Knowledge Skill Flashcards

A physician performs a diagnostic colonoscopy and removes a polyp during the same session. How should this be coded?

Answer: Code only the colonoscopy with polypectomy

When a therapeutic service is performed during a procedure that started as diagnostic, only the therapeutic (higher-level) code is reported.

Under the outpatient coding guidelines, the coder should code the condition to the highest degree of certainty when:

Answer: A definitive diagnosis has been established and documented

For outpatient encounters, only confirmed diagnoses should be coded; uncertain conditions are coded to the presenting sign or symptom.

Which of the following best describes a 'global surgical package'?

Answer: Pre-operative, intra-operative, and standard post-operative care included in one surgical fee

The global surgical package bundles the pre-op visit, the surgery itself, and routine post-op care within the global period into one payment.

ICD-10-CM code Z23 is reported to indicate:

Answer: Encounter for immunization

Z23 is used to report an encounter for immunization/vaccination as the reason for the visit.

Which type of CPT code requires additional documentation and narrative to identify the service performed?

Answer: Unlisted procedure codes

Unlisted procedure codes (e.g., 29999) require a special report explaining the nature, extent, and need for the procedure.

A coder is reviewing a claim where a physician billed for a high-complexity office visit but the documentation only supports a low-complexity visit. This is an example of:

Answer: Upcoding

Upcoding is billing for a higher level of service than the documentation supports, which constitutes fraud.

In CPT surgery coding, the term 'incidental appendectomy' during another abdominal procedure is:

Answer: Not separately reported unless the appendix was diseased

An incidental appendectomy performed prophylactically during another procedure is not separately billable unless the appendix was diseased.