CPT & HCPCS CODING CH 1-6 EXAM 1 – Flashcards

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T/F Chapter 1: The current edition of CPT is pocket-sized and contains approximately 4,000 codes.
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false
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T/F CPT is updated by CMS, and this occurs in May of each year.
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false
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T/F A circle is used to denote an add-on code in CPT.
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false
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True or False The semi-colon separates the main term, or common portion, of the CPT code from the additional, or unique portion, of the CPT code.
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true
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T/F CPT was first published by the American Health Information Management Association. True or False
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false
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HCPCS is the abbreviation for ______________________________________.
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Correct Healthcare Common Procedure Coding System
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Category II codes are not mandatory and are considered ________________ codes.
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tracking
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When a double triangle appears around information in the CPT manual, this means that the text is new or _______________.
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revised
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When the plus symbol appears before a code number, this indicates to the coder that the code is considered a(n) ___________________ code.
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add-on
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Clinical examples of the CPT codes for Evaluation and Management services are found in appendix ______ of the CPT manual.
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C
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F/T Chapter 2: A CPT modifier is a three-digit code that is appended to a code to indicate that a service or procedure has been altered.
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false
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T/F Modifiers are placed in item 24d of the CMS-1500 form.
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true
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T/F Third-party payers use different instructions for reporting modifiers.
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true
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T/F The CMS form contains three modifier fields. True or False
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false
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T/F When reporting more than one modifier, the modifiers must be ranked according to whether or not the modifier will affect the fee for service.
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true
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T/F A pricing modifier only increases the fee for the service
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false
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T/F When reporting more than one statistical modifier, with no other pricing modifiers, the modifiers can be reported in any order, with the exception of the QT, QW, and SF modifiers.
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true
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T/F Modifier 26 is used to indicate the professional component.
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true
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T/F Modifier 52 indicates a reduced service.
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true
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T/F Procedure codes for procedures performed on neonates and infants less than 4 kg should be modified with modifier 63.
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true
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A statistical modifier, also known as a(n) __________________ modifier is used for informational purposes and does not affect the fee.
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informational
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Using a CPT manual, select the correct modifier to use for the following case: Dr Smith completed a cholecystectomy on Mary Jones. Because of prolonged bleeding, the procedure took 65 minutes longer than usual. The modifier that should be reported is ____________.
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22
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Using a CPT manual, select the correct modifier to use the following case: Dr Won, a radiologist, interpreted a cervical X-ray of the spine. The modifier that should be reported is ________________.
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26
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Using a CPT manual, select the correct modifier to use the following case: Dr Woks, performed the postoperative care for a surgical patient. The modifier that should be reported is modifier _____________.
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55
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Modifier _________ is used to report a decision for surgery.
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57
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E4 is a modifier for what?
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lower right eyelid
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F8 modifier is for what?
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right hand 4th digit
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P1 is a modifier for what?
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normal healthy patient
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P5 is a modifier for what?
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a moribund patient who is not expected to survive without the surgery
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GC is a modifier for what?
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This service was performed in part by a resident under the direction of a teaching physician.
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Evaluation and management codes are used to code surgical procedures.
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false
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A new patient, as defined by CPT is a patient who has not received professional services from a physician, or another physician of the same specialty who belongs to the same group practice, within the past 3 years. True or False
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true
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A chief complaint is the reason for the patient encounter.
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true
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T/F Social history includes information regarding the patient's and patient's family's marital status, occupation, sexual history, or other social factors.
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false
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T/F A detailed examination is the highest level of examination and consists of a multi-system or complete examination of the single organ system.
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false
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Information regarding major illnesses, surgeries, injuries, and hospitalizations is part of the _____________________________.
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past history of the patient
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The objective portion of a "SOAP" note contains the:
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exam of the patient
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Constitutional elements of an examination include all EXCEPT which of the following?
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inspection of the eyes
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Medical decision making is based on all the following EXCEPT:
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examination of the patient
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Which of the following is NOT considered a key component when selecting an evaluation and management code?
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coordination of care
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A chronological description of the patient's present illness is the ______________.
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history of present illness
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A complete PFSH includes:
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past patient history, family history, social history
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Which of the following codes would NOT be reported for an inpatient hospital encounter?
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99213
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Which of the following would be reported in a clinic?
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99214
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Which of the following statements is FALSE in regard to an emergency department service code?
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A distinction is made between new and established patients.
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An E and M nursing facility service involving an annual nursing facility assessment which requires a detailed interval history, comprehensive examination and medical decision making that is of low to moderate complexity is reported with code _______________.
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99318
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A home visit E and M service that involved a problem focused history and examination of a new patient and straightforward medical decision making would be reported with code _____________.
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99341
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A smoking and tobacco use cessation counseling visit of 15 minutes would be reported with code _______________.
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99407
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Dr Jones is the admitting physician for patient Sally Smith. On the first day of hospitalization Dr Jones completes a comprehensive history and examination, and the medical decision making is of moderate complexity.
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99222
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Mr Hinds is a patient in the ICU who is listed in critical condition. Because of his condition, Dr Jones spends 1 hour in the evaluation of the patient and this is documented in the chart. During this time, Dr Jones reviewed X-rays that were taken, reviewed ECGs, and performed ventilation management
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99291
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Define the term observation status.
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The patient has NOT been admitted to the hospital as an inpatient, but needs to be admitted under "observation" for assessment.
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List and define the 3 Rs that are used for consultation codes.
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Request-dr receives request from another dr to see patient Render-dr renders an opinion Response or Report-dr responds to initial/requesting dr via written report
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Differentiate between the hospital discharge codes 99238 and 99239.
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99238 is for discharge day 30 minutes or less 99239 is for discharge day more than 30 minutes
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T/F Anesthesia is administered to patient to relieve pain and to perform surgery. True or False
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true
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T/F Medicare requires the use of the CPT anesthesia codes to bill for anesthesia services. True or False
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true
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T/F When locating CPT codes for anesthesia, the main terms to reference would be "Surgery", then "Anesthesia".
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false
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T/F The American Medical Association publishes the Relative Value Guide for the anesthesia codes. True or False
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false
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T/F Anesthesiologists bill for their services separately from the surgery charges. True or False
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true
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A certified registered nurse anesthetist is a registered nurse with ___________ months of additional training in anesthesiology.
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36
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When an anesthetic agent is administered directly into the bloodstream, it is known as ________________.
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injection
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The history and exam performed by the anesthesiology staff is part of which component of care?
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preoperative care
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During the administration of anesthesia, the case was complicated by emergency conditions. They type of code to report this occurrence with an addition to the anesthesia code would be __________________.
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qualifying circumstance code
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An anesthesiologist performed a history and physical exam that took 20 minutes to complete. The procedure required 80 minutes of anesthesia time. The time units used by the insurance company are calculated in 20 minute increments. How many units of time would be reported for this procedure?
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4
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Select the appropriate anesthesia CPT code(s). Patient: Tom Smith Age: 6 months Anesthesia: General Procedure: Hernia repair, lower abdomen
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00834
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Select the appropriate anesthesia CPT code(s). Anesthesia: General Procedure: Closed reduction of femur, lower one-third
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01340
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Select the appropriate anesthesia CPT code(s). Diganosis: Morbid obesity Anesthesia: General Procedure: Gastric bypass and restriction
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00797
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Select the appropriate anesthesia CPT code(s). Anesthesia: General Procedure: Second-degree burn excision with skin grafting for TBSA of 8 percent
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01952
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Select the appropriate anesthesia CPT code(s). Anesthesia: General Procedure: Amniocentesis
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00842
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Select the appropriate anesthesia CPT code(s). Anesthesia: Regional Procedure: Corneal transplant
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00144
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T/F The Surgery chapter of the CPT manual is arranged by body system and types of procedures.
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true
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T/F Diagnostic procedures are completed to treat an established diagnosis. True or False
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false
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T/F Unbundling of codes is an accurate manner in which to report two procedures that are performed on the same date of service. True or False
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false
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T/F Fine needle aspiration is a type of aspiration by which a fine needle is inserted into the body site and then fluid is drawn from the site. True or False
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true
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T/F A biopsy is a procedure in which a sampling of tissue is removed for pathological examination. True or False
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true
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A(n) ________________ repair would be used to report a layered closure or to report extensive cleansing of a wound that is heavily contaminated.
