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NEW QUESTION # 161
A complete cardiac MRI for morphology and function without contrast, followed by contrast with four additional sequences and stress imaging, is performed on a patient with systolic left ventricular congestive heart failure and premature ventricular contractions.
What CPT and ICD-10-CM codes are reported?
- A. 75559, I50.20, I49.3
- B. 75557, 75559, I50.1, I49.1
- C. 75561, 75563, I50.1, I49.1
- D. 75563, I50.20, I49.3
Answer: C
Explanation:
Procedure: Complete cardiac MRI for morphology and function without contrast, followed by contrast with four additional sequences and stress imaging.
CPT Codes:
75561: Cardiac MRI for morphology and function without contrast material.
75563: Cardiac MRI with contrast and further sequences.
ICD-10-CM Codes:
I50.1: Left ventricular failure.
I49.1: Premature ventricular contractions.
Code Selection Justification: The CPT codes accurately capture the MRI procedures performed. The ICD-10-CM codes represent the diagnoses of left ventricular failure and premature ventricular contractions.
AMA CPT Professional Edition (current year)
ICD-10-CM (current year)
HCPCS Level II (current year)
NEW QUESTION # 162
A 5-year-old who has an allergy history experienced a possible reaction to peanuts. A quantitative, high-sensitive fluorescent enzyme immunoassay was used to measure specific IgE for recombinant peanut components. Results showed there was no reaction indicating the child has a peanut allergy.
What lab test is reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: C
NEW QUESTION # 163
A 65-year-old gentleman presents for refill of medications and follow-up for his chronic conditions. The patient indicates good medicine compliance. No new symptoms or complaints.
Appropriate history and exam are obtained. Labs that were ordered from previous visit were reviewed and discussed with patient. The following are the diagnoses and treatment:
Hypokalemia - stable. Refill Potassium 20 MEQ
Hypertension - blood pressure remaining stable. Patient states home readings have been in line with goals. Refill prescription Lisinopril.
Esophageal Reflux - Patient denies any new symptoms. Stable condition. Continue taking over the counter Prevacid oral capsules, 1 every day.
Patient is instructed to follow up in 3 months. Labs will be obtained prior to visit.
What CPT code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: C
Explanation:
The patient presented for a follow-up visit for chronic conditions, including hypokalemia, hypertension, and esophageal reflux. During this visit, the physician reviewed and discussed lab results, managed prescriptions, and noted that there were no new symptoms or complaints.
The level of service provided included an appropriate history and exam, as well as the management of multiple chronic conditions, which aligns with the criteria for CPT code 99214. This code is used for an established patient office or other outpatient visit that requires at least 2 of the following 3 key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity.
CPT Professional Edition, AMA
Evaluation and Management Coding Guidelines
NEW QUESTION # 164
A patient underwent a cystourethroscopy with a pyeloscopy using lithotripsy to break up the ureteral calculus.
An indwelling stent was also inserted during the same operative session on the same side. This service was performed in the outpatient hospital surgery center.
What CPT coding reported?
- A. 52325, 52332-51
- B. 52352, 52332-51
- C. 52353, 52332-51
- D. 0
Answer: D
Explanation:
Cystourethroscopy: This is a procedure that involves the use of a cystoscope to look inside the urethra and bladder.
Pyeloscopy: Involves the examination of the upper urinary tract, typically done through the cystoscope.
Lithotripsy: A procedure that uses shock waves or a laser to break up stones in the kidney, bladder, or ureter.
Indwelling stent insertion: A procedure to place a stent in the ureter to help urine flow from the kidney to the bladder.
52356: Cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization and
/or ureteral stent placement).
The code 52356 includes all components mentioned: cystourethroscopy, pyeloscopy, lithotripsy, and stent insertion performed in the same operative session.
References:
AMA's CPT Professional Edition (current year)
ICD-10-CM (current year), HCPCS Level II (current year)
NEW QUESTION # 165
A patient has chronic cholesteatoma in the right middle ear. The otolaryngologist performed a tympanoplasty with a radical mastoidectomy, removing the middle ear cholesteatoma. Grafting technique was used to repair the eardrum without ossicular chain reconstruction.
What CPT code is reported for this surgery?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: A
Explanation:
The procedure involves a tympanoplasty with a radical mastoidectomy and removal of a cholesteatoma from the middle ear, including grafting of the eardrum without ossicular chain reconstruction.
* Procedure Description:
* Tympanoplasty.
* Radical mastoidectomy.
* Removal of cholesteatoma from the middle ear.
* Grafting technique used to repair the eardrum without ossicular chain reconstruction.
* CPT Coding:
* 69645: Tympanoplasty with mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), radical or complete, with removal of cholesteatoma; with mastoid obliteration.
References:
* AMA's CPT Professional Edition (current year).
* CPT Assistant for detailed coding guidelines on otolaryngology procedures.
NEW QUESTION # 166
A patient presents to the ER from a nursing home after the patient was found to have foul smelling, large sacral pressure ulcer during daily nursing rounds. The ER provider swabbed the wound for culture (which measured at 7cm in largest diameter); then cleaned the site before painting with povidone around the entire sacrum to reduce cutaneous bacterial load. The provider made an elliptical excision with 3mm margins around the outer edge of the ulcer and removed the lesion in its entirety.
Further examination revealed deep tissue damage, prompting muscle and
segmental bone removal. The wound was then closed using a layered skin flap closure.
What CPTcoding and ICD-10-CM coding is reported?
- A. 15937, L89.156
- B. 15935, L89.156
- C. 15933, L89.153
- D. 15931, L89.153
Answer: A
Explanation:
In this scenario, the procedure involved the excision of a large sacral pressure ulcer with deep tissue damage that required muscle and bone removal and was followed by a layered flap closure. The coding reflects both the extent of the ulcer and the procedure performed:
1. CPTCode 15937: This code describes excision of a pressure ulcer with muscle and bone removal followed by flap closure, which matches the detailed procedure performed on the sacral ulcer.
2. ICD-10-CM Code L89.156: This code is used for a stage 4 sacral pressure ulcer, indicating the presence of deep tissue damage down to muscle and possibly bone, which aligns with the clinical findings.
Explanation of other options:
A: 15933, L89.153 and B. 15931, L89.153: These codes do not adequately describe the excision with muscle and bone removal nor the stage 4 severity of the ulcer.
C: 15935, L89.156: Although L89.156 is correct for a stage 4 ulcer, 15935 does not account for both muscle and bone excision with flap closure.
Therefore, the correct answer is D. 15937, L89.156, accurately capturing the procedure performed and the severity of the ulcer.
NEW QUESTION # 167
A 32-year-old is in the outpatient clinic for an esophagoscopy due to increased difficulty swallowing with his eosinophilic esophagitis. The flexible scope is inserted in the mouth and into the esophagus. Examination of the esophagus noted narrowing in the distal esophagus. Following an injection of Kenalog, a transendoscopic balloon dilation was performed in the area of stenosis. Inflation was repeated eventually reaching 18 mm in diameter. What CPTcoding is reported for this procedure?
- A. 43214, 43201
- B. 43220, 43204
- C. 43220, 43200-59
- D. 43220, 43201
Answer: D
NEW QUESTION # 168
(Preoperative diagnoses:Bradycardia.
Postoperative diagnosis:Bradycardia.
Procedure performed:Dual-chamber pacemaker implantation.
Brief history:77-year-old female with recurrent syncope; evaluation revealed first-degree AV block, sinus bradycardia, bundle-branch block; bradyarrhythmia suspected; after discussion with her sister, dual-chamber pacemaker recommended; risks explained; consent obtained.
Procedure details:Taken to cardiac catheterization lab; positioned on cath table; prepped/draped standard; procedure challenging due to agitation despite adequate sedation; left infraclavicular area anesthetized with
0.5 cc Xylocaine; pacemaker pocket created; hemostasis with cautery; 9-French peel-away sheath used to introduce an atrial and a ventricular lead; leads positioned with excellent thresholds; secured with O-silk sutures over sleeves; pulse generator connected; pocket flushed with antibiotic solution; pacemaker/leads placed in pocket; incision closed in two layers; performed under fluoroscopic guidance.
Complication:None.
Plan:Return to recovery; discharge later this evening to nursing home with routine post-pacemaker care.
Question:What CPT coding is reported for this procedure?)
- A. 33206, 33207
- B. 0
- C. 1
- D. 2
Answer: C
Explanation:
This operative report documents anew permanent dual-chamber pacemaker implantation: creation of a subcutaneouspocket, placement oftwo transvenous leads(oneatrialand oneventricular) via a peel-away sheath, confirmation of thresholds, and connection/insertion of thepulse generatorinto the pocket with layered closure.
CPT pacemaker insertion coding is determined by thenumber of chambers/leads placedduring the session.
33208is the correct code for insertion of adual-chamberpermanent pacemaker system (atrial and ventricular leads with generator).33206is for asingle-chamber ventricularsystem and33207is for asingle-chamber atrialsystem, so neither matches a dual-lead implantation. Reporting 33206 and 33207 together is not correct because CPT provides the single comprehensive dual-chamber code when both leads are placed. The fluoroscopic guidance and catheterization lab setting support how the leads were placed but do not change the CPT selection, and "challenging due to agitation" does not by itself create a separate reportable service.
Therefore, report33208.
NEW QUESTION # 169
A 4-year-old, critically ill child is admitted to the PICU from the ED with respiratory failure due to an exacerbation of asthma not manageable in the ER. The PICU provider takes over the care of the patient and starts continuous bronchodilator therapy and pharmacologic support with cardiovascular monitoring and possible mechanical ventilation support.
What is the E/M code for this encounter?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: C
Explanation:
The code 99471 is used for initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill infant or young child. Given the scenario where a 4-year-old critically ill child is admitted to the PICU and requires intensive care management, this code is appropriate as it reflects the critical care provided beyond the emergency department services. References: CPT Professional Edition (current year), AMA.
NEW QUESTION # 170
A patient undergoes a laparoscopic appendectomy for chronic appendicitis.
What CPT and diagnosis codes are reported?
- A. 44970, K36, R11.2, R10.31
- B. 44950, K35.80
- C. 44970, K36
- D. 44950, K35.80, R11.2, R10.31
Answer: C
Explanation:
44970 = Laparoscopic appendectomy
K36 = Chronic appendicitis
Symptoms are not coded once definitive diagnosis is made
NEW QUESTION # 171
According to the Repair (Closure) CPT guidelines, what type of repair is reported when a single layer closure includes copious irrigation and extensive cleaning to remove particulate matter?
- A. Intermediate repair
- B. Simple repair
- C. Complex repair
- D. Simple repair plus a code for irrigation
Answer: A
Explanation:
According to the CPT guidelines for Repair (Closure), an intermediate repair includes the closure of a wound with one or more layers of subcutaneous tissue and superficial fascia in addition to the skin (epidermal and dermal) closure. It also involves extensive cleaning of the wound, which includes copious irrigation and the removal of particulate matter. This description fits the scenario provided in the question.References:
AMA's CPT Professional Edition, Repair (Closure) guidelines.
NEW QUESTION # 172
A 10-year-old had a cochlear implant in his left ear few weeks ago. Today he sees the audiologist to initialize and program the implant.
What CPTcode is reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: B
Explanation:
1. Procedure and CPTCode Selection:
The patient had a cochlear implant placed in the left ear and is now seeing the audiologist for initialization and programming of the implant.
CPTCode 92603 is specific for initial programming of a cochlear implant for patients younger than 12 years old. This includes the setup and initial adjustments required for the cochlear implant, making it the correct code.
2. Rationale for Excluding Other Options:
Code 92626 is used for evaluating auditory function with the cochlear implant, focusing on assessment rather than programming, and is therefore incorrect for this programming session.
Code 92630 is for aural rehabilitation following cochlear implant, which does not apply to the programming
/initiation stage.
Code 92604 is for subsequent programming sessions after the initial programming and is therefore not applicable for the first-time programming.
3. AAPC and CPTCoding Guidelines:
According to AAPC guidelines, 92603 is the appropriate code for initial programming of a cochlear implant in children under 12 years of age.
Therefore, the correct answer is D. 92603.
NEW QUESTION # 173
Mrs. Wilder presents with right and left leg swelling. Venous thrombosis imaging of each leg is done and shows deep venous embolism and thrombosis in each leg.
What CPTand ICD-10-CM codes are reported?
- A. 74858-50, 182.401, 182.402
- B. 78457-RT, 78457-LT, 182.401, 182.402
- C. 78457-50, 182.403
- D. 78458, 182.403
Answer: C
Explanation:
1. Procedure and CPTCode Selection:
The patient underwent venous thrombosis imaging of each leg to assess for deep venous thrombosis (DVT).
CPTCode 78457 is used for a venous thrombosis imaging study. This code is appropriate for imaging to detect DVT.
Modifier 50 is applied to indicate a bilateral procedure, as imaging was performed on both legs.
2. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code I82.403 is used for acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities. This code accurately describes the finding of DVT in both legs.
Other ICD-10-CM options, such as I82.401 and I82.402, specify unilateral lower extremity involvement, which does not accurately reflect the bilateral findings in this case.
3. Rationale for Excluding Other Options:
Code 78458 (in options A and D) is for a more comprehensive study, often cardiac or whole-body blood pool imaging, and is not specific to leg venous thrombosis.
Option C, which lists 78457 with individual RT and LT modifiers, is incorrect as Modifier 50 is appropriate for bilateral imaging on both legs.
4. AAPC and CPTCoding Guidelines:
According to AAPC and CPTguidelines, 78457 with Modifier 50 should be used for bilateral venous imaging studies, and I82.403 correctly captures bilateral DVT.
Thus, the correct answer is B. 78457-50, I82.403.
NEW QUESTION # 174
According to the Application of Cast and Strapping CPTguidelines, what is reported when an orthopedic provider performs initial fracture care treatment for a closed scaphoid fracture of the wrist, applies a short arm cast, and the patient will be returning for subsequent fracture care?
- A. 25622, 29075
- B. 0
- C. 1
- D. 29075-22
Answer: C
Explanation:
For initial fracture care of a closed scaphoid fracture, code 25622 is used, which includes treatment and initial casting. The application of the cast is part of the fracture care and is not reported separately. CPTguidelines specify that casting or strapping performed as part of the fracture care is included in the fracture care code.
References: AMA's CPTProfessional Edition (current year), Surgery section, Musculoskeletal System.
NEW QUESTION # 175
Preoperative diagnosis: Right thigh benign congenital hairy nevus. *1
Postoperative diagnosis: Right thigh benign congenital hairy 0 nevus.
Operation performed: Excision of right thigh benign congenital>1
nevus, excision size with margins 4.5 cm and closure size 5 cm.
Anesthesia: General.0
Intraoperative antibiotics: Ancef.0
Indications: The patient is a 5-year-old girl who presented with her parents for evaluation of her right thigh congenital nevus. It has been followed by pediatrics and thought to have changed over the past year. Family requested excision. They understood the risks involved, which included but were not limited to risks of general anesthesia, infection, bleeding, wound dehiscence, and poor scar formation. They understood the scar would likely widen as the child grows because of the location of it and because of the age of the patient. They consented to proceed.
Description of procedure: The patient was seen preoperatively in > I the holding area, identified, and then brought to the operating room. Once adequate general anesthesia had been induced, the patient's right thigh was prepped and draped in standard surgical fashion. An elliptical excision measuring 6 x 1.8 cm had been marked. This was injected with Lidocaine with epinephrine, total of 6 cc of 1% with 1:100,000. After an adequate amount of time, a #15 blade was used to sharply excise this full thickness.
This was passed to pathology for review. The wound required limited undermining in the deep subcutaneous plane on both sides for approximately 1.5 cm in order to allow mobilization of the skin for closure. The skin was then closed in a layered fashion using 3-0 Vicryl on the dermis and then 4-0 Monocryl running subcuticular in the skin, the wound was cleaned and dressed with Dermabond and Steri-Strips.
The patient was then cleaned and turned over to anesthesia for S extubation.
She was extubated successfully in the operating room and taken S to the recovery room in stable condition. There were no complications.
What CPT coding is reported?
- A. 52320-RT, 52332-RT
- B. 52356-RT, 52332-RT
- C. 52353-RT, 52332-RT
- D. 52356-RT
Answer: D
Explanation:
52356 = Cystourethroscopy with ureteroscopy, lithotripsy and stent placement Combination code → do not report components separately
NEW QUESTION # 176
A cardiologist performs remote monitoring for a 30-day period via a previously implanted hemodynamic pulmonary artery pressure monitor for a patient with congestive heart failure with resulting pulmonary edema. The first month of monitoring includes weekly downloads, interpretations, trend analysis, and subsequent reports.
What CPT code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: A
Explanation:
1. Procedure and CPT Code Selection:
The cardiologist provided remote monitoring over a 30-day period for a hemodynamic pulmonary artery pressure monitor implanted in a patient with congestive heart failure.
CPT Code 93264 is appropriate for remote monitoring of a hemodynamic system for up to 30 days. This code includes services such as weekly data transmissions, interpretation, trend analysis, and reporting-exactly as described in this case.
2. Rationale for Excluding Other Options:
Code 93286 is for in-person interrogation and programming of pacemakers or defibrillators, not for remote monitoring of a hemodynamic monitor, making it incorrect.
Code 93288 is for interrogation device evaluation (remote), specifically for pacemakers or defibrillators, and does not apply to a pulmonary artery pressure monitor.
Code 93279 is for in-person programming of certain cardiac devices, which does not match the remote monitoring described in this scenario.
3. AAPC and CPT Coding Guidelines:
AAPC and CPT guidelines specify that 93264 is the correct code when reporting remote hemodynamic monitoring for a pulmonary artery pressure device over a period of up to 30 days, including data review and interpretation.
Therefore, the correct answer is B. 93264.
NEW QUESTION # 177
A patient with abnormal growth had a suppression study that included five glucose tests and five human growth hormone tests.
What CPT@ coding is reported?
- A. 80430, 82947 x 5, 83003 x 5
- B. 80430, 82947, 83003
- C. 80430, 82947 x 2, 83003
- D. 82947 x 5, 83003 x 5
Answer: A
Explanation:
1. Procedure and CPTCode Selection:
The patient underwent a suppression study involving five glucose tests and five human growth hormone tests.
CPTCode 80430 represents a suppression panel specifically for growth hormone studies, which includes various assessments for diagnosing abnormal growth.
CPTCode 82947 is used for each glucose test performed, and since five glucose tests were conducted, it should be coded as 82947 x 5.
CPTCode 83003 is used for each human growth hormone test performed, and since five tests were conducted, it should be coded as 83003 x 5.
2. Rationale for Excluding Other Options:
Option A lists 82947 x 2 and 83003 without sufficient units to account for the five tests each, which does not match the actual number of tests performed.
Option B omits the suppression panel code 80430, which is necessary for documenting the overall suppression study.
Option D does not provide the correct quantity of glucose and growth hormone tests, which were each performed five times.
3. AAPC and CPTCoding Guidelines:
According to AAPC guidelines, when a suppression panel includes multiple components that are performed more than once, the specific panel code 80430 should be used along with the correct number of individual component codes.
Therefore, the correct answer is C. 80430, 82947 x 5, 83003 x 5.
NEW QUESTION # 178
A 20-year-old female is being seen for the first time by a primary care physician to have a yearly physical.
During the examination for the physical, the provider discovers non-inflammed lesions on her legs and arms.
The physician performs a complete physical and additional separate documentation for the treatment of the lesions on the bilateral upper and lower extremities. The provider has the patient buy an over-the-counter ointment and will continue to watch them.
What CPT coding is reported for this visit?
- A. 99385-25, 99203
- B. 0
- C. 99385, 99203-25
- D. 1
Answer: C
Explanation:
CPT code 99385 is used for initial comprehensive preventive medicine evaluation and management of an individual, including a detailed history and examination, and anticipatory guidance. Since additional documentation and treatment for non-inflamed lesions are provided, an additional E/M service code 99203 with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day) is appropriate to indicate both services were rendered. References: CPT Professional Edition (current year), AMA.
NEW QUESTION # 179
A patient has a 5 cm tumor in the left lower quadrant abdominal wall, excised through dermis and subcutaneous tissue. Pathology is pending to rule out cancer.
What CPT and ICD-10-CM codes are reported?
- A. 22903, D49.2
- B. 22901, D49.2
- C. 22903, R19.04
Answer: A
Explanation:
22903 = Excision of soft tissue tumor, abdominal wall, subcutaneous, 3 cm or greater D49.2 = Neoplasm of unspecified behavior of soft tissue R codes are not used when a neoplasm is documented
NEW QUESTION # 180
When a patient has ESRD, which system is affected?
- A. Genitourinary
- B. Cardiovascular
- C. Neurologic
- D. Respiratory
Answer: A
NEW QUESTION # 181
A patient complains of tarry, black stool, and epigastric tightness. An esophagogastroduodenoscopy is recommended to evaluate the source of the bleeding. The endoscope is inserted orally. The esophagus appears normal on scope insertion. No evidence of bleeding in the stomach. The scope is then passed into the duodenum, where a polyp is found and removed with hot biopsy forceps. No evidence of bleeding post procedure.
What CPT code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: D
Explanation:
An esophagogastroduodenoscopy (EGD) was performed with the removal of a polyp using hot biopsy forceps.
Procedure Description:
An EGD was performed.
A polyp was found in the duodenum and removed with hot biopsy forceps.
CPT Coding:
43250: Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.
AMA's CPT Professional Edition (current year).
CPT Assistant for detailed coding guidelines on endoscopic procedures.
NEW QUESTION # 182
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