2014 Physician Coding for CPC Chapter 6 Review – Flashcards

a Physician work, Practice expense, Malpractice Insurance . b Geographic region, Practice expense, Malpractice Insurance . c Geographic region, Conversion factor, Physician fee schedule . d Physician work, Physician fee schedule, Conversion factor . ANS: A Rationale: Per CMS - Relative value units (RVUs) Ð RVUs capture the three following components of patient care: Physician work RVU, Practice Expense RVU, and Malpractice RVUs.

a CPT¨ Category I codes b CPT¨ Category II codes c CPT¨ Category III codes . d HCPCS Level II codes . . ANS: B Rationale: Per AMA, CPT¨ Category II codes are a set of supplemental tracking codes that can be used for performance measurement.

a 10 percent . b 100 percent . c 85 percent . d Reimbursement, if any, is determined by the payer . D Rationale: Per AMA, no relative value units (RVUs) are assigned to these codes. Payment for these services or procedures is based on the policies of payers.

a Hospitals . . b Ambulatory Surgical Centers c PhysicianÕs offices d All of the above . . D Rationale: The Medicare approved amount for surgery includes the following services when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, eg, in hospitals, ASCs, and physicians' offices. Visits to a patient in an intensive or critical care unit are also included if made by the surgeon.

a XXX . b 010 c 000 . d 090 . C Rationale: Per CMS Internet-only manuals (IOM) Medicare Claims Processing Manual Ð surgical status indicator 000 = Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

a Healthcare Physician Coding Standards . b Healthcare Common Procedure Coding System . c Healthcare Physician Communicating System . d Health Codes for Physicians and Coding Surgeries . B Rationale: HCPCS stands for Healthcare Common Procedure Coding System.

a Transportation Services including Ambulance (A0021-A0999) . b Orthotic Procedures and Devices (L0000-L4999) . c Durable Medical Equipment (E0100-E9999) . d Prosthetic Procedures (L5000-L9999) . C Rationale: A wheelchair is considered durable medical equipment. In the HCPCS index, look for the term Wheelchair. Majority of the codes listed are E HCPCS codes.

a 365 b 90. c 30 . d 60 . . B Rationale: Per CMS Temporary codes can be added, changed, or deleted on a quarterly basis. Once established, temporary codes are usually implemented within 90 days, the time needed to prepare and issue implementation instructions and to enter the new code into CMS's and the contractors' computer systems and initiate user education. This time is needed to allow for instructions such as bulletins and newsletters to be sent out to suppliers to provide them with information and assistance regarding the implementation of temporary CMS codes.

a C codes. b G codes. c H codes . d Q codes. A Rationale: Outpatient PPS (C1300-C9899) Guideline explains C codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals to report new technology procedures, medical devices, drugs, biologicals, and radiopharmaceuticals; that do not have other HCPCS codes assigned. Other facilities may report C-codes at their discretion.

a Use an unlisted code when a procedure is . b Parenthetical instructions define each. c Select the name of the procedure or . modified. . service that most closely approximates the procedure or service performed. d Select the name of the procedure or . code listed in the codebook. . service that accurately identifies the service performed. D Rationale: CPT¨ Instructions for the use of the CPT¨ codebook include "select the name of the procedure or service that accurately identifies the service performed"

a Surgery codes b Add-on codes . . c Mandated services . d . Bilateral procedures B Rationale: Per CPT¨ "all add-on codes found in the CPT¨ codebook are exempt from the multiple procedure concept."

a AMA b CMS c HIPAA . . d CPT¨ Assistant . . B Rationale: CMS has been delegated to maintain and distribute HCPCS Level II codes.

a 26 b 52 c 32 . . d 76 . . C Rationale: Modifier 32 reports "mandated services"

a Category II codes, temporary national codes, and miscellaneous codes. . b Dental codes, morphology codes, miscellaneous codes, and, permanent national codes. . c Permanent national codes, dental codes, category II codes. . d Permanent national codes, miscellaneous codes, and temporary national codes. . D . Rationale: HCPCS Level II codes consist of permanent national codes, miscellaneous codes, and temporary national codes.

a CPT¨, codebook, HCPCS Level II b CPT¨ codebook c AHA Coding Clinic . codebook, ICD-9-CM codebook . d CPT¨ codebook and CPT¨ Assistant . . D Rationale: CPT¨ (all three categories) and CPT¨ Assistant is published, copyrighted, and maintained by AMA.

a annually b quarterly c bi-annually . . d three times a year . . A Rationale: Permanent national codes are updated once a year in January.

a hospitals b nursing homes c non-hospital owned physician practices . . d hospital owned physician practices . . C Rationale: "Non-facility" location calculations are for private practices or non-hospital-owned physician practices. Reimbursement is higher for private practices because the practice incurs the full expense of providing the service.

