MBC 3100 CODING PREP MIDTERM EXAMS

MBC 3100 CODING PREP MIDTERM EXAMS 1. Patient presents with malignant neoplasm of the breast with metastasis to the uterus. Primary site has been treated and is no longer present. Patient presents for chemotherapy. • Z51.11, C79.82, Z85.3 • Z51.11, C79.82 • Z51.11, C50.911, C79.82 • C50.911, C79.82, Z51.11 (Note: Since the chief reason for the encounter is chemotherapy, a Z code, specifically Z51.11 would be required. The documentation states that the malignant neoplasm is no longer present; therefore, the metastatic uterine site is the treatment site, which would be assigned a secondary neoplasm code. Secondary neoplasm codes begin with the C77 series through C99 series; therefore, the code C79.82 would be listed second, followed by a code for personal history of malignant breast neoplasm, a Z code as well, Z85.3.) 2. Metastatic neoplasm of the spine • C79.51 • D48.0 • C41.2 • C79.51, C80.1. (Note: The metastatic neoplasm of the spine is the chief reason for the encounter; therefore, C79.51, secondary neoplasm, spine, would be listed first, followed by a code for the primary site, which, in this case, was not stated. Hence, C80.1 would be listed to indicate unspecified site.) 3. Right kidney mass • N28.89 • N28.9 • R19.07 • N28.1. (Note: Since there is no specific code for kidney mass, the condition would be coded to “other” conditions of kidney/ureter, code N28.89. N28.1 is for an acquired kidney cyst, not a mass. N28.9 is for disease of the kidney or ureter not otherwise specified, while R19.07 is an intraabdominal mass or swelling, not one of the kidney/ureters which would not be intraabdominal.) 4. Injection, methotrexate, 100 mg • J9260 • J9250 • J9250 X 2 units • J9260 X 2 units (Note: As HCPCS code J9260 is for 50 mg, two (2) units of service would need to be assigned. Therefore, the correct answer would be J9260 × 2 units for a total of 100 mg of methotrexate. Code J9250 is for two (2) units of methotrexate, that is, 5 mg each, which would only equal 10 mg. Code J9250 would be for one (1) unit only of methotrexate, that is, 5 mg. Code J9260 would be for one (1) unit only of methotrexate, that is, 50 mg when 100 mg was actually administered.) 5. When fracture is not specified as open or closed, it should • be coded as open. • be coded as closed. • not be coded. • be determined how to code by referring to surgical procedure. (Note: According to coding guidelines, when additional information is necessary, but not documented, the coder should assume “the least significant.” Therefore, in this instance, a closed fracture would be less significant than an open fracture, and therefore, a closed fracture code would be assigned. Since the remaining three (3) selections are not the “least significant,” they would be incorrect.) 6. Patient presents to the physician's office with complaints of high blood pressure, chest tightness, and dizziness. An expanded problem-focused history and exam and low MDM are performed before the patient is instructed to present for admission to the local hospital. The physician sees the patient later in the afternoon for admission, where a comprehensive history and exam and moderate MDM are performed on admission. What services are appropriate to be coded/billed by this physician? • The hospital admission only would be appropriate. • The office visit only would be appropriate. • Both an office visit and the hospital admission are appropriate. • Both an office visit and the hospital admission with modifier -25 appended to the subsequent service. (Note: In general, each provider is allowed one E/M per day (there are some exceptions, such as critical care). Therefore, if the patient is seen more than once by the same provider, only one service would be assigned. While the office visit could be assigned for this encounter, CPT guidelines indicate either may be billed. Since the hospital admission code is more significant, it would be advisable to assign the hospital admission only for these services.) 