Download AAPC CPMA 2024 Chapter 4 Exam with verified answers and more Exams Auditing in PDF only on Docsity!
AAPC |! CPMA |! 2024 |! Chapter |! 4 |! Exam |!
with |! verified |! answers
A |! 3-year-old |! presents |! to |! the |! office |! for |! an |! MMR |! vaccine. |! The |! nurse |! confirms |! the |! order, |! administers |! the |! SQ |! injection, |! and |! documents |! site, |! vaccine, |! lot |! number, |! dosage, |! date, |! and |! time. |! What |! are |! the |! codes |! to |! report? |! - |! Correct |! answer |! ✔90471, |! 90707 There |! is |! no |! indication |! the |! nurse |! performed |! the |! counseling |! for |! the |! vaccine |! = |! 90471 The |! vaccine |! includes |! measles, |! mumps, |! and |! rubella |! = |! 90707 Which |! statement |! best |! supports |! the |! use |! of |! modifier |! 22? |! - |! Correct |! answer |! ✔Additional |! 2 |! hours |! were |! spent |! in |! lysis |! of |! adhesions |! and |! to |! identify |! the |! point |! of |! obstruction. |! To |! support |! modifier |! 22, |! the |! documentation |! must |! clearly |! indicate |! why |! the |! procedure |! was |! more |! extensive |! and |! requiring |! more |! time |! / |! effort |! than |! typically |! required. A |! CRNA |! performs |! anesthesia |! for |! a |! tubal |! ligation |! on |! healthy |! 35-year-old. |! The |! CRNA |! is |! working |! independently. |! What |! is |! the |! correct |! code |! and |! modifier? a. |! 00851-QZ-P
b. |! 00860-QZ-P c.00840-QX-P d. |! 00860-QX-P1 |! - |! Correct |! answer |! ✔00851-QZ-P CPT |! Index |! for |! Anesthesia |! > |! Tubal |! Ligation |! = CRNA |! is |! working |! without |! medical |! direction |! = |! QZ The |! patient |! is |! healthy |! = |! P A |! patient |! has |! a |! cholecystectomy |! and |! a |! soft |! tissue |! lipoma |! removed |! during |! the |! same |! operative |! session. |! Both |! specimens |! were |! sent |! to |! pathology |! in |! separate |! containers |! and |! are |! examined |! by |! the |! pathologist. |! What |! CPT |! coding |! is |! reported? |! - |! Correct |! answer |! ✔ 88304 |! x CPT |! Index |! > |! Pathology |! and |! Lab |! / |! Surgical |! Pathology |! / |! Gross |! and |! Micro |! Exam. |! Both |! specimens |! (gallbladder |! and |! soft |! tissue |! lipoma) |! are |! coded |! under |! 88304. A |! provider |! receives |! multiple |! denials |! from |! Medicare |! on |! all |! claims |! submitted |! with |! 19307-LT, |! 19307-RT, |! 19340-LT, |! and |! 19340-RT. |! After |! completing |! a |! review |! of |! the |! records |! to |! verify |! the |! procedures |! were |! performed, |! what |! recommendations |! would |! you |! make |! to |! resolve |! the |! denials? |! - |! Correct |! answer |! ✔Correct |! the |! modifiers |! and |! resubmit |! the |! claim. |! Medicare |! requires |! modifiers |! 50 |! and |! 1 |! unit |! for |! bilateral |! procedures. A |! patient |! at |! 14 |! weeks |! gestation |! is |! coming |! back |! to |! her |! OB's |! office |! for |! a |! repeat |! trans |! abdominal |! ultrasound |! to |! measure |! fetal |! size |! and |! to |! confirm |! abnormalities |! seen |! in |! a |! previous |! scan. |! The |! OB |! documented |! the |! ultrasound |!
