such as the endometrial polyps in the outpatient setting.

Question 40

A patient who may have a stricture of the artery is undergoing an aortogram in which the left femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta. Contrast medium was injected, and films taken by serialography showing the aortoiliac inflow vessels were widely patent. The bilateral common femoral arteries appear normal. What CPT® codes are reported for the professional component?
A. 36200, 75625-26
B. 36200, 75805-26
C. 36200, 75630-26
D. 36200-75635-26

Answer 40

C. 36200, 75630-26

Rationale: The patient is having abdominal aortography, which is a radiographic visualization of the aorta and its branches. It was performed by injecting contrast medium through a catheter to see if there is an aneurysm, atherosclerotic disease or trauma to the aorta. The nonselective catheterization of the aorta is found in the CPT® Index under Catheterization/Aorta. Code 36200 is correct for the Introduction of the aorta. In the CPT® Index look for Serialography/Aorta. A review of the codes in the numeric section code 75630 is correct to report because it includes serialography abdomen plus bilateral ileofemoral lower extremity.

Question 41

A 70-year-old female presents with a complaint of right knee pain with weight bearing activities. She is also developing pain at rest. She denies any recent injury. There is pain with stair climbing as well as start-up pain. AP, Lateral and Sunrise views of the right knee are ordered and interpreted. They reveal calcification within the vascular structures. There is decreased joint space through the medial compartment where she has near bone-on-bone contact, flattening of the femoral condyles, no fractures noted. The diagnosis is right knee pain secondary to underlying primary localized degenerative arthritis. What CPT® and ICD-10-CM codes are reported?
A. 73562, M17.11
B. 73565, M17.11, M25.561
C. 73562, M17.9, M25.561
D. 73560, M17.11

Answer 41

A. 73562, M17.11

Rationale: Look in the CPT® Index for X-ray/Knee which directs you to 73560-73564, 73580. Code 73562 reports three views of one knee. The scenario is reported with one ICD-10-CM code. Look in the ICD-10-CM Alphabetic Index for Arthritis/degenerative which states to see Osteoarthritis. Look for Osteoarthritis/knee which guides you to code M17.1. A 4th character is reported for laterality. Report code M17.11 for the right knee. You do not report the ICD-10-CM code for knee pain as this is a symptom of the degenerative arthritis and included in the code.

Question 42

What ICD-10-CM code is reported for an adverse effect to diagnostic iodine, initial encounter?
A. T49.0X1A
B. T49.0X5A
C. T50.995A
D. T50.8X5A

Answer 42

D. T50.8X5A

Rationale: Look in the ICD-10-CM Table of Drugs and Chemicals for Iodine/diagnostic. Report the code from the Adverse effect column which refers you to T50.8X5-. In the Tabular List T50.8X5 requires a 7th character. A is reported for the initial encounter.

Question 43

A Computed tomography scan (CT) confirms improper ossification of cartilages in the upper jawbone and left side of the face of a patient with facial defects. A CT scan is performed with contrast material in the hospital. What CPT® code is reported by an independent radiologist contracted by the hospital?
A. 70460-26
B. 70481-26
C. 70487-26
D. 70542-26

Answer 43

C. 70487-26

Rationale: The CT scan with contrast is performed on the maxillofacial area. The maxilla is the upper part of the jawbone. In the CPT® Index look for CT Scan/with Contrast/Maxilla directing you to 70487. Modifier 26 denotes the professional service.

Question 44

A CT study of the lumbar spine (L2–L4) was performed with IV contrast in the hospital outpatient radiology department and the interpretation of the images is performed by the radiologist. What CPT® code(s) should be reported by the radiologist who is not an employee of the hospital?
A. 72132
B. 72132-TC
C. 72132-26
D. 72132-26, 72132-TC

Answer 44

C. 72132-26

Rationale: Look in the CPT® Index for CT Scan/with Contrast/Spine/Lumbar which directs you to 72132. Modifier 26 is appended to the radiological service for the professional service. The hospital would also bill the radiological service for the technical component as the hospital owns the equipment used for the service.

Question 45

A 55-year-old female is having a diagnostic mammogram performed on her left breast because a screening mammogram detected density in the breast. What CPT® and ICD-10-CM codes are reported?
A. 77046-LT, Z12.31, R92.30
B. 77066-LT, Z12.39, R92.30
C. 77065-LT, R92.30
D. 77067-LT, R92.30

Answer 45

C. 77065-LT, R92.30

Rationale: Diagnostic mammograms differ from screening mammograms. The examination focuses specifically on an area of breast tissue appearing abnormal in a screening mammogram. In the CPT® Index look for Mammography; or look for Breast/Diagnostic Imaging/Mammography, Diagnostic. The mammogram was performed only on the left breast (unilateral) reporting code 77065 and appending the LT modifier. Because this is not a screening mammogram, the Z codes for screening would be inappropriate to report. In the ICD-10-CM Alphabetic Index look for Dense breasts which has a see also Density, breast. Density / breast refers you to code R92.30. Verify code selection in the Tabular List.