a 00218 b 00216 c 00212 . . d 00210 . . D Rationale: In the CPT¨ Index, look for Anesthesia/Brain. Here you are directed to see codes 00210-00218, 00220-00222. When you turn to these codes in the Anesthesia section and review them, it is code 00210 you would report. This represents Anesthesia for intracranial (brain) procedures, not otherwise specified.

a 01400 b 01402 c 29870-LT . . d 29880-LT . . A Rationale: In the CPT¨ Index, look for Anesthesia/Knee. You are given multiple codes to choose from. When you turn to these codes in the Anesthesia section and review them, it is code 01400 you would report. This represents Anesthesia for arthroscopic procedures performed on the knee.

a 11720 b 11750 c 11765 . . d 11760 . . C Rationale: In the CPT¨ Index, look for Excision/Nail Fold. The code you are directed to use is 11765.

a 11403 b 11603 c 11423 . . d 11623 . . C . Rationale: In the CPT¨ Index, look for Excision/Skin/Lesion/Benign or look for Skin/Excision/Lesion/Benign. You are directed to see codes 11400-11471. When you turn to these codes in the Integumentary code section and review them, it is code 11423 you would report. This represents the excision of a benign lesion on the scalp, neck, hand feet or genitalia which is 2.1-3.0 cm in diameter excised including margins.

a 29065 . . b 29075 c 29125 d 29280 . . B DIF: Rationale: In the CPT¨ Index, look for Cast/Ambulatory/Short Arm. The code you are directed to use is 29075.

a 28290 . b 28292 c 28293 . d 28285 . . B Rationale: In the CPT¨ Index, look for the term Mayo procedure. The code you are directed to use is 28292.

a 30020 b 30100 c 30110 . . d 30115 . . D Rationale: In the CPT¨ Index, look for Excision/Polyp/Nose. You are directed to 30110, 30115. Looking at the description for each code in the Respiratory Section, 30115 is for extensive.

a 30400. . b 30430 c 30435 d 30462 . . B Rationale: In the CPT¨ Index, look for Rhinoplasty/Secondary. You are directed to see codes 30430-30450. Look at the codes in the Respiratory code section and review them, it is code 30430 you would report. This represents a small amount of work for a secondary rhinoplasty when performed on the tip of the nose.

a 31020 . . b 31050 c 31030 d 31051 . . C Rationale: In the CPT¨ Index, look for Sinusotomy/Maxillary. You are directed to see codes 31020-31032. Look in the Respiratory Section and review the code descriptors, it is code 31030 you would report.

a IM b SC c INH . . d IT . . D Rationale: In the HCPCS Level II codebook, there is an appendix that lists the abbreviations and acronyms and their meanings listed. IT stands for Intrathecal. IT is the route where a drug is introduced into the subdural space of the spinal cord.

a B4176 b B4172 c B4168 . . d B4178 . . C Rationale: In the HCPCS Level II Index, look up Parenteral nutrition/solution. You are directed to codes B4164-B5200. When you turn to the B codes to review, it is code B4168 you would report.

a Modifier 52 b Modifier 22 c Modifier 53 . . d Modifier 54 . . C Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well being of the patient. CPT¨ modifiers are found on the inside front cover and in Appendix A of your CPT¨ codebook.

a L3050 b L3060 c L3080 . . d L3090 . . A Rationale: In the HCPCS Level II Index, look for Support/arch. You are directed to see codes L3040-L3090. When you turn to the L codes to review, it is code L3050 which represents a removable metatarsal foot arch support.

a J2540 x 4 . b J0561 x 24 . c . . J2510 x 4 d J0558 x 24 B Rationale: In the HCPCS Level II Table of Drugs, look up Bicillin LA. Here you are directed to see Penicillin G benzathine, referring you to code J0561. J0561 is for 100,000 U so 24 units of J0561 are reported for 2,400,000 are reported.

a 44208 b 44210 c 44145 . . d 44207 . . D Rationale: In the CPT¨ Index, look for Laparoscopy/Colon/Colectomy/Partial. You are directed to codes 44204-44208 and 44213. In the Digestive Section, review the codes, it is code 44207 which represents a partial colectomy with anastomosis and coloproctostomy performed laparoscopically.

a 50060 b 50065 c 50070 . . d 50075 . . C . Rationale: In the CPT¨ Index, look for Nephrolithotomy. You are directed to see codes 50060-50075. In the Urinary Section, review the descriptions of these codes. Code 50070 represents a complicated nephrolithotomy performed on a patient having a congenital kidney abnormality.

a 52007 b 52005 c 52000, 52007 . . d 52005, 52007 . . A Rationale: In the CPT¨ Index, look for Cystourethroscopy/Biopsy/Brush. The code you are directed to is 52007.

