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A series of multiple-choice questions related to medical coding, specifically focusing on the aapc cpc exam. It covers various aspects of medical coding, including fraud detection, place of service codes, cpt® code descriptions, icd-10-cm coding guidelines, and anatomical terminology. Each question includes the correct answer and a brief explanation, offering valuable insights into the intricacies of medical coding practices.
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Which one of the following is an example of fraud? A. Reporting the code for ultrasound guidance when used to perform a liver biopsy B. Reporting a biopsy and excision performed on the same skin lesion during the same encounter C. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physician's office D. Reporting a lab panel with an additional lab test that is not included in the lab panel - correct answer - B. Reporting a biopsy and excision performed on the same skin lesion during the same encounter Answer B is the only example of unbundling of CPT® which would result in a fraudulent claim. According to National Correct Coding Initiative (NCCI) and CPT® coding guidelines, a biopsy performed on the same lesion as an excision during the same encounter is an incidental service and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is billable. X-rays performed in a physician's office do not require modifier 26, because the physician owns the equipment and performs the interpretation, he bills the global service. Lab panels can be reported with additional lab tests that are not listed in a lab panel. Which place of service code is reported for fracture care performed by an orthopedic physician in the ED? A. 11 B. 20 C. 22 D. 23 - correct answer - D. 23 Place of service codes are reported on the claim form to identify the site of the service provided. In this case, the services are rendered in the ED which is reported with place of service (POS) 23. The place of service codes can be found in the CPT® codebook. What is the full CPT® code description for 61535?
A. Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) C. For removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) D. For excision of epileptogenic focus without electrocorticography during surgery; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) - correct answer - B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) In the CPT® codebook the description for code 61535 is indented which means the description from 61533 up to the semicolon is the beginning of the full description for 61535. Which Z code category can ONLY be reported as a first listed diagnosis code? A. Z B. Z C. Z D. Z03 - correct answer - D. Z The Official ICD- 10 - CM Coding Guidelines provides a list of Z code categories and Z codes that can only be reported as a first listed diagnosis code. The list can be found in the ICD- 10 - CM codebook referring to guideline I.C.21.c.16. The patient has a history of symptomatic HIV and has been treated for an HIV related illness. Which ICD- 10 - CM code is reported? A. Z B. B C. Z20.
Both the heart and the nose have a septum, defined as a wall dividing two chambers. The nasal septum separates the two nostrils. A septum also divides the right and left atriums and right and left ventricles of the heart. In the CPT® Index, look for the term Septum or Septal referring you to codes pertaining to the nose or heart. Which one of the following patients might be documented as having meconium staining? A. Woman with renal failure B. Teenage boy with sickle cell anemia C. Newborn with pneumonia D. Man with alcoholic cirrhosis of liver - correct answer - C. Newborn with pneumonia Meconium is fetal stool, composed of materials ingested in utero. It is odorless and tarlike. Meconium is usually expelled in a neonate's first bowel movements, but during stress before or during birth, may be expelled into the amniotic fluid. It can be inhaled into the fetal lung and cause pneumonia at birth. Meconium staining refers to discoloration of the amniotic fluid, or of the neonate (for example, meconium staining of fingernails). Look in the ICD- 10 - CM Alphabetic Index for Stain, staining/meconium (newborn) refers you to a newborn code, P96.83. The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A laparoscopy found several small cysts in the area of the fallopian tubes. These cysts are called: A. Pilonidal cysts B. Myomas C. Paratubal cysts D. Synovial cysts - correct answer - C. Paratubal cysts Paratubal cysts are benign, they are frequently found adjacent to the fallopian tubes. Pilonidal cyst develops in the deeper layers of the skin in the lower back near the upper crease of the buttocks. Myomas or leiomyomas are benign tumors of the uterus. Synovial cyst develops in any joint, for example at the back of the knee. Look in the ICD- 10 - CM Alphabetic Index for, Cyst/paratubal N83.8. Go to the Tabular List and the code indicates where these cysts are located.
What is orchitis? A. Inner ear imbalance B. Lacrimal infection C. Inflammation of testis D. Inflammation of an ilioinguinal hernia - correct answer - C. Inflammation of testis Orchitis is marked by painful swelling of the testis. It may occur without cause, or be the result of infection. The Greek root "orchis" means testicle, and - "itis" is a suffix indicating inflammation or infection. Look in the ICD- 10 - CM Alphabetic Index for Orchitis referring you to code N45.2. In the Tabular List this code is found under Diseases of the Male Genital Organs (N40-N53).