FREE Certified Coding Associate Questions and Answers
An OB-GYN (obstetrician-gynecologist) sees a 34-year-old woman for the purpose of draining a sizable cyst that had grown on her vulva as a result of shaving. The patient yells in pain during the lidocaine injection but instructs the doctor to continue. The doctor uses a knife multiple times to try to break the cyst's surface after allowing a few minutes for numbing to take effect, but the patient's pain-related anguish simply gets worse. The doctor stops the procedure as soon as the patient declines a second dosage of lidocaine via tears. The patient is then pacified and given an antibiotic before being released. What format should be used to report the incision and drainage procedure?
Across most surgical specialties, it happens frequently for a surgeon to stop performing a technique. When this occurs, a helpful coding tactic is to attempt to comprehend coding policy from the perspective of the Centers for Medicare & Medicaid Services (CMS), whether from a standpoint of medical necessity, a financial one, or both. Starting off, from neither of these perspectives does it make logical sense to completely omit to report the incision and drainage procedure. Why would CMS pay for a lidocaine injection by itself without additional proof of its need? For this reason, the process must be listed in the claim, but it must also be followed by a modification to signal any unique conditions that CMS should take into account. Although it is simple to mix up modifiers 52 and 53, a stopped operation (modifier 53) in coding is distinct from reduced services (modifier 52). Remembering that modifier 52 presumes that the procedure was fully carried out while modifier 53 does not is an excellent approach to distinguish between the two. The best response is to report the incision and drainage procedure with modifier 53 because it was attempted but stopped because the doctor was worried about the patient's safety and well-being.
Which code set is commonly used by Certified Coding Associates for outpatient coding?
Certified Coding Associates often use the Current Procedural Terminology (CPT) code set for outpatient coding.
An anesthesiologist who is knowledgeable with coding in his area is verifying the modifiers used by a new coder for an anesthetic service that was rendered yesterday. He also instructs and supervises anesthesiology residents, one of whom assisted him during this identical procedure under his direct supervision. The head modifier QY is used in the coder's documentation for anesthesiology services, and the surgical procedure's total modifier combination is QY-QS-P1. How would the doctor talk to the coder about the work's accuracy?
Modifiers are essential for effective reimbursement of anesthesiology services since the entity paying for the service will alter payment based on who provided the service. In this instance, an anesthesia resident provided the necessary services under the anesthesiologist's close supervision. Modifier GC would thus accurately describe the nature of these services. This rules out both responses that have modifier QY in the final code since it is only used when a certified registered nurse anesthetist is providing services while under the anesthesiologist's supervision (versus a resident). The patient health status (P1) always appears at the end of an anesthesiology modifier sequence, before by QS (MAC services, if applicable), which is further preceded by who did the procedure, in this example GC. As a result, the modifier sequence P1-GC-QS is erroneous. The anesthesiologist should therefore instruct the new coder to simply swap out modifier QY for modifier GC, resulting in a total modifier sequence of GC-QS-P1.
Bilateral salpingectomy surgery is performed on a 31-year-old woman. Choose the relevant descriptors for this procedure based on your understanding of medical language.
The word "bilateral" denotes the fact that two body sections are being operated on. Due to the fact that women typically only have one uterus, both uterus removal and repair are no longer necessary. However, "salping-" denotes a fallopian tube as opposed to "hyster-," which denotes a uterus. The correct response is to remove the fallopian tubes because the suffix "-ectomy" denotes the removal of bodily components. The suffix would be "-rrhaphy" rather than "ectomy" if the patient were having her fallopian tubes surgically repaired.
Which organization develops and maintains the ICD-10 code sets?
The World Health Organization (WHO) is responsible for developing and maintaining the International Classification of Diseases (ICD) code sets.
Which of the following is NOT a level of HCPCS codes?
There are only two levels of HCPCS codes: Level I and Level II.
What relevant International Classification of Diseases, 10th Revision (ICD-10) code(s) apply to nausea and vomiting symptoms?
This diagnosis is rather typical. If both symptoms are vague and present at the same time, a combination code is used to identify them. Thus, combining R11.0 and R11.10 would not be suitable. Additionally, it is obvious that the distinct codes R11.0 (nausea, not otherwise specified [NOS]) and R11.10 (vomiting, undefined), which are mutually exclusive, are not combination codes. Therefore, using either of these is inadequate to properly record the patient's complaint. The precise diagnosis code for nausea and vomiting is R11.2, nonspecific.
Which type of code describes a disease, condition, or injury?
ICD-10-CM codes are used to describe diseases, conditions, and injuries in diagnosis coding.
What does CCA stand for in the context of healthcare?
CCA stands for Certified Coding Associate, which is a professional certification for medical coders.
What is the primary role of a Certified Coding Associate?
Certified Coding Associates are responsible for accurately coding and categorizing medical data for billing and statistical purposes.
Which organization offers the CCA certification?
The CCA certification is offered by AHIMA.
Which of the following is true about ICD-10-CM codes?
ICD-10-CM codes are used for diagnosis coding and include codes for evaluation and management (E/M) services.
A healthy patient who is a matching donor arrives at the hospital for surgery on behalf of his brother, who requires a kidney transplant. The admitting physician performs a thorough history, thorough examination, and extremely complicated medical decision-making. What kind of code would be appropriate for this encounter?
During this particular interaction, the patient is presenting to the hospital for the first time. Inferring that the patient has spent at least 24 hours in the hospital, the code 99233 for subsequent hospital treatment is removed as a result. Additionally, it eliminates the observation services code 99236 because it is inappropriate for this patient's initial hospital admission. The degree of E/M services provided is fairly distinct for the initial hospital care codes 99222 and 99223. Although both codes need a thorough history and examination, only code 99223 demands that medical decision-making is of the greatest level of complexity (compared to code 99222 requires only moderate complexity). This encounter is suitable for code 99223.
Which of the following E/M service codes applies to a routine pediatric checkup for a healthy 8-year-old boy?
It is crucial to distinguish in the CPT codebook between the E/M code sets for patients who come into the office with a medical complaint and those who are there for a regular preventative medicine visit. Options 99201 and 99211 can be ruled out because the youngster is healthy and shows up to his appointment (likely an annual checkup) without complaining. In order to categorize patients according to age groups and whether they are new or returning patients, the codes 99393 and 99383 are used exclusively for preventative medicine. The right decision may be found in the patient's medical record because both codes accurately reflect the boy's age (5–11 years old) in both cases. 99383 is disregarded because it is inferred that the child has previously seen this pediatrician. The right response is 99393.
What does HCPCS Level II coding primarily involve?
HCPCS Level II codes are used to identify products, supplies, and services not included in CPT codes, including durable medical equipment.
College soccer player Amanda shows up for her second session with Dr. Yakamoto to discuss her damaged meniscus and possible treatments. Her personal doctor requested a consultation visit for her first appointment just last week, and at the conclusion of that appointment, Dr. Yakamoto consented to assume responsibility for her treatment. Which E/M code applies to Amanda's follow-up visit?
An official transfer of care occurs when a doctor accepts formal responsibility for a patient's care following a consultation appointment by referral (i.e., from one physician to another). The coder is required to "use the appropriate office or other outpatient consultation codes and then the established patient office or other outpatient services codes" if this occurs at the completion of an initial consultation appointment (CPT 19). Codes 99243 and 99254 are immediately ruled out because they are both consultation codes and are no longer applicable to Kendra since this is her second appointment with Dr. Yakamoto after being admitted as a new patient in his clinic last week. Only new patients should utilize the code 99203, and the aforementioned recommendations caution against doing so. Therefore, the appropriate response is 99213, an office code for a regular patient.