Chapter 19 Procedural Coding Study Review with Complete
Solutions
Listed below are the six main sections of the 3. Using Volume II
CPT manual. Match the range of codes with the 4. Verify
appropriate section. - -00100-01999, 5. Choose
99100-99140 Anesthesiology 6. Determine
10021-69990 Surgery 7. Record
70010-79999 Radiology 8. Match
80047-89398 Pathology and Laboratory
90281-99199, 99500-99607 Medicine
99201-99499 Evaluation and Management The (1) listed the patient as new; however, we
have several claims from your office for this
patient within the past year.
Listed below are the actions one would take to The patient SOAP notes indicate a (2) should
find a code in the CPT manual. Put each action have been used with the (3) code as the patient
in proper order in which it is performed. was seen for more than one issue.
The (4) for this type of code is 90 days. I would
- Verify the code in the numeric section of the suggest that you use the (5) and the current (6)
book and look for any needed add-on codes or to make the necessary corrections to this claim. -
modifiers. -1. evaluation and management code
- Review each description and indented term 2. Modifier
under the main term. 3. procedure
- Locate the procedure in the alphabetic index at 4. Global Period
the back of the book. - -1. Locate 5. current procedural terminology
2. Review 6. International Classifications of Diseases
3. Verify
Identify whether Fraudulent billing or Honest
Place in order the steps that should be taken billing.
when locating CPT codes.
1. Coding services that were not performed
Determine the appropriate modifiers. 2. Not overstating the complexity of the decision-
Choose the correct code from the range. making process
Record the number on the health claim form. 3. Performing procedures that are not medically
Ensure that the services were documented in the necessary
patient's chart. 4. Unbundling of services
Using Volume II, look up the CPT code for the 5. Coding to the highest specificity
service performed. 6. Reporting the same service twice
Verify the code number in the numeric index and 7. Reporting the extent of patient history taken -
note any code range. -1. Fraudulent billing
Match the procedure with the diagnosis that 2. Honest billing
verifies medical necessity. 3. Fraudulent billing
Using the encounter form and/or the patient's 4. Fraudulent billing
chart, find the service performed. - -1. 5. Honest billing
Using Encounter 6. Fraudulent billing
2. Ensure 7. Honest billing
1/5
, Chapter 19 Procedural Coding Study Review with Complete
Solutions
calcium levels.
Matthew Davies arrives at the office for lab work. CPT 77080 is the code for the dual energy X-ray
His provider is ordering a lipid panel, which absorptiometry (DXA), bone density study, 1 or
consists of cholesterol, triglycerides, HDL, and more sites, axial skeleton.
LDL breakdown. Matthew's diagnosis is mixed
hyperlipidemia. - -CPT 80061, 83721
Richard was referred to the hematologist
Procedure Codes: because of persistent easy bruising with purpura
80061 is the CPT code for a lipid panel, which and petechiae. Diagnosis at this time is idiopathic
includes a total serum cholesterol (82465), HDL thrombocytopenia. In addition to the high-level-
cholesterol (83718), and triglycerides (84478). complexity consult, testing includes CBC
CPT guidelines state when ordered tests fit into a w/platelet count and automated WBC differential,
panel, the panel must be coded and not the platelet assay (reticulated), and bone marrow
individual tests. The LDL cholesterol (83721) is biopsy (trocar), which also reveals aplastic
not included in the panel and so will be coded anemia. - -CPT 85025, 85055, 38221,
and billed separately. No modifiers are required. 99245 (MOD. 25)
Procedure Codes:
Oliva is a 6-month-old infant with a diagnosis of
(classical) PKU (phenylketonuria). The physician CPT 99245 is the consult for a new patient is a
has ordered labs for phenylalanine and highly complex condition. Some payers may
phenylketones to check on her levels to make require a modifier 25 attached to the "E/M" code,
sure her current treatment is effective. - - which means that an exam was performed and
CPT 84030, 84035 necessary in addition to procedure (bone marrow
biopsy) or service performed on the same date of
Procedure Codes: service by the same provider.
Code 84030 is the code for phenylalanine (PKU)
in the blood. CPT 84035 is the code for CPT 85025 is used for a CBC with platelet count
phenylketones, qualitative. No modifiers are and automated differential study.
required with this scenario. CPT 85055 is the code for a reticulated platelet
count.
CPT 38221 is the CPT code for a bone marrow
Mari Lou is a 55-year-old white female, S/P biopsy using a needle or trocar to obtain the
hysterectomy at age 41. She feels she is getting sample.
shorter, and after being measured during her
physical several weeks ago, it does appear she
has "lost" several inches. At her request, a bone Louisa is a 42-year-old mother-to-be. Because of
densitometry of the axial skeleton (DXA) and maternal age, an amniocentesis and a
blood calcium test are ordered. Her diagnosis is chromosome analysis of the amniotic fluid (15
post-menopausal osteoporosis. - -CPT cells) is ordered. When the results are returned,
77080, 82310 the fetus is diagnosed with Down syndrome, also
known as Trisomy 21, mosaicism type. - -
Procedure Codes: CPT 59000, 88267
CPT 82310 is the code for measurement of blood
Procedure Codes:
2/5
Solutions
Listed below are the six main sections of the 3. Using Volume II
CPT manual. Match the range of codes with the 4. Verify
appropriate section. - -00100-01999, 5. Choose
99100-99140 Anesthesiology 6. Determine
10021-69990 Surgery 7. Record
70010-79999 Radiology 8. Match
80047-89398 Pathology and Laboratory
90281-99199, 99500-99607 Medicine
99201-99499 Evaluation and Management The (1) listed the patient as new; however, we
have several claims from your office for this
patient within the past year.
Listed below are the actions one would take to The patient SOAP notes indicate a (2) should
find a code in the CPT manual. Put each action have been used with the (3) code as the patient
in proper order in which it is performed. was seen for more than one issue.
The (4) for this type of code is 90 days. I would
- Verify the code in the numeric section of the suggest that you use the (5) and the current (6)
book and look for any needed add-on codes or to make the necessary corrections to this claim. -
modifiers. -1. evaluation and management code
- Review each description and indented term 2. Modifier
under the main term. 3. procedure
- Locate the procedure in the alphabetic index at 4. Global Period
the back of the book. - -1. Locate 5. current procedural terminology
2. Review 6. International Classifications of Diseases
3. Verify
Identify whether Fraudulent billing or Honest
Place in order the steps that should be taken billing.
when locating CPT codes.
1. Coding services that were not performed
Determine the appropriate modifiers. 2. Not overstating the complexity of the decision-
Choose the correct code from the range. making process
Record the number on the health claim form. 3. Performing procedures that are not medically
Ensure that the services were documented in the necessary
patient's chart. 4. Unbundling of services
Using Volume II, look up the CPT code for the 5. Coding to the highest specificity
service performed. 6. Reporting the same service twice
Verify the code number in the numeric index and 7. Reporting the extent of patient history taken -
note any code range. -1. Fraudulent billing
Match the procedure with the diagnosis that 2. Honest billing
verifies medical necessity. 3. Fraudulent billing
Using the encounter form and/or the patient's 4. Fraudulent billing
chart, find the service performed. - -1. 5. Honest billing
Using Encounter 6. Fraudulent billing
2. Ensure 7. Honest billing
1/5
, Chapter 19 Procedural Coding Study Review with Complete
Solutions
calcium levels.
Matthew Davies arrives at the office for lab work. CPT 77080 is the code for the dual energy X-ray
His provider is ordering a lipid panel, which absorptiometry (DXA), bone density study, 1 or
consists of cholesterol, triglycerides, HDL, and more sites, axial skeleton.
LDL breakdown. Matthew's diagnosis is mixed
hyperlipidemia. - -CPT 80061, 83721
Richard was referred to the hematologist
Procedure Codes: because of persistent easy bruising with purpura
80061 is the CPT code for a lipid panel, which and petechiae. Diagnosis at this time is idiopathic
includes a total serum cholesterol (82465), HDL thrombocytopenia. In addition to the high-level-
cholesterol (83718), and triglycerides (84478). complexity consult, testing includes CBC
CPT guidelines state when ordered tests fit into a w/platelet count and automated WBC differential,
panel, the panel must be coded and not the platelet assay (reticulated), and bone marrow
individual tests. The LDL cholesterol (83721) is biopsy (trocar), which also reveals aplastic
not included in the panel and so will be coded anemia. - -CPT 85025, 85055, 38221,
and billed separately. No modifiers are required. 99245 (MOD. 25)
Procedure Codes:
Oliva is a 6-month-old infant with a diagnosis of
(classical) PKU (phenylketonuria). The physician CPT 99245 is the consult for a new patient is a
has ordered labs for phenylalanine and highly complex condition. Some payers may
phenylketones to check on her levels to make require a modifier 25 attached to the "E/M" code,
sure her current treatment is effective. - - which means that an exam was performed and
CPT 84030, 84035 necessary in addition to procedure (bone marrow
biopsy) or service performed on the same date of
Procedure Codes: service by the same provider.
Code 84030 is the code for phenylalanine (PKU)
in the blood. CPT 84035 is the code for CPT 85025 is used for a CBC with platelet count
phenylketones, qualitative. No modifiers are and automated differential study.
required with this scenario. CPT 85055 is the code for a reticulated platelet
count.
CPT 38221 is the CPT code for a bone marrow
Mari Lou is a 55-year-old white female, S/P biopsy using a needle or trocar to obtain the
hysterectomy at age 41. She feels she is getting sample.
shorter, and after being measured during her
physical several weeks ago, it does appear she
has "lost" several inches. At her request, a bone Louisa is a 42-year-old mother-to-be. Because of
densitometry of the axial skeleton (DXA) and maternal age, an amniocentesis and a
blood calcium test are ordered. Her diagnosis is chromosome analysis of the amniotic fluid (15
post-menopausal osteoporosis. - -CPT cells) is ordered. When the results are returned,
77080, 82310 the fetus is diagnosed with Down syndrome, also
known as Trisomy 21, mosaicism type. - -
Procedure Codes: CPT 59000, 88267
CPT 82310 is the code for measurement of blood
Procedure Codes:
2/5