Question 46

A patient in her 2nd trimester with a triplet pregnancy is seen in the obstetrician’s office for an obstetrical ultrasound only for obtaining fetal heartbeats and position of the fetuses. What CPT® code(s) is/are reported for the ultrasound?
A. 76814 X3
B. 76811, 76812, 76812
C. 76815
D. 76805, 76810, 76810

Answer 46

C. 76815

Rationale: This is a limited ultrasound performed on three fetuses. Look in the CPT® Index for Ultrasound/Obstetrical/Pregnant Uterus. CPT® code 76815 has in its code description the ultrasound is for 1 or more fetuses. There is also a parenthetical note stating Use 76815 only once per exam and not per element.

Question 47

The patient has malignant ascites due to ovarian cancer. She is coming back to the operating room for a planned ultrasound guided abdominal paracentesis. This is the second time she has needed fluid removed from her abdominal cavity. The global days for the initial abdominal paracentesis are zero. What CPT® and ICD-10-CM codes are reported?
A. 49083, C56.9, R18.0
B. 49082, 77012-26, R18.0, C56.9
C. 49083-78, 77002-26, R18.0
D. 49082-76, 76942-26, R18.0, C56.9

Answer 47

A. 49083, C56.9, R18.0

Rationale: The patient is coming in for a subsequent (second or staged) abdominal paracentesis. In the CPT® Index look for Paracentesis/Abdomen directing you to 49082, 49083. Code 49083 includes imaging guidance, so the radiology codes are not separately reported. 49083 does not have a post-operative period because it has 000 for the global days indicator. Modifier 58 is not required.

Look in the ICD-10-CM Alphabetic Index for Cancer and you are directed to see also Neoplasm, by site, malignant. Go to the ICD-10-CM Table of Neoplasms and look for Neoplasm, neoplastic/ovary and select from the Malignant Primary (column) guiding you to code C56.-. In the Tabular List a 4th character is reported to complete the code. Malignant ascites is found by looking for Ascites/malignant which directs you to code R18.0. In the Tabular List there is a code first note under code R18.0 indicated to “Code first malignancy, such as: malignant neoplasm of ovary (C56.-); secondary malignant neoplasm of retroperitoneum and peritoneum (C78.6).” This means the malignant ascites is reported as a secondary code and the ovarian cancer is reported as the primary diagnosis code.

Question 48

Myocardial Perfusion Imaging (MPI)—Office Based Test
Indications: Chest pain.
Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion.
Findings: This is a technically fair study. There was no stress induced electrocardiographic changes noted. There were no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%.
Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. What CPT® code(s) is/are reported?
A. 78454
B. 78452
C. 78453
D. 78472

Answer 48

B. 78452

Rationale: Tomographic myocardial perfusion imaging was performed. In this procedure the patient receives an intravenous injection of a radionuclide which localizes in nonischemic tissue. SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. In the CPT® Index look for Heart/Myocardium/Perfusion Study which directs you to 78451-78454. The MPI was performed at rest and exercise (which is stress), reporting code 78452 for multiple studies.

Question 49

A young child is taken to the OR to reduce a meconium plug bowel obstruction. A therapeutic enema is performed with fluoroscopy. The patient is in position and barium is instilled into the colon through the anus for the reduction. What CPT® code is reported by the independent radiologist for the radiological service?
A. 74270-26
B. 74280-26
C. 74246-26
D. 74283-26

Answer 49

D. 74283-26

Rationale: A therapeutic enema was performed with contrast (barium) to reduce the meconium plug (intraluminal obstruction). In the CPT® Index look for Enema/Therapeutic/for Intussusception directing you to 74283. The code description includes therapeutic enema with contrast for intraluminal obstruction. Modifier 26 denotes the professional service.

Question 50

The patient is a 63-year-old gentleman diagnosed with rectal cancer, who had a resection of the cancer performed. He now presents to have a Port-A-Cath (a central venous access device) inserted for postoperative adjuvant therapy. An 18-gauge introducer needle was inserted into the left subclavian vein through which a soft tipped guide wire was inserted into the superior vena cava under fluoroscopy. A subcutaneous pouch in the anterior part of the chest was created for the port. The catheter was then tunneled and measured to length. The dilator and introducer sheath were passed over the wire into the superior vena cava under fluoroscopic guidance. The catheter was passed through the sheath and the port was applied with good venous return. What CPT® codes are reported?
A. 36560, 77002-26
B. 36571, 77001-26
C. 36563, 77003-26
D. 36561, 77001-26

Answer 50

D. 36561, 77001-26

Rationale: The insertion of a tunneled Port-A-Cath via the subclavian vein (which is a central venous access device with a subcutaneous port) was performed on a 63-year-old. It is important to note, it is tunneled. The procedure was performed under fluoroscopic guidance for placement of a central venous access device. The Port-A-Cath procedure is found in the CPT® Index by looking for Central Venous Catheter Placement/Insertion/Central/Tunneled with Port directs you to 36560, 36561, 36566. Code 36561 is the correct code. If the procedure was performed going through the basilic or cephalic vein in the arm you would report code 36571. Code 36563 would be reported if a pump was placed. The guidelines for central venous access procedures instruct you to use 77001 for fluoroscopic guidance. This can be found in the CPT® Index by looking for Fluoroscopy/Guidance/Venous Access Device or Venous Access Device/Fluoroscopic Guidance directing you to add-on code 77001.