kaysmith_mod3assignment_04232023

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Module 03 Assignment - Apply CPT Coding Guidelines and Modifiers Instructions: Read each scenario and answer the associated questions. Refer to Appendix A and Section coding guidelines in the CPT code book. Be sure to write your answer beneath each question, using complete sentences, reflecting proper spelling and grammar. Scenario 1 A patient presents to the Emergency Room following an incident in her home where she fell and hit her head on the edge of a table. She indicated she felt dizzy prior to the fall. The fall resulted in a 1.5 cm laceration to her forehead and another 0.75 cm laceration to her neck. In addition, she was experiencing a headache and some blurred vision. Note: In this scenario, the provider would need to evaluate the source of the dizziness and performed a simple repair the lacerations. Questions: 1. Indicate the modifier that would be appended to the E/M code. The modifier that would be the appended to the E/M code is modifier 25. The reason why is because as stated in the scenario, the provider would need to evaluate the source of dizziness and would need a repair performed which is in line with what modifier 25 is defined as. The textbook states for modifier 25, “Significant, Separately Identifiable Evaluation and Management Services by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.” 2. Indicate the coding guideline applied to a simple repair of two lacerations, same site. The coding guideline that is applied to a simple repair of two lacerations, same site would e as specifically stated in the textbook, “A simple wound repair code is used when the wound is superficial, primarily involving epidermis, dermis, or subcutaneous tissues without significant involvement of deeper structures where only one layer of closure is necessary using sutures, staples, tissue adhesive, or other closure materials.” 3. Indicate the code for a Simple Repair of two lacerations to the forehead (scalp) and neck. The code for Simple Repair of two lacerations to the forehead and neck would be 12011, 12001. This was listed in our textbooks in the index and also in the 3M coding AHIMA system. Scenario 2 A patient is scheduled for an inpatient (hospital) surgical procedure. The patient was intubated, and anesthesia administered. The surgeon made the initial incision to access the operative site when the patient’s blood pressure dropped, and the patient became hypotensive. The procedure was aborted. Questions: 1. Indicate the modifier that the surgeon would append to the surgical CPT code? The modifier that the surgeon would append to the surgical CPT code would be Modifier 54. According to the textbook where it specifically states, “When 1 (one) physician or other qualified

heath care professional performs a surgical procedure and another provider preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.” 2. Indicate the modifier that would be appended to the surgical CPT code if this was an Outpatient Procedure? The modifier that would be appended to the surgical CPT code if this was an Outpatient Procedure would be Modifier 66. This modifier would be sufficient when more than two surgeons of different specialties perform a procedure. Each doctor would bill the codes with modifier 66 appended. 3. Under which circumstances would a “Discontinued Service” modifier not be allowable based on the definition? This is regarding modifier 53 which is defined as not valid when another (lesser) code is available to describe the portion of the discontinued service which was completed as specified in the textbook. If the surgical or diagnostic procedure threatens the well-being of the patient, it may be required to discontinue the treatment even if it started already. This would be one of the circumstances on why the service would be discontinued like in this case the patient’s blood pressure had dropped so that could have been one of the factors on why this doctor had stopped the procedure since the patient become hypotensive putting the patient’s well-being at risk. Scenario 3 A patient is admitted for an emergency appendectomy due to a ruptured appendix with abscess. The patient is morbidly obese which presents difficulty in removing the appendix and managing the operative site to avoid infection. Due to the obesity and complicated nature of the procedure, the procedure took 30 minutes longer than usual to perform the procedure and close the operative site. Questions: 1. Which modifier would be appended to the appendectomy CPT code due to the increase in operative time? Modifier 22 would be appended to the appendectomy CPT code due to the increase in operative time. This is used for increased procedural services and shows when a doctor has gone above the typical time frame of a procedure. 2. Which CPT format (punctuation) guides the coding pathway for determining the appropriate code for Ruptured Appendix? The punctuation that helps the coding pathway for determining the appropriate code for Ruptured Appendix is a semi colon. This is used to help separate the main terms and any modifying sub terms.

3. What is the code for Appendectomy for a ruptured appendix with abscess? The code for Appendectomy for a ruptured appendix with abscess is 44960. This was listed in our textbooks in the index and also in the 3M coding AHIMA system. Scenario 4 A patient is recovering from a recent surgical procedure and is presenting to the physician’s office for routine postoperative follow-up care. The postoperative follow-up care is included in the charges for the surgical procedure. Question: 1. Which “Surgery Guideline” states that typical postoperative follow-up care is not to be billed separately? Modifier 78 which states that typical postoperative follow-up care is not to be billed separately. It is defined as unplanned return to operating/procedure room by the sane physician or other qualified health care professional following the initial procedure for a related procedure during the postoperative period.

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