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NEW QUESTION # 91
(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 # 92
When a patient has ESRD, which system is affected?
Answer: A
Explanation:
End-Stage Renal Disease (ESRD) is a condition in which the kidneys fail to work effectively to remove waste products and excess fluids from the blood. This primarily affects the genitourinary system, which includes the kidneys, ureters, bladder, and urethra. Patients with ESRD often require dialysis or a kidney transplant.References: ICD-10-CM (current year), Chapter 14: Diseases of the Genitourinary System (N00-N99).
NEW QUESTION # 93
Mr. Roland has difficulty breathing and congestion with a productive cough. The physician takes frontal and lateral view chest X-rays in the office (the equipment is owned by the physician group). The physician reads the X-rays and determines a diagnosis of walking pneumonia. The physician's interpretation is placed in the patient's chart.
How does the physician bill for the chest X-ray?
Answer: D
Explanation:
For a physician who owns the equipment and interprets the chest X-rays (both frontal and lateral views), code
71046 is used. This code includes both the technical and professional components, as the equipment is owned by the physician group and the physician also provides the interpretation.
References:
* AMA's CPT Professional Edition (current year)
* ICD-10-CM (current year)
NEW QUESTION # 94
(A 55-year-old female with severe coronary arteriosclerosis with angina is admitted for elective coronary artery bypass. The surgeon performed a coronary artery bypass using asaphenous vein harvested endoscopically. The vein graft was anastomosed to theobtuse marginaland theleft circumflex. What CPT coding is reported for this procedure?)
Answer: D
Explanation:
CABG coding depends on(1) number of coronary venous graftsand(2) the conduit type(venous vs arterial).
This case uses asaphenous vein graft(a venous conduit) to bypasstwocoronary targets: theobtuse marginaland theleft circumflex. The CPT code for CABG withtwo venous graftsis33511. The separate code33508is reported forendoscopic harvest of veinwhen performed for CABG, which is specifically documented here ("harvested endoscopically").33534is for anarterial graft(e.g., internal mammary artery) and does not match a saphenous vein-only description. Option D omits the separately reportable endoscopic harvest service documented. CPC exam approach: identify conduit (vein = 33510-33516 family), count distal anastomoses (two = 33511), and add endoscopic harvest (33508) when documented.
NEW QUESTION # 95
A mother brings her 2-year-old son to the pediatrician's office because he stuck a bead up his left nostril. The pediatrician uses a nasal decongestant to open the blocked nostril and removes the bead with nasal forceps.
What CPT coding is reported?
Answer: C
Explanation:
Removal of a foreign body from the nose using forceps or other instrumentation is coded with CPT 30300.
This code includes the use of local anesthesia, which aligns with the scenario where a nasal decongestant was used.
References:
* AMA's CPT Professional Edition (current year)
NEW QUESTION # 96
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