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intermediate
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A(n) ________ graft is a type of graft where tissue is taken from one part of a person's body and grafted to another part of the same person's body.
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autogenous
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Cryosurgery, electrosurgery, and chemosurgery are all forms of _______________.
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destructions
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Dr Smith performed an incision and removal of a foreign body on the left arm int he subcutanous layer of the skin. The correct code to report is ____________.
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10120
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Which code is used to report a 12.8 cm simple repair of superficial wound of the neck?
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12005
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A procedure, completed to clean a wound site, that involves the removal of dirt or foreign objects along with tissue that may be necrotic or damaged is called ___________________.
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debridement
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A cutting instrument, called a(n) _________________, is used for debridements and for skin grafting.
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dermatome
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Common sites for skin tags include the axillae, ___________, and inguinal areas.
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neck
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Select the appropriate surgery CPT code(s). Diagnosis: Lesion on left upper arm area Procedure: Excision of 1 cm lesion, total excised diameter was 1.5 cm. Pathology: Malignant
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11602-LT
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Select the appropriate surgery CPT code(s). Procedure: Fine needle aspiration with imaging guidance
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10022
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Select the appropriate surgery CPT code(s). Diagnosis: Multiple lacerations Procedures: 2.2 cm intermediate repair of laceration of arm, 3.5 cm complex repair of laceration of forehead, and 3.4 cm intermediate repair of laceration of scalp
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13132 and 12032
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Select the appropriate surgery CPT code(s). Diagnosis: Second- and third-degree burns of 15% of total body surface Procedure: Subsequent dressing and debridement of partial-thickness burns
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16030
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Select the appropriate surgery CPT code(s). Procedure: Removal of tissue expander
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11971
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T/F Chapter 6 When imaging guidance is used to complete an injection made into a joint or bursa, additional CPT code(s) should be assigned to report the imaging guidance if the imagine guidance is not included in the primary CPT code .
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true
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T/F The application of force to a limb using felt that is appllied to the skin is known as skeletal traction.
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false
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Reduction, also known as _________________ , is completed to realign a bone.
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manipulation
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ORIF is the abbreviation for ______________________________________________.
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open reduction internal fixation
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A(n) ____________________ is an endoscopic instrument used to visualize the interior structures of a joint.
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arthroscope
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Select the appropriate surgery CPT code(s). Procedure: Deep, open bone biopsy of femur
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20245
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Select the appropriate surgery CPT code(s). Diagnosis: Fracture of greater humeral tuberosity Procedure: Closed treatment with reduction of fracture
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23625
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Select the appropriate surgery CPT code(s). Procedure: Arthrodesis of metacarpophalangeal joint with internal fixation
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26850
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Select the appropriate surgery CPT code(s). Sharon Jones was in a motor vehicle accident and sustained a fracture of the ulna that required the placement of an external fixation device. Today, Dr Bones is removing the external fixation device under anesthesia.
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20694
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Select the appropriate surgery CPT code(s). Diagnosis: Trigger finger Procedure: Incision of tendon sheath
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26055
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Select the appropriate surgery CPT code(s). Radical resection of a malignant tumor of the soft tissue of the pelvis and hip area, 4 cm
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27049
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Select the appropriate surgery CPT code(s). Shoulder arthroscopy with lysis of and resection of adhesions
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29825
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Select the appropriate surgery CPT code(s). Endoscopic plantar fasciotomy
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29893
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When modifier 22, unusual procedural services, is reported, an insurance company may require a special report to be completed. List two items that would be reported on the special report.
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Complete description of procedure performed. The reason the service fell outside the parameters of the CPT code description. The time, effort, and equipment used during the procedure. The complexity of the case, describing the patient's condition and symptoms occurring during the procedure. The preop and postop diagnoses. Pertinent physical findings that impacted the case and procedure. Any diagnostic or therapeutic services that were rendered in association with the procedure. Concurrent diagnosis(es), symptoms, and problems that were present. The anticipated follow-up care.
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