CT |! images |! were |! taken |! of |! the |! abdomen |! and |! pelvis |! with |! administration |! of |! oral |! contrast. |! What |! CPT |! coding |! is |! reported? |! - |! Correct |! answer |! ✔ 74176 When |! CT |! is |! performed |! on |! the |! pelvis |! and |! abdomen, |! report |! the |! combination |! code |! for |! the |! service. |! Oral |! contrast |! does |! not |! support |! reporting |! with |! a |! contrast |! code. Patient |! was |! seen |! in |! the |! office |! and |! it |! was |! determined |! the |! patient |! would |! need |! an |! amputation |! which |! was |! scheduled |! for |! the |! next |! day. |! For |! major |! the |! global |! period |! includes |! the |! day |! before |! surgery. |! What |! modifier |! is |! applied |! to |! this |! office |! visit? |! - |! Correct |! answer |! ✔Modifier |! 57 |! - |! decision |! for |! surgery |! was |! made |! during |! the |! office |! visit A |! patient |! undergoes |! the |! destruction |! of |! 3 |! actinic |! keratoses |! on |! 2/1. |! The |! pt |! returns |! on |! 2/13 |! for |! the |! evaluation |! of |! another |! suspicious |! lesion. |! Which |! modifier |! is |! appropriate? |! - |! Correct |! answer |! ✔None. An |! AK |! is |! a |! premalignant |! lesion. |! The |! original |! procedure |! is |! reported |! with |! 17000, |! which |! has |! a |! 10-day |! global |! period. |! Because |! the |! date |! of |! service |! for |! the |! E/M |! is |! outside |! of |! the |! global |! period, |! a |! modifier |! is |! not |! required. How |! are |! revisions |! to |! coding |! guidelines |! identified |! in |! the |! CPT |! code |! book? |! - |! Correct |! answer |! ✔Green |! text |! and |! opposing |! arrows |! enclosing |! the |! revised |! text. Which |! of |! the |! following |! code |! combinations |! are |! NOT |! subject |! to |! a |! multiple |! procedure |! payment |! reduction? A.) |! 32666, |! 32674 B.) |! 48150, |! 494440
C.) |! 21433, |! 21401
D.) |! 31254, |! 31287 |! - |! Correct |! answer |! ✔32666, |! 32674 Add-on |! codes |! are |! not |! subject |! to |! the |! multiple |! fee |! reduction. The |! provider |! performs |! a |! simple |! 2.0 |! cm |! repair |! on |! the |! back |! and |! a |! simple |! 1.0 |! cm |! repair |! on |! the |! thigh. |! What |! CPT |! coding |! is |! reported? |! - |! Correct |! answer |! ✔ 12002 Guidelines |! for |! the |! repairs |! state |! to |! sum |! the |! lengths |! of |! repairs |! for |! each |! group |! of |! anatomic |! sites. |! The |! back |! and |! extremities |! are |! considered |! the |! same |! anatomic |! group. Which |! scenario |! qualifies |! for |! modifier |! 22? |! - |! Correct |! answer |! ✔A |! provider |! attempts |! to |! perform |! foreign |! body |! removal |! via |! bronchoscopy. |! The |! provider |! is |! not |! successful |! and |! decides |! to |! perform |! a |! thoracotomy |! to |! remove |! the |! intrapulmonary |! foreign |! body, |! which |! increased |! the |! time |! to |! perform |! the |! procedure. Operation |! Report: Preoperative |! Diagnosis: |! Cataract, |! left |! eye Postoperative |! Diagnosis: |! Cataract, |! left |! eye Procedure |! in |! Detail: |! Pt |! is |! a |! 56-year |! old |! with |! a |! dense |! nuclear |! cataract |! of |! the |! left |! eye. Codes |! reported: |! 66984, |! H25. Which |! one |! of |! the |! following |! deficiencies |! are |! found |! after |! review |! of |! the |! documentation |! and |! codes |! submitted? |! - |! Correct |! answer |! ✔The |! diagnosis |! code |! submitted |! is |! incorrect. |!
When |! auditing |! CBC |! tests |! for |! a |! primary |! care |! physician, |! you |! review |! the |! records |! and |! verify |! the |! tests |! were |! performed, |! but |! there |! is |! no |! order. |! When |! you |! question |! the |! provider, |! he |! indicates |! there |! is |! a |! standing |! order |! to |! perform |! a |! CBC |! on |! every |! patient. |! What |! do |! you |! advise |! the |! provider? |! - |! Correct |! answer |! ✔This |! is |! an |! audit |! finding. |! Standing |! orders |! cannot |! be |! used |! in |! this |! manner. |! Standing |! orders |! are |! not |! usually |! acceptable |! documentation |! that |! tests |! are |! reasonable |! and |! necessary. Which |! of |! the |! following |! must |! be |! performed |! and |! documented |! to |! code |! for |! medical |! direction |! by |! an |! anesthesiologist |! for |! a |! case |! involving |! a |! CRNA |! for |! a |! Medicare |! patient? |! - |! Correct |! answer |! ✔The |! anesthesiologist |! must |! perform |! and |! document |! the |! pre-anesthesia |! exam. What |! modifier |! is |! appended |! to |! indicate |! a |! service |! is |! provided |! under |! the |! primary |! care |! exception |! without |! the |! presence |! of |! a |! teaching |! physician? |! - |! Correct |! answer |! ✔Modifier |! GE If |! approved |! for |! the |! primary |! care |! exception, |! the |! resident |! can |! see |! patients |! on |! their |! own |! and |! discuss |! the |! case |! with |! the |! teaching |! physician. |! The |! physician |! is |! not |! required |! to |! perform |! a |! face-to-face |! encounter |! unless |! it |! is |! medically |! necessary. |! The |! highest |! E/M |! level |! that |! can |! be |! billed |! is |! a |! level |! III. Which |! code |! combination |! is |! appropriate |! to |! report? A) |! 43261, |! 43263 B) |! 43262, |! 43274 C) |! 43264, |! 43265
D) |! 43277, |! 43262 |! - |! Correct |! answer |! ✔A) |! 43261, |! 43262 Review |! the |! parenthetical |! notes |! to |! determine |! the |! appropriate |! add-on |! code |! with |! the |! primary |! code. |! Coding |! guidelines |! and |! parenthetical |! notes |! provide |! instructions |! for |! codes |! that |! can |! and |! cannot |! be |! reported |! together. Which |! of |! the |! following |! scenarios |! will |! result |! in |! an |! audit |! finding? |! - |! Correct |! answer |! ✔The |! lab |! results |! were |! not |! reviewed |! by |! the |! provider |! after |! the |! tests |! were |! performed. When |! labs |! are |! performed, |! there |! must |! be |! an |! order |! indicating |! the |! test |! and |! diagnoses |! to |! support |! medical |! necessity, |! there |! must |! be |! a |! report, |! and |! there |! must |! be |! a |! review |! of |! the |! results. |! If |! the |! provider |! orders |! the |! tests, |! but |! does |! not |! review |! them, |! the |! labs |! will |! not |! be |! considered |! medically |! necessary |! if |! they |! were |! not |! used |! to |! treat |! or |! assess |! the |! patient. Which |! one |! of |! the |! following |! would |! be |! an |! audit |! finding |! for |! psychiatric |! services? |! - |! Correct |! answer |! ✔Reporting |! code |! 90863 |! only. Code |! 90863 |! is |! an |! add-on |! code. |! It |! can |! only |! be |! reported |! with |! a |! code |! for |! psychotherapy. A |! patient |! presents |! to |! the |! PCP |! for |! follow |! up |! of |! his |! diabetes. |! 30 |! days |! prior, |! the |! pt |! underwent |! open |! reduction |! and |! surgical |! fixation |! of |! a |! radial |! fracture |! by |! the |! orthopedist. |! Which |! modifier |! is |! reported |! for |! the |! visit |! with |! the |! PCP? |!
- |! Correct |! answer |! ✔No |! modifier |! is |! submitted. The |! global |! package |! concept |! only |! applies |! to |! the |! provider/group |! who |! performed |! the |! surgery. |! when |! the |! patient |! sees |! other |! providers |! outside |! of |! the |! group/specialty, |! the |! services |! are |! not |! considered |! to |! be |! part |! of |! the |! global |! package.
