Question

QUESTION 21

1. Using the table below, select which code(s) should be reported for a Medicare patient receiving follow-up mammogram imagery on the right breast, following abnormal screening mammogram the prior week. This service is provided in a physician-owned freestanding imaging center.

   HCPCS Code	Descriptor
   G0202	Screening mammography, digital images, bilateral, all views
   G0204	Diagnostic mammography, digital images, bilateral, all views
   G0206	Diagnostic mammography, digital images, unilateral, all views
   R0070	Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen

   	A.	G0206-RT, R0070
   	B.	G0204-52-RT
   	C.	G0206-RT
   	D.	G0202-52

10 points   

QUESTION 22

1. A patient visits the hospital clinic for two appointments, one a follow-up with primary care for hypertension, diabetes, and hypothyroidism. The second appointment is for consultation with a hematologist regarding consistently low white blood cell counts.

   Which CPT modifier would the hospital outpatient coder assign to indicate that 2 hospital clinic visits occurred on the same date of service?

   	A.	25
   	B.	77
   	C.	24
   	D.	59

10 points   

QUESTION 23

1. Select the best codes for this service performed in the ambulatory surgery center.

   With the patient having had a wire localization performed by radiology earlier this morning, she was taken to the operating room and under general anesthesia, the left breast was prepped and draped in a sterile fashion. A breast line incision was made through the entry point of the wire, and a core of tissue surrounding the wire, of approximate 1 X 2 CM, was removed using electrocautery for hemostasis. The specimen, including the wire, was then submitted to radiology for imaging. The presence of the lesion within the specimen was confirmed under radiologist supervision. The breast tissue was then reapproximated with suture. In speaking with the pathologist, whose report shall follow, the lesion was found to be fibroadenoma.

   	A.	19125-LT, D24.2
   	B.	19120-LT, C44.591
   	C.	19085, C50.912
   	D.	19105-LT, C50.919

10 points   

QUESTION 24

1. Capture the professional fees for the following case.

   Bart, a retired U.S. Air Force pilot, was on observation status 16 hours to assess the outcome of a fall from the back of a parked pickup truck.

   HPI: The patient is a 42-year-old gentleman who works at the local garden shop part-time. He explained that yesterday he fell from his pickup truck as he was loading gravel for a landscaping project. He lost his footing when attempting to climb from the bed of the truck and fell about 4 feet and landed on a rock, striking his head. He did not lose consciousness, but was quite dizzy. He subsequently developed a throbbing headache of 8/10 severity, and localized swelling at the impact point.

   This headache persisted to the point that the patient grew concerned. Self-administration of ibuprofen provided no significant improvement in pain level. Hence, he sought care here. I met the patient after the emergency room physician had cleared him as stable.

   At the time of admission, the patient's review of systems were negative, except for the noted dizziness, headache. He had no blurred vision or confusion, just substantial pain.

   His past history includes being married with 2 children, work at the garden shop since retirement, and he smoke around 2 packs of cigarettes per day, for the past 10 years. He father died of non-specific heart disease at 52. His older brother has some chronic bony spinal problem, but his twin sister is in good health as far as he knows. No known allergies, and no significant surgical or medical history. This includes no long-terms use or prescription of medication.

   His admission exam revealed tenderness, erythema, and localized edema at the occipital region of the skull. No skin lesions or tears were noted per my examination. CT and plain film imaging showed no subdural bleeding or suggestion of encephalitis. He was cognizant and oriented to 4 spheres, lucid and alert. His main complaint was pain.

   I thought it prudent to maintain him on observation status in the proceeding hours as a precaution against concussive symptoms. It is my belief, after re-examination, that the patient is ready for discharge.

   Currently, his pupils are equal, round, and reactive to light. He professes no ringing in his ears. While the occiput area is still exquisitely tender, his neurological exam is fully normal. He expresses an interest to go home and I concur.

