Vol. 12 •Issue 15 • Page 8
CCS Prep!
CPT, HCPCS and Modifier Coding Quiz
In this segment of CCS Prep! we provide a brief multiple-choice exam to test your skills in CPT, HCPCS and modifier coding. See if you can answer in one or two minutes per question. Do not assign anesthesia codes. Try answering the non-coding assignment questions from memory. Accuracy and speed are important ingredients for a successful examination. The multiple-choice questions test your recall, application and analysis. Due to space constraints, we are unable to print the full text of the codes so you will need your books to look up the descriptions. The questions will let you know if the scenario applies to hospital facility coding or to physician office coding, as the modifiers may differ, depending on the site.
1. How is arch aortogram with bilateral selective common carotid arteriograms (catheter in common carotids) coded? Normal anatomy. Include S&I codes. (S&I for CCS-P exam)
a.) 36216-50, 75650-50
b.) 36216-RT, 36215-LT, 75650, 75680
c.) 36215-50, 75650, 75680
2. A Medicare patient undergoes a colonoscopy for possible polyp removal. By hot biopsy forceps, a polyp is removed from the descending colon, and a biopsy is removed further up just into the transverse colon. What CPT code(s) are reported by the FACILITY?
a.) 45384, 45380
b.) 45384, 45380-51
c.) 45380
d.) 45384
3. For question #2 what code (s) would be reported for the SURGEON?
a.) 45384, 45380
b.) 45384, 45380-51
c.) 45380
d.) 45384
4. Double osteotomy bunionectomy to correct severe hallux valgus of the left first metatarsal with 0.062 K wire fixation and application of cast. This is a Medicare patient being treated at the hospital.
a.) 28296-TA
b.) 28299-TA
c.) 28296-TA, 29425-TA
d.) 28899-LT
5. Esophagogastroduodenoscopy with Savory dilation of the esophagus over a guide wire at same operative episode.
a.) 43453, 43235-59
b.) 43226, 43235-59
c.) 43248
d.) 43456, 43235
6. Excision of 6-cm inclusion cyst of left neck located below the fascia, entire dissection of tumor from the deep subfascia; closure of deep fascia with 3-0 Vicryl; skin closed with 4-0 Maxon. Steri-strips were applied.
a.) 21556
b.) 11426, 12042-59
c.) 11426
d.) 21557
7. A patient with thoracic vertebral fractures of the spine presents for a percutaneous vertebroplasty. A needle is inserted through the right pedicle of the T7 and T8 vertebral body defects and methyl methacrylate is injected. The procedure was done under fluoroscopic guidance. What codes are reported for the facility?
a.) 22305, 76013-TC
b.) 22325, 76012-TC
c.) 22305, 76012-TC
d.) 22520, 22522, 76012-TC, 76012-TC
8. Supervision and interpretation (professional component) for one view study of the ankle provided by the physician.
a.) 73600-52-26
b.) 73600
c.) 76499-26
9. Laboratory components of calcium (82310), carbon dioxide (82374), chloride (82435), creatinine (82565), glucose (82947), potassium (84132), sodium (84295), and nitrogen-BUN (84520) compose what panel?
a.) No panel, code all as individual codes
b.) 80048, basic metabolic panel
c.) 80050, general health panel
d.) 80051, electrolyte panel
10. A Medicare patient complains of severe lower back and leg pain, which are not responding to conservative treatment. A lumbar caudal injection is given with three injections at the left L4-L5 level for pain relief.
a.) 62289-LT
b.) 62311-LT
c.) 62273-LT
d.) 62311-LT, 62311-LT, 62311-LT
11. The following is true in relation to the CPT coding of lysis of adhesions:
a.) Always code lysis of adhesions when mentioned.
b.) An additional code is assigned only when the adhesions are extensive and required additional resources to complete the surgery.
c.) No code is ever necessary as procedure includes all lysis of adhesions
d.) Assign the code for lysis of adhesion with modifier -59.
12. Which HCPCS modifier is used to indicate cancellation of surgery after anesthesia due to poor patient condition in a Medicare patient? (For facility coding)
a.) No modifier is used because the procedure is already started
b.) -73
c.) -74
d.) -52
13. Critical care given for less than 30 minutes total duration on a given date should be reported as:
a.) 99291
b.) The appropriate evaluation and management code
c.) 99285
d.) 99499
14. The patient undergoes a right endoscopic total ethoidectomy, septoplasty with submucous resection.
a.) 31255-RT, 31256-RT
b.) 31201-RT, 31020-RT
c.) 30520-RT, 31255-RT
d.) 31255-RT
15. A Medicare patient has several calculi of the right and left ureter. A laparoscopic surgical ureterolithotomy is performed and 2 calculi are taken from the left side, 3 from the right.
a.) 50945-50
b.) 50945-LT-RT
c.) 50945-LT, 50945-LT, 50945-RT, 50945-RT, 50945-RT
16. For a comprehensive eye examination with the performance of a gonioscopy, how many codes are necessary to report the scenario? The patient is new to the physician practice. (CCS-P only)
a.) Assign one code because the gonio-scopy is a separate procedure and included with the eye exam.
b.) Assign two codes, one for the eye exam and one for the gonioscopy
c.) Assign three codes, one for the comprehensive eye exam, one for the gonio-scopy and one for the patient visit
d.) Assign two codes, one for the comprehensive eye exam and one for the patient visit.
We hope this short quiz assists you in preparation for taking the CCS or CCS-P examinations. Remember that Part I of the CCS exam consists of 60 multiple-choice questions (1 hour), testing both inpatient and ambulatory care (ICD-9-CM). Part I of the CCS-P exam consists of 60 multiple-choice questions (90 minutes), testing physician-based coding (ICD-9-CM diagnosis only, CPT and HCPCS Level II procedure coding across all specialties). z
Patricia Maccariella-Hafey is director of education for Health Information Associates Inc., Pawley’s Island, SC.
Answers:
1. b.) the aortogram is not coded as it is nonselective.
2. a.) 45384, 45380-59 (Facilities do not use -51. See Appendix A of the CPT book. Misinterpretation of -51 and -59 is a frequent error) Both codes are necessary per CPT Assistant February, 1999, pg. 11. Current-ly, there is no edit for -59 on the facility side.
3. b.) 45385, 45384-51 (The surgeon utilizes -51 to report multiple procedures. Both codes are necessary per CPT Assistant July, 1998, p. 10.)
4. b.) 28299-TA (See note under this code and CPT Assistant December, 1996, p. 7. The cast is included in the procedure, no need to report separately; see the CPT instructions prior to code 29000.) Some may disagree about what modifier is appropriate as the metatarsal is not technically the first toe, but given the choices in the answers, b is the most correct.
5. c.) 43248 (The patient had EGD so only 43248 applies.)
6. a.) 21556 (Tumor was below the fascia, layered sutures are included in this code. No need for modifier as not contra-lateral, and code description includes more than one site. See HCFA Transmittal A-99-41, A-00-09)
7. d.) 22520, 22522, 76012-TC, 76012-TC (This is per CPT Assistant March, 2001, pp. 1-2. No modifier is needed on add on codes per above transmittal.) The S&I is per veterbral body so you need two codes to represent both vertebral bodies.
8. a.) 73600-52-26 (Because no code exists for one view of the ankle, the modifier -52 for reduced services is used. -26 signifies the professional component.)
9. b.) 80048, basic metabolic panel (See CPT Assistant January, 2000, p. 8.)
10. b.) 62311-LT (The injection codes were revised in 2000; only one injection code is reported at a particular level. See CPT Assistant, January, 2000, p. 3).
11. b.) An additional code is assigned only when the adhesions are extensive and required additional resources to complete the surgery. (CPT Assistant January, 1996, p. 7)
12. c.) -74
13. b.) The appropriate evaluation and management code
14. c.) 30520-RT, 31255-RT
15. a) 50945-50 (Per CPT Assistant May 2000, p. 4, report the code only once if calculus or calculi are removed. Use -50 if bilateral)
16. a.).Assign one code because the gonioscopy is a separate procedure and included with the eye exam.
