Medical Coding Principles Flashcards

In HCPCS Level II coding, which category of codes is used for durable medical equipment (DME)?

Answer: E codes

HCPCS Level II 'E' codes (E0100–E8002) are designated for durable medical equipment.

What is the correct action when ICD-10-CM instructs 'Code first the underlying condition' beneath a manifestation code?

Answer: Sequence the underlying condition code first, then the manifestation

The etiology/manifestation convention requires the underlying disease to be sequenced first, followed by the manifestation.

A coder finds a diagnosis documented as 'probable pneumonia' in an outpatient record. What is the correct coding approach?

Answer: Code the sign or symptom (e.g., cough, fever) that prompted the visit

Outpatient coding guidelines prohibit coding uncertain diagnoses; the coder should report the sign/symptom instead.

Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally?

Answer: -50

CPT modifier -50 indicates a bilateral procedure performed at the same operative session.

In ICD-10-CM, what is the significance of a 7th character 'A' in injury codes?

Answer: Initial encounter — active treatment phase

The 7th character 'A' denotes the initial encounter when the patient is receiving active treatment for the injury.

Which CPT code range covers Evaluation and Management (E/M) services for hospital inpatient initial care?

Answer: 99221–99223

CPT codes 99221–99223 are used for initial hospital inpatient care, with varying levels of complexity.

What does the ICD-10-CM Excludes1 note mean?

Answer: The two conditions cannot occur together and the excluded code should never be used with this code

Excludes1 means the excluded condition cannot coexist with the code and should not be coded together.