7. Patient presents with nausea, vomiting, and was determined to be suffering from dehydration. IV Normal Saline was administered from 9:00 AM to 9:45 AM for dehydration. Phenergan was administered IVP at 11:25 AM, following another IVP of Phenergan at 12:15 PM. Patient's symptoms appeared improved and the patient was released. What services would be appropriate to code/bill? • 96361, 96375, 96376 • 96374, 96375, 96361 • 96360, 96365, 96409 • 96360, 96375, 96376 (Note: Code 96360 should be assigned for the infusion of normal saline. Since this service was performed first, and appeared to be the main treatment for the patient’s condition, in physician coding, it would be assigned first and followed by the IVP of Phenergan with CPT code 96375 (only one initial infusion code may be utilized per encounter). Code 96376 should then be assigned for the subsequent IVP of the same substance. Therefore, the correct answer is 96360, 96375, 96376.) 8. Procedure Performed: Resection of 3 cm left posterior neck lesion/mass. A natural skin crease incision was made. Care was taken to reset the entire mass, however, taking care to avoid the underlying cranial nerve. Once the entire mass was resected free, the wound was closed in layers, using 3-0 chromic for the deep subcutaneous and 4-0 Propene for the skin. • 11420 • 11423, 12031 • 11423, 12041 • 11423 (Note: Two codes are appropriate; one for the excision of the lesion. Since the lesion is not stated as malignant, and additional information is not available, the lesion is assumed to be benign. Code 11423 would be assigned based on the location and size of the benign lesion. Remember the CPT guideline of assigning “the least significant” procedure in these instances. Per CPT, repair/closure may be assigned when more than a simple closure is required. Therefore, also assign code 12041 for intermediate repair. Code 11420 can be eliminated as this indicates excision of benign lesion to the trunk, arms, or legs, but the lesion was located on the neck. Codes 11423, 12041 is not appropriate as the closure code is designated for scalp, axillae, trunk, and extremities, but the closure was to the neck.) 9. A general surgeon performs both laparoscopic and open cholecystectomies as a part of their regular surgical procedures. An internal audit of these cases reveals that a number of these procedures were erroneously coded as open rather than laparoscopic. The following documentation was provided for training purposes: Procedure: Cholecystectomy. A supraumbilical incision was made, trocar was placed, and pneumoperitoneum was insufflated. Ports were placed and adhesions were taken down. The gallbladder was identified and dissected free. The gallbladder was brought out through the Endobag. What words or phrases in this example are most beneficial for training staff to recognize a laparoscopic cholecystectomy? • Supraumbilical incision, trocar(s), pneumoperitoneum, Endobag • Procedure: Cholecystectomy • Adhesions were taken down • Gall bladder was dissected free (Note: The header(s) of the operative report should never be utilized to code surgical procedures. The header indicated “cholecystectomy” only, which could be open or laparoscopic. Therefore, the body of the operative report will need to be read for key terms that indicate the approach of the procedure. The term “supraumbilical incision” indicates that a small incision was made directly above (“supra”) the umbilicus, which is the usual site for the incision for a laparoscopic procedure. In addition, trocar(s) are the instruments that are inserted to visualize the abdominal cavity and through which surgical instruments are passed for completing the procedure. A pneumoperitoneum is the inflation of the abdominal cavity with CO2 gas to “expand” the cavity for visualization and in order to effectively perform the intended procedure. The Endobag is attached to one of the surgical instruments so that once the gall bladder is freed, it is placed in the Endobag and brought through one of the sites. All of these terms would indicate that the procedure was performed laparoscopically, rather than open. The coder must keep in mind that the surgeon is not documenting his/her procedure from a coding perspective, and, in fact, performed a cholecystectomy. Therefore, the coder must read all the operative report in order to determine the actual procedure performed. While each of the other selections is “partially” correct, and certainly aids the coder in making the correct selection, the key terms “supraumbilical incision, trocar(s), pneumoperitoneum, and Endobag,” all refer to laparoscopic technique.) 