Mixed Deck — All CPC Topics Flashcards

His doctor gave a 66-year-old man a viral test for Covid-19. The viral test resulted in a positive result. His physician also sent him for a chest x-ray, where he tested positive for pneumonia at the Rapid Urinalysis Laboratory (RUL). Which code from ICD-10 should be used?

Answer: U07.1, J12.82

For a confirmed COVID-19 infection, the primary ICD-10 code is U07.1. When COVID-19 presents with pneumonia, the pneumonia is considered a manifestation of the viral infection. J12.82 is the specific ICD-10 code for 'Pneumonia due to other coronavirus,' which is appropriate for COVID-19 related pneumonia. Therefore, U07.1 is sequenced first, followed by J12.82 to describe the manifestation.

Which CPT code range covers digestive system procedures?

Answer: 40000–49999

CPT codes 40000–49999 encompass all digestive system surgical procedures including the esophagus, stomach, intestines, liver, and pancreas.

Which section of CPT codes covers Radiology services?

Answer: 70000–79999

CPT codes 70000–79999 are designated for Radiology services including diagnostic imaging and radiation therapy.

Which of the following is the correct way to report a bilateral procedure when the CPT code descriptor does not specify bilateral?

Answer: Either A or B depending on payer requirements

Bilateral procedures can be reported with modifier -50 or with separate line items using -RT and -LT modifiers; the approach depends on specific payer requirements.

Which of the following is NOT a recognized setting for E/M services coded with office visit codes (99202–99215)?

Answer: Hospital inpatient room

Hospital inpatient services use inpatient hospital care codes (99221–99223 initial, 99231–99233 subsequent), not office visit codes.

Which section of the CPT codebook contains codes for non-face-to-face physician services, such as online medical evaluations?

Answer: Evaluation and Management

Non-face-to-face E/M services including online digital evaluation and management services are found within the Evaluation and Management section of CPT.

A surgical package (global period) typically includes all of the following EXCEPT:

Answer: Postoperative complications requiring return to the OR

Return trips to the operating room for complications are NOT included in the surgical package and should be billed separately.

Which section of the CPT manual contains codes for Evaluation and Management services?

Answer: Section 99202–99499

Evaluation and Management (E/M) codes are found in the 99202–99499 range within the CPT manual.

What does the 'E' in E/M codes stand for?

Answer: Evaluation

E/M stands for Evaluation and Management, describing services provided when a physician evaluates and manages a patient's condition.

A coder is reviewing a claim for a new patient office visit. The physician documented a comprehensive history, comprehensive exam, and high complexity MDM. Which E/M code is most appropriate?

Answer: 99205

99205 represents a new patient office visit with high complexity medical decision making (or 60-74 minutes of total time).

For the past three weeks, a 12-year-old kid has been experiencing right hip discomfort. When checked physically, his temperature is 38.2°C. There is swelling, pronounced palpable discomfort, and restricted range of motion in the area. On radiographs of the pelvis, the femoral metaphysis is shown to have regions of osteolysis and cortical erosion, as well as nearby soft tissue enlargement in the sub-periosteal region and what seems to be the development of an abscess. Choose the organism from the list that is most likely to cause these findings.

Answer: Staphylococcus aureus

The clinical presentation of a 12-year-old with right hip discomfort, fever, localized swelling, pain, restricted motion, and radiographic evidence of osteolysis, cortical erosion, and abscess formation in the femoral metaphysis is highly suggestive of osteomyelitis. Staphylococcus aureus is overwhelmingly the most common bacterial pathogen responsible for acute osteomyelitis in children, making it the most likely causative organism.

What is the primary purpose of HCPCS Level II codes?

Answer: To report products, supplies, and services not included in CPT®.

HCPCS Level II is a standardized coding system used primarily to identify products, supplies, and services not included in the CPT (Level I) code set, such as ambulance services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

The bulbourethral gland is also referred to as:

Answer: Cowper's

The bulbourethral glands are also widely known as Cowper's glands. These two small exocrine glands are located inferior to the prostate gland and secrete a clear, alkaline fluid into the urethra during sexual arousal. This pre-ejaculate fluid helps to lubricate the urethra and neutralize any residual acidity from urine, preparing it for the passage of sperm.

Under the Outpatient Prospective Payment System (OPPS), how are hospital outpatient services reimbursed?

Answer: Based on ambulatory payment classifications (APCs)

The OPPS reimburses hospital outpatient services using Ambulatory Payment Classifications (APCs), which group services with similar clinical characteristics and costs.

When coding an outpatient encounter, what should be coded as the first-listed diagnosis?

Answer: The condition established after study to be chiefly responsible for the visit

For outpatient encounters, the first-listed diagnosis is the condition established after study to be chiefly responsible for the visit.

What is a frozen section in pathology coding?

Answer: Rapid intraoperative tissue analysis used to guide surgical decisions

A frozen section is an intraoperative rapid tissue analysis that provides the surgeon with a preliminary pathology result during the procedure.

Which anesthesia code should be used when performing intravertebral procedures on the spine or spinal cord, including lumbar percutaneous image-guided neuromodulation or kyphoplasty or vertebroplasty?

Answer: 1942

The CPT code for anesthesia for extensive spinal procedures, such as kyphoplasty or vertebroplasty, is 00670. This code covers anesthesia for procedures on the vertebral column involving extensive work. The options provided (1941, 1938, 1942, 1940) are not standard CPT anesthesia codes. If '1942' is the designated correct answer, it likely represents a placeholder or a non-standard reference within the context of the exam's specific materials, rather than a universally recognized CPT code.

To divert or create an artificial passage is what this term means:

Answer: Shunt

In medical terminology, a 'shunt' refers to a bypass or diversion. It is an artificial passage or a natural channel that diverts a bodily fluid from one part of the body to another. For example, a ventriculoperitoneal shunt diverts cerebrospinal fluid from the brain to the abdomen.

When contrast material is used during a CT scan, how does this affect code selection?

Answer: A separate code is selected that specifies 'with contrast'

CPT provides distinct codes for CT scans performed without contrast, with contrast, or without followed by with contrast, so the appropriate code must be selected.

A hospital provides free transportation services to Medicare patients to encourage them to use the hospital's services. This arrangement most likely violates:

Answer: Anti-Kickback Statute

Offering free services to induce patient referrals to a Medicare-covered entity likely violates the Anti-Kickback Statute.