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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Compliance & Regulations | 8-10% | - Reimbursement rules - HIPAA, fraud & abuse |
| Topic 2: ICD-10-CM Coding | 15-17% | - Diagnosis coding guidelines - Code selection & sequencing |
| Topic 3: Modifiers | 5-7% | |
| Topic 4: Medical Terminology & Anatomy | 8-10% | |
| Topic 5: CPTยฎ Coding | 45-50% | - Evaluation & Management (E/M) - Radiology, Pathology/Laboratory, Medicine - Surgery (10000โ69999) |
| Topic 6: HCPCS Level II Coding | 5-7% | |
| Topic 7: Reimbursement & Revenue Cycle | 5-7% |
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NEW QUESTION # 273
Which one of the following is a commercial or private payer?
Answer: D
Explanation:
Blue Cross Blue Shield is a commercial or private payer, which means it is an insurance company that provides health insurance plans to individuals and groups. In contrast, Medicare and Medicaid are government programs, and the Veterans Health Administration (VHA) is a federal healthcare system for military veterans.References: AMA's CPT Professional Edition (current year), Appendix B: Payers and Reimbursement.
NEW QUESTION # 274
(Regarding the CPT Surgery Guidelines for a surgical code designated as a"Separate Procedure,"which statement isFALSE?)
Answer: C
Explanation:
In CPT, a code labeled"separate procedure"is typically a service that isnormally includedas part of a more comprehensive procedure andshould not be reported separatelywhen performed as an integral component.
However, itmaybe reported when performedindependentlyorunrelatedto the primary procedure-this supports options A, B, and C as true. The false statement isDbecause CPT doesnotinstruct that modifier79is specifically required to report a separate procedure with an unrelated primary service. Modifier selection depends on the actual circumstances and payer rules, and "separate procedure" logic is about whether the service isdistinct and not integral, often supported by documentation of a different site/session or separate clinical intent; when a modifier is needed, it is commonly adistinct procedural servicemodifier (e.g., 59 or X
{EPSU}) rather than automatically 79. Modifier79is a global surgery modifier used for anunrelated procedure during the postoperative period, which is a different concept than "separate procedure" designation.
NEW QUESTION # 275
View MR 099405
MR 099405
CC: Shortness of breath
HPI: 16-year-old female comes into the ED for shortness of breath for the last two days. She is an asthmatic.
Current medications being used to treat symptoms is Advair, which is not working and breathing is getting worse. Does not feel that Advair has been helping. Patient tried Albuterol for persistent coughing, is not helping. Coughing 10-15 minutes at a time. Patient has used the Albuterol 3x in the last 16 hrs. ED physician admits her to observation status.
ROS: No fever, no headache. No purulent discharge from the eyes. No earache. No nasal discharge or sore throat. No swollen glands in the neck. No palpitations. Dyspnea and cough. Some chest pain. No nausea or vomiting. No abdominal pain, diarrhea, or constipation.
PMH: Asthma
SH: Lives with both parents.
FH: Family hx of asthma, paternal side
ALLERGIES: PCN-200 CAPS. Allergies have been reviewed with child's family and no changes reported.
PE: General appearance: normal, alert. Talks in sentences. Pink lips and cheeks. Oriented. Well developed. Well nourished. Well hydrated.
Eyes: normal. External eye: no hyperemia of the conjunctiva. No discharge from the conjunctiva Ears: general/bilateral. TM: normal. Nose: rhinorrhea. Pharynx/Oropharynx: normal. Neck: normal.
Lymph nodes: normal.
Lungs: before Albuterol neb, mode air entry b/l. No rales, rhonchi or wheezes. After Albuterol neb. improvement of air entry b/l. Respiratory movements were normal. No intercostals inspiratory retraction was observed.
Cardiovascular system: normal. Heart rate and rhythm normal. Heart sounds normal. No murmurs were heard.
GI: abdomen normal with no tenderness or masses. Normal bowel sounds. No hepatosplenomegaly Skin: normal warm and dry. Pink well perfused Musculoskeletal system patient indicates lower to mid back pain when she lies down on her back and when she rolls over. No CVA tenderness.
Assessment: Asthma, acute exacerbation
Plan: Will keep her in observation overnight. Will administer oral steroids and breathing treatment. CXR ordered and to be taken in the morning.
What E/M code is reported?
Answer: D
Explanation:
99222: This code is used for initial hospital care, per day, for the evaluation and management of a patient, which requires a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making of moderate complexity.
The documentation shows a detailed history (including HPI, ROS, PMH, SH, and FH) and a detailed examination (covering multiple organ systems). The medical decision making involves the management of an acute asthma exacerbation, which includes admitting the patient to observation status, administering oral steroids, and planning for further diagnostic testing.
CPT Professional Edition, AMA
NEW QUESTION # 276
Patient has cervical spondylosis with myelopathy. The surgeon performed a bilateral posterior laminectomy with facetectomies at each level and foraminotomies performed between interspaces C5-C6 and C6-C7. Bilateral decompression of the nerve roots is achieved.
What CPT coding is reported?
Answer: B
NEW QUESTION # 277
(An 8-day-old newborn, weighing 3 kilograms, is seen for a circumcision. A numbing cream is applied. A circumferential incision is made and the foreskin is excised with a scalpel. What CPT coding is reported?)
Answer: D
Explanation:
Newborn circumcision coding depends primarily on whether the circumcision is performed using aclamp
/device techniqueversus asurgical excision technique. CPT54150is commonly associated with circumcision using a clamp or other device method (often described with a Gomco/Mogen-type approach in many training contexts). In contrast, CPT54160representssurgical circumcisionusing acircumferential incisionwith excision of the foreskin-matching the documentation ("circumferential incision... foreskin excised with a scalpel").
The infant's age (8 days old) supports that this is a newborn service, but the decisive factor in this vignette is thetechnique described. Modifier-52(reduced services) is not supported because the full circumcision service is performed. Modifier-63applies to procedures performed on infants less than 4 kg for certain CPT codes when applicable, but it is not universally appended and is not the best answer here given typical CPC exam expectations for standard newborn circumcision technique identification. Therefore,54160is correct.
NEW QUESTION # 278
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