Medical Coding and Billing

1. This 60-year-old patient was admitted with emphysematous nodules.  A thoracoscopic wedge resection was performed in the left lung to remove the lung nodules.  A resection was done in the upper and lower lobes.  Which of the following answers is correct? (Points : 2)

J98.4, 32666, 32667        J43.9, 32666        J98.4, 32505        J43.9, 32666, 32667
Question 2. 2. A neonatal patient is brought to the operating room for repair of complete transposition of the great arteries under cardiopulmonary bypass. The infant is in critical condition and may not survive. Assign the correct diagnosis codes and CPT codes to report the administration of anesthesia, including physical status, Level I and II modifiers, and qualifying conditions for this procedure. (Points : 2)

Q20.3, 00562–AA–23, 99100        Q20.1, 00561–AD–P5, 99140        Q20.3, 00561–AA–P5        Q20.3, 00563–AA–P5, 99100, 99140
Question 3. 3. A 69-year-old patient was hit by a car, causing intra-thoracic trauma and hemorrhage.  The patient was taken directly from the Emergency Department to the operative suite where the chest was opened and hemorrhage was controlled, but the patient’s heart stopped.  Open heart massage was performed but the patient expired before the patient could be admitted.  Assign the appropriate CPT code(s) and any required modifier(s) to report this service. (Points : 2)

32110-CA        32110, 32160        32160-CA        32110-CA, 32160-CA
Question 4. 4. A non-Medicare patient with carcinoma of the oral cavity and lower lip is receiving daily intramuscular injections of the interferon alfa-2a (3 million units) in the outpatient cancer center.  Which of the following will be reported for this service?  The payer does accept HCPCS Level II codes for drugs. (Points : 2)

Z51.12, I49.8, 96401, J9213        C14.8, 96372, J9213        C06.9, C00.2, 96372        Z51.12, 96549
Question 5. 5. An elderly patient has an abscess formation around a pacemaker pocket on his chest wall that requires that the device be removed and the pocket reformed in another location.  Which of the following code sets is appropriate for this outpatient surgical service?  (Points : 2)

T82.7XXA, L02.219, 33222        L02.219, 33222        T82.7XXA, 33223        T82.857A, L02.219, 33999
Question 6. 6. Assign the appropriate ICD-10-CM diagnosis code for aspiration pneumonia due to inhalation of food. (Points : 2)

J15.9        J69.0        J18.9        J69.1
Question 7. 7. A hospital-based pediatric clinic is treating a newborn with talipes equinovarus by manipulation and short leg casting. Which of the following code sets is reported for a visit where the condition is evaluated with a -problem-focused history and examination and parents’ questions are answered, followed by foot and ankle manipulation and replacement of the plaster cast? (Points : 2)

Q66.6, 29450        M21.549, 29405        Q66.0, 29405        Q66.0, 99212–25, 29450
Question 8. 8. A 32-year old female has recently had surgery for melanoma of the right lower leg, Clark level IV>  She had no other signs of metastasis or adenopathy.  Under general anesthesia, a sentinel node biopsy of the deep axillary nodes was performed with a gamma counter probe.  An injection of isosulfan blue dye was performed and the nodes followed carefully to the single-bright-blue node.  This node was excised and sent for frozen section, which proved to be negative for melanoma.  Before the procedure, the radiologist performed a lymphoscintigraphy.  Which of the following code sets would the surgeon report. (Points : 2)

C44.691, 38525        C4A.71, 38525, 38792        C4A.71, 38525, 38792–51, 78195        C43.9, 38525, 38790–51
Question 9. 9. What code(s) is/are assigned for a patient receiving home care after a kidney transplant? (Points : 2)

Z48.29        Z48.298, Z94.0        N18.6        Z94.0
Question 10. 10. What would be the appropriate ICD-10-CM code for lumbar stenosis? (Points : 2)

M48.00        M48.06        M48.07        M48.26
Question 11. 11. Dr. Smith sent a patient to observation care at the local hospital following his visit to the nursing facility.  The patient was admitted for observation to rule out stoke due to a change in mental status.  The next morning, Dr. Smith left town, and his partner, Dr., Johnson, admitted the patient to inpatient care because of sudden worsening symptoms.  The patient expired later the same day.  Assuming documentation guidelines were met, how would E/M services for these two physician be coded? (Points : 5)

Dr. Smith: 99315; 99219; Dr. Johnson:  99236        Dr. Smith: 99219; Dr. Johnson:  99217, 99236        Dr. Smith: 99219; Dr. Johnson:  99236        Dr. Smith: 99315; 99222; Dr. Johnson:  99238
Question 12. 12. The following documentation is from the health record of a 3-year-old child.  Parents bring their 3-year-old boy, who was born with hydrocephalus, to the pediatric neurology clinic at Unive3rsity Hospital to have the child evaluated by the pediatric neurologist and have his VP shunt lengthened to accommodate a growth spurt.  Their pediatrician requested a consultation to evaluate the shunt and replace the peritoneal catheter if needed.  Outpatient surgery had been previously scheduled tentatively pending this evaluation for the afternoon.  The catheter used in the shunt was removed and replaced in the outpatient surgery suite following a follow-up consultation, which included a detailed interim history, a detailed examination, and medical decision making of moderate complexity.  Findings documented in the consultation include “Assessment: Shunt valve malfunction requiring replacement”.  The VP shunt valve was replaced along with a new peritoneal catheter in a longer length.  Which of the following code sets will be reported for this service? (Points : 5)

Z45.41, 62230        T8503XA, Q03.9, 62230        Q03.9, Z45.41, 62225        Q03.9, 62230
Question 13. 13.

