CPT & HCPCS CODING CH 1-6 EXAM 1

A certified registered nurse anesthetist is a registered nurse with ___________ months of additional training in anesthesiology. - answer-36 A chief complaint is the reason for the patient encounter. - answer-true A chronological description of the patient's present illness is the ______________. - answer-history of present illness A complete PFSH includes: - answer-past patient history, family history, social history A cutting instrument, called a(n) _________________, is used for debridements and for skin grafting. - answer-dermatome A home visit E and M service that involved a problem focused history and examination of a new patient and straightforward medical decision making would be reported with code _____________. - answer-99341 A new patient, as defined by CPT is a patient who has not received professional services from a physician, or another physician of the same specialty who belongs to the same group practice, within the past 3 years. True or False - answer-true A procedure, completed to clean a wound site, that involves the removal of dirt or foreign objects along with tissue that may be necrotic or damaged is called ___________________. - answer-debridement A smoking and tobacco use cessation counseling visit of 15 minutes would be reported with code _______________. - answer-99407 A statistical modifier, also known as a(n) __________________ modifier is used for informational purposes and does not affect the fee. - answer-informational A(n) ________ graft is a type of graft where tissue is taken from one part of a person's body and grafted to another part of the same person's body. - answer-autogenous A(n) ________________ repair would be used to report a layered closure or to report extensive cleansing of a wound that is heavily contaminated. - answer-intermediate A(n) ____________________ is an endoscopic instrument used to visualize the interior structures of a joint. - answer-arthroscope An anesthesiologist performed a history and physical exam that took 20 minutes to complete. The procedure required 80 minutes of anesthesia time. The time units used by the insurance company are calculated in 20 minute increments. How many units of time would be reported for this procedure? - answer-4 An E and M nursing facility service involving an annual nursing facility assessment which requires a detailed interval history, comprehensive examination and medical decision making that is of low to moderate complexity is reported with code _______________. - answer-99318 Category II codes are not mandatory and are considered ________________ codes. - answer-tracking Clinical examples of the CPT codes for Evaluation and Management services are found in appendix ______ of the CPT manual. - answer-C Common sites for skin tags include the axillae, ___________, and inguinal areas. - answer-neck Constitutional elements of an examination include all EXCEPT which of the following? - answer-inspection of the eyes Cryosurgery, electrosurgery, and chemosurgery are all forms of _______________. - answer-destructions Define the term observation status. - answer-The patient has NOT been admitted to the hospital as an inpatient, but needs to be admitted under "observation" for assessment. Differentiate between the hospital discharge codes 99238 and 99239. - answer-99238 is for discharge day 30 minutes or less 99239 is for discharge day more than 30 minutes Dr Jones is the admitting physician for patient Sally Smith. On the first day of hospitalization Dr Jones completes a comprehensive history and examination, and the medical decision making is of moderate complexity. - answer-99222 Dr Smith performed an incision and removal of a foreign body on the left arm int he subcutanous layer of the skin. The correct code to report is ____________. - answer-10120 During the administration of anesthesia, the case was complicated by emergency conditions. They type of code to report this occurrence with an addition to the anesthesia code would be __________________. - answer-qualifying circumstance code E4 is a modifier for what? - answer-lower right eyelid Evaluation and management codes are used to code surgical procedures. - answer-false F/T Chapter 2: A CPT modifier is a three-digit code that is appended to a code to indicate that a service or procedure has been altered. - answer-false F8 modifier is for what? - answer-right hand 4th digit GC is a modifier for what? - answer-This service was performed in part by a resident under the direction of a teaching physician. HCPCS is the abbreviation for ______________________________________. - answer-Correct Healthcare Common Procedure Coding System Information regarding major illnesses, surgeries, injuries, and hospitalizations is part of the _____________________________. - answer-past history of the patient List and define the 3 Rs that are used for consultation codes. - answer-Request-dr receives request from another dr to see patient Render-dr renders an opinion Response or Report-dr responds to initial/requesting dr via written report Medical decision making is based on all the following EXCEPT: - answer-examination of the patient Modifier _________ is used to report a decision for surgery. - answer-57 Mr Hinds is a patient in the ICU who is listed in critical condition. Because of his condition, Dr Jones spends 1 hour in the evaluation of the patient and this is documented in the chart. During this time, Dr Jones reviewed X-rays that were taken, reviewed ECGs, and performed ventilation management - answer-99291 ORIF is the abbreviation for ______________________________________________. - answer-open reduction internal fixation P1 is a modifier for what? - answer-normal healthy patient P5 is a modifier for what? - answer-a moribund patient who is not expected to survive without the surgery Reduction, also known as _________________ , is completed to realign a bone. - answer-manipulation Select the appropriate anesthesia CPT code(s). Anesthesia: General Procedure: Amniocentesis - answer-00842 Select the appropriate anesthesia CPT code(s). Anesthesia: General Procedure: Closed reduction of femur, lower one-third - answer-01340 Select the appropriate anesthesia CPT code(s). Anesthesia: General Procedure: Second-degree burn excision with skin grafting for TBSA of 8 percent - answer-01952 Select the appropriate anesthesia CPT code(s). Anesthesia: Regional Procedure: Corneal transplant - answer-00144 Select the appropriate anesthesia CPT code(s). Diganosis: Morbid obesity Anesthesia: General Procedure: Gastric bypass and restriction - answer-00797 Select the appropriate anesthesia CPT code(s). Patient: Tom Smith Age: 6 months Anesthesia: General Procedure: Hernia repair, lower abdomen - answer-00834 Select the appropriate surgery CPT code(s). Diagnosis: Fracture of greater humeral tuberosity Procedure: Closed treatment with reduction of fracture - answer-23625 Select the appropriate surgery CPT code(s). Diagnosis: Lesion on left upper arm area Procedure: Excision of 1 cm lesion, total excised diameter was 1.5 cm. Pathology: Malignant - answer-11602-LT Select the appropriate surgery CPT code(s). Diagnosis: Multiple lacerations Procedures: 2.2 cm intermediate repair of laceration of arm, 3.5 cm complex repair of laceration of forehead, and 3.4 cm intermediate repair of laceration of scalp - answer-13132 and 12032 Select the appropriate surgery CPT code(s). Diagnosis: Second- and third-degree burns of 15% of total body surface Procedure: Subsequent dressing and debridement of partial-thickness burns - answer-16030 Select the appropriate surgery CPT code(s). Diagnosis: Trigger finger Procedure: Incision of tendon sheath - answer-26055 Select the appropriate surgery CPT code(s). Endoscopic plantar fasciotomy - answer-29893 Select the appropriate surgery CPT code(s). Procedure: Arthrodesis of metacarpophalangeal joint with internal fixation - answer-26850 Select the appropriate surgery CPT code(s). Procedure: Deep, open bone biopsy of femur - answer-20245 Select the appropriate surgery CPT code(s). Procedure: Fine needle aspiration with imaging guidance - answer-10022 Select the appropriate surgery CPT code(s). Procedure: Removal of tissue expander - answer-11971 Select the appropriate surgery CPT code(s). Radical resection of a malignant tumor of the soft tissue of the pelvis and hip area, 4 cm - answer-27049 Select the appropriate surgery CPT code(s). Sharon Jones was in a motor vehicle accident and sustained a fracture of the ulna that required the placement of an external fixation device. Today, Dr Bones is removing the external fixation device under anesthesia. - answer-20694 Select the appropriate surgery CPT code(s). Shoulder arthroscopy with lysis of and resection of adhesions - answer-29825 T/F A biopsy is a procedure in which a sampling of tissue is removed for pathological examination. True or False - answer-true T/