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| Section | Weight | Objectives |
|---|---|---|
| ICD-10-CM Coding | 15-17% | - Code selection & sequencing - Diagnosis coding guidelines |
| Reimbursement & Revenue Cycle | 5-7% | |
| CPT® Coding | 45-50% | - Surgery (10000–69999) - Evaluation & Management (E/M) - Radiology, Pathology/Laboratory, Medicine |
| HCPCS Level II Coding | 5-7% | |
| Medical Terminology & Anatomy | 8-10% | |
| Compliance & Regulations | 8-10% | - Reimbursement rules - HIPAA, fraud & abuse |
| Modifiers | 5-7% |
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問題 #440
(What modifier is appended to indicate that during thepostoperative period, a procedure is performed that wasplanned,more extensivethan the original procedure, or done fortherapeutic reasons?)
答案：A
解題說明：
Modifier58is used when a subsequent procedure during the postoperative period isstaged or relatedto the original procedure and meets one of these classic criteria:(1) planned/prospective (staged), (2) more extensive than the original, or (3) therapeutic following a diagnostic procedure. It signals that the later procedure is not an unplanned complication but part of a planned course of care or an escalation of treatment. This is different from modifier78, which is for anunplanned returnto the operating room/procedure room during the postoperative period for arelated procedure(often due to complications) and typically doesnotrestart the global period. Modifier26is theprofessional componentmodifier for certain diagnostic services, not a global surgical modifier. Modifier56is not the appropriate postoperative modifier for staged/related surgical services. For CPC exam accuracy, associate58with staged/planned/more extensive/therapeutic-after-diagnostic, and78with unplanned return to OR.
問題 #441
An established patient suffering from migraines without aura, no mention of intractable migraine, and no mention of status migrainosus, is seen by his ophthalmologist who conducts a visual field examination of both eyes. The examination was accomplished plotting four isopters utilizing the Goldmann perimeter testing method. The patient and requesting physician receive the interpretation and report on the same date of service.
What procedure and diagnosis codes are reported for this encounter?
答案：B
解題說明：
* Procedure: Visual field examination of both eyes using Goldmann perimeter testing with four isopters.
* CPT Code:
* 92082: This code is for visual field examination with intermediate examination.
* ICD-10-CM Code:
* G43.009: Migraine without aura, not intractable, without status migrainosus.
* Code Selection Justification: The visual field exam method and complexity align with 92082. The patient's diagnosis of non-intractable migraine without aura is coded as G43.009.
References:
* AMA CPT Professional Edition (current year)
* ICD-10-CM (current year)
問題 #442 
Refer to the supplemental information when answering this question:
View MR 138093
What E/M coding is reported?
答案：D
解題說明：
This patient presents to the ER with syncope, requiring a comprehensive evaluation and critical care. Here's the breakdown of the codes:
* CPT Code 99291-25: Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
* This code is appropriate because the patient's syncope and vital signs (low blood pressure, shallow respirations, low oxygen saturation) indicate a critical condition requiring immediate intervention.
* Modifier -25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. This modifier is appended because the critical care services were provided in addition to the separately reported procedures below.
* CPT Code 92950: Cardiopulmonary resuscitation (eg, CPR, external cardiac massage, endotracheal intubation, ventilation)
* While the documentation doesn't explicitly mention CPR, it states the patient was unresponsive upon arrival but had spontaneous pulse and respirations. This suggests possible resuscitation efforts were performed by the paramedics before the physician's assessment.
* CPT Code 31500: Intubation, endotracheal, emergency procedure
* Although not explicitly stated, the documentation indicates the patient was placed on "high flow oxygen," which strongly suggests endotracheal intubation was performed to manage the patient's respiratory distress.
* CPT Code 82803: Blood gases, arterial, pH, PCO2, PO2, with oxygen saturation; interpretation and report
* This code is likely reported based on the patient's respiratory distress and the need to monitor their oxygenation status.
Why other options are incorrect:
* 99285: This is a standard emergency department visit code and doesn't capture the critical nature of the patient's condition.
* 99285-25, 99291-25, 92950, 31500, 82803: This includes 99285, which is not necessary as 99291 encompasses the evaluation and management.
* 99291-25, 99292-25, 92950, 31500: This includes 99292, which is for subsequent critical care time.
There's no indication in the documentation that the physician provided critical care beyond the initial 74 minutes.
References:
* CPT Codes 99281-99285: Emergency department visits
* CPT Codes 99291-99292: Critical care services
* CPT Code 92950: Cardiopulmonary resuscitation
* CPT Code 31500: Endotracheal intubation
* CPT Code 82803: Arterial blood gases
* AAPC Coder's Desk Reference: This resource provides detailed information on coding guidelines and procedures.
問題 #443
A catheter was placed into the abdominal aorta via the right common femoral artery access. An abdominal aortography was performed. The right and left renal artery were adequately visualized. The catheter was used to selectively catheterize the right and left renal artery. Selective right and left renal angiography were then performed, demonstrating a widely patent right and left renal artery.
What CPT coding is reported?
答案：D
解題說明：
CPT code 36252 describes selective catheter placement of the main renal artery with angiography of both kidneys, which matches the procedure of selectively catheterizing the right and left renal arteries and performing angiography. Additionally, CPT code 75625-26 is for an abdominal aortography with interpretation and report. The -26 modifier indicates that the professional component of the service was performed.
Reference:
AMA's CPT Professional Edition (current year), Codes 36252, 75625-26
問題 #444
A patient has suspicious lesions on his feet. Biopsies confirm squamous cell carcinoma. The patient elects to destroy a 0.6 cm lesion on the right dorsal foot and a 2.0 cm lesion on the left dorsal foot using cryosurgery.
What CPT coding is reported?
答案：C
解題說明：
Malignant lesion destruction → CPT 17260-17286
Trunk/extremities
0.6-1.0 cm → 17261
1.1-2.0 cm → 17262
Both lesions are reported separately.
問題 #445
......
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