Vol. 11 •Issue 15 • Page 6-7
Quiz Tests CPT, HCPCS and Modifier Coding
Patricia Maccariella-Hafey, RHIA, CCS, CCS-P
We have only one more segment after this before the examinations! In this segment of CCS Prep! we provide a brief multiple-choice exam to test your skills in CPT, HCPCS and modifier coding. See if you can answer in one or two minutes per question. Do not assign anesthesia codes. Try answering the non-coding assignment questions from memory. Accuracy and speed are important ingredients for a successful examination. The multiple-choice questions test your recall, application and analysis. In the last column, we will provide some actual coding scenarios that mimic those on Part II of the examinations. Due to space constraints, we are unable to print the full text of the codes so you will need your books to look up the descriptions.
1. How many diagnosis and CPT codes are reported on the ambulatory care records on the examinations?
a.) 4 diagnosis, as many CPT procedures as necessary
b.) 4 diagnosis, 4 CPT procedure codes
c.) As many codes as necessary in both categories
2. A patient undergoes a colonoscopy for possible polyp removal. By hot biopsy forceps, a polyp is removed from the descending colon, and by snare technique, a polyp is removed further up just into the transverse colon. What CPT code(s) are reported by the FACILITY?
a.) 45385, 45384-59
b.) 45384, 45385-51
3. For question #2 what code (s) would be reported for the SURGEON?
a.) 45385, 45384-59
b.) 45385, 45384-51
4. Double osteotomy bunionectomy to correct severe hallux valgus of the left first metatarsal with 0.062 K wire fixation and application of cast.
c.) 28296-TA, 29425-TA
5. Esophagogastroduodenoscopy with dilation of the esophagus over a guide wire at same operative episode.
a.) 43453, 43235-59
b.) 43226, 43235-59
d.) 43456, 43235
6. Excision of 6-cm inclusion cyst of left neck located below the fascia, entire dissection of tumor from the subfascia; closure of deep fascia with 3-0 Vicryl; skin closed with 4-0 Maxon. Steri-strips were applied.
b.) 11426, 12042-59
7. A patient with thoracic vertebral fractures of the spine presents for a percutaneous vertebroplasty. A needle is inserted through the right pedicle of the T7 and T8 vertebral body defects and methyl methacrylate is injected. The procedure was done under fluoroscopic guidance. What codes are reported for the facility?
a.) 22305, 76013-TC
b.) 22325, 76012-TC
c.) 22305, 76012-TC
d.) 22520, 22522, 76012-TC
8. Supervision and interpretation (professional component) for one view study of the ankle provided by the physician.
9. Laboratory components of calcium (82310), carbon dioxide (82374), chloride (82435), cre- atinine (82565), glucose (82947), potassium (84132), sodium (84295), and nitrogen-BUN (84520) compose what panel?
a.) No panel, code all as individual codes
b.) 80048, basic metabolic panel
c.) 80050, general health panel
d.) 80051, electrolyte panel
10. A patient complains of severe lower back and leg pain, which are not responding to conservative treatment. A lumbar caudal injection is given with three injections at the left L4-L5 level for pain relief.
d.) 62311-LT, 62311-LT, 62311-LT
11. The following is true in relation to the CPT coding of lysis of adhesions:
a.) Always code lysis of adhesions when mentioned
b.) An additional code is assigned only when the adhesions are extensive and required additional resources to complete the surgery
c.) No code is ever necessary as procedure includes all lysis of adhesions
d.) Assign the code for lysis of adhesion with modifier -59
12. Which HCPCS modifier is used to indicate cancellation of surgery after anesthesia due to poor patient condition?
a.) No modifier is used because the procedure is already started
13. Which national code is used to report administration of Ampicillin sodium, 500 mg IV?
d.) A code from range 99201-05, or 99211-15
14. Patient receives a 60 sq cm split thickness skin graft for extensive partial skin thickness wounds on the arm with excisional preparation of the site performed.
a.) 15000, 15100
c.) 14300, 15000
15. Surgeon A performs a surgical procedure early in the morning. Later that day, the patient experiences complications, and Surgeon B repeats the entire procedure. What level I modifier would Surgeon B append to the surgical CPT code?