a 67311 b 67312 c 67314 . . d 67316 . . B Rationale: In the CPT¨ Index, look for Strabismus/Repair/Two Horizontal Muscles. The code you are directed to use is 67312.

a 71034 b 71030 c 71023 . . d 71020 . . A . Rationale: In the CPT¨ Index, look for X-ray/Chest/Complete (Four Views) with Fluoroscopy. The code you are directed to use is 71034.

a 81000 b 81001 c 81003 . . d 81015 . . D DIF: Rationale: In the CPT¨ Index, look for Urinalysis/Microscopic. The code you are directed to use is 81015.

a 88305 b 88304 c 88309 . . d 88307 . . A Rationale: In the CPT¨ Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam/ Level IV. The code you are directed to use is 88305

a 93451 b 93530 c 93453 . . d 93531 . . B Rationale: In the CPT¨ Index, look for Catheterization/Cardiac and you are directed to see Cardiac Catheterization. Cardiac Catheterization/Right Heart/Congenital Cardiac Anomalies directs you to use is 93530.

a 3476F b 3475F c 3471F . . d 3470F . . C Rationale: In the CPT¨ Index, look for Performance Measures/Rheumatoid Arthritis/ Diagnostic/Screening Processes or Results/Rhematoid Arthritis Disease Activity Assessment. You are directed to see codes 3470F3472F. When you turn to these codes found with the Category II codes and review them, it is code 3471F you would use. This represents the measurement of disease activity in a patient with rheumatoid arthritis.

a 90471 b 94073 c 90461 . . d 90460 . . D Rationale: In the CPT¨ Index, look for Immunization Administration/One Vaccine/Toxoid/ with Counseling. Here you are directed to use code 90460 . Code 90461 is an add-on code and would not be reported alone.

a 70554 b 70553 c 70552 . . d 70551 . . B Rationale: In the CPT¨ Index, look for Magnetic Resonance Imaging (MRI) /Diagnostic/Brain. You are directed to see codes 70551-70555. In the Radiology Section, review these codes, it is code 70553 you would report. This represents an MRI performed on the brain. First this is done without contrast materiel then with contrast material.

a 66 b 80 c 62 . . d 59 . . C Rationale: Modifier 62 is used when two surgeons work together as primary surgeons performing distinct part(s) of a procedure. Modifiers and their descriptions can be found on the inside front cover and Appendix A of your CPT¨ codebook.

a Femoral artery b Aorta c Carotid artery . . d Brachial artery . . B DIF: Rationale: Look in Appendix L of yourCPT¨ codebook. The guidelines for Appendix L states the assumption is made that the starting point is catheterization of the aorta.

a Debridement of extensive eczematous or infected skin; up to 10% of body surface; each . additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure). b Debridement of extensive eczematous or infected skin; each additional 10% of the body . surface, or part thereof (List separately in addition to code for primary procedure) c Each additional 10% of the body surface, or part thereof (List separately in addition to . code for primary procedure) d Debridement of extensive eczematous or infected skin; up to 10% of body surface . B Rationale: Look at code 11001 in the Integumentary Section of the CPT¨ codebook. The code description of an indented code includes the portion before the semicolon in the main code. In this example, the common potion of the code is shown in 11000 which is "Debridement of extensive exzemetous or infected skin;" The remaining portion of the code descriptor is stated next to add-on code 11001, "each additional 10% of the body surface, or part therof."

a Facility services b Nonfacility services c Nursing services . . d Non covered services . . A Rationale: The Introduction section of the CPT¨ codebook (after the Table of Contents) includes instructions under the subheading, Place of Service and Facility Reporting, states services provided in the home by an agency are considered facility services.

a Italic print b Red print c Green print . . d Bold print . . C Rationale: New additions and revisions are indicated in your CPT¨ codebook each year by green print.

a 49555-49557 b 49654-49659 c 49560-49566 . . d 49570-49572 . . C Rationale: Look in your CPT¨ codebook for 49568. The parenthetical instruction under code 49568 states, "Use 49568 in conjunction with 11004-11006, 49560-49566."

a They identify mileage traveled during the encounter. . b They identify emergency or non-emergency transport types. . c They identify the time elements of the ambulance service. . d They identify ambulance place of origin and destination. . D Rationale: Transportation (ambulance) services utilize modifiers made up of two letters identifying the origin and the destination according to the guidelines in the A section (Transportation Services Including Ambulance A0021-A0999) of the HCPCS codebook.

a The HCPCS Level II code. b The CPT¨ code. c Report both. . . d It depends on the payer. D Rationale: The payer determines whether a CPT¨ or HCPCS Level II code is reported.