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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: CPT® Coding | 45-50% | - Surgery (10000–69999) - Radiology, Pathology/Laboratory, Medicine - Evaluation & Management (E/M) |
| Topic 2: HCPCS Level II Coding | 5-7% | |
| Topic 3: Reimbursement & Revenue Cycle | 5-7% | |
| Topic 4: Medical Terminology & Anatomy | 8-10% | |
| Topic 5: Modifiers | 5-7% | |
| Topic 6: ICD-10-CM Coding | 15-17% | - Code selection & sequencing - Diagnosis coding guidelines |
| Topic 7: Compliance & Regulations | 8-10% | - Reimbursement rules - HIPAA, fraud & abuse |
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NEW QUESTION # 17
(Day 1: Provider admits patient toobservation carefor type 2 diabetes with hyperglycemia, orders labs, consults endocrinologist, starts IV insulin drip, keeps overnight. Day 2: orders glucose test, dietitian, documents total time 25 minutes. Day 3: glucose normal, documents 15 minutes, discharges patient. What E
/M coding is reported by the physician for the patient in observation care?)
Answer: D
Explanation:
Observation E/M coding is chosen by thetype of serviceprovided on each calendar date. Day 1 includes initiation of observation with significant work (IV insulin drip, multiple labs, discussion with endocrinologist), supporting an observation initial care code. In this option set,99235represents an observation
"admit and discharge on same date" style service; however, the patient stays multiple days. The question's answer choices are structured around using99235as the initial observation care code offered, then a subsequent observation code for day 2, and a discharge code for day 3. Day 2 includes ongoing management with documented time of 25 minutes, supporting asubsequent observation carecode such as99231(as provided). Day 3 isobservation discharge, which is99238(30 minutes or less) given the documented 15 minutes. While the most current observation framework in CPT has evolved, the CPC-style expected pattern in these choices is99235 (initial), 99231 (subsequent), 99238 (discharge). Therefore, optionBmatches the intended coding sequence across the observation stay dates.
NEW QUESTION # 18
A 16-year-old female just moved to the area and is living in a campground with her parents. She has several medical conditions and the parents are unable to take her to a physician's office. A physician sees the patient in the campground and documents a medical decision making of moderate complexity. After the visit, the physician spends an additional 25 minutes in a prolonged discussion with the patient's parents; he reviews complex and detailed medical records from her previous physicians and completes a comprehensive treatment plan. A care plan with the local hearth agency and a dietician is initiated.
What E/M coding is reported for this visit?
Answer: A
Explanation:
Service location = campground → domiciliary/home visit
Patient is new
99344 = New patient domiciliary visit, moderate MDM
Prolonged Services:
Additional 25 minutes beyond base time
99417 is used for prolonged services with office/home E/M codes
Why others are incorrect:
99349 - Established patient
99204 - Office visit (wrong location)
NEW QUESTION # 19
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: D
NEW QUESTION # 20
The procedure is performed at an outpatient radiology department. From a left femoral access, the catheter is placed in the abdominal aorta and is then selectively placed in the celiac trunk and manipulated up into the common hepatic artery for an abdominal angiography. Dye is injected, and imaging is obtained. The provider performs the supervision and interpretation.
What CPT codes are reported?
Answer: A
Explanation:
* Procedure: Abdominal aorta catheterization and selective placement in the celiac trunk for angiography.
* CPT Codes:
* 36246: This code is for the catheter placement in the abdominal aorta.
* 75726-26: This code represents the abdominal angiography with supervision and interpretation, with the -26 modifier indicating the professional component.
* Code Selection Justification: The procedure involves the catheterization of the abdominal aorta and the specific imaging performed with supervision and interpretation.
References:
* AMA CPT Professional Edition (current year)
* ICD-10-CM (current year)
* HCPCS Level II (current year)
NEW QUESTION # 21
A 25-year-old woman underwent percutaneous breast biopsy on the right breast with placement of a Gelmark clip. The procedure was performed using stereotactic imaging.
What CPT codes will be reported?
Answer: B
Explanation:
CPT code 19081 is used for percutaneous biopsy of breast(s) using stereotactic guidance, which includes the placement of a localization device and imaging of the biopsy specimen when performed. This accurately describes the procedure performed on the right breast with the placement of a Gelmark clip using stereotactic imaging. The other codes either describe open biopsies or separate procedures that are not applicable here.References: AMA's CPT Professional Edition (current year)
NEW QUESTION # 22
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