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84 terms

Medical Billing and Coding

Study guide questions
New and/or revised text within the guidelines or instructional notes.
Code can only be reported secondary to another code.
The narrative description of the code has been revised
The code is out-of-numerical sequence.
Which of the following terms directs you, the coder, to another term or other terms in the CPT Index?
Which of the following would not be reported with a CPT code?
The hospital will submit codes for reimbursement for services/procedures provided on which of the following?
The CPT manual is divided into six (6) sections. Name them, in order.
Evaluation/Management, Anesthesia, Surgery, Radiology, Pathology/Laboratory, Medicine
Which of the following classification systems is a component of HCPCS?
National Codes
When a physician bills for services provided during an outpatient encounter at the hospital, he/she will report ICD-9-CM diagnosis codes and HCPCS procedure/service codes. What codes will the facility report?
ICD-9-CM diagnosis codes and HCPCS procedure/service codes
In order to be included in the CPT manual, a procedure must meet which of the following criteria?
After reviewing the following excerpt from CPT, code 47125 would be interpreted as:

47120 Hepatectomy, resection of liver; partial lobectomy
47122 trisegmentectomy
47125 total left lobectomy
47130 total right lobectomy
Hepatectomy, resection of liver; total left lobectomy
The use of Category II codes is
The patient visits the physician's office for a sore throat. The services for this patient would be submitted on which claim form?
Which code set is used to report new and emerging technologies?
HCPCS Level I, Category III codes
The Level II (National) codes of the HCPCS classification system are maintained by the:
Centers for Medicare and Medicaid Services
After reviewing the following excerpt from CPT, code 27646 would be interpreted as:

27645 Resection of tumor, bone; tibia

27646 fibula

27647 talus or calcaneus
27646 Radical resection of tumor, bone; fibula
The physician develops a new technique for performing a procedure that is not currently described in the CPT or HCPCS Level II code books. How should the coder report this case?
Select the code number designated in that section of CPT for unlisted procedures.
There are several types of main terms in the CPT alphabetic index that you can utilize when locating a code. Which of the following is not one of the code location methods?
What action should the coder take when an entry such as the following is seen in the CPT alphabetic index: 27310, 27330, 27403?
Review all of the codes in the tabular list to identify the proper code.
Which coding system would be used to report the following statement: "Penicillin G potassium, 600,000 units"?
"Divorced, smokes one pack/per day, and drinks an occasional glass of wine after dinner" represents what component of a patient's record?
Past, family, and social history
According to the CPT definition of the "Surgical Package," which of the following is not included in the global surgery payment based on the CPT Surgery code reported?
Complication treatment
You are auditing physician records for the correct E/M code assignment, looking for documentation of the number of diagnoses or management options, the amount or complexity of data reviewed, and the risk of complication or death if the condition were left untreated. What key component of E/M code assignment are you looking for?
Medical-decision making
According to E/M Guidelines, a new patient is one who has not received any professional services from a physician or another physician of the same specialty belonging to the same group practice within what time frame?
The last three (3) years.
Because E/M codes represent the work a physician performs in gathering and analyzing data and information which will enable him/her to diagnose and manage a health problem, they are considered what type of codes?
Documentation of an inventory of body systems obtained by asking the patient questions in order to identify signs and/or symptoms that the patient is experiencing or has experienced, which helps the patient clarify differential diagnoses, is known as the:
The NCCI consists of two tables that identify pairs of HCPCS codes that are not separately payable except under certain circumstances. What does the Mutually Exclusive table identify?
Code pairs that are clinically unlikely to be reported together
Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period.
Repeat clinical diagnostic laboratory test,
Staged or related procedure or service by the same physician during the postoperative period.
Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.
A patient is seen by her primary care physician for headaches. The physician documented performance of a physical examination, review lab reports of tests that were performed at the local hospital, and outlined two management options. Which of the following key components is missing from the documentation of this visit?
The NCCI consists of two tables that identify pairs of HCPCS codes that are not separately payable except under certain circumstances. What does the Column 1/Column 2 table identify
Code pairs that should not be reported together because one of the codes inherently includes performance of the other code
How many sets of guidelines exist to explain how to code E/M?
There are seven (7) components of E/M code assignment. What are the "key" components?
History, physical examination, and medical decision making.
In general, the level of all three (3) key components of E/M codes must meet or exceed the stated documentation requirements to qualify for a particular level when:
the patient is new to the physician
Which of the following includes an edit that rejects claim line items once the maximum number of units of service allowable under most circumstances for a single HCPCS code billed by a provider on the same date of service for a single beneficiary has been reached?
Medically Unlikely Edits
What is a chronological review or description of the patient's symptom(s) defined by location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms?
History of present illness
Which of the following would NOT be found in a medical history?
Vital signs.
The physician office note states "Follow-up visit of an established patient recently diagnosed with diabetes mellitus, including 15 minutes of counseling." If the physician decided to report the encounter with code 99214 (established patient, office visit), which vital piece of documentation is missing that would substantiate using this code based on time as the main criterion for E/M code selection?
Total length of visit
When reporting the same procedure code on two (2) fingers of the same hand, what action should the coder take?
Use an anatomical modifier for each finger.
A patient has a total abdominal hysterectomy with bilateral salpingectomy. The coder reported the following:

58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)


58700 Salpingectomy, complete or partial, unilateral or bilateral

This type of erroneous coding is referred to as:
Upper left eyelid
Left foot, fourth digit
Left hand, thumb
Right foot, fifth digit
A patient who hadn't been in to see his physician for four (4) years was seen for abdominal pain. The physician performed a detailed history and expanded problem focused examination. Medical-decision making was of moderate complexity.