   He knows the signs of neurological changes and I have also included his wife in on that discussion. He will return to the ER here for any such changes. Otherwise, he has been given a low dosage of Vicodin for pain, and is asked to follow-up with our outpatient clinic within 2 weeks or with symptomatic escalation.

   	A.	99239
   	B.	99204
   	C.	99291
   	D.	99217

10 points   

QUESTION 25

1. Code for this report.

   Indications: Acute onset of severe headache.

   Study: Unenhanced cranial CT.

   Axial images were acquired from the top of the skull down to C2.

   Findings: Ventricles are normal in size and morphology. There is no evidence of intracranial hemorrhage or mass effect. Basal cisterns and falx are unremarkable. Mucosal thickening is noted at the dome of the right maxillary sinus. Mastoid air cells are clear.

   Impression: Mucosal thickening at the dome of the visualized portions of the right maxillary sinus. The study is otherwise unremarkable, and cannot explain the patient's symptomatology. Correlate clinically.

   	A.	70460
   	B.	70450
   	C.	70250
   	D.	70551

10 points   

QUESTION 26

1. Which laboratory code would you report for a urine pregnancy test?

   	A.	84703
   	B.	84704
   	C.	84702
   	D.	81025

10 points   

QUESTION 27

1. This service is performed in the outpatient hospital radiology area.

   Liver Biopsy: Informed consent was obtained from the patient. He was then placed supine on the CT table, and axial CT was performed to localize the low-density lesion within the dome of the liver medially. A right mid-axillary skin line marked out after infiltration with local anesthetic. A 19-gauge co-axial needle was advanced into the low-density lesion, axial CT performed to confirm needle placement. Four 20-gauge core biopsies were obtained via monotype biopsy gun. Needles and gun were removed. Procedure was tolerated well and he left radiology in stable condition.

   Pathology report to follow.

   Which procedures should the hospital code for the services described in this report?

   	A.	47000, 77002, 77012, 77014
   	B.	77011, 47001
   	C.	47100, 74150
   	D.	47000, 77012

10 points   

QUESTION 28

1. According to ICD, which of the following patients is suffering from poisoning?

   	A.	An 18-year old who develops hives, itching and shortness of breath after a nurse administers an IV antibiotic as the provider prescribed.
   	B.	A 64-year-old with cancer who experiences nausea and vomiting after properly-administered chemotherapy.
   	C.	A 48-year-old male who has trouble stopping the bleeding after a papercut. He is on chronic anti-coagulation, which is closely monitored and to which he is highly compliant and adherent.
   	D.	A 24-year-old female having ingested several Lortab, 2 alcoholic beverages, and psilocybin-laced fudge, now experiencing hallucinations, somnolence, and disorientation.

  

QUESTION 29

1. Which ICD code would be reported for interdigitating dendritic cell sarcoma?

   	A.	C47.9
   	B.	G98.8
   	C.	G90.9
   	D.	C96.4

QUESTION 30

1. A diabetic patient seen in the ambulatory surgery center receives 3 separate blood glucose readings by reagent strip at bedside. These are necessary to ensure that the patient's blood sugar is within normal limits prior to and after the surgical intervention.

   Suppose that you code for ancillary services at the ambulatory surgery center and find documentation of the 3 blood glucose tests in the nurses' notes of the patient's charts. Which of the following would be the best way to report these services?

   	A.	82950 X 3
   	B.	82948, 82948-91 X 2
   	C.	82947, 82948
   	D.	82947, 82947-91 X 2

Answer 1

Question 21

Answer: C. G0206 -RT

Q 22

Answer: B: 77

Question 23: Answer: A : 19125-LT, D24.2

Question 24: Answer B: 99204

Question 25: Answer: B: 70450

Question 26. Answer D: 81025

Question 27: Answer D: 47000, 77012

Question 28: Answer D: 24 year old female

Question 29: Answer D: C96.4

Question 30: Answer B: 82948, 82948-91×2