CCS QUESTIONS & ANSWERS CORRECT!!

1. A 12-year-old boy was seen in an ambulatory surgical center for pain in his right arm. The x-ray showed fracture of ulna. Patient underwent closed reduction of fracture right proximal ulna and an elbow-to-finger cast was applied. What diagnostic and procedure codes should be assigned? S52.101A Unspecified fracture of upper end of right radius, initial encounter for closed fracture S52.101B Unspecified fracture of upper end of right radius, initial encounter for open fracture S52.001A Unspecified fracture of upper end of right ulna, initial encounter for closed fracture S52.001B Unspecified fracture of upper end of right ulna, initial encounter for open fracture 0PSH0ZZ Reposition right radius, open approach 0PSK0ZZ Reposition right ulna, open approach 24670 Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without manipulation 24675 Closed treatment of ulnar fracture, proxi - ANSWERSd The patient has a fracture of the right proximal ulna and closed reduction is necessary. In the ICD-10-CM Code Book, under Fracture, ulna, proximal, the coder is referred to Fracture, ulna, upper end. The term "manipulation" is used to indicate reduction in CPT. According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure (AMA CPT Professional Edition 2020, 182). (Note: Since this is an ambulatory surgery center case, CPT codes are assigned rather than ICD-10-PCS codes.) 2. A 75-year-old male patient was admitted from a nursing home with dehydration and dysphagia due to a previous stroke. During hospitalization, the patient was rehydrated and transferred back to the nursing home. What codes should be assigned? a. E86.0, I69.390, R13.19 b. E86.1, I69.391, R13.10 c. E86.9, I69.390, R13.19 d. E86.0, I69.391, R13.10 - ANSWERSd Assign dehydration as the first listed diagnosis as it is the key circumstance of the admission and was treated. Code the previous stroke and dysphagia as additional diagnoses (CMS 2020a, Section II, 107; Section III, 110; Schraffenberger and Palkie 2020, 196). 3. Sepsis due to the presence of an indwelling urinary catheter with a positive blood culture reflected in the progress notes as Staphylococcus aureus sepsis. What codes should be assigned? a. T83.511A, A41.01 b. T83.511A, A41.9 c. T83.510A, R78.81 d. T81.4XXA, A41.01 - ANSWERSa For a diagnosis of sepsis secondary to the presence of an indwelling urinary catheter, assign an additional appropriate code for the underlying systemic infection. Category T83 classifies complications of genitourinary devices (Leon-Chisen 2020, 144-148, 543; CMS 2020a, Section I.C.1. d.1.a, 24). 4. A laparoscopic tubal ligation is completed. What is the correct CPT code assignment? 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 58662 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 58671 Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) a. 49320, 58662 b. 58670 c. 58671 d. 49320 - ANSWERSb The code that best reports the tubal ligation is 58670 Laparoscopy, surgical; with fulguration of oviducts because there are no clips or excision of lesion completed during the procedure (CPT Assistant Nov. 1999, 29; March 2000, 10). 5. A patient is admitted to an acute-care facility with chest pain. The patient was awakened from sleep by the pain. This was the patient's first experience with chest pain. The patient was given two nitroglycerin tablets in the emergency department. The chest pain was not relieved, resulting in the diagnosis of new onset unstable angina. Serial creatine phosphokinase was normal. Following a left cardiac catheterization with fluoroscopic angiogram of multiple coronary arteries with low osmolar contrast, the patient is found to have arteriosclerotic coronary artery disease. What ICD-10-CM and PCS codes should be assigned? a. I25.10, 4A023N7, B2111ZZ b. I25.110, 4A023N7, B211Y10 c. I25.110, 4A023N7, B2111ZZ d. I25.110, 4A023N6, B2111ZZ - ANSWERSc ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes include I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris. When using one of these combination codes, it is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis (CMS 2020a, Section I.C.9.b., 49). Use 4A023N7 for Measurement of cardiac sampling and pressure, left heart, percutaneous approach. The left heart catheterization is reported with code B2111ZZ. The ICD-10-PCS root operation is Measurement along with the function value of Sampling and Pressure. The angiogram code reflects the use of fluoroscopy performed with low osmolar contrast (Schraffenberger and Palkie 2020, 308-310). 6. Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What conditions should have codes assigned? O30.003 Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester O30.009 Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester O60.14X0 Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified O60.14X1 Preterm labor third trimester with preterm delivery third trimester, fetus 1 O60.14X2 Preterm labor third trimester with preterm delivery third trimester, fetus 2 O80 Encounter for full-term uncomplicated delivery Z3A.30 30 weeks gestation of pregnancy Z37.0 Single live birth Z37.2 Twins, both liveborn a. O80, Z3A.30, Z37.0 b. O30.003, O60.14X0, Z3A.30, Z37.2 c. O60.14X1, O60.14X2 O30.003, Z3A.30, Z37.2 d. O80, O30.009, Z3A.30, Z37.2 - ANSWERS. c A code for preterm labor and delivery is assigned for each fetus since both babies were born preterm as noted in Coding Clinic. Additionally, a code from category O30, Multiple gestations, must be assigned (Leon-Chisen 2020, 325; AHA Coding Clinic 2016 2nd Quarter, 10-11). 7. A patient is admitted with metastatic carcinoma from breast to liver with previous bilateral mastectomy and no reoccurrence at the primary site. In the progress note of day three, the physician indicates that patient now has pneumonia and begins treatment with an antibiotic which will be continued on discharge. What is the proper coding and sequencing of this admission? a. C78.6, Z85.3, Z90.13 b. C78.7, J18.9, Z85.3, Z90.13 c. J18.9, C78.7, Z90.13 d. C78.7, Z85.3, Z90.10 - ANSWERSb The Table of Neoplasms should be used to identify the correct neoplasm code based on the histological nature of the neoplasm (carcinoma) and the site of "liver." Metastatic carcinoma of the liver is the principal diagnosis because this is the condition the patient was admitted for. When a primary malignancy has been previously excised or eradicated and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Secondary codes are assigned to identify the acquired absence of the breasts and pneumonia which meets the definition of an additional diagnosis based on treatment of the condition (Schraffenberger and Palkie 2020, 150-152; CMS 2020a, Section I.C.2.d, 31-32). 8. Patient admitted with syncope due to taking Valium in combination with an over-the-counter antihistamine, taken as directed on the package but without consulting a healthcare provider. What are the correct codes and sequencing for this admission? a. R55, T42.4X1A, T45.0X1A b. T42.4X1A, T45.0X1A, R55 c. T45.0X1A, T42.4X1A d. R55, T42.4X6A, T45.0X5A - ANSWERS. b Syncope caused by taking prescription medication in combination with over-the-counter medication without consulting the prescribing physician is coded as a poisoning. Per the Official ICD-10-CM Guidelines for Coding and Reporting, CMS 2020, I.C.19.e.5(b) 81-82: Nonprescribed drug taken with correctly prescribed and properly administered drug: If a nonprescribed drug or medicinal agent was taken in combination with a correctly prescribed and properly administered drug, any drug toxicity or other reaction resulting from the interaction of the two drugs would be classified as a poisoning (CMS 2020a, Section I.C.19. e.5.b., 81-82; Schraffenberger and Palkie 2020, 613). 9. 50-year-old woman with a diagnosis of metastatic ovarian cancer to the pleura has an outpatient thoracoscopic pleurodesis performed. What is the correct coding and sequencing? a. C56.9, C78.2, 32650 b. C78.2, C56.9, 32650 c. C78.2, C56.9, 32661 d. C56.9, C78.2, 32609 - ANSWERSb ICD-10-CM: C78.2, C56.9; CPT: 32650 (Schraffenberger and Palkie 2020, 139-148, 151-155; CPT Assistant Fall 1994, 1, 6; AMA CPT Professional Edition 2020, 205-206).