Which entity offers compliance program guidance to form the basis of a voluntary compliance
program for a provider practice?
C
Explanation:
The Office of Inspector General (OIG) provides compliance program guidance to form the basis of a
voluntary compliance program for provider practices. This guidance is intended to help healthcare
providers develop effective internal controls to monitor adherence to applicable statutes,
regulations, and program requirements of Federal healthcare programs. The OIG issues various
compliance guidelines and resources to assist organizations in establishing comprehensive
compliance programs to prevent fraud, waste, and abuse.
Reference: OIG Compliance Program Guidance, AMA's CPT® Professional Edition, and healthcare
compliance resources.
A cardiologist attempted to perform a percutaneous transluminal coronary angioplasty of a totally
occluded blood vessel. The surgeon stopped the procedure because of an anatomical problem
creating risk for the patient and preventing performance of the catheterization.
What modifier is appended to the procedure code?
B
Explanation:
Modifier 53 is used to report a discontinued procedure. It indicates that a procedure was started but
terminated due to the patient's well-being being at risk. In this scenario, the percutaneous
transluminal coronary angioplasty was attempted but stopped because of an anatomical problem
that created a risk for the patient, preventing the completion of the procedure.
Reference: AMA's CPT® Professional Edition, coding guidelines on the use of modifiers.
According to the Repair (Closure) CPT® guidelines, what type of repair is reported when a single layer
closure includes copious irrigation and extensive cleaning to remove particulate matter?
C
Explanation:
According to the CPT® guidelines for Repair (Closure), an intermediate repair includes the closure of
a wound with one or more layers of subcutaneous tissue and superficial fascia in addition to the skin
(epidermal and dermal) closure. It also involves extensive cleaning of the wound, which includes
copious irrigation and the removal of particulate matter. This description fits the scenario provided in
the question.
Reference: AMA's CPT® Professional Edition, Repair (Closure) guidelines.
The CPT® code book provides full descriptions of medical procedures, although some descriptions
require the use of a semicolon (;) to distinguish among closely related procedures.
What is the full description of CPT® code 69644?
A
Explanation:
CPT® code 69644 refers to a tympanoplasty with mastoidectomy, which includes canalplasty, middle
ear surgery, and tympanic membrane repair. The specific procedure described by this code is
performed with an intact or reconstructed canal wall and includes ossicular chain reconstruction. The
use of a semicolon in the CPT® description helps distinguish between different variations of the
procedure.
Reference: AMA's CPT® Professional Edition, specific code descriptions and guidelines.
Which statement regarding lesion excision is TRUE?
A
Explanation:
Lesion excision codes in the CPT® codebook include the removal of the lesion along with the
necessary margins and a simple (nonlayered) closure when performed. These codes do not cover
intermediate or complex closures, which are reported separately if performed. The measurement for
selecting the appropriate lesion excision code includes the lesion and the margins required for
complete excision.
Reference: AMA's CPT® Professional Edition, lesion excision guidelines.
Which one of the following is an example of a case in which a diabetes-related problem exists and
the code for diabetes is never sequenced first?
B
Explanation:
When a patient experiences an underdose of insulin due to an insulin pump malfunction, the
primary reason for the encounter would be the malfunction itself, which is coded first. The resulting
hyperglycemia or hypoglycemia due to the pump failure is a secondary condition. According to ICD-
10-CM guidelines, the code for the mechanical complication of the pump (T85.633-) is sequenced
first, followed by a code for the diabetes with complication (E11.65 for type 2 diabetes with
hyperglycemia).
Reference: ICD-10-CM (current year), Chapter 19: Injury, Poisoning and Certain Other Consequences
of External Causes (S00-T88), ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.4.
A patient suffering from idiopathic dystonia is seen today and receives the following Botulinum
injections: three muscle injections in both upper extremities and seven injections in six paraspinal
muscles.
How are these injections reported according to the CPT® guidelines?
B
Explanation:
For the injections, CPT® code 64642 is used for chemodenervation of one extremity; 64643 for each
additional extremity, and 64647 for chemodenervation of muscles in the paraspinal region. The
modifier -50 is added to 64642 and 64643 to indicate bilateral procedures. According to CPT®
guidelines, when multiple sites are treated, each site is coded separately, and appropriate modifiers
are used.
Reference: AMA's CPT® Professional Edition (current year), Surgery section, Nervous System.
According to the Application of Cast and Strapping CPT® guidelines, what is reported when an
orthopedic provider performs initial fracture care treatment for a closed scaphoid fracture of the
wrist, applies a short arm cast, and the patient will be returning for subsequent fracture care?
A
Explanation:
For initial fracture care of a closed scaphoid fracture, code 25622 is used, which includes treatment
and initial casting. The application of the cast is part of the fracture care and is not reported
separately. CPT® guidelines specify that casting or strapping performed as part of the fracture care is
included in the fracture care code.
Reference: AMA's CPT® Professional Edition (current year), Surgery section, Musculoskeletal System.
A patient is diagnosed with diabetic polyneuropathy.
Using ICD-10-CM coding guidelines, what ICD-10-CM coding is reported?
D
Explanation:
Diabetic polyneuropathy is coded as E11.42, which indicates type 2 diabetes mellitus with diabetic
polyneuropathy. The ICD-10-CM guidelines direct that when a patient has both diabetes and
polyneuropathy, a single combination code is used to capture both conditions.
Reference: ICD-10-CM (current year), Chapter 4: Endocrine, Nutritional, and Metabolic Diseases
(E00-E89), ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.4.a.6.
An elderly patient comes into the emergency department (ED) with shortness of breath. An ECG is
performed The final diagnosis at discharge is impending myocardial infarction.
According to ICD-10-CM guidelines, how is this reported?
D
Explanation:
Impending myocardial infarction is reported with I21.3 for a myocardial infarction (acute). The
shortness of breath, which is a symptom, is coded separately as R06.02. According to ICD-10-CM
guidelines, when a definitive diagnosis is established, the diagnosis code is sequenced first followed
by symptom codes.
Reference: ICD-10-CM (current year), Chapter 9: Diseases of the Circulatory System (I00-I99), ICD-10-
CM Official Guidelines for Coding and Reporting, Section I.C.9.e.4.