16. Critical care given for less than 30 minutes total duration on a given date should be reported as:
b.) The appropriate evaluation and management code
17. Strabismus surgery. Recession of medial rectus muscle of left eye; strabismus surgery on superior oblique muscle of right eye.
c.) 67311-LT, 67318-LT
18. The patient undergoes a right endoscopic total ethoidectomy, septoplasty with submucous resection.
a.) 31255-RT, 31256-RT
b.) 31201-RT, 31020-RT
c.) 30520-RT, 31255-RT
19. A patient has several calculi of the right and left ureter. A laparoscopic surgical ureterolithotomy is performed and 2 calculi are taken from the left side, 3 from the right.
c.) 50945-LT, 50945-LT, 50945-RT, 50945-RT, 50945-RT
20. For a comprehensive eye examination with the performance of a gonioscopy, how many codes are necessary to report the scenario? The patient is new to the physician practice.
a.) Assign one code because the gonioscopy is a separate procedure and included with the eye exam.
b.) Assign two codes, one for the eye exam and one for the gonioscopy
c.) Assign three codes, one for the comprehensive eye exam, one for the gonioscopy and one for the patient visit
d.) Assign two codes, one for the comprehensive eye exam and one for the patient visit.
We hope this short quiz assists you in preparation for taking the CCS or CCS-P examinations. Remember that Part I of the CCS exam consist of 60 multiple-choice questions (1 hour), testing both inpatient and ambulatory care (ICD-9-CM). Part I of the CCS-P exam consist of 60 multiple-choice questions (90 minutes), testing physician-based coding (ICD-9-CM diagnosis only, CPT and HCPCS Level II procedure coding across all specialties). Part II will be discussed during the next segment of CCS Prep! n
Patricia Maccariella-Hafey is director of education for Health Information Associates Inc., a company specializing in providing contract coding and coding compliance review services for hospitals. The corporate office is headquartered in Pawley’s Island, SC.
Answers: 1. b.) 4 (The certification exam booklet states up to 4 diagnoses and up to 4 CPT procedures are to be reported for ambulatory surgeries. This is important when factoring time applied to each question while taking the examination); 2. a.) 45385, 45384-59 (Facilities do not use Ð51. See Appendix A of the CPT book. Misinterpretation of Ð51 and Ð59 is a frequent error) Both codes are necessary per CPT Assistant July 1998 p. 10.; 3. b.) 45385, 45384-51 (The surgeon utilizes Ð51 to report multiple procedures. Both codes are necessary per CPT Assistant July 1998 p. 10.; 4. b.) 28299-T5 (See note under this code and CPT Assistant December 1996 p. 7. The cast is included in the procedure, no need to report separately; see the CPT instructions prior to code 29000.); 5. c.) 43248 (The patient had EGD so only 43248 applies.); 6. a.) 21556 (Tumor was below the fascia, layered sutures are included in this code. No need for modifier as not contra-lateral, and code description includes more than one site. See HCFA Transmittal A-99-41, A-00-09); 7. d.) 22520, 22522, 76012-TC (This is per CPT Assistant March 2001 pp. 1-2. No modifier is needed on add on codes per above transmittal.); 8. a.) 73600-52-26 (Because no code exists for one view of the ankle, the modifier Ð52 for reduced services is used. Ð26 signifies the professional component.); 9. b.) 80048, basic metabolic panel (See CPT Assistant January 2000 p. 8.); 10. b.) 62311-LT (The injection codes were revised in 2000; only one injection code is reported at a particular level. See CPT Assistant, January 2000, p. 3); 11. b.) An additional code is assigned only when the adhesions are extensive and required additional resources to complete the surgery. (CPT Assistant January 1996 p. 7); 12. c.) -74; 13. b.) J0290; 14 a.) 15000, 15100; 15. a.) Ð77; 16. b.) The appropriate evaluation and management code; 17. c.) 67311-LT, 67318-LT; 18. c.) 30520-RT, 31255-RT; 19. a) 50945-50 (Per CPT Assistant May 2000, p. 4, report the code only once if calculus or calculi are removed. Use Ð50 if bilateral); 20. a.) Assign one code because the gonioscopy is a separate procedure and included with the eye exam.