Practice Medical Coding Question & Answers for Medical coders

1. What Z code is used to represent an encounter for a routine child health examination with abnormal findings?
A. Z00.00
B. Z01.818
C. Z00.121
D. Z01.419

2. If the provider’s assessment indicates an overweight patient has been binge eating with vomiting, which code is most appropriate?
A. F50.2
B. F50.81
C. F50.02
D. F50.82

Anorexia Nervosa is defined by an extremely low body weight coupled with an illogical fear of weight gain and an inaccurate perception of the body image. There are three types of anorexia nervosa: unspecified, restricting, and binge eating/purging. In this case, the patient is binging and purging, but is not underweight; therefore, aneroxia does not apply. Bulimia (F50.2 Bulimia nervosa), which better describes this case, differs from anorexia nervosa binge-eating/purging in that the patient is defined as a compulsive eater, often consuming large amounts of food secretly and then purging or using laxatives, etc., to rid themselves of the unwanted calories. When a patient is binging and purging, ensure the provider documentation includes the detail necessary (e.g., patient body weight) to make this distinction.

3. A 45-year-old patient who has been HIV positive for several years presents to his physician’s office today with breathlessness on exertion. He was diagnosed with atrial septal defect in 2000. Before confirmation of the diagnosis, he experienced exertional dyspnea for a few years. Repair of the atrial septal defect was done the same year. Today, he notes gradual worsening of the breathlessness on exertion. He is able to perform only minimal activities; and upon physical examination, shows elevated jugular venous pressure. An echocardiogram performed today confirms severe pulmonary arterial hypertension. The patient declines surgical intervention at this time. Therapy was initiated

A. Q21.1
B. I28.21
C. B20
D. I27.21

4. Reporting 99024 for post-operative care:

A. Allows the surgeon to get credit for additional relative value units (RVUs)
B. Assists Medicare in determining the need for possible future Medicare Physician Fee Schedule adjustments
C. Demonstrates post-operative care was delivered when properly documented
D. Both b and c

There are no RVUs assigned to 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure.

5.CPT code 31253 bundles which codes?

A. 31254 and 31267
B. 31255 and 31267
C. 31255 and 31276
D. 31254 and 31276

6. Hashimoto’s thyroiditis is also known as:

A. Goiter
B. Autoimmune thyroiditis
C. Lymphocytic thyroiditis
D. b and c

7. Amy is a new patient to Dr. Wilson’s office, and due to a scheduling conflict she has been asked if she’s comfortable meeting with David, who is Dr. Wilson’s PA. David has his own NPI number. He performs a detailed HPI, a detailed examination, and determines moderate MDM. Because the patient had originally been scheduled with Dr. Wilson, how do you code and bill the visit?

A. 99204, billed under Dr. Wilson.
B. 99204, billed under David, PA.
C. 99203, billed under David, PA.
D. This is not a billable service because a PA cannot see a new patient.

This new patient visit codes to 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity, based on a detailed history, detailed exam and moderate medical decision-making (MDM). Because David has a national provider identifier (NPI) number, this visit must be billed under him. New patients are not eligible for incident-to billing because there must first be an established care plan in place.

8. A pleasant 65-year-old male with no history of skin cancer, presents to his dermatologist requesting skin evaluation. He has two spots on his abdomen that have been there for 30 years unchanged, except occasionally itchy. The dermatologist performed a full skin examination. The areas examined included scalp, face, eyelids, lips, neck, ears, chest, back, abdomen, buttocks, upper and lower extremities bilaterally, hands, feet, hair, and nails. The doctor noted no significant findings other than two suspicious lesions on his abdomen. The physician performed a shave biopsy after an informed consent was obtained. A tangential shave biopsy of each lesion was obtained using a derma blade. Hemostasis was achieved with 20 percent aluminum chloride solution and pressure. Bandages were applied and wound care instructions were provided. CPT® coding in this scenario is:

A. 11100 x 2
B. +11101 x 2
C. 11100
D. 11100, +11101(deleted in 2019) new CPT codes will be 11102 & +11103 for tangential biopsy

The tissue for pathological evaluation was obtained independently, and it is not an integral part of another procedure performed at the same time. Two skin biopsies are performed. Report 11100 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion for the first, and +11101 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary procedure) for the second.

9. An established patient presents to her dermatologist with a recurrent seborrheic keratosis of the left leg. The area was marked for a shave removal. The area was infiltrated with local anesthetic, prepped, and draped in a sterile fashion. The lesion measuring 1.6 cm was shaved using a 13-blade. Hemostasis was achieved using light pressure. The specimen was sent to pathology. How do you code this?

A. 11312
B. 11302
C. 11310
D. 11311

Select from codes 11300-11313, based on the anatomic area and size of the lesion. The lesion measured 1.6 cm, so 11302 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm is your best code option. Because obtaining the tissue for the pathological evaluation is integral part of the shave removal, a separate biopsy procedure is not separately reported.

10. Patient receives 24 minutes of 97112 and 23 minutes of 97110 during a 47-minute treatment encounter. Which code(s) should you assign?

A. Two units of 97112, two units of 97110
B. Two units of 97112, one unit of 97110
C. Three units of 97112, one unit of 97110
D. Three units of 97110, one unit of 97112

11. A 62-year-old patient with left tibial and left peroneal artery stenosis undergoes revascularization in both arteries using transluminal angioplasty and stent placement, including atherectomy. The procedures are performed percutaneously. Proper coding is:

A. 37228, 37231
B. 37231, 37235
C. 37228
D. 37231

Angioplasty, stent placement, and atherectomy are performed on two arteries in the same territory (left tibial and left peroneal). You may report a single “initial” code within a territory, and an add on code for additional arteries treated within that territory. Proper coding is 37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed for the initial vessel, and +37235 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to the code for the primary procedure) for angioplasty, stent placement, and atherectomy in the additional artery within the same territory.

12.PTA is performed in the left superficial femoral artery. Atherectomy and stent placement are also performed in the same artery. What is the correct code for reporting these procedures?
A. 37226
B. 37228
C. 37227
D. 37225

Code 37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed supports stent and atherectomy. The entire femoral/popliteal territory in one lower extremity is considered a single vessel for CPT® reporting.

13. Effective Jan. 1, 2018, proper anesthesia coding for combined upper and lower endoscopic procedures is:

A. 00740
B. 00731
C. 00811
D. 00813