What E/M code should be reported for this office visit?
An office visit for an established postmenopausal patient who is complaining of spotting for the last six (6) months with right-lower-quadrant tenderness. A detailed history and physical was performed with low complexity decision making.
A new patient office visit for a 35-year-old male in which a comprehensive history and comprehensive examination were performed, and medical-decision making was of straightforward complexity.
A 32-year-old female patient presents for an excision of a chalazion of her left upper eyelid and a biopsy of her left lower eyelid was also performed during the same operative episode.
67800-E1, 67810-E2
Following an automobile accident, a patient presents for closed treatment of a right foot metatarsal fracture with manipulation.
A physician excises a 3.1 cm benign skin lesion which requires V-Y plasty to repair the resultant skin defect. In CPT, which of the following would be the accurate way to report and sequence the procedures performed?
V-Y plasty only.
A procedure that is usually an integral part of a more extensive procedure, and would not be reported in addition to the more extensive procedure, is identified in CPT as a:
separate procedure
If an orthopedic surgeon attempted to reduce a fracture but was unsuccessful in obtaining acceptable realignment, what type of CPT code would be assigned for the procedure?
a "with manipulation" code
The code for lesion excision includes this type of repair:
How is the Respiratory System subsection arranged?
When lesions are excised from multiple sites of the integumentary system, which of the following is the correct action the coder should take?
Code all lesion excisions separately.
In which type of fracture treatment is the fracture not open to view, but fixation is utilized?
Percutaneous treatment
CPT distinguishes between benign and malignant lesions regarding which of the following procedures?
A physician performs a diagnostic laryngoscopy using a laryngeal mirror. Which type of laryngoscopy is being performed?
In CPT, if a patient has two lacerations of the arm that are repaired with simple closure, which of the following would apply for correct coding?
One CPT code, adding the lengths of the lacerations together
A physician excises a 3.1 cm malignant lesion of the scalp which requires a full-thickness graft from the thigh to the scalp. In CPT, which of the following procedures should be reported?
Excision of lesion, and full-thickness skin graft to scalp.
The three (3) types of wound repair identified in CPT are:
Simple, intermediate, and complex.
The phrase "reduction of a fracture" is most closely related to which of the following?
Manipulation of a bone
A pulmonologist performs a diagnostic bronchoscopy with biopsy. The endoscope was introduced into the bronchus, and attachments were used to perforate the bronchial wall. Tissue was obtained and submitted to the pathologist, who identified it as "lung parenchyma." What type of biopsy was performed?
transbronchial biopsy
Moh's Micrographic Surgery involves the surgeon acting as both:
surgeon and pathologist
Use the following codes to answer this question:

11312 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm or less
11422 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
11440 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less
11442 excised diameter 1.1 cm to 2.0 cm

This patient had multiple skin lesions of the cheek, nose, and finger. The 0.1 cm cheek lesion was excised with simple closure; the 2.0 cm nasal lesion was shaved and cauterized; and the 1.5 cm lesion of the finger was excised with primary closure. All were found to be benign.

The appropriate CPT procedure codes/sequencing are:
11422, 11440, 11312
Use the following codes to answer this question:

31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe
+31632 with transbronchial lung biopsy(s), each additional lobe
31717 Catheterization with bronchial brush biopsy
32405 Biopsy, lung or mediastinum, percutaneous needle
76000 Fluoroscopy

Bronchoscopy with multiple transbronchial right upper and right lower lobe lung biopsy with fluoroscopic guidance.

How are these procedures coded?
31628-RT, 31632-RT
A hernia being repaired subsequently to a previous repair is referred to as what type of herniorrhaphy in CPT
Codes in the Cardiovascular System subsection of CPT are divided first by body part and then by
procedure performed.
In coding arterial catheterizations, when the tip of the catheter is manipulated from the insertion point into the aorta and then out of the aorta into another artery, this is called
selective catheterization
The directional term "ipsilateral" means:
situated. or appearing on, the same side, or affecting the same side
To accurately report herniorrhaphy, specific information must be made available to the coder. Which of the following elements is NOT required to report herniorrhaphy?
size of the hernia
In coding arterial catheterizations, when the tip of the catheter is manipulated from the insertion point into the aorta and then removed after completion of the procedure, this is called:
nonselective catheterization
The physician documented that she changed the cardiac pacemaker battery. In CPT, the battery in a pacemaker is called the:
pulse generator
To accurately report lower GI endoscopies, specific questions must be answered in documentation. Which of the following questions does NOT need to be answered in documentation?
What is the age of the patient?
Placement of an additional electrode in the left ventricle in addition to the pacemaker electrodes placed in the right ventricle and right atrium is called:
biventricular pacing
When mesh is used for a hernia repair, it can be reported separately with an add-on code when performing which type of repair?
incisional and ventral
Which of the following is NOT reported separately when performed adjunct to a coronary artery bypass graft (CABG) procedure?
saphenous vein harvest
Which of the following statements related to the coding of biopsies and lesion removals is FALSE?
When a biopsy is followed by an excision of the same lesion, assign a code for both procedures.
Which of the following statements about Interventional Radiology is FALSE?
One vascular access is reported per encounter.
Central lines are placed in the large veins of the:
neck or chest
During interventional radiology, the procedure will be coded to a higher level of selectivity each time the catheter tip passes another: