MEDICAL CODING GUIDELINES EXAM
QUESTIONS AND ANSWERS
When a patient is admitted with a pressure ulcer that evolves to another stage during
the admission. - Answer-Assign two codes:
1) site and stage of the ulcer on admission
2) highest stage reported for that site.
When a patient presents for a second time to the ED for an issue needing continued
care. - Answer-7th character A is used
Care of complications of fractures, such as malunion and nonunion - Answer-Report
with the appropriate 7th character for subsequent care.
Diabetic ulcer. - Answer-1. Code diabetes first "with" ulcer.
2. Directed to code site of the ulcer.
3. Verify code selection in the Tabular List.
Hypertensive Heart Disease (I11) - Answer-- use additional code from I50 for heart
failure
AMI with CAD - Answer-- Acute Myocardial Infarction coded first
Relative Value Units - Answer-physician work, practice expense and malpractice
insurance costs
Category II codes - Answer-used voluntarily by physicians to report quality patient
performance measurements
Surgical Global Package - Answer-- Preoperative Visits
- Intraoperative Services
- Complications Following Surgery
- Postoperative Visits
- Postsurgical Pain Management
- Miscellaneous Services.
Modifiers appended to E/M codes to report payable services within the global
package - Answer-24 - Unrelated E/M by the same physician during a postoperative
period
25 - Significant, separately identifiable E/M by the same physician on the same day
of the procedure or other service
57 - Decision for surgery are used on evaluation and management CPT® codes
only.
Types of codes printed in the HCPCS Level II codebook - Answer-- Permanent
National Codes
- Miscellaneous Codes/not otherwise classified
, - Temporary National Codes.
Fine needle aspiration results show a malignancy. Surgeon performs mastectomy. -
Answer-- FNA is NOT coded as it is included in the mastectomy.
A pathology report is pending. - Answer-Without the results of the pathology report,
the diagnosis to report is the reason for the exam.
A patient presents for surgery to repair a defect caused by previous cancer surgery. -
Answer-- Aftercare visit codes required.
- aftercare codes should not be used if treatment is directed at a current, acute
disease.
- Index: Aftercare - following surgery (for)/neoplasm (Z48.3)
- use an additional code to identify the
neoplasm, however code for History/personal (of)/malignant neoplasm in this case.
Lesion is noted as "suspicious" and removed for further testing. - Answer-- CPT
INDEX = Excision - skin- benign
- Code selection is based on anatomic location and size in centimeters.
- Add up measurements including margins.
- convert mm to cm if needed.
Skin cancer types - Answer-- Benign - nevus, lipoma
- malignant - carcinoma, melanoma
Measuring a lesion - Answer-Size of lesion + margin + margin = total lesion size
Same repair + different body parts + SAME anatomical grouping (EX. intermediate
closure, nose and intermediate repair of cheek). - Answer-- Add BOTH
measurements in cm together and code ONE repair code (simple, inter. complex)
- Code excisions separately
- Modifier 51 may be used for multiple surgeries on excision codes.
CPT code description for 15931 says "with primary
suture." - Answer-- Not appropriate to report a layered closure along with 15931,
unless
the wound repair was of a separate site or for a separate encounter.
Coding Moh's Surgery - Answer-- Each layer = 1 stage
- Each tissue removed per stage = 1 tissue block
- There are only 5 codes in CPT
Another procedure is mentioned in the report, but will be performed by another
surgeon. - Answer-Completely eliminate. Do not code.
ICD-10 diagnosis for patient being seen for abdominoplasty for diastasis recti and
localized fat in abdomen. - Answer-- there is no direct code for abdominal muscle
OR belly fat.
- Code M62.08 - Separation of muscle (nontraumatic), other site.
- Code the localized fat = E65 - Localized adiposity.
QUESTIONS AND ANSWERS
When a patient is admitted with a pressure ulcer that evolves to another stage during
the admission. - Answer-Assign two codes:
1) site and stage of the ulcer on admission
2) highest stage reported for that site.
When a patient presents for a second time to the ED for an issue needing continued
care. - Answer-7th character A is used
Care of complications of fractures, such as malunion and nonunion - Answer-Report
with the appropriate 7th character for subsequent care.
Diabetic ulcer. - Answer-1. Code diabetes first "with" ulcer.
2. Directed to code site of the ulcer.
3. Verify code selection in the Tabular List.
Hypertensive Heart Disease (I11) - Answer-- use additional code from I50 for heart
failure
AMI with CAD - Answer-- Acute Myocardial Infarction coded first
Relative Value Units - Answer-physician work, practice expense and malpractice
insurance costs
Category II codes - Answer-used voluntarily by physicians to report quality patient
performance measurements
Surgical Global Package - Answer-- Preoperative Visits
- Intraoperative Services
- Complications Following Surgery
- Postoperative Visits
- Postsurgical Pain Management
- Miscellaneous Services.
Modifiers appended to E/M codes to report payable services within the global
package - Answer-24 - Unrelated E/M by the same physician during a postoperative
period
25 - Significant, separately identifiable E/M by the same physician on the same day
of the procedure or other service
57 - Decision for surgery are used on evaluation and management CPT® codes
only.
Types of codes printed in the HCPCS Level II codebook - Answer-- Permanent
National Codes
- Miscellaneous Codes/not otherwise classified
, - Temporary National Codes.
Fine needle aspiration results show a malignancy. Surgeon performs mastectomy. -
Answer-- FNA is NOT coded as it is included in the mastectomy.
A pathology report is pending. - Answer-Without the results of the pathology report,
the diagnosis to report is the reason for the exam.
A patient presents for surgery to repair a defect caused by previous cancer surgery. -
Answer-- Aftercare visit codes required.
- aftercare codes should not be used if treatment is directed at a current, acute
disease.
- Index: Aftercare - following surgery (for)/neoplasm (Z48.3)
- use an additional code to identify the
neoplasm, however code for History/personal (of)/malignant neoplasm in this case.
Lesion is noted as "suspicious" and removed for further testing. - Answer-- CPT
INDEX = Excision - skin- benign
- Code selection is based on anatomic location and size in centimeters.
- Add up measurements including margins.
- convert mm to cm if needed.
Skin cancer types - Answer-- Benign - nevus, lipoma
- malignant - carcinoma, melanoma
Measuring a lesion - Answer-Size of lesion + margin + margin = total lesion size
Same repair + different body parts + SAME anatomical grouping (EX. intermediate
closure, nose and intermediate repair of cheek). - Answer-- Add BOTH
measurements in cm together and code ONE repair code (simple, inter. complex)
- Code excisions separately
- Modifier 51 may be used for multiple surgeries on excision codes.
CPT code description for 15931 says "with primary
suture." - Answer-- Not appropriate to report a layered closure along with 15931,
unless
the wound repair was of a separate site or for a separate encounter.
Coding Moh's Surgery - Answer-- Each layer = 1 stage
- Each tissue removed per stage = 1 tissue block
- There are only 5 codes in CPT
Another procedure is mentioned in the report, but will be performed by another
surgeon. - Answer-Completely eliminate. Do not code.
ICD-10 diagnosis for patient being seen for abdominoplasty for diastasis recti and
localized fat in abdomen. - Answer-- there is no direct code for abdominal muscle
OR belly fat.
- Code M62.08 - Separation of muscle (nontraumatic), other site.
- Code the localized fat = E65 - Localized adiposity.
