CCS Practice Exam Complete Solutions

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? S52.101AUnspecified fracture of upper end of right radius, initial encounter for closed fracture S52.101BUnspecified fracture of upper end of right radius, initial encounter for open fracture S52.001AUnspecified fracture of upper end of right ulna, initial encounter for closed fracture S52.001BUnspecified fracture of upper end of right ulna, initial encounter for open fracture 0PSH0ZZReposition right radius, open approach 0PSK0ZZReposition right ulna, open approach 24670Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without manipulation 24675Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); with manipulation 25560Closed treatment of radial and ulnar shaft fractures; without manipulation 29075Application, cast; elbow to finger (short arm) a. S52.101A, S52.001A, 0PSK0ZZ b. S52.101B, S52.001B, 0PSH0ZZ c. S52.101B, S52.001B, 25560, 29075 d. S52.001A, 24675 - ANSWER Correct Answer: D 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.) A laparoscopic tubal ligation is completed. What is the correct CPT code assignment? 49320Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 58662Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 58670Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 58671Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) a. 49320, 58662 b. 58670 c. 58671 d. 49320 - ANSWER Correct Answer: B 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). Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What conditions should have codes assigned? O30.003Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester O30.009Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester O60.14X0Preterm 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 O60.14X2Preterm labor third trimester with preterm delivery third trimester, fetus 2O80Encounter for full-term uncomplicated delivery Z3A.3030 weeks gestation of pregnancy Z37.0Single live birth Z37.2Twins, 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 - ANSWER Correct Answer: 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). A patient with acute respiratory failure, hypertension, and congestive heart failure is admitted for intubation and ventilation. The patient's heart failure is stable on current medications. What are the correct diagnosis codes and sequencing? I10Essential hypertension I11.0Hypertensive heart with heart failure I50.9Heart failure, unspecified J96.00Acute respiratory failure, unspecified whether with hypoxia or hypercapnia J96.20Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia a. J96.00, I11.0, I50.9 b. I50.9, J96.00, I10 c. J96.20, I10, I50.9 d. I50.9, J96.20, I11.0 - ANSWER Correct Answer: A The patient was admitted and treated for respiratory failure. The other conditions present are also coded. The classification presumes a causal relationship between hypertension and congestive heart failure unless the physician documents otherwise (Leon-Chisen 2020, 228-231; CMS 2020a, Section I.C.10.b., 53, Section I.C.9.a, 46; AHA Coding Clinic 2017 1st Quarter, 47). A 64-year-old female was discharged with the final diagnosis of acute renal failure and hypertension. What coding guideline applies? a. Use combination code of hypertension and chronic renal failure. b. Use separate codes for hypertension and chronic renal failure. c. Use separate codes for hypertension and acute renal failure. d. Use combination code for hypertension and acute renal failure. - ANSWER Correct Answer: C There is not a combination code for acute renal failure and hypertension. Acute kidney failure is not the same as chronic kidney disease (CMS 2020a, Section I.C.9. 2-3, 46-47; Leon-Chisen 2020, 262). A patient was discharged from the same-day-surgery unit with the following diagnoses: posterior subcapsular, mature, incipient, senile cataract right eye, diabetes mellitus, hypertension, and was treated for mild acute renal failure. Which codes are correct? E11.36Type 2 diabetes mellitus with diabetic cataract E11.29Type 2 diabetes mellitus with other diabetic kidney complication E11.9Type 2 diabetes mellitus without complications H25.9Unspecified age-related cataract H25.21Age-related cataract, morgagnian type, right eye H25.041Posterior subcapsular polar age-related cataract, right eyeI10Essential hypertension I12.9Hypertensive chronic kidney disease with stage 1 through stage 4, or unspecified chronic kidney disease N17.9Acute kidney failure, unspecified a. H25.21, E11.29, I12.9, N17.9 b. E11.36, H25.041, I10, N17.9 c. H25.9, E11.29, I12.9, N17.9 d. H25.041, E11.9, I12.9 - ANSWER Correct Answer: B The patient has posterior subcapsular, mature, incipient, senile cataract right eye, diabetes mellitus, hypertension, acute renal failure. The hypertension and diabetes are not related to the renal failure as it is acute and not chronic. Because of this, no combination code is assigned for hypertension, diabetes and chronic renal failure. However, the diabetes and cataract are related conditions which are coded using a combination code. Th