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| Section | Weight | Objectives |
|---|---|---|
| Medical Terminology & Anatomy | 8-10% | |
| HCPCS Level II Coding | 5-7% | |
| Reimbursement & Revenue Cycle | 5-7% | |
| ICD-10-CM Coding | 15-17% | - Diagnosis coding guidelines - Code selection & sequencing |
| CPT® Coding | 45-50% | - Evaluation & Management (E/M) - Radiology, Pathology/Laboratory, Medicine - Surgery (10000–69999) |
| Modifiers | 5-7% | |
| Compliance & Regulations | 8-10% | - HIPAA, fraud & abuse - Reimbursement rules |
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NEW QUESTION # 215
A physician prescribes carbamazepine to treat a patient with epileptic seizures. After six months, the physician performs a therapeutic drug test to monitor the total level of the drug in the patient.
What CPT and ICD-10-CM coding is used for the six month-evaluation?
Answer: D
Explanation:
The correct CPT code for a therapeutic drug test to monitor the total level of carbamazepine is 80156. The ICD-10-CM code G40.909 is used for epileptic seizures, not otherwise specified, which aligns with the patient's condition being treated for seizures.
References:
* AMA's CPT Professional Edition (current year)
* ICD-10-CM (current year)
NEW QUESTION # 216
A 45-year-old patient presents with right shoulder pain. The provider administers three trigger point injections in the trapezius muscle and two in the pectoralis muscle.
What CPT coding is reported?
Answer: A
Explanation:
20552 = Injection(s); single or multiple trigger points, 1-2 muscles
Total muscles injected = 2 (trapezius + pectoralis)
Number of injections does not determine code selection-number of muscles does
NEW QUESTION # 217
A driver loses control of a vehicle and crashes into a guardrail on the side of the highway. The patient sustains a fracture of the anterior fossa cranial base. Imaging confirms Involvement of the sphenoid sinus, but no cerebrospinal fluid (CSF) leak is identified. The patient undergoes a surgical nasal sinus endoscopy with sphenoidotomy lo evaluate and treat the sinus injury. No CSF leak repair is performed.
What is the correct procedure and diagnosis coding combination to report this service?
Answer: B
Explanation:
Procedure Coding (CPT):
31287 - Nasal/sinus endoscopy, surgical; with sphenoidotomy
Correct because the surgeon performed a surgical endoscopic sphenoidotomy to evaluate and treat sphenoid sinus injury.
No CSF leak repair was performed, so codes 31290-31291 are not appropriate.
31231-59 - Nasal endoscopy, diagnostic
Diagnostic endoscopy is separately reportable because:
It was performed to evaluate traumatic injury
It is not bundled into the surgical service when it provides distinct diagnostic information Modifier -59 indicates a separate and distinct service per NCCI edits.
Diagnosis Coding (ICD-10-CM):
S02.109A - Unspecified fracture of base of skull, initial encounter for closed fracture The anterior cranial fossa fracture with sphenoid sinus involvement qualifies as a skull base fracture No CSF leak is documented Correct 7th character "A" for initial encounter Why Other Options Are Incorrect:
A - Incorrect format and duplicated CPT logic
B - 31267 = maxillary sinus, wrong sinus
D - 31291 includes CSF leak repair, which was not performed
NEW QUESTION # 218
A woman at 36-weeks gestation goes into labor with twins. Fetus 1 is an oblique position, and the decision is made to perform a cesarean section to deliver the twins. The obstetrician who delivered the twins, provided the antepartum care, and will provide the postpartum care.
What CPT coding is reported for the twin delivery?
Answer: A
Explanation:
* Cesarean Delivery with Antepartum and Postpartum Care: The procedure involved the cesarean section delivery of twins, including antepartum and postpartum care.
* CPT Code 59510: This code is used for routine obstetric care including antepartum care, cesarean delivery, and postpartum care. The code is not reported per fetus but per delivery, even when delivering multiples.
References:
* AMA's CPT Professional Edition (current year)
NEW QUESTION # 219
A 44-year-old female patient with chest pains had a CT of her chest that identified a mass in her left lower lung. The patient currently has ovarian cancer with metastases to the liver. The radiologist suspects the cancer has spread to her lungs. The physician performed an outpatient bronchoscopic biopsy and the pathology report documents the mass as a tumor of uncertain behavior.
What ICD-10-CM codes are reported for this patient?
Answer: D
Explanation:
For a patient with a mass in the left lower lung suspected to be cancer that is currently documented as a tumor of uncertain behavior, with existing ovarian cancer with metastases to the liver, the ICD-10-CM codes are:
* D38.1: Neoplasm of uncertain behavior of bronchus and lung.
* C56.9: Malignant neoplasm of unspecified ovary.
* C78.7: Secondary malignant neoplasm of liver and intrahepatic bile duct.
D38.1 is used because the behavior of the lung tumor is uncertain, and C56.9 and C78.7 are used to document the known primary and metastatic cancers.
References:
* ICD-10-CM guidelines
* AMA's CPT Professional Edition (current year)
NEW QUESTION # 220
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