Answers to Chapter Review Exercises, Appendix D

1 Appendix D text AC200610: Basic CPT and HCPCS Coding Page 1 of 26 Answers to Chapter Review Exercises, Appendix D Chapter 1: Introduction to Clinical Coding Chapter 1 Review 1. The American Medical Association (AMA) updates the CPT codes, and the Centers for Medicare and Medicaid Services (CMS) updates the HCPCS National Codes (Level II). 2. Four 3. ICD-9-CM and CPT/HCPCS 4. a. Diagnosis: ICD-9-CM Procedure: CPT/HCPCS b. Diagnosis: ICD-9-CM Procedure: CPT/HCPCS c. UB-04 (CMS-1450) 5. ICD-9-CM 6. Procedure code 11440 is linked with diagnosis code #1 ( ). Procedure code 82951 is linked with diagnosis code #3 ( ). Note: Depending on the carrier, you may link more than one reference number in block 24E, whereas some payers require just one. When reporting more than one code on a CMS-1500 claim, enter the code with the highest fee in line 1 of block 24 and the remaining in descending order of charges.

2 Chapter 2: Application of the CPT System exercise Organization of CPT 1. Surgery 2. Evaluation and Management 3. Pathology and Laboratory 4. Category II codes 5. Medicine 6. Radiology 7. Anesthesia 8. Category III codes 9. Maternity Care and Delivery 10. StandbyServices Appendix D text AC200610: Basic CPT and HCPCS Coding Page 2 of 26 11. Radiation Oncology 12. Surgical Pathology exercise CPT Conventions 1. Repair blood vessel, direct; hand, finger 2. Two 3. Revised descriptor 4. Esophagoscopy, rigid or flexible, with insertion of plastic tube or stent 5. New descriptor 6. No 7. No 8. 13152, 13153 9. 40814 10. 31578, 31576 exercise Use of the Alphabetical Index 1. 23400 Green operation, see scapulopexy 2. 10021 Fine Needle Aspiration 3.

3 35556 Graft, see Bypass graft, Femoral Artery or Popliteal Artery 4. 49555 Hernia repair, femoral, recurrent 5. 26991 Incision and drainage , bursa, hip 6. 01680 Anesthesia, shoulder 7. 31525 Laryngoscopy, direct 8. 72149 MRI see magnetic resonance imaging, spine, lumbar 9. 11055 Paring, skin lesion, benign hyperkeratotic, single lesion 10. 86701 HIV-1, antibody 11. 41105 Biopsy, tongue 12. 43239 Esophagogastroduodenoscopies, see Endoscopy, gastrointestinal, upper, biopsy 13. 29881 Arthroscopy, surgical, knee 14. 95827 EEG, see Electroencephalography, sleep 15. 65220 Removal, foreign body, cornea, without slit lamp 16. 58356 Endometrial Ablation (this exercise is difficult find in the alphabetic index, but a good lesson on how locating correct entries in the index is not a perfect science). Endometrial ablation directs coder to 58363, which is endometrial ablation (thermal).

4 Alert students to look at the code below 58363 58356. 17. 4008F Beta-blocker therapy, see Performance Measures, Therapeutic, preventive or other interventions, Beta-Blocker therapy 18. 0184T Excision, Tumor, Rectum, Transanal Endoscopic 19. 77082 DXA, see Dual X-ray Absorptiometry, vertebral fracture Appendix D text AC200610: Basic CPT and HCPCS Coding Page 3 of 26 20. 25112 Ganglion, Cyst, Wrist Excision exercise CPT Coding Process 1. Colonoscopy and polypectomy 2. 45384 45385 3. How was the polyp removed (hot biopsy forceps, snare, and so on)? 4. Was removed with hot biopsy forceps and retrieved 5. 45384 exercise CPT Coding Process 1. Excision 2. Can be located under Excision, lesion, skin; or Lesion, skin, excision Selections: Benign 11400 11471 Malignant 11600 11646 3.

5 Pathologic diagnosis indicates that the lesion was malignant (11600 11646). 4. Documentation is needed to code malignant lesion, size of lesion + margins (or size of excision) ( cm + cm + cm = cm excision site) and site (arm). 5. 11603 exercise CPT Coding Process 1. Hernia repair 2. Index entries: Hernia repair, umbilicus; Repair, hernia, umbilical. Codes to Review : 49580 49587 3. Age of patient; incarcerated or strangulated hernia 4. Review of documentation (38-year-old patient and no documentation for incarcerated/strangulated hernia). Using the abstracted documentation and process of elimination, the correct code would be 49585. 5. Wound closure would be an integral part of the procedure and would not be assigned a CPT code. exercise Coding References 1. 45380 2. CPT Assistant, January 1996, page 7, instructs the coder to assign 45385. CPT Assistant, January 2004, states that if a small polyp is removed via cold knife biopsy, the appropriate code is 45380.

