Clinical Coding Cert Prep: Quiz 7 – Flashcards

51729-26, 51797-26 Code 51797 should not be used without its primary code. Beneath code 51797 it states that this code should be used in addition to either code 51728 or 51729. Since options A and C utilized code 51797 without its primary code these two options are incorrect. Code 51729 utilized the common descriptor next to code 51726 but also includes its own unique descriptor "with voiding pressure studies", making its full description "Complex cystometrogram (ie. Calibrated electronic equipment); with voiding pressure studies". Code 51797 is an add-on code describing the "intra-abdominal" portion and notes that it should be used in addition to code 51729. This would make the codes in options B and C both correct. According to the Urodynamics coding guidelines (above vode 51725), if the physician did not provide the equipment and is simply operating it and interpreting the report then modifier 26 should be added to these codes. Since the physician in our scenario is utilizing hospital equipment and not his own adding modifier 26 would be correct.

Malleus, incus, and stapes *The only way to find the answer for this question is to use the anatomical diagrams in the auditory chapter. There are two diagrams in the auditory chapter that have picture of ossicles. One diagram depicts a tympanoplasy (codes 69635-69646), and the other diagram depicts a tympanostomy (codes 69433-69436). Although the ossicles are not labeled individually, they are labeled "auditory ossicles". Using the picture of three ossicles you can then look at a second diagram of the ear, located in the auditory coding guidelines (prior to code 69000). The same picture of the three ossicles is shows, but this time they are labeled individually as the Incus, Malleus, and Stapes. Writing the terms hammer, anvil, and stirrup beneath these three diagram may be useful when taking the CPC Exam.*

63040 Code 63040 is for a laminectomy (-ectomy meaning removal, of the lamina) and a partial facetectomy (-ectomy meaning removal, of the facet), with nerve decompression, or with or without removal of herniated a disc. Choosing option A as your answer would be done by focusing on key phrases in this question, such as: "the ligamentum flavum, lamina, and fragments of a ruptured C3-C4 intervertebral disc were all removed" and "the surgeon removed a portion of the facet", and "to relieve the compressed nerve".

Lymph nodes *The endocrine system codes start with code 6000 and end with code 60699. The first heading in the endocrine chapter is "thyroid gland". Following the codes through the chapter you come to code 60500 and the next (and final) heading (directly above this code), which reads 'Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body'. The only organ not listed in the endocrine chapter is the Lymph nodes, which are part of the hemic-lymphatic system located at the end of the 30000 codes.*

61315 The neurosurgeon performed a crainiotomy (he cut into the skull; Craini means head and -otomy means to cut into), and drained an intracerebellar hematoma (which is a collection of blood). Code 61154 describes the burr hold accurately, but no craniotomy, it also describes the evacuation of the hematoma correctly, but it is missing the location (intracerebellum). This means you can eliminate options A and D. Code 61315 correctly describes the scenario. Although the neurosurgeon did create a burr hold during the procedure, notations beneath code 61253 state that "if burr holes or trephine are followed by a crainiotomy at the same operative session, use 61304-61321; do not use 61250 or 61253.

69667-50, 69990 The procedure performed is a repair to a fistula in the round window. Code 69666 and code 69667 both accurately describes this procedure, but code 69666 is performed on the oval window and code 69667 is performed on the round window. Options A and C can be ruled out, because they describe the oval window code instead of the round window code. There are no notations beneath code 69667 excluding modifier 50, and coding guidelines state that if a procedure is not stated it as a bilateral operation (or is not specified in the guidelines), then it is assumed to be uni-lateral. Since code 69667 is not noted as being bilateral we must assume it is unilateral. Since the surgeon performed this procedure on both ear modifier 50 would be correct. Code 69990 has a list of CPT codes it cannot be coded in conjunction with (see operating microscopic coding guidelines above code 69990), however, code 69667 is not one of them, therefore, coding 69990 in addition to code 69967 is correct.

The CPT code with a modifier 26 The full CPT code has both components, technical and professional, and if the physician did not perform both components he cannot be reimbursed for them both. The TC modifier is used to depict the technical component, which what the radiologist often utilizes. Modifier 26 is the professional component, which is what the physician should append to his CPT code. Modifier 52 is used when a physician must terminate a procedure or attempts an entire procedure but has unsuccessful results. A full description of modifier 26 and 52 can be found in appendix A. Modifier TC is a HCPCS modifier and should be referenced in the HCPCS book.

