Certified Coding Associate Professional Flashcards

What does it signify when a CPT code is preceded by the symbol #?

Answer: That the code is listed out of numerical order

In the Current Procedural Terminology (CPT) codebook, the # (pound sign) symbol indicates that a code has been resequenced. This means the code appears out of numerical order to group related procedures together for easier reference. This helps coders locate services that are clinically related, even if their numerical sequence is broken.

What ICD-9 code should be used to diagnose a history of personal heart attacks?

Answer: 412

In the ICD-9-CM coding system, code 412 is specifically used to diagnose 'Old myocardial infarction' or 'Healed myocardial infarction.' This code is appropriate for documenting a patient's personal history of a heart attack when they are not currently experiencing an acute event, indicating a past cardiac episode.

Why is it important to include ICD-9 codes on a claim?

Answer: They indicate the medical necessity of the service

ICD-9 (and now ICD-10) codes are diagnosis codes that describe the patient's condition or the reason for their visit. They are essential on a claim because they provide the medical justification for the services (CPT codes) performed, thereby establishing medical necessity. Without appropriate diagnosis codes, insurance companies may deny claims as they cannot ascertain why the services were rendered.

HIPAA stands for what?

Answer: Health Insurance Portability and Accountability Act

HIPAA stands for the Health Insurance Portability and Accountability Act. Enacted in 1996, this federal law established national standards to protect sensitive patient health information from unauthorized disclosure. It also includes provisions aimed at improving the portability and continuity of health insurance coverage.

What is the main diagnosis in an outpatient setting?

Answer: The reason the paient came in for the visit

In an outpatient setting, the main diagnosis, also known as the primary diagnosis, is the condition, problem, or complaint that is chiefly responsible for the patient seeking medical attention and receiving services during that specific encounter. It is the diagnosis that best describes the patient's chief complaint or the primary reason for the visit.

After seeing Natasha in the office, the doctor determined that she had acute bronchitis and COPD. What ICD-9 diagnosis code would be appropriate for her condition?

Answer: 491.22

In ICD-9-CM, code 491.22 specifically represents 'Obstructive chronic bronchitis with acute exacerbation.' This code is appropriate when a patient with Chronic Obstructive Pulmonary Disease (COPD), which often includes chronic bronchitis, experiences an acute worsening of their condition, such as acute bronchitis. It accurately captures both aspects of Natasha's diagnosis.

Typically, Tricare Prime patients are required to see a doctor:

Answer: At their military treatment facility

Tricare Prime is a managed care health plan for military beneficiaries that typically requires patients to enroll with a primary care manager (PCM) at a military treatment facility (MTF). Under this plan, patients generally receive most of their routine care at the MTF and need referrals to see specialists or receive care outside the MTF.

Which of the following is a CPT code from the surgery section?

Answer: 11000

CPT codes are organized into distinct sections based on the type of medical service. Code 11000, 'Debridement of extensive eczematous or infected skin; up to 10% of body surface,' is found within the Integumentary System subsection, which is part of the broader Surgery section (codes 10000-69990). The other options belong to different CPT sections, such as Evaluation and Management, Pathology and Laboratory, and Radiology.

In preparation for a kidney transplant, a 20-month-old baby with end-stage renal illness was getting dialysis twice a week. The patient had dialysis once a day for the last month of his life. The period of dialysis went from June 1 to June 14. Daily face-to-face counseling about the patient's care and ESRD status was provided to the patient's parents. Which code is appropriate for the patient's dialysis treatment?

Answer: 90967 (X14)

CPT code 90967 is used for 'End-stage renal disease (ESRD) related services for a patient less than 2 years of age, per month.' Since the 20-month-old baby received daily dialysis and counseling for 14 days in June, this represents a partial month of ESRD-related services. The (X14) modifier indicates the specific number of days of service provided within that month, making it the appropriate code for this scenario.

After an automobile accident, Mr. Cheng had to get checked out in order to file an insurance claim. Which modifier should be applied to the claim?The proper modifier to apply to the claim is modifier-32. When an operation is carried out at the request of an official authority, such as an auto or life insurance company, the modifier-32, required services, is used. Modifier-22 is ideal for an unusual procedural service, while Modifier-51 and Modifier-99 are utilized for various procedures and modifiers, respectively.

Answer: -32

Modifier -32, 'Required Services,' is used when a service is mandated by an official authority, such as a third-party payer or governmental regulatory body. In Mr. Cheng's case, the check-up is required for filing an automobile insurance claim, indicating an external requirement for the service. Therefore, modifier -32 is the appropriate choice to convey this information on the claim.

An elderly 90-year-old man named Thiago has spent the last six months confined to his bed. The doctor observed a pressure ulcer on the back of his leg muscle during his most recent examination. The ulcer was already advanced, and the rear of the calf's epidermis had experienced partial thickness skin loss. Theodore's doctor advised that he be turned upright to reduce pressure on his calf muscle and avoid infection. If the pressure ulcer doesn't heal, your doctor in Thiago can suggest utilizing a healing chamber to stop the wound from getting worse. What kind of coding should be used to describe Theodore's pressure sore?

Answer: 707.09, 707.22

The scenario describes a pressure ulcer on the back of the leg muscle, which is considered an 'other site' for ICD-9-CM coding, and it has partial thickness skin loss, indicating Stage II. Therefore, the correct ICD-9-CM codes are 707.09 for 'Pressure ulcer, other site' and 707.22 for 'Pressure ulcer, stage II'. This combination accurately reflects both the location and the severity of the ulcer.

What does a comA compliance plan's goal is to assist your office in adhering to the right coding and billing procedures. A compliance plan is a document, or set of documents, that outlines the HIPAA regulations that your practice must adhere to. The compliance plan describes, among other things, how frequently your office should audit, how staff should be instructed on confidentially, and how to choose a compliance manager to make sure that all compliance plan components are carried out.pliance plan serve?

Answer: It helps your office follow the correct coding and billing protocols

A compliance plan is a crucial set of guidelines designed to ensure that a healthcare practice adheres to all relevant laws and regulations, particularly those concerning coding, billing, and HIPAA. Its primary purpose is to prevent fraud, waste, and abuse by establishing internal controls and procedures. By following these protocols, the office minimizes the risk of errors and maintains ethical and legal operations.

In a worldwide package, which of the following is NOT normally included?

Answer: Appointments for problems that are not related to the procedure

A global surgical package includes all necessary services normally furnished by a surgeon before, during, and after a procedure within a specific timeframe (the global period). This typically covers the surgery itself, pre-operative visits, and routine post-operative care for issues *related* to the surgery. However, appointments for problems or conditions *unrelated* to the original surgical procedure are not part of the global package and should be billed separately.

When the words "separate procedure" appear after the code description in a CPT code, you should:

Answer: Only code for the procedure if tit was the only thing performed

When 'separate procedure' appears after a CPT code description, it indicates that the procedure is usually considered an integral part of a more extensive procedure. Therefore, it should only be coded and reported if it is performed independently and not as a component of another, more comprehensive service. If performed with another procedure, it is typically bundled and not coded separately, unless specific circumstances warrant it (e.g., different site, unusual circumstances, documented modifier).

In response to a sizable worrisome nevus on her back, a 76-year-old woman went to her dermatologist's clinic. The nevus was removed by the dermatologist, who then sent it for analysis to the pathology lab. Due to the great size of the excision site, the patient experienced agony and was given pain medication. What two Medicare insurance components would the patient be required to pay for the dermatologist visit and the prescription costs?

Answer: Medicare Parts B and D

Medicare Part B covers outpatient medical services, including doctor visits, such as the dermatologist visit for the nevus removal. Medicare Part D covers prescription drugs, which would include the pain medication prescribed to the patient. Therefore, for the dermatologist visit and prescription costs, the patient would utilize Medicare Parts B and D.

The GPCI factors the following factors into the RBRVS calculation:

Answer: The gegraphic location of a practice of a practice or provider

GPCI stands for Geographic Practice Cost Index. It is a component of the Resource-Based Relative Value Scale (RBRVS) physician payment system used by Medicare. The GPCI adjusts the physician work, practice expense, and malpractice expense components of the RBRVS to account for variations in the cost of practicing medicine in different geographic areas.