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| Section | Weight | Objectives |
|---|---|---|
| HCPCS Level II | 5-10% | - Modifiers - Supplies and Equipment |
| E/M (Evaluation and Management) | 10-15% | - Office/Outpatient Visits - Emergency Department |
| Anatomy & Physiology | 10-15% | - Medical Terminology - Body Systems |
| Laboratory / Pathology | 5-10% | - Organ and Disease Panels |
| Surgery Coding | 40-50% | - Integumentary System - Digestive System - Genitourinary System - Musculoskeletal System - Cardiovascular System - Nervous System - Respiratory System |
| Radiology | 5-10% | - Diagnostic Imaging |
| ICD-10-CM (Diagnosis Coding) | 10-15% | - Conventions and Guidelines - Code Selection |
| Medicine | 5-10% | - Specialty Coding |
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NEW QUESTION # 371
Which circumstance supports medical necessity for a payment by the insurance company?
Answer: C
Explanation:
Medical necessity is determined by whether a procedure or treatment is necessary to treat or manage a health condition. Removing excess skin after significant weight loss from a gastric bypass often meets medical necessity criteria because excess skin can lead to physical complications, such as infections, rashes, and mobility issues. Insurance companies are more likely to cover this procedure when it's needed to alleviate health issues rather than for cosmetic purposes.
A: Speech therapy for a lisp: Typically, therapy for minor speech impediments like a lisp may not be deemed medically necessary unless it severely affects communication or daily functioning.
B: Tummy tuck after a pregnancy: This procedure is generally classified as cosmetic and not medically necessary, as it is often done to improve appearance rather than address a health condition.
C: Second rhinoplasty for a smaller nose: This would likely be considered elective and cosmetic, especially if it is solely for aesthetic preference without any health-related issues.
Thus, the correct answer is D. Removing excess skin in losing weight from a gastric bypass, as it can be essential for physical health and quality of life.
NEW QUESTION # 372
Preoperative diagnosis: Right thigh benign congenital hairy nevus. *1
Postoperative diagnosis: Right thigh benign congenital hairy 0 nevus.
Operation performed: Excision of right thigh benign congenital>1
nevus, excision size with margins 4.5 cm and closure size 5 cm.
Anesthesia: General.0
Intraoperative antibiotics: Ancef.0
Indications: The patient is a 5-year-old girl who presented with her parents for evaluation of her right thigh congenital nevus. It has been followed by pediatrics and thought to have changed over the past year. Family requested excision. They understood the risks involved, which included but were not limited to risks of general anesthesia, infection, bleeding, wound dehiscence, and poor scar formation. They understood the scar would likely widen as the child grows because of the location of it and because of the age of the patient. They consented to proceed.
Description of procedure: The patient was seen preoperatively in > I the holding area, identified, and then brought to the operating room. Once adequate general anesthesia had been induced, the patient's right thigh was prepped and draped in standard surgical fashion. An elliptical excision measuring 6 x 1.8 cm had been marked. This was injected with Lidocaine with epinephrine, total of 6 cc of 1% with 1:100,000. After an adequate amount of time, a #15 blade was used to sharply excise this full thickness.
This was passed to pathology for review. The wound required # limited undermining in the deep subcutaneous plane on both sides for approximately 1.5 cm in order to allow mobilization of the skin for closure. The skin was then closed in a layered fashion using 3-0 Vicryl on the dermis and then 4-0 Monocryl running subcuticular in the skin, the wound was cleaned and dressed with Dermabond and Steri-Strips.
The patient was then cleaned and turned over to anesthesia for S extubation.
She was extubated successfully in the operating room and taken S to the recovery room in stable condition.
There were no complications.
Which CPT and ICD-10-CM codes are reported for this procedure?
Answer: D
Explanation:
65420 = Excision or transposition of pterygium without graft
LT = Left eye
H11.002 = Pterygium of left eye
NEW QUESTION # 373
(A patient with age-related osteoporosis is hospitalized after a slip and fall resulting in fractures to both hips.
The physician ordersthree-view imaging of both hips and the pelvis, interpreted by the hospital radiologist.
Later the same day, the patient falls from bed and the doctor ordersthree additional viewsof both hips and pelvis, interpreted by thesame radiologist. What CPTcoding is reported?)
Answer: C
NEW QUESTION # 374
A patient with a history of chronic venous embolism in the inferior vena cava has a radiographic study to visualize any abnormalities. In outpatient surgery the physician accesses the subclavian vein and the catheter is advanced to the inferior vena cava for injection and imaging. The supervision and interpretation of the images is performed by the physician.
What codes are reported for this procedure?
Answer: D
Explanation:
For the procedure involving access to the subclavian vein and advancing a catheter to the inferior vena cava for injection and imaging, the following codes are used:
36010 for the catheter placement.
75825-26 for the supervision and interpretation of the imaging.
Modifier -26 indicates the professional component of the radiological supervision and interpretation.
Reference:
AMA's CPT Professional Edition (current year)
ICD-10-CM (current year)
NEW QUESTION # 375
A 65-year-old man had a right axillary block by the anesthesiologist. When the arm was totally numb, the arm was prepped and draped, and the surgeon performed tendon repairs of the right first, second, and third fingers. The anesthesiologist monitored the patient throughout the case.
What anesthesia code is reported?
Answer: C
Explanation:
The anesthesia code for an axillary block for procedures on the upper arm and elbow, which includes the monitoring by the anesthesiologist throughout the procedure, is 01830. This code is appropriate for anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla.
CPT Professional Edition, AMA
Anesthesia Coding Guidelines
NEW QUESTION # 376
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