6 This is a good example of the need to research the most current coding advice. Appendix D text AC200610: Basic CPT and HCPCS Coding Page 4 of 26 exercise Coding References 1. When a biopsy of a lesion is obtained and the remaining portion of the same lesion is then excised/fulgurated, only the code for the excision/fulguration should be used. When the biopsy is taken from a different lesion than the one excised, the biopsy code and an additional code for the removal of the separate lesion are reported. It would be appropriate to append modifier 59 to the code reported for the biopsy procedure. 2. Reference: CPT Assistant, October 2004, Skin Biopsy Coding Guidelines. exercise Coding References 1. No. Code 36479 would be reported only once. The code descriptor for code 36479 states, second and subsequent veins treated in a single extremity, each through separate access sites, indicating that the second, third, fourth, etc.

7 Vein(s) are represented in code 36479. No additional reporting occurs after the second vein is treated. 2. Reference: CPT Assistant, July 2012, pages 12-13 (Frequently Asked Questions) exercise Chapter 2 Review 1. Bullet 2. 11100 and 11101 3. Category III 4. 42320 5. 40843 6. Removal of less than 80% of vulvar area, and there was removal of skin and deep subcutaneous tissue. (See the note before CPT code 56405.) 7. Method of removal 8. No. Versed is a type of conscious sedation. The symbol appears before code 43235; therefore, administration/monitoring of conscious sedation would be inherent in the procedure. 9. 76857, based on the definitions provided in the note before code 76830 10. 11730, 11732, 11732 Chapter 3: Modifiers exercise Chapter 3 Review 1. 55 2. 77 3. 22 4. 62 5. 53 6. 64721 50 Carpal tunnel syndrome, decompression 7.

8 11730 FA Avulsion, nails Appendix D text AC200610: Basic CPT and HCPCS Coding Page 5 of 26 8. 11043 73 Debridement, muscle 9. 64611-52 Chemodenervation, salivary glands 10. 19102 LT Biopsy, breast 11. 28485 RT Fracture, metatarsal, open treatment Note: T9 is not applicable in this case because the procedure refers to the bones of the foot, not the toes. Chapter 4: Surgery exercise Integumentary System Debridement 1. 11042 Debridement, skin, subcutaneous tissue 2. 11010 Debridement, skin, with open fracture 3. 11005 Debridement, skin, infected 11008 Removal, mesh, abdominal wall exercise Integumentary System Lesions 1. 11421 Excision, skin, lesion, benign; or 11402 Lesion, skin, excision, benign 2. 17110 Lesion, skin, destruction, benign 3. 11642 Excision, skin, lesion, malignant; or Lesion, skin, excision, malignant 4.

9 11200 Skin, tags, removal 5. 11403 Lesion, skin, excision, benign 6. 11644 Lesion, skin, excision, malignant 7. 11641 Lesion, skin, excision, malignant 11640 exercise Integumentary System 1. 11442 Excision, skin, lesion, benign; or Lesion, skin, excision, benign exercise Integumentary System 1. 11308 Lesion, skin, shaving exercise Integumentary System Wound Repairs 1. 12002 Wound, repair; or Repair, wound, simple 2. 12032 Wound, repair; or Repair, wound, intermediate 3. 12041 Wound, repair; or Repair, wound, intermediate Appendix D text AC200610: Basic CPT and HCPCS Coding Page 6 of 26 12002 Wound, repair; or Repair, wound, simple (sum of repairs) exercise Integumentary System 1. 12001 Wound, repair; or Repair, wound, simple exercise Integumentary System 1. 12032 Wound, repair; or Repair wound (simple and intermediate) 12005 exercise Integumentary System 1.

10 13121 Wound, repair (complex) 13122 exercise Integumentary System 1. 11603 Lesion, skin, excision, malignant 12031 Wound, repair (intermediate) exercise Integumentary System Skin Grafts 1. 14021 Skin Graft and Flap, tissue transfer 2. 15150 Skin Graft and Flap, tissue-cultured 15151 3. 15220 Skin Graft and Flap, free skin graft, full thickness exercise Integumentary System 1. 15120 Autograft, skin, epidermal 11646 Excision, skin, lesion, malignant; or Lesion, skin, excision, malignant exercise Integumentary System 1. 15100 Skin, grafts, free exercise Integumentary System 1. 19000 LT Breast, cyst, puncture aspiration exercise Integumentary System 1. 19125 LT Excision, breast, cyst; or Breast, excision, lesion by needle localization Note: The hospital also would assign 19290 for placement of the wire.