COC 2023 - FINAL EXAM STUDY QUESTIONS (SET 6) And ANSWERS

Each page of the medical record should contain the patient's or . - ANS name, patient ID number. Electrocautery - ANS Instrument for directing electrical energy through tissue for lesion destruction Electrodessication - ANS The use of monopolar high frequency electrical current for lesion removal Exam: CT Abdomen Admitting Diagnosis: Pt states gallbladder problem Clinical History: Right upper quadrant abdominal pain; history of colon cancer; colostomy Comparison: None Result: The study was performed with oral and intravenous contrast material (Isovue 300, 150 mL). The lung bases appear normal. The liver, spleen, both kidneys and adrenal glands appear normal. There is faint calcification density in the dependent portion of the gallbladder, suspicious for a possible gallstone. Recommend ultrasound correlation. Visualized portions of the pancreas appear unremarkable. There is no retroperitoneal lymphadenopathy. Opacified bowel loops are unremarkable. Note is made of left lower quadrant colostomy. No abnormality is noted within the pelvis. Impression: Small calcification-appearing density in the dependent portion of the gallbladder, suspicious for gallstone. Recommend ultrasound correlation. What CPT ® and ICD-10-CM codes are reported by the facility? - ANS 74160, Q9967 x 150, R10.11, Z85.038, Z93.3 Exam: CT Maxillofacial Admitting Diagnosis: Allergic rhinitis nasal congestion Clinical History: Allergic rhinitis; nasal congestion; no comparison Result: The paranasal sinuses are clear except for a small mucus retention cyst in the base of the right maxillary sinus. This measures about 5 mm. The osteomeatal complexes are patent. There are no air fluid levels. There is mild nasal septal deviation towards the left side. The bones appear intact. There are no soft tissue masses. Impression: Mild acute right maxillary sinusitis, mild nasal septal deviation towards the left side. What CPT ® and ICD-10-CM codes are reported by the facility? - ANS 70486, J01.00, J34.2 Exam: CT Maxillofacial WO contrast Admitting Diagnosis: Chronic Sinusitis Clinical History: Chronic sinusitis Result: There has been a mild increase in the amount of mucosal thickening seen anteriorly in the right sphenoid sinus. There is opacification of multiple bilateral ethmoid air cells mildly increased as well over the interval. There is an increasing amount of lobulated mucosal disease seen along the floor of the frontal sinuses. There is less than 1 cm of mucosal thickening seen along the floor of the left maxillary sinus, probably not significantly changed. The left osteomeatal unit is patent. There are a few millimeters of mucosal thickening along the floor and lateral wall of the right maxillary sinus, slightly increased. The osteomeatal unit is patent. There is bowing of the nasal septum to the right. Impression: Sinusitis, mildly increased What CPT ® and ICD-10-CM codes are reported by the facility? - ANS 70486, J32.9 Exam: CT of the chest with intravenous contrast (Omnipaque 350, 150 mL) Admitting Diagnosis: Difficulty swallowing Result: The transverse aorta is prominent in size and measures approximately 3 centimeters in transverse dimension. There are a couple of small right peritracheal lymph nodes measuring a centimeter or less in size. No infiltrate or evidence of effusion is seen. There is evidence of old granulomatous exposure. Impression: Slight dilatation of the thoracic aorta. What CPT ®, HCPCS and ICD-10-CM codes are reported for the facility? - ANS 71260, Q9967 x 150, R13.10 Exam: MRI brain W/O and W contrast Admitting Diagnosis: Left facial weakness/Bell's palsy Clinical History: Comparison. Left facial weakness in a patient w/hx of Bell's Palsy and MS Result: MRI of the brain was obtained at 1.5 Tesla. Axial T1 weighted pre- and post-Gadolinium (1.6 mL) (iron-based contrast), T2 weighted FLAIR, and diffusion images were obtained. Sagittal T1 weighted and high resolution coronal and axial pre- and post-Gadolinium images of the internal auditory canals were obtained. The old study was available for comparison. The ventricles and sulci are within normal limits. There is no evidence of mass effect or midline shift. There are no extra-axial fluid collections. There are multiple punctuate areas of abnormal increased T2 weighted signal in the periventricular white matter and in the subcortical white matter of the centrum semiovale. Many of the foci are elongated and oriented toward the ventricles. Since the prior exam, there has been an increase in the number of hyperintense plaques. With contrast enhancement, none of the plaques appear to enhance at this time. The enhancement seen previously has resolved. The pattern and distribution is most characteristic for MS. The pituitary gland and cerebellum are unremarkable. There are multiple punctuate areas of hyperintense signal in the brain stem and brachium pontis. These do not enhance with gadolinium. There is no edema or mass effect from the lesions. There is a 7 mm focus of increased signal at the left CP angle. No abnormal signal, enhancement of discrete mass lesion is appreciated within the internal auditory canals. This would correlate with the patient's