Mixed Deck — All AAPC Topics Flashcards

A durable medical equipment (DME) supplier provides a Medicare patient with a new standard manual wheelchair for home use. Which HCPCS Level II modifier is required to indicate the status of the equipment?

Answer: NU - New equipment

HCPCS Level II modifiers are used to provide additional information about a service or supply. For durable medical equipment, modifier -NU is appended to the HCPCS code to specify that the item provided is new equipment. Modifier -RR is used for rentals and -UE is for used equipment.

During the global period, a patient's related postoperative office visit is billed. How should this be handled?

Answer: The visit is included in the global package and is not billed separately

Postoperative visits directly related to the surgery are bundled into the global surgical package and cannot be reported separately.

An attending physician is perplexed by a patient's conflicting lab results and requests a formal consultation from the hospital pathologist. The pathologist reviews the patient's medical records and laboratory data, and provides a comprehensive written report with their medical interpretive judgment. Which CPT code series would be used to report this service?

Answer: 80503-80506 (Pathology Clinical Consultation)

The CPT code range 80503-80506 is specifically designated for pathology clinical consultations. These codes are used when a pathologist, upon the request of another physician, renders a medical interpretive judgment and provides a written report based on a review of patient records and lab findings, without evaluating a new specimen. The 88321 series is for reviewing slides from another institution, 99242-99245 involves face-to-face patient evaluation, and the 88300 series is for the examination of tissue specimens.

Which CPT code describes a proctosigmoidoscopy with biopsy?

Answer: 45305

CPT 45305 describes a proctosigmoidoscopy with biopsy of a single or multiple lesions.

Which of the following scenarios allows for the separate reporting of a cast application CPT® code (e.g., 29000-29799)?

Answer: Application of a short leg cast for a severe ankle sprain when it is the only procedure performed.

The application of the initial cast or splint is included in the global package for fracture care and is not separately reported. Similarly, replacement casts applied by the same physician during the global period are generally not separately billable. However, when cast application is the definitive treatment for a condition that does not have a separate surgical procedure code (such as a sprain or contusion), the cast application code itself is the reportable service.

A patient is admitted with neck pain following a collision with another softball player at a community baseball field. The diagnosis at the time of discharge is right internal carotid artery dissection likely secondary to trauma. The diagnoses coded for this injury are:

Answer: I77.71, W51.XXXA, Y93.64, Y92.320

Explanation: *I77.71: This code represents the diagnosis of right internal carotid artery dissection. *W51.XXXA: This code represents the external cause of injury, which in this case is "struck by a projectile" (softball) in an initial encounter. *Y93.64: This code represents the activity code for "participation in baseball" at the time of injury. *Y92.320: This code represents the place of occurrence code for "recreational area" (community baseball field). Options B, C, and D include different codes that do not accurately represent the scenario described in the question.

Which CPT code range covers procedures on the esophagus?

Answer: 43020–43499

CPT codes 43020–43499 cover surgical and endoscopic procedures performed on the esophagus.

An interlaminar epidural steroid injection at the lumbar level performed with fluoroscopic imaging guidance is reported using:

Answer: 62323 (lumbar/sacral, with imaging)

CPT 62323 describes an interlaminar epidural injection at the lumbar or sacral region performed with fluoroscopic or CT imaging guidance.

A neurosurgeon performs a laminectomy with spinal cord decompression at a single lumbar level without disc removal. Which CPT code is most appropriate?

Answer: 63047

CPT 63047 describes a laminectomy with decompression of the spinal cord or cauda equina at the lumbar level without disc removal.

Open carpal tunnel release (decompression of the median nerve at the wrist) is reported with which CPT code?

Answer: 64721

CPT 64721 describes neuroplasty and/or transposition of the median nerve at the carpal tunnel (open carpal tunnel release).

If past family and social history is not documented for the evaluation and management of a new patient, what is the highest level of service that can be coded?

Answer: 99202

Explanation: To code 99203-99205, the provider must document a detailed and/or comprehensive history intake, which must include past medical, family, and social history. For codes 99201-99202, a past medical, family, and social history intake is not required. Answers B and D are for the evaluation of an established patient and are not applicable to this scenario because the patient is new.

An anesthesiologist is medically directing one CRNA for an anesthesia case. Which HCPCS Level II modifier should be appended to the anesthesiologist's claim?

Answer: QY

Modifier QY is used to indicate the medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist. Modifier QX is used by the CRNA to report the service with medical direction. QZ is used by the CRNA when no medical direction is provided. QK is for medical direction of two, three, or four concurrent anesthesia procedures.

Which modifier is used on an E/M service when the decision for a major surgery is made on the day before or the day of surgery?

Answer: -57

Modifier -57 is appended to an E/M code when the service resulted in the initial decision to perform a major surgical procedure.

The inpatient admission certification must be signed by whom?

Answer: The admitting or attending physician

Explanation: The inpatient admission certification must be signed by the admitting or attending physician. This ensures that the physician responsible for the patient's care acknowledges and certifies the medical necessity of the inpatient admission. Other personnel, such as hospital administrators, patients' family members, or case managers, do not have the authority to sign the inpatient admission certification.

A patient with symptomatic bradycardia undergoes a procedure for the insertion of a new permanent dual-chamber pacemaker system, which includes the pulse generator and transvenous electrodes in both the right atrium and right ventricle. Which CPT® code should be reported for this entire procedure?

Answer: 33208

CPT® code 33208 describes the insertion of a new or replacement permanent pacemaker with transvenous electrodes in both the atrium and ventricle (a dual-chamber system). This is a comprehensive code that includes the pulse generator and the placement of both leads. The other codes represent components of the procedure or a different device (33249 is for an implantable defibrillator system).

CPT codes for nervous system procedures are found in which numeric range?

Answer: 61000–64999

CPT codes 61000–64999 cover all nervous system procedures including skull, brain, spine, and peripheral nerves.

Which of the following best describes the primary purpose of External Cause of Morbidity codes (V00-Y99) in ICD-10-CM?

Answer: To provide supplemental information about the cause, intent, and place of an injury or health condition.

External Cause codes are intended to be used as secondary codes to provide additional information. They describe how an injury or health condition occurred (cause), whether it was intentional or accidental (intent), where it happened (place), and what the patient was doing (activity). They should never be sequenced as the principal diagnosis.

Which of the following services is an example of a presumptive drug test?

Answer: A qualitative immunoassay test using a dipstick or cup that is read by direct optical observation.

Presumptive drug tests (CPT codes 80305-80307) are used to detect the presence or absence of a drug class and yield a qualitative result (positive or negative). CPT 80305 specifically describes tests, such as dipsticks or cups, read by direct optical observation. Definitive tests (like GC-MS) provide quantitative results, therapeutic assays monitor prescribed drugs, and molecular tests analyze genes.

A patient undergoes a percutaneous coronary intervention (PCI). The cardiologist performs a successful balloon angioplasty in the left anterior descending (LAD) artery and then places a drug-eluting stent in the right coronary artery (RCA) during the same session. Which of the following is the correct coding?

Answer: 92928-RC, 92920-LD

When different types of PCI are performed on separate major coronary arteries, each intervention is reported with a base code. Code 92928 is for stent placement in a single major coronary artery, and 92920 is for balloon angioplasty in a single major coronary artery. The appropriate coronary artery modifiers (-RC for right coronary, -LD for left anterior descending) are appended to specify the location of each intervention. Add-on codes are used for interventions in branches of the *same* major artery, which is not the case here.

According to CPT® guidelines, when a surgical arthroscopy is performed, which of the following procedures is typically considered an integral part of the service and is NOT reported separately for the same joint?

Answer: Diagnostic arthroscopy

CPT® guidelines explicitly state that a diagnostic arthroscopy (e.g., 29870 for the knee) is always included in a surgical arthroscopy when performed on the same joint during the same session. If a diagnostic scope leads to a surgical scope, only the surgical scope is reported. The other answer choices are therapeutic surgical procedures that are typically reported separately, although specific bundling rules may apply depending on the primary procedure performed.