Question 1
A licensed clinical social worker is called into a group home where a resident is experiencing a mental crisis and threatening to harm himself and others. The social worker assesses the resident, performs a mental status exam, documents the resident’s history, addresses his needs, and creates a safety plan. The social worker coordinates referral and transport to a mental health facility and documents time spent of 110 minutes. What code(s) should be reported?
A. G0017
B. G0017, G0018 x 1
C. G0018 x 3
D. G0017, G0018 x 2
Rationale:
HCPCS Level II code G0017 is reported for the first 60 minutes and G0018 is reported for each additional 30 minutes. For time that is less than a full 30 minutes, the midpoint rule must be followed, and the add-on code should only be reported if the additional time spent is 16 minutes or more. As there are 20 minutes remaining after the initial unit of G0018, an additional unit may be reported.
Question 2
A patient has surgery via open approach to remove a tumor located in the abdomen on Feb. 12, 2025. The entire tumor is removed. The surgeon measures the excised tumor and documents its size as 10.9 cm before it is destroyed. How is the lesion size coded?
A. 49186
B. 49187
C. 49188
D. 49189
Rationale:
Each cyst or tumor must be measured before excision or destruction; and the size of each lesion must be documented in centimeters for coding purposes. The new abdomen, peritoneum, and omentum excision/destruction code descriptors for 2025 are: 49186 Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less; 49787 (5.1 to 10 cm), 49188 (10.1 to 20 cm); 49189 (20.1 to 30 cm); and 49190 (greater than 30 cm).
Question 3
Which of the following codes should be reported for a bone density study, one or more sites of the hips, pelvis, and spine using DEXA (DXA)?
A. 77072
B. 77078
C. 77080
D. 77086
Rationale:
The dual-energy X-ray absorptiometry (DEXA or DXA) scan is reported with CPT® codes 77080-77081 and 77085). This is a simple non-invasive imaging modality that uses low-level X-rays to measure the amount of calcium and other minerals in bone.
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Question 4
The condition established after study to be chiefly responsible for occasioning the admission of a patient to a hospital for care is known as what?
A. Primary diagnosis
B. Principal diagnosis
C. Prognosis disