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質問 # 75
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. 0
- B. 52352, 52332-51
- C. 52325, 52332-51
- D. 52353, 52332-51
正解：A
解説：
* 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)
質問 # 76
A patient presents with recurrent spontaneous episodes of dizziness of unclear etiology. Caloric vestibular testing is performed irrigating both ears with warm and cold water while evaluating the patient's eye movements. There is a total of three irrigations.
What CPT coding is reported?
- A. 92537-50
- B. 92537-52
- C. 92538-50
- D. 92537-50-52
正解：B
質問 # 77
A patient has nausea with several episodes of emesis along with severe stomach pain due to dehydration.
Normal saline is infused in the same bag with 2 mg ondansetron to help with the nausea. Then a dose of 15 mg ketorolac tromethamine was given for the stomach pain.
What J codes are reported for these services?
- A. J2405, J1885
- B. J2405 x 2, J1835 x 15
- C. J2405 x 2, J1885
- D. J2405, J1885 x 15
正解：A
解説：
The correct J codes are selected based on the specific medications administered and their quantities:
J2405 represents "ondansetron, 1 mg," and since the patient received a 2 mg dose, J2405 is reported once with a quantity of 2 mg.
J1885 represents "ketorolac tromethamine, 15 mg," which matches the single 15 mg dose administered to the patient, so J1885 is reported once.
Each J code is billed according to the precise dosage given, as no multipliers are required beyond the single- unit codes provided in choice A, making it the correct answer.
質問 # 78
The documentation states:
He was then sterilely prepped and draped along the flank and abdomen in the usual sterile fashion. I first made a skin incision off the tip of the twelfth rib, extending medially along the banger's lines of the skin. This was approximately 3.5 cm in length. Once this incision was carried sharply, electrocautery was used to gain access through the external oblique, internal oblique, and transverse abdominis musculature and fascia.
What surgical approach was used for this procedure?
- A. Open
- B. Percutaneous
- C. Laparoscopic
- D. Cannot determine based on the documentation
正解：A
解説：
The documentation describes making a skin incision off the tip of the twelfth rib and extending medially along the banger's lines of the skin. The use of electrocautery to gain access through multiple layers of musculature and fascia indicates an open surgical approach. Open surgery involves making a large incision to expose and directly view the surgical site. This is distinct from percutaneous (which involves needles or catheters), laparoscopic (which uses small incisions and a camera), and other minimally invasive techniques.
References: AMA's CPTProfessional Edition, ICD-10-CM, and HCPCS Level II (current year)
質問 # 79
According to the Application of Cast and Strapping CPT guidelines, 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. 0
- B. 1
- C. 29075-22
- D. 25622, 29075
正解：B
質問 # 80
A patient has swelling in both arms and lymphangitis is suspected. She is in the outpatient radiology department for a lymphangiography of both arms.
What CPTcoding is correct?
- A. 75803-50
- B. 0
- C. 75801-50
- D. 75801, 75803
正解：A
解説：
1. Procedure and CPTCode Selection:
The patient underwent a lymphangiography of both arms in an outpatient radiology setting to evaluate suspected lymphangitis.
CPTCode 75803 is for bilateral lymphangiography of an extremity. This code covers lymphangiography procedures where multiple images are obtained in the study of lymphatic channels and nodes in an extremity.
2. Modifier for Bilateral Procedure:
Modifier 50 is applied to indicate that the procedure was performed bilaterally (on both arms). This modifier appropriately reflects the bilateral nature of the lymphangiography.
3. Rationale for Excluding Other Options:
Code 75801 is for lymphangiography of a single extremity and does not apply to bilateral procedures.
Code 75801-50 (option B) would indicate bilateral use of a code meant for a single extremity, which is not appropriate when a specific bilateral code, 75803, is available.
Option C, without the bilateral modifier, would not indicate that both arms were examined.
4. AAPC and CPTCoding Guidelines:
AAPC guidelines specify using 75803 for bilateral lymphangiography procedures of extremities, and Modifier 50 is applied for clarity on bilateral involvement.
Therefore, the correct answer is D. 75803-50.
質問 # 81
The gynecologist performs a colposcopy of the cervix including biopsy and endocervical curettage.
What CPT code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：A
質問 # 82
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. 15935, L89.156
- B. 15933, L89.153
- C. 15937, L89.156
- D. 15931, L89.153
正解：C
解説：
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.
質問 # 83
Which one of the following is a commercial or private payer?
- A. Medicaid
- B. Veterans Health Administration (VHA)
- C. Blue Cross Blue Shield
- D. Medicare
正解：C
解説：
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 CPTProfessional Edition (current year), Appendix B: Payers and Reimbursement.
質問 # 84
Adenoids, tonsils, appendix, and spleen belong to which organ system?
- A. Lymphatic
- B. Gastrointestinal
- C. Nervous
- D. Cardiovascular
正解：A
解説：
The adenoids, tonsils, appendix, and spleen are all part of the lymphatic system, which plays a crucial role in immune function and the filtration of pathogens. These organs contribute to the body's defense by trapping and eliminating bacteria and other pathogens.
Adenoids and tonsils are lymphatic tissues located in the throat and help prevent infection by filtering pathogens from inhaled or ingested particles.
The appendix contains lymphoid tissue and is thought to play a role in gut immunity.
The spleen filters blood, removing old or damaged blood cells and producing lymphocytes for immune response.
The other options are unrelated:
B: Gastrointestinal: Involved in digestion, but not specifically immune response.
C: Cardiovascular: Involved in blood circulation, not immune response.
D: Nervous: Coordinates sensory and motor functions, unrelated to lymphatic tissue.
Therefore, the correct answer is A. Lymphatic.
質問 # 85
Patient has a 5 cm tumor in the left lower quadrant abdominal wall. A horizontal skin incision is made directly over the tumor in the patient's left lower quadrant and dissection was carried down through the dermis and subcutaneous tissue. The tumor is located and completely excised using electrocautery. The specimen is sent immediately to pathology to rule out cancer. What CPTand ICD-10-CM codes are reported?
- A. 22901, C76.2
- B. 22903, R19.04
- C. 22903, D49.2
- D. 22901, D49.2
正解：C
解説：
1. Procedure and CPTCode Selection:
The scenario describes the excision of a 5 cm tumor located in the left lower quadrant of the abdominal wall.
The tumor was excised down to the dermis and subcutaneous layers and removed using electrocautery.
Code 22903 is appropriate for the excision of a soft tissue tumor in the abdominal wall greater than 5 cm, making it the correct CPTcode.
Code 22901 applies to the excision of a soft tissue tumor in the abdominal wall but only for tumors 5 cm or less. Given that the tumor in this case is exactly 5 cm, it meets the threshold for 22903, which is more appropriate here.
2. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code D49.2 is used for a neoplasm of unspecified behavior in the abdominal area, reflecting the fact that the pathology report is pending to determine if the tumor is malignant.
Code C76.2 would be incorrect because it is for malignant neoplasms of unspecified abdominal areas, which we cannot confirm based on the initial excision. Similarly, R19.04 (indicating a mass in the abdominal region) is a symptom code and is not appropriate for a definitive diagnosis when a neoplasm code (D49.2) exists.
3. AAPC and CPTCoding Guidelines:
Per AAPC coding guidelines, the size of the tumor is critical in selecting the correct excision code for abdominal wall neoplasms. Additionally, if the tumor's pathology is not confirmed as malignant, it is coded as a neoplasm of unspecified behavior until further details are known.
Therefore, based on CPTand ICD-10-CM coding guidelines, the verified answer is B. 22903, D49.2.
質問 # 86
Patient has undergone open surgery for a left total knee arthroplasty. While in the recovery room, he continued to have severe postoperative pain. The surgeon ordered a femoral block for postoperative pain. The anesthesiologist evaluated the patient and performed a left femoral block, which provided significant post-operative pain relief.
What CPT coding is reported?
- A. 01404, 64450, 01996
- B. 01402, 64447-59-LT
- C. 01380, 64447-59-LT
- D. 01402, 64448-59-LT, 01996
正解：B
解説：
The patient has undergone a left total knee arthroplasty and subsequently received a femoral nerve block for postoperative pain management. CPT code 01402 is used for anesthesia for total knee arthroplasty. Code
64447-59-LT is for a femoral nerve block (single injection) for postoperative pain management, with modifier
59 indicating a distinct procedural service and LT indicating the left side. Therefore, the appropriate codes are
01402 and 64447-59-LT.References: CPT Professional Edition (current year), AMA.
質問 # 87
The gastroenterologist performs a simple excision of three external hemorrhoids and one internal hemorrhoid, each lying along the left lateral column. The operative report indicates that the internal hemorrhoid is not prolapsed and is outside of the anal canal.
What CPT and ICD-10CM codes are reported?
- A. 46320, 46945, K64.0, K64.9
- B. 46250, 46945, K64.0, K64.4
- C. 46250, K64.0, K64.9
- D. 46255, K64.0, K64.4
正解：D
解説：
CPT code 46255 describes the excision of both internal and external hemorrhoids, which matches the procedure described. The ICD-10-CM codes K64.0 (First degree hemorrhoids) and K64.4 (Residual hemorrhoids) describe the conditions treated.
References:
* AMA's CPT Professional Edition (current year), Code 46255
* ICD-10-CM (current year), Codes K64.0, K64.4
質問 # 88
A patient with a history of chronic venous embolism in the inferior vena cava has a radiographic study to visualize any abnormalities. In outpatient surgery the physician accesses the subclavian vein and the catheter is advanced to the inferior vena cava for injection and imaging. The supervision and interpretation of the images is performed by the physician.
What codes are reported for this procedure?
- A. 36000, 75825-26
- B. 36000, 75827-26
- C. 36010, 75825-26
- D. 36010, 75827-26
正解：C
解説：
For the procedure involving access to the subclavian vein and advancing a catheter to the inferior vena cava for injection and imaging, the following codes are used:
* 36010 for the catheter placement.
* 75825-26 for the supervision and interpretation of the imaging.
Modifier -26 indicates the professional component of the radiological supervision and interpretation.
References:
* AMA's CPT Professional Edition (current year)
* ICD-10-CM (current year)
質問 # 89
View MR 099407
MR 099407
Emergency Department Visit
Chief Complaint: VOMITING.
This started just prior to arrival and is still present. He has had nausea and vomiting. No diarrhea, black stools, bloody stools or abdominal pain. Pt is diabetic and has been having elevated blood sugars (320 mg/dL).
REVIEW OF SYSTEMS: Unobtainable due to patient's altered mental status.
PAST HISTORY: Poorly controlled diabetes mellitus, with history of poor compliance.
Medications: See Nurses Notes.
Allergies: PCN.
SOCIAL HISTORY: Nonsmoker. No alcohol use or drug use.
ADDITIONAL NOTES: The nursing notes have been reviewed.
PHYSICAL EXAM
Appearance: Lethargic. Patient in mild distress.
Vital Signs: Have been reviewed-tachycardic.
Eyes: Pupils equal, round and reactive to light.
ENT: Dry mucous membranes present.
Neck: Normal inspection. Neck supple.
CVS: Tachycardia. Heart sounds normal. Pulses normal.
E D. Course: Insulin IV drip per protocol, at 10 units/hr.
Zofran 8 mg 01:33 Jul 13 2008 IVP.
Phenergan 25 mg IVP. 07:52. Discussed case with physician. Dr. X. Reviewed test results. Agreed upon treatment plan. Physician will see patient in hospital.
Total critical care time: 45 min.
Disposition: Admitted to Intensive Care Unit. Condition: stable.
Admit decision based on need for monitoring and IV hydration and medications.
CLINICAL IMPRESSION: Vomiting, diabetic ketoacidosis, probable diabetes insipidus.
What E/M code is reported for this encounter?
- A. 99291, 99292
- B. 0
- C. 1
- D. 2
正解：C
質問 # 90
A patient with empyema requires a Schede thoracoplasty.
What CPT code is reported for this procedure?
- A. 0
- B. 1
- C. 2
- D. 3
正解：B
質問 # 91
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