Question

QUESTION 18

1. The hospital outpatient prospective payment system for Medicare applies to all of the following EXCEPT:

   	A.	Physician reimbursement for observation services
   	B.	Facility reimbursement for emergency room visits
   	C.	Facility reimbursement for hospital outpatient surgery
   	D.	Facility reimbursement for outpatient clinic visits

10 points   

QUESTION 19

1. Julia is an 80-year-old female with osteoporosis. She presents to the emergency room complaining of severe back pain. X-ray interpretation shows pathological compression fractures of several vertebrae. Which diagnosis would the coder assign as first-listed (Primary) for the x-ray interpretation?

   	A.	Severe back pain
   	B.	Osteoporosis
   	C.	Pathological compression fractures
   	D.	Traumatic fracture of the spine

10 points   

QUESTION 20

1. Surgical endoscopies in CPT always include which of the following?

   	A.	Diagnostic endoscopies
   	B.	Ligation of bleeding vessels
   	C.	Subsequent procedures for additional problems/conditions
   	D.	General anesthesia

10 points   

QUESTION 21

1. A patient without prior complaints presents for a screening colonscopy. Under conscious sedation, the physician passes the scope from the ana to the cecum and visualizes the structures. During the examination, the gastroenterologist notices that the patient has what appears to be a bleeding ulcer in the ascending colon. At that point, the physician injects a vasoconstrictor directly into the bleeding site. This is performed endoscopically. No other abnormal findings are identified.

   Which CPT should be reported for the services described above?

   	A.	43243, 43235
   	B.	45378
   	C.	45378, 45381
   	D.	45381

10 points   

QUESTION 22

1. An outpatient interventional cardiology report states the following:

   "Coronary angiography of left anterior descending reveals patent vessel with good flow. The catheter was then manipulated into the right coronary artery, where no abormalities were found."

   Of the following codes, which best represents the CPT coding for this case?

   	A.	93460
   	B.	93454
   	C.	93453
   	D.	93451, 93452, 93453

10 points   

QUESTION 23

1. If three (3) separate skin lesions are excised from a patient's abdomen, which of the following rules applies to how those excisions must be coded in CPT?

   	A.	Lesion excision codes are always bundled into payment for repairs.
   	B.	Only the largest lesion's excised diameter is used to select a CPT.
   	C.	Each lesion gets a code.
   	D.	The sum of lengths of all lesions are added together.

10 points   

QUESTION 24

1. The following laboratory studies are performed in a patient during the same encounter:

   • Blood glucose
   • BUN
   • Calcium, Total
   • Carbon dioxide
   • Chloride
   • Potassium
   • Sodium

   How should these labs be reported with CPT codes?

   	A.	82310, 82947, 84520, 80051
   	B.	80048-52
   	C.	82310, 82947, 84520, 82435, 84132, 84295, 82347
   	D.	80047

10 points   

QUESTION 25

1. A patient with end-stage renal disease and hypertension presents to outpatient dialysis for a regularly scheduled session. How should the medical necessity of this encounter be coded?

   	A.	I12.0, N18.6
   	B.	I12.9, N18.6
   	C.	N18.6, I10
   	D.	I12.9, N18.9

10 points   

QUESTION 26

1. A patient recently discharged after a 5-day stay for AMI returns to the emergency room 2 days after discharge. The patient is dyspneic, diaphoretic, and complaining of severe chest tightness. He says that he's afraid he's having another heart attack.

   After labs, an EKG, and evaluation by the ER attending physician, it is determined that this patient requires admission for further treatment.

   The ER attending notes describes the diagnosis as "subsequent STEMI AMI on top of previous non-ST elevation AMI."

   How should the coder capture this diagnosis?

   	A.	I25.2
   	B.	I21.29
   	C.	I24.1
   	D.	I22.9

10 points   

QUESTION 27

1. Code Z09 is used for follow-up encounters after completed treatment for a condition (other than malignant neoplasia). Of the following, which patient's scenario warrants the use of Z09?

   	A.	The patient with strep throat which has not responded to antibiotic treatments. The patient states that he has complied with the medication regimen but is feeling worse.
   	B.	The patient who presents without symptoms for a colonoscopy (at age 50) to screen for colon cancer. This patient has no symptoms and was referred by her primary care physician.
   	C.	A patient previously treated with antibiotics for severe bronchitis, but who returns at the physician's request for surveillance and check-up. The patient expresses no complaints or symptoms.
   	D.	A patient with a prior history of asymptomatic HIV who has returned for routine bloodwork and refill of anti-retroviral medications.

10 points   

QUESTION 28

1. An independent, Licensed Clinical Social Worker (LCSW) provides outpatient psychotherapy for patient's suffering from PTSD. During these sessions, she works to attempt alleviation of the patient's emotional disturbances, change maladaptive behaviors, encourage patients, and similar types of services. Which CPT code would the LCSW report for her professional services if she furnished an hour-long session with one of her patients?

   	A.	90837
   	B.	99404
   	C.	90791
   	D.	90882

10 points   

QUESTION 29

1. CPT codes group into which of the following for hospital outpatient payment?

   	A.	RUG
   	B.	RVU
   	C.	APC
   	D.	MS-DRG

10 points   

QUESTION 30

1. If renal failure is described as both acute and chronic, which one is sequenced first in accordance with ICD-10-CM guidelines?

   	A.	Either one. The nature of the encounter determines which would be listed first.
   	B.	Whichever is listed first on the physician's record
   	C.	Chronic kidney failure
   	D.	Acute kidney failure

Answer 1

Question 18) a) Physician reimbursement for observation services.( the other 3 option will have correct record of time or date but the observation services by a physician cannot be reimbursed.

Question 19) b) osteoporosis( age related osteoporosis should be considered)

Question 20) a) diagnostic endoscopy

Question 21) d) 45381( it indicates colonoscopy with the injection)

Question 22) a) 93460( it is combined right and left heart catheterization.)

Question 23)c) each lesion gets a code.

Question 24) a) 82310,82947,84520,80051