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NEW QUESTION # 419
(A 7-year-old child presents with third-degree circumferential burns of his chest, resulting in restricted chest expansion and concern for respiratory compromise. To relieve pressure caused by the eschar, the surgeon performs anescharotomy. During the procedure,two incisionsare made through the eschar down to the subcutaneous tissue to release the constrictive effects. The burns are full-thickness and involve10% TBSA, resulting in all third-degree burns. What CPT and ICD-10-CM codes are reported for this service?)
Answer: C
Explanation:
Escharotomy is reported using CPT codes16035(escharotomy; initial incision) and16036(each additional incision). Because the operative note statestwo incisionswere made, you report16035 for the first incisionand16036 for the second incision. Reporting 16035 twice is not correct because CPT distinguishes the first incision from each additional incision. "-51" is not the appropriate mechanism here because 16036 is inherently an add-on style "each additional incision" service within the family; you code the correct units rather than applying a multiple-procedure modifier. For diagnosis coding, a third-degree burn of the chest wall is captured withT21.31XA(third-degree burn of chest wall, initial encounter). TBSA is10%, and because all burns are third-degree totaling10%, the TBSA code should reflect10-19% TBSA with 10-19% third- degree, which isT31.11. Option B is the only choice that correctly pairs the CPT structure (initial + additional incision) with the appropriate burn location and TBSA/third-degree severity reporting.
NEW QUESTION # 420
The evisceration of ocular contents was performed using a surgical microscope for enhanced visualization.
The procedure was performed on the left eye and an implant was not placed in the ocular cavity.
What CPTcoding is reported?
Answer: D
Explanation:
1. Procedure and CPTCode Selection:
The procedure performed was an evisceration of ocular contents without the placement of an implant. The surgical microscope was used for enhanced visualization, but this does not require a separate code if the primary procedure code includes it inherently.
CPTCode 65091 is used for an evisceration of the ocular contents without implant placement. This code correctly describes the procedure performed on the left eye.
2. Modifier:
Modifier LT is added to indicate that the procedure was performed on the left eye.
3. Exclusion of Code 69990:
Code 69990 is for the use of an operating microscope, but it should not be billed separately when it is used as part of a procedure where enhanced visualization is typical or expected, such as an evisceration procedure.
According to CPTguidelines, 69990 is not separately reported when the microscope is used for visualization in procedures where its use is considered part of the standard of care.
4. Rationale for Excluding Other Options:
Code 65093 is for an evisceration with implant placement, which does not apply since no implant was used.
Options B and C incorrectly include 69990, which is not separately reportable in this scenario.
5. AAPC and CPTCoding Guidelines:
According to AAPC and CPTcoding guidelines, 65091 is sufficient to capture the procedure without the need to add code 69990 for the microscope.
Therefore, the correct answer is D. 65091-LT.
NEW QUESTION # 421
(A provider states that all of their office visits should be reported asmoderate levelsbecause they treat patients with high-complexity problems. Would this be considered a compliance problem?)
Answer: D
Explanation:
Systematically billing all office visits at a predetermined level-without documentation supporting the requiredmedical decision making (MDM)ortime-is a classic compliance red flag and is generally treated asabuse(often described as upcoding when higher levels are billed than supported). E/M levels must reflect what was actually performed and documented for that encounter, using the E/M rules (MDM elements or total time, depending on code selection). Even if a provider treats complex patients, not every visit will meet the same level; stable follow-ups may be lower complexity than acute exacerbations or new problems. "Waste" generally refers to inefficient or unnecessary use of resources without intent to misrepresent; a blanket instruction to code moderate levels suggestssystematic misbillingrather than inefficiency. Option D is incorrect because providers cannot select any level at will-coding must be supported by documentation. This type of pattern is exactly what audits target, and it can trigger overpayment recoupment, penalties, and corrective action plans.
NEW QUESTION # 422
Repeat three-view imaging of both hips and pelvis is performed on the same day due to a new fall, interpreted by the same radiologist.
What CPT coding is reported?
Answer: B
Explanation:
73522 = Bilateral hips with pelvis, 3-4 views
Modifier -76 = Repeat procedure by the same physician
Modifier -51 identifies multiple procedures
NEW QUESTION # 423
A 30-year-old patient with a scalp defect is having plastic surgery to insert tissue expanders. The provider inserts the implants, closes the skin, and increases the volume of the expanders by injecting saline solution.
Tissue is expanded until a satisfactory aesthetic outcome is obtained to repair the scalp defect.
What CPT code is reported?
Answer: A
Explanation:
The CPT code 11960 is used for the insertion of tissue expanders for other than breast, which includes the scalp in this case. The procedure involves inserting the tissue expanders, closing the skin, and gradually increasing the volume of the expanders until a satisfactory outcome is achieved for repairing the scalp defect.
The other options do not accurately describe the procedure performed on the scalp.References: AMA's CPT Professional Edition (current year)
NEW QUESTION # 424
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