70150 The radiologist took 3 views of the patient's facial bones. The Water's view (oblique anterior-posterior), anterior-posterior view, and lateral view. Code 70100 is a view of the mandible only, which is located in the jaw. Code 70120 describes 3 views of the mastoid, which is located near the end and attached to the temporal bone. Code 70150 accurately describes three views taken of unspecified facial bones. Code 70250 describes skull bones, and not facial bones, being viewed.

20225, 77012 For the bone biopsy, code 20225 accurately describes a percutaneous, deep bone, biopsy. Code 20245 describes the same thing; only open insteadof percutaneous (requiring an incision instead of a needle). Code 38221 is a biopsy of the bone marrow (not the actual bone). Beneath code 20225 the notations state to use either code 77002, 77012, or 77021 for radiological supervision and interpretation. Code 77012 accurately depicts the CAT scan (computed tomography). Code 76998 describes the use of an ultrasound instead of a CAT scan, and code 73700 is used when a diagnostic CAT Scan is being taken, not a procedural one.

78451, 93016 There is a little difference between codes 78451 and 78453. Code 78451 is done by SPECT and include attenuation correction and code 78453 is a planar type image. In our scenario code 78451 is correct. This rules out options B and D. According to the Radiology Cardiovascular System coding guidelines, (above code 78414), when a myocardial perfusion study using codes 78451-78454 or 78472-78492 is performed in conjunction with a stress test, then the stress test should be coded in addition to the study using codes 73015-73018. In our scenario code 73016 is correct because the physician did not provide the interpretation and report (the cardiologist did).

36598 Code 3598 accurately describes the injection of a contrast material (radiopaque lodine) into a central venous access device (Hickman's catheter). This code also includes the fluoroscopic imaging and report. According to the notation beneath code 36598 you are not to code 76000 in conjunction with it, so option C is incorrect. These notations also state that if you are looking to code "complete diagnostic studies, see 75820, 75825, 75827", it does not say you must use them i addition to this code though. When reading the Radiology "Vein and Lymphatic" coding guidelines (above code 75801), it states that if a "Diagnostic venography is performed at the same time as an interventional procedure it is NOT separately reported if it is specifically included in the interventional code descriptor". Also, in our scenario there is not clear indication that a full vein study was done, only a CVAD check. Since code 36598 includes a fluoroscopic imaging and report there is nothing else to report.

c. 80047, 84460, 84450, 84155, 84443 When coding a panel every test in that panel must be performed or that panel cannot be coded. Every code listed in our scenario is listed beneath code 80053 except the TSH (which is coded using code 8443). Code 80053 also has an additional test for Albumin listed. Since an Albumin level was not ordered we cannot use code 80053, even with a 52 modifier. This eliminates option A. Option B lists total calcium levels being ordered instead of ionized calcium levels, so this is incorrect. Option C is correct because every test listed beneath code 80047 was ordered. In addition to 80047, the lab tests not listed are accurately coded individually. Option D seems like a good option because it does accurately capture each test listed in our scenario, however, code 80047 captures a larger number of tests while still being correct and utilizes fewer codes overall which makes this the better option. When given the option between choosing a panel or listing each test individually, you should select the panel.

B. 83874, 83874-91 x2, 84484, 84484-91 x2, 82550, 82550-91 x2 Appendix "A" has a full description of each modifier and how it should or should not be listed. Modifier 99 should be used when a single CPT code has two or more modifiers appended to it. Modifier 99 could be used in place of the multiple modifiers and the specific modifiers could then be listed elsewhere on a claim form. Modifier 76 is meant to be used on a service and/or procedure code, not laboratory codes. The use of modifier 76 eliminates option A. Modifier 91 is meant to be used on laboratory codes, and is used when a test is purposely ran more than once on the same day. Modifier 91 should only be appended to the second test and beyond though, and not to the first test performed (like in option C). Option B is correct because it lists each test once without a modifier and then the second and third time each of those tests were ran modifier 91 was appended, indicating that it was actually performed multiple times in one day. If option D was billed, the insurance company would pay each test only once then deny the second and third time the test was ran as a "duplicate charge", this is because the 91 modifier was not appended to indicate they were not duplicates.