symptoms of a left facial palsy. Impression: Multiple hyperintense lesions predominately in the periventricular white matter with characteristic pattern for MS. None of the plaques currently enhance. There has been a fairly significant increase in the number of lesions since the last exam. Multiple lesions were also seen in the brain stem and the brachium pontis. Specifically, there is a 7 mm focus in the left CP angle which is probably the cause of the patient's left facial palsy. No discrete abnormality was seen in the internal auditory canals. What CPT ® and ICD-10-CM codes are reported by the facility? - ANS 70553, A9579 x 2, G51.0, G93.9, G35 Exam: MRI Lumbar Spine W/O Contrast Admitting Diagnosis: MRI-L spine, low back pain Clinical History: No comparison; low back pain which radiates to the right lower extremity Result: Vertebral body height is normal. The bone marrow signal appears normal. The visualized portions of the spinal cord appear normal. The foramina are patent in the sagittal images. There is normal disc space height and hydration. The intervertebral discs appear normal. There is specifically no evidence of disc herniation, spinal or foraminal stenosis. Impression: Negative What CPT ® and ICD-10-CM codes are reported for the facility? - ANS 72148, M54.5 Exam: MRI right upper extremity joint W/O contrast Admitting Diagnosis: RT shoulder pain Indication: Right shoulder pain and numbness; no comparison study Result: There are a few small subchondral cysts in the humeral head adjacent to the greater tuberosity. These lie subjacent to the supraspinatus insertion. No other marrow space abnormality is identified. There are mild degenerative changes in the right acromioclavicular joint with small osseocartilaginous spur inferiorly. Undersurface of the acromion is flat. No joint effusion is seen. No abnormal periarticular fluid collections are identified. Glenoid labrum is intact. Long head of the biceps is intact and is normally positioned. Supraspinatus tendon shows no evidence of full thickness tear and there is no evidence of fluid in the subacromial/subdeltoid bursa. I cannot exclude a small partial thickness tear along the distal most aspect of the right supraspinatus tendon in its inferior border. Subscapularis and infraspinatus tendons are intact. Impression: Minor localized degenerative diseases of right shoulder. Possible small partial thickness tear along inferior border of right supraspinatus tendon at tendon insertion, otherwise negative. What CPT ® and ICD-10-CM codes are reported by the facility? - ANS 73221, M19.011 Examples of procedures considered "inpatient only" include: - ANS Surgical thoracoscopy, laminectomies, vertebral corpectomy, enterostomies, risky invasive procedures Facial - ANS Controls facial muscles around the eyes, forehead, external ear, and mouth; sensa-tion of taste; and certain salivary and lacrimal (tear) glands Facilities report Medicare outpatient clinic (E/M) visits with code(s): - ANS G0463 Rationale: Clinic E/M visits () are reported to Medicare by the facility with HCPCS Level II code G0463. Field: - ANS Geometric area defined by a collimator at the skin surface Flow cytometry is performed for DNA analysis. What CPT ® code is reported? - ANS 88182 Food moves through the digestive tract by what means? - ANS Peristalsis For Medicare how is each claim paid for outpatient facility reimbursement? - ANS Each claim is paid based on the determined interim outpatient reimbursement rate. Rationale: During the year-end cost report settlement, the prior year's entire outpatient claims are analyzed via a computer system. This method is to determine an interim reimbursement rate on which to pay the following year's Medicare claims. For OPPS, critical care is paid at two levels. What is the distinguishing factor for payment? - ANS One level for critical care services, another level when trauma activation occurs in addition to critical care For surgical procedures involving a primary surgeon and an assistant surgeon, who is the person responsible for the information in the procedural note? - ANS Primary surgeon Rationale: For surgical procedures with more than one surgeon, the primary surgeon is responsible for the procedural note. A resident, intern, or assistant can dictate the note, but the primary surgeon must indicate agreement by reading and signing it. For the UB-04 Form, which provider type qualifier is used to report the rendering provider? - ANS 82 Fractionation: - ANS Division of total planned dose into number of smaller doses given over time Friends brought a young male with type 1 diabetes to the emergency department, in a comatose state. He was admitted with ketoacidosis and was resuscitated with saline hydration via insulin drip. After regaining consciousness, the patient reported that the morning of admission he was experiencing nausea and vomiting and decided not to take his insulin because he had not eaten. He was treated with intravenous hydration and insulin drip. By the following morning, his laboratory work was within normal range and he was experiencing no symptoms. What ICD-10-CM code(s) are reported? - ANS E10.11 Ganglion cyst: - ANS are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid. Glossopharyngeal - ANS Responsible for swallowing, secretion of saliva, sensations of the throat and taste sensations for the back of the tongue Hospitals are required to provide a list of standard charges on the internet and update the list at least annually. - ANS True How are claims sent to most payers? - ANS Electronically in format required by HIPAA Rationale: Claims are sent to the payer. Most payers require electronic transmission. The current electronic format required by HIPAA is X12N 837P version 5010A1. How are codes selected for claim submission? - ANS Answer: Coders review the medical documentation to assign codes or outpatient department personnel select codes using the facility chargemaster. Rationale: There are different methods for code selection. In some departments, the charge for the service is selected by a technician performing the test (for example, X-ray technician performing a CT scan) or it is selected by the secretary for the department by using the facility chargemaster. Coders select codes for surgical procedures and emergency department encounters. How are NCCI edits used in OPPS? - ANS NCCI edits are used to determine codes considered by CMS to be bundled in a major procedure How are sking grafts measured? - ANS Square centimeters How are teaching hospitals typically reimbursed? - ANS Based on a reasonable cost basis How do you report 0.25 mg of Aranesp for ESRD on dialysis use? HCPCS lists this drug as J0881 injection, darbepoetin alfa, 1 mcg (non-ESRD use) and J0882 injection, darbepoetin, 1 mcg (for ESRD on dialysis). Use this code for Aranesp. - ANS J0882 x 250 How does Medicare define medical necessity for services provided? - ANS When the services are reasonable and necessary and/or appropriate based on evidence-based clinical standards of care How does the lymphatic system work to ensure lymph fluid travels one way to the heart? - ANS With a system of one-way valves How many characters in sections 1 and 2 define the same aspects of the procedure as in the medical and surgical section? - ANS 7 How many lobes make up the right lung? - ANS three How many muscles does each eye have to direct vision? - ANS Six How often are MS-DRGs updated? - ANS Annually How would you report the following surgeries performed on the same Pt by two surgeons? An 18 yr old male was involved in an automobile accident. Dr. A performed an open treatment of femoral shaft fracutre with plate and screws (25707) and Dr. B performed a complex closure of a 7.5 CM laceration of the left cheek (13132) - ANS Dr. A reports 27507, Dr. B reports 13132 Hypoglossal - ANS Responsible for tongue movements affecting speech and swallowing ICD-10-CM codes are: - ANS Diagnosis codes. Rationale: Coding staff or outpatient department(s) staff typically assign ICD-10-CM (diagnosis) codes. ICD-10-PCS can easily be expanded without disrupting the ___________ of the system. - ANS Structure ICD-10-PCS code descriptions do not include __________ or common procedure names. - ANS Eponyms ICD-10-PCS is composed of how many sections? - ANS 17 ICD-10-PCS preserves the capacity to define _________, _________, and _________ procedures accurately using stable terminology in the form of characters and values. - ANS past, present and future If a code change in the chargemaster increases or decreases revenue, the person responsible for the chargemaster should: - ANS Refer the issue to the Finance/Accounting Department If a diabetic patient uses insulin, and the type of diabetes is not documented, what type of diabetes would be coded according to ICD-10- CM guidelines? - ANS Type 2 If a patient is brought into the Emergency Department due to an accident at work to determine the specific drug and the quantity in the patient's system, is the test performed presumptive or definitive? - ANS D. Definitive; identifies specific drugs and associated metabolites If a portion of a body part is removed (ie, lobe of lung) and PCS includes a value for the specific body part (lobe of lung) for the anatomic subdivision, the root operation and body part value should identify, what? - ANS Resection, anatomical subdivision If a procedure is discontinued before completion (and prior to any other root operation being performed) report the code for: - ANS Root operation performed or inspection of the body part of anatomical region inspected If a woman has a pap smear performed by her gynecologist, what part of the female anatomy is involved? - ANS Cervix If an ST elevation myocardial infarction converts to a non-ST elevation myocardial infarction in the course of thrombo- lytic therapy, how is it coded? (Reference ICD-10-CM guideline I.C.9.e.l) - ANS Code only STEMI If invalid information such as an invalid ICD-10-CM code, invalid age, or incorrect sex is submitted on a claim, what DRG is assigned? - ANS DRG 999 If the Operative Report indicates that the postoperative diagnosis is a benign lesion, and the pathology report indicates a malignant lesion, what diagnosis is reported? - ANS Code the malignant lesion. Impetigo is best described as: - ANS A bacterial skin infection In a composite APC, Medicare pays: - ANS A single rate of service, which is reported with a combination of HCPCS codes on the same date of service or different dates of service. In a typical hospital's CDM layout, three asterisks indicate that these services: - ANS Do not have a CPT®/HCPCS Level II code built into the CDM. In an outpatient hospital facility, a urologist performs three needle biopsies of the prostate gland using ultrasound guid ance. The patient has an elevated PSA. What CPT® and ICD-10-CM codes are reported? - ANS 55700, 76942, R97.20 In context of the ear, what does conduction refer to? - ANS Sound waves In facilities, internal guidelines for E/M should: - ANS Relate the intent of the CPT® code descriptor to the intensity of the hospital resources used. In regard to X-rays, lab tests, and other ancillary services, documentation should include the and of those services in the medical record. - ANS reasons for, results In the ASC, a patient undergoes drainage of a right nasal abscess. The physician makes an incision into the nasal mucosa and then inserts a hemostat into the abscess to allow drainage of the pus. After successful decompression, the patient's right nasal cavity is packed with Telfa. Once recovered, the patient is instructed to follow up in two days. What CPT ® and ICD-10-CM codes are reported? - ANS 30000, J34.0 In the ASC, a patient with cataracts has phacoemulsification of the cataract and posterior chamber lens implantation of the left eye. What CPT® and ICD-10-CM codes are reported by the facility? - ANS 66984-LT, H26.9 In the cardiac suite, an electrophysiologist performs an EP study. With programmed electrical stimulation, the heart is stimulated to induce arrhythmia. Observed is right atrial and ventricular pacing, recording of the bundle of His, right atrial and ventricular recording, and left atrial and ventricular pacing and recording from the left atrium. What CPT ® codes are reported? - ANS 93620, 93621, 93622 In the cath lab, from a right femoral artery access, the following procedures are performed: Catheter placed in the left renal, accessory renal superior to the left renal and one main right renal artery. Contrast is injected. Radiologic supervision and imaging is performed in all locations. Report the CPT ® code(s). - ANS 36252 In the hospital outpatient facility, all facility services must be: - ANS Answer: Billed on a UB-04 claim form Rationale: All outpatient hospital facility services are reported on the UB-04 claim form. In the hospital outpatient radiology department, a MRA of the pelvis with contrast was performed . Which HCPCS Level II code is reported by the facility for Medicare? - ANS C8918 In the hospital outpatient surgery department, a patient is treated for brachial neuritis of the shoulder. The patient is positioned supine and given general anesthesia. Following full evaluation, manipulation of the shoulder is performed. The physician manipulates the shoulder to achieve the appropriate range of motion. A fixation apparatus is applied at the end of the procedure. What are the correct procedure and diagnosis codes for this service? - ANS 23700, M54.12 In the hospital's outpatient surgery suite, a patient is in for reshaping of her left breast due to atrophy and ptosis of the left breast. After being prepped and draped, the surgeon makes a circular incision above the nipple to indicate where the nipple is to be relocated. Another incision is made around the nipple, then two more incisions are made from the circular cut above the nipple to the fold beneath the breast, which creates a keyhole-shaped skin and breast incision. Skin wedges and tissue are removed until the surgeon is satisfied with the size. Electrocautery was performed on bleeding vessels and the nipple was then elevated to its new position and the nipple pedicle was sutured with layered closure. The last incision was repaired with a layered closure as well. What are the correct procedure and diagnosis codes for this procedure? - ANS 19316-LT, N64.2, N64.81 In the ICD-10-CM Alphabetic Index next to Hypertension, what do the terms in parentheses indicate? - ANS Supplementary words that can be present or absent with the diagnosis hypertension and does not affect the code to which it is assigned. In the ICD-10-CM codebook, what is the category for asthma? - ANS J45 In the outpatient facility, add-on codes are: - ANS Reported In the outpatient hospital radiology department, a 2-view X-ray of both hips and pelvis was performed on a 68 year-old patient. How should the radiology services be reported for the facility? - ANS 73521 In the outpatient hospital surgery department, a general surgeon performed a partial right thyroid lobectomy on a Medicare patient with chronic lymphocytic thyroiditis. The thyroid was exposed via a transverse cervical incision into the skin line. The platysma was divided and the strap muscles were separated in the midline. The superior and inferior thyroid vessels were divided and dissected with cautery dissection. The isthmus was then dissected and part of the lobe was removed. The wound was closed with 8-0 Ethilon. The patient tolerated the procedure well with minimal blood loss and was sent to the recovery room in good condition. Code the procedure and diagnosis. - ANS 60210-RT, E06.3