This 21-month old male presents to the Emergency Department with nausea and vomiting since 10 pm last night, at least 8 times, which is nonbloody but bilious.  Temp of 39.8 since last night.  He has a history of Tetralogy of Fallot, s/p repair 2 months ago.  He has known immunodeficiency, laryngomalacia, and a gastrostomy tube.  After examination, working differential diagnoses are acute gastroenteritis, bacteremia, or possible septicemia.  Symptoms similar to episode about 1 month ago that was determined to be bacteremia with G-tube site infection.  The patient is treated with Zofran 2 mg IV, followed by Ceftriaxone 600 mg IV.  The patient is discharged after resolution of vomiting and fever.  Diagnosis listed as acute gastroenteritis.

Assign the correct ICD-10-CM codes for the facility services provided today.

(Points : 5)

D84.9, K52.9, Q31.5, Z87.74, Z93.1        D84.9, K52.9, Q31.5, Z98.89, Z93.1        D84.9, K52.9, Q33.5, Z84.74, Z98.89, Z93.1        D84.9, K52.9, Q31.5, Z84.74, Z98.89
Question 14. 14. A 48-year-old man came in to the emergency department complaining of vomiting material resembling coffee grounds several times within the past hour.  He has abdominal pain and has been unable to eat for the past 24 hours.  He is dizzy and lightheaded.  Two stools today have been black and tarry.  While in the emergency department, he vomited bright-red blood and some material resembling coffee grounds.  A nasogastric tube was inserted by the ED physician and attached to suction.  An abdominal exam showed a fluid wave consistent with ascites.  CBC and clotting studies were drawn.  A detailed history and physical exam with high-complexity medical decision making were documented.  A GI consultant was called and the patient was taken to the Endoscopy for further evaluation of upper GI bleeding.  Diagnosis:  Hematemesis, rule out esophageal varices; blood loss anemia, acute; ascites.  Which of the follow is the correct diagnosis and CPT procedure assignment for the independent ED physician? (Points : 5)

K92.0, D62, R18.8, 99285, 43752         K92.0, R10.9, R42, 99284-25, 91105         R18.0, K92.0, D50.0, 99284, 43752         K92.0, D62, R18.8, 99284-25, 43752
Question 15. 15. The following documentation is from the health record of a 39-year-old female patient.  This 39-year-old female was diagnosed with breast cancer 2 years ago.  At that time she had a mastectomy performed, with no evidence of metastases to the lymph nodes.  About 8 months ago, metastases were found in her liver.  The patient was given chemotherapy.  She has been losing weight and developing increased fatigue.  Patient was referred to hospice care program, with a life expectancy of 4 to 6 months.  Progressive weight loss due to loss of appetite led to cachexia and program of home intravenous hyperalimentation.  Progressive, unrelenting abdominal pain led to chronic use of analgesics.  Patient is awake, alert, and desires to spend more time with family.  Progressive weakness and dropping hemoglobin led to the decision to transfuse the patient every 2 weeks with 2 units of packed cells.  Patient is stable and more comfortable on this regimen.  What are the correct diagnosis codes assigned in this case? (Points : 5)

D63.0, D64.81, C78.7, Z85.3, T45.1X5        D64.9, C78.7, Z85.3, T45.1X5         D63.0, C78.7, Z85.3, T45.1X5         D64.9, C78.7, Z85.3
Question 16. 16. The patient is a four-year-old male with acute lymphocytic leukemia who has had a fever for the last 24 hours.  It has been nine days since his last chemotherapy, which was his first.  A comprehensive history is documented.  On examination, the skin over his Hickman site is extremely red and starting to break down.  No other abnormal findings are noted in the comprehensive exam.  Labs show that the patient is not neuropenic.  The physician lists the diagnoses as :  ALL not in remission, infected Hickman.  The patient is given 770 mg of Ceptz over 10 minutes through a new peripheral IV site and admitted for continued treatment.  Medical decision making is moderate. What code set is reported for the services of the emergency physician? (Points : 5)

C91.00, T827XXA, R50.9, 99284-25, 96374        T80218A, Y83.8, 99284        C91.00, T8579XA, R50.81, 99285        C91.00, T80219A, 99285-25, 96374

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