Final Exam for Essentials students 12.8.23
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Essentials of Medical Coding Final Exam Name: ____Anjelica LaCour________________________
Matching
A.
ICD-10
B.
Preauthorization C.
CPT – HCPCS Level 1
D.
HCPCS Level 11
E.
Chapter 21 Codes
F.
Main Term
G.
ABN
H.
Medical Necessity
I.
Link
J.
Modifier
K.
Chapter 18 Codes L.
AMA
M.
CMS
N.
Up-Coding
O.
Down- Coding
P.
LCD Policy
__e___ ICD-10 codes that explain the reason for the visit when patient is not ill.
__b__ This is the process of obtaining advance approval of a treatment plan proposed by a medical professional.
___i__ Failure to ________ the ICD-10 diagnosis code and the CPT procedure code could result in a denial for the claim submitted.
__c___ Coding system that translates written documentation of office visit, procedures, and x-ray into numbers. __n___
Means reporting a higher-level service or procedure or a more complex diagnosis, than is supported by medical necessity, medical facts, or the provider's documentation.
__a___
Coding system that translates written diagnoses into numbers
__j___ This is a communication tool that tells the insurance company that something is different about the CPT code but not enough to change it. Example: Decision for surgery ___________. ___f__ What you look up in the Alphabetic Index of the ICD-10 book, such as diseases, nouns, conditions. __g___ Known as a waiver of liability, is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover.
__l___
Who publishes the CPT book?
__k___ This chapter contains ICD-10 codes of signs and symptoms.
__h__
This is the determination that services or procedures provided are reasonable and necessary for diagnosis or treatment of illness or injury.
__d__
This is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT book. __p__ When a contractor or fiscal intermediary makes a ruling as to whether a service or item can be reimbursed.
__m__ Who mandates that all part B providers must use this coding system? ___o__ When the provider fails to provide relevant documentation details to assign a service, procedure, or diagnosis to the optimal level of specificity
.
Fill in the blank for evaluation and management questions. 1.
What is TOS ___Type of Service_____________
2.
What is LOS ___Length of Stay_________________
3.
What is POS __Place of Service___________
4.
A patient is considered a new patient when_the patient hasn’t received care from the provider before or within the last 3 years.______
5.
What does MDM stand for _____Medical Decision Making________
6.
The provider did not give you enough information to code the case study. What communication would you have with the provider to solve this situation? _______It would be best to query the physician to get additional information needed to properly code.
E/M – Office Visits 1.
Shirley, a 28 year old established patient, presents to her gynecologist for her routine annual checkup. Shirley has no problems to report. The physician performs a complete preventive medicine check-up. E/M Code____99385_____
2.
Dr. Marble, an orthopedic surgeon, admits Mr. Franks, who is 86 years old, into the hospital for a shattered hip. Dr. Marble bills moderate initial inpatient hospital visit. E/M Code____99222________
3.
Dr. White saw Sally in the office, she is a new patient. Sally has end stage renal disease and diabetes. The diagnoses and risks for mortality were extensive and high. There was an extensive amount of data for Dr. White to review with Sally. Dr. White spent 55 minutes with Sally. E/M Code_________99204__________
4.
After talking to the family and Mrs. Green, Dr. George decided it would be best to admit (initial) Mrs. Green into a nursing home. She had fallen and hurt her hip and her blood sugars were not stable. Dr. George reports a high level of MDM to Sunshine Nursing home. E/M Code___________99306_________________
5.
An 80-year-old had was taken to the ER after falling and hitting his head. The ER physician performed a moderate level of MDM as all tests came out negative and was sent home with family. E/M Code ______99284______________
6.
The patient was seen in the ER after falling from the jungle gym at the playground. She had quite a few bumps and
bruises but no major lacerations or fractures. MDM was straightforward visits. E/M Code ____99282______
7.
The patient had been admitted into the hospital 3 days ago when the family practice doctor decided to call in the infectious disease doctor for his advice and opinion on the patient. The infectious disease doctor performed MDM of low for hospital consultation. A report was sent back to the requesting physician. E/M Code ___99253______
8.
48-year-old established patient came in for his 6 month follow-up for his HTN, COPD and DM. The provider reports
a level 4 office visit. E/M Code________99214_______________
9.
Mark had been in the initial hospital for 2 days now and his fever and blood pressure were both elevated. Dr. Clue ordered and IV and more blood work to see if this was a viral or bacterial infection. Dr. Clue reports a level 2 daily inpatient subsequent hospital visit. E/M Code__________99232_________________
10.
Dr. Lynn was called in for attendance at delivery for a 32-week gestational newborn. EM Code _____99464___________
11.
Mark has been out of the hospital for 7 days now and is seeing the provider for transitional care management of moderate MDM. EM Code__________99495_________________
12.
Julie was not feeling well at all so Dr. Bob did a home visit and called in a script for her bronchitis. He did a level 3 established home visit. E/M Code _____99349_______________
ICD – 10 Coding
1. Tommy was up all night with a fever. His mom is taking him to the clinic to rule out ear infection. ICD-
10___R50.9_______
2. Matt has had left lower abdominal pain for 2 day. He hopes it’s not his appendix. ICD-10 ___R10.32________
3. Margaret has stage three chronic kidney disease. ICD-10 ___N18.30__________________
4. Mary had been coughing for 3 days. Dr. Bob took a chest x-ray, and it was positive for pneumonia. He is also nicotine dependent and needs to stop smoking ICD-10 _____J18.9______________ _______F17.210_____________
5. We are still in shock that they diagnosed Ray with Louis- Bar Syndrome. ICD-10 _______G11.3__________
6. Patty finally went to OBGYN for her menorrhagia. ICD-10 ____N92.1___________
7. The 22-year old female presents to the ER after falling down a hill while hiking with her dog. She complains of left wrist pain. The ED physician gets a wrist x-ray and assess it is a left wrist sprain. ICD-10 ____S63.502A__________
8. 1- year -old established patient visited the pediatrician for her well-bay exam, which included discussion with the mother about the need for routine vaccines. She wants to wait and read up on vaccines for before she inoculates her baby. ICD-10 _______Z00.12__________
9. Kate is a long-time patient of Dr. Hardy’s office and presents today with a sinus pain and a fever. She also has hyperlipidemia and hypertension that he assesses and refills medication on. . Dr. Hardy diagnosis she also has acute sinusitis and refills her medication for hyperlipidemia and HTN. ICD-10 Codes(s)__J01.10____ _E78.5___ __I10__
10. 45 –year - old patient woke up to get ready for works this morning, feeling his usual self. Prior to leaving home, he developed a headache. He described it as a dull pain in the back of his head. It was constant ache at first, but is just keeps intensifying. He has presented to the ER for treatment. CT of the head was ordered and it came back negative. The headache could not be brought under control so a MRI was then ordered and that came back negative. Patient was given IV Morphine for his cluster headache and more tests. ICD-10 (only) _G44.001______
11. Barbara is here for 3 month follow-up for her medications. Labs were drawing for her hypothyroidism. She also has an
issue of congestive heart failure, which has been stable. ICD-10 Code (s) ___E03.9_________ ____I50.20________
12. The patient is here for her chronic left shoulder pain (two codes). ICD-10 _____M25.512____ _G89.2____
13. John is here for his 3-month type 2 diabetic check. He is on 32 units of insulin (two codes). ICD-10 _____E11.9_________ ____Z79.4_________
14. George is in for his pre-operative examination as he is going to have surgery for his cataract. ICD-10 ___H26.9_________ ______Z01.818______ (two codes). CPT Coding 1.
A 92-year -old came in to have 2 skin tags removed that were red and inflamed. CPT Code _____11200______
2.
Marsha was washing dishes and sliced her hand open on a steak knife. She went to the doctor and had a simple skin wound laceration repair of her hand. The wound was 4 cm long. CPT Code______12002____________
3.
Billy came in for debridement of his left thumb nail. CPT Code_______11720____________
4.
Joey is playing in the back yard and falls over a wagon and twists his ankle. His mom takes him to his primary care
physician. The physician exams the boy and takes an ankle x-ray. The physician provides a closed treatment of a
shaft fibula fracture without manipulation. CPT Code_73600 and 27780____________
5.
3-year-old had put tiny little beads up her nose. The provider had to remove the foreign body from her nose. CPT Code__30300_______
6.
28-year-old was in a head on automotive collision. She was brought to the hospital and after examination she was taken to surgery for a partial splenectomy. CPT Code___38101__________
7.
A surgeon performs a tongue lingual frenectomy on a patient. CPT Code______41115________
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8.
Rose, a 13 year old, has very severe and frequent sore throats with swelling of his tonsils. The surgeon does a tonsillectomy on Rose. CPT Code____42826__________
9.
A patient presents with a renal abscess. The surgeon performs renal incision and drainage. CPT Code__50020____
10.
65-year-old male came in for manipulation of the foreskin including lysis. CPT Code_____54450__________
11.
The patient had to have lysis of labial adhesions. CPT Code ______56441____________
12.
A physician removes impacted ear wax (cerumen) with a curette from both ears (check for modifier). CPT Code__69209_____
modifier __-50_____
13.
Patient comes in for foreign body removal of superficial conjunctiva. CPT Code ____65205______
14.
Patient came in with severe pain in her shoulder area. The provider ordered a complete X-ray of her clavicle. CPT Code______73000______________
15.
Patient was having severe headaches so the provider ordered a MRI of the brain without contrast. CPT Code______70551_________
16.
Joan was having her bilateral screening mammogram done today. CPT Code _______77067________________
17.
June was having problems breathing so the provider did a bronchoscopy with alveolar lavage. CPT Code__31624____
Code both the ICD-10 code and the CPT code
Billy was having a lot of headaches and blurred vision so the physician scheduled him for a CT of the head without contrast.
ICD -10 Code (s)___R51.9________ ____H53.8________ and CPT Radiology Code____70450______________
58- year-old was having lots of rectum pain. The provider found external hemorrhoids. After trying some preventive measures the patient decided he needed a hemorrhoidectomy. The patient had an external complete hemorrhoidectomy. ICD-10 Code___K64.9_________ and CPT Surgery Code___46260__________
56-year old was taken to the hospital for shortness of breath and wheezing they did an initial thoracentesis of the pleural cavity. ICD-10 Code ____R06.2________ and CPT Surgery Code ____32554__________
2-day old baby boy had a neonatal circumcision using a clamp but without a ring block
ICD-10 Code __Z41.2__________ and CPT Surgery Code __54160_______ and what modifier on CPT Code__-63_____
The patient is having lower right abdominal pain the ultrasound comes back as elongated and inflamed appendix. The provider diagnosis with appendicitis and is going to do a LAP appendectomy. You are in charge of the preauthorization. What is your ICD-10 code _____K35.80____________ and CPT code ____44970___________ for the preauthorization? Modifiers
1.
What modifier do you use for decision for surgery. Modifier ______-57___________________
2.
What modifier do you use for increased time for a procedure. Modifier ____________-22____________
3.
What modifier do you use for a stagged procedure. Modifier _______-58_________________
4.
What modifier do you use for bilateral procedure. Modifier ________-50_______________
HCPCS
1.
Julie was in the ER getting and IV of 15 mg of Toradol -. HCPCS Code ____J1885_______________
2.
George was in for his Medicare wellness visit and the provider did a screening depression exam. HCPCS Code ____G0438_____________
3.
Billy was in home health getting a CPAP mask. HCPCS Code ______A7034________________