10. When pathology services are provided, however, not documented as automated versus manual, what code(s) should be assigned? • Manual • Automated • automated with modifier -22 • manual with modifier -52. (Note: Remember the coding guideline that indicates when services are not specified and cannot be further clarified, assign the “least significant code.” As it related to a physician service in this case, “automated” would be the least significant service for the physician to perform. Automated services are performed primarily by laboratory equipment, with the need for the physician to provide only an interpretation of the automated report and, therefore, would be considered less significant than a manual laboratory service that would require the physician to perform manual testing, such as observance under a microscope and analysis prior to providing an interpretation and report. Automated with modifier -22 would not be appropriate as greater than the usual service was not performed (or documented) in this instance.) 11. Fracture left distal radius following fall from bus • S52.502S • S52.509A • S52.522A • S52.502A. (Note: The correct code assignment needs to include the “distal” (lower end) of the radius as well as a seventh digit for initial/active visit (A); therefore, S52.502A would be appropriate. S52.522A is for a torus fracture, but the documentation does not specify the fracture as such. S52.509A does not specify the laterality, which was specified as left.) 12. Patient with urinary incontinence presents for diagnostic testing. Cystometrogram and uroflowmetry performed and findings of urinary stress incontinence were confirmed. • N39.3 • N39.3, N39.42 • N39.46 • N39.42 (Note: Specifically, urinary stress incontinence was diagnosed at the conclusion of the urodynamics testing. Since urinary incontinence is part of urinary stress incontinence, only N39.3 is assigned, located under Incontinence, Urinary, Stress, ICD-10 code N39.3. N39.3 and N39.42 would be inappropriate. N39.42 is for incontinence without sensory awareness, and N39.46 is for mixed incontinence. However, the documentation did not reflect this diagnosis. N39.42 is for incontinence without sensory awareness which was not documented either.) 13. Patient presents to clinic, status postarthroscopy of left knee 7 days ago for follow-up. Problem-focused history and exam and straightforward MDM were performed. What code(s)/modifier(s) would be appropriate for this encounter? • No CPT code assigned • 99212 • 99024 • 99212-24 (Note: All surgical procedures include a defined global surgical period that covers the normal preoperative, operative, and uncomplicated, postoperative care. Therefore, CPT code 99024, postoperative visit, would be assigned for this service, for which there is no value/charge. It is assigned for tracking purposes only, and, since it is a “0” charge, usually does not print on the claim or get submitted to the carrier.) 14. Provider documents the diagnosis as both chronic kidney disease stage 4 and end-stage renal disease. • N18.6, N18.5 • N18.5 • N18.6 • N18.9, N18.5. (Note: Since end-stage renal disease is more specific than chronic kidney disease, the most severe stage would be assigned, end-stage renal disease code N18.6. Codes 18.6 and N18.5 do not need to be assigned, only the most severe stage would be reported. N18.5 is for chronic kidney disease, stage 5, which was not documented. N18.9 and N18.5 would be for chronic kidney disease, stage 5, as well as unspecified chronic kidney disease. The chronic kidney disease, was, in fact, specified, so utilizing the unspecific chronic kidney code would not be appropriate.) 15. Malignant hypertension with CHF • I50.9, I10 • I50.9 • I10 • I11.0, I50.9. (Note: ICD-10 guidelines indicate that a causal relationship exists between hypertension and heart disease, therefore, a combination code may be assigned for this condition, I11.0. However, coding guidelines, indicate that an additional code should be assigned when the type of heart disease is known. In this case, congestive heart failure is identified, therefore, I50.9 should also be assigned.) 16. Initial visit for a greenstick femur fracture, right • S72.8X1B • S72.441A • S72.444A • S72.8X1A. (Note: Since the fracture was documented as a “greenstick” fracture and there is no specific ICD-10 for that specific fracture, a code from the “other” fracture right femur would be assigned, code S72.8X1A. The remaining diagnoses are for specific femur fractures, that is, open and lower epiphysis, which were not specified in this scenario.) 17. Sickle cell anemia in crisis. • D57.02 • D57.00 • D57.01 • D57.1 (Note: Although all of the codes are for sickle cell disease, only D57.00 specifies “with crisis.”) 18. When a radiology service is performed utilizing IV contrast only, how should it be coded? • modifier -51 • modifier -22 • Without contrast • With contrast (Note: Per radiology guidelines in CPT, intravenous infusion of contrast is considered “with contrast” and, therefore, should be assigned the “with contrast” code for the services. Modifiers are not necessary for radiological services for these services, and therefore, modifier -52 and modifier -22 would be incorrect answers.) 19. What should be reported for a complex extracapsular cataract extraction with intraocular lens implantation? • 66984-CX • 66982 • 66820 • 66984. (Note: For the complex cataract extraction, CPT code 66982 would be assigned. No additional codes are necessary as the intraocular lens implantation is inherent in this procedure as noted in the CPT descriptor. Code 66984-CX would be incorrect as the cataract was stated as “complex,” which codes to 66982. CPT code 68820 only indicates the removal of the cataract with no intraocular lens implantation.) 20. When locating an open wound in ICD10 in the alphabetic section, the coder would look under • contusion. • wound, open. • laceration. • abrasion. (Note: Lacerations and open wounds are now distinguished by separate codes in ICD-10. Open wounds will be found to be located under Wound, Open and the specific location. Contusions, abrasions, and lacerations are not located under open wound.) 21. Administration of penicillin G benzathine, 1.2 million units • J0561 X 12 units • J0558 • J0561 • J0520. (Note: HCPCS code J0561 is assigned for each 100,000 units administered. Since a total of 1.2 million units was performed, a total of 12 units was administered. Therefore, J0561 × 12 units would be assigned for this scenario. Code J0520 is for bethanechol chloride. Code J0558 is for both penicillin G benzathine and penicillin G procaine. Only penicillin G benzathine was administered. Code J0561 is for penicillin G benzathine, however, for only 100,000 units, whereas 1.2 million units was administered.) 22. Encounter with double vision (diplopia) of a 10-year-old due to ingestion of the parents' Prozac. • H53.2, T43.221D • H53.2, T43.221A • H53.8, T43.221A • H53.2 (Note: Two (2) codes are appropriate to code the condition that is the chief reason for the encounter (H53.2) as well as the reason for the diplopia, ingestion of Prozac. The ingestion of Prozac would be located in the Drugs and Chemicals Table under Prozac, utilizing the column “accidental” since the ingestion was not intentional, ICD-10 code T43.221A. H53.8, T43.221A is incorrect as H53.8 is for other visual defects. Since diplopia has a specific code, this answer would be incorrect. The remaining two (2) answers differ in the seventh digit for the drug. Since the condition was not stated as a subsequent encounter, the seventh digit “D” would not be appropriate.) 23. Headache NOS • G44.029 • G44.009 • R52 • R51 (Note: Headache was not specified; therefore, headache, code R51 would be assigned. G44.029 is for chronic cluster headaches, which was not specified, while G44.009 is for cluster headaches, again, not specified. R52 is for general pain, not specific to head.) 24. Suicidal ingestion of acetaminophen • T39.1X2A • T39.1X2D • T39.1X5A, T39.1X1D • T39.1X5A (Note: Since the condition is a current, active condition, the seventh digit “A” would need to be assigned, eliminating two (2) of the answers as incorrect. Of the remaining possible answers, only T39.1X2A indicates self-harm, or suicide attempt, and, therefore, would be the correct answer.) 25. When a diagnostic colonoscopy and colonoscopy with biopsy are performed during the same surgical session, what code(s) are reported? • colonoscopy with biopsy and diagnostic colonoscopy with modifier -59 • Diagnostic colonoscopy only • Colonoscopy with biopsy only • colonoscopy with biopsy and diagnostic colonoscopy. (Note: According to CPT and NCCI guidelines, only the definitive procedure is reportable. Therefore, only the colonoscopy with biopsy(ies) would be reported in this instance. Note that the diagnostic colonoscopy is designated as a “separate procedure,” which means it would only be reportable if it were the only procedure performed in that anatomical area. Appending modifier -59 to the diagnostic colonoscopy would not be considered appropriate, and it is not considered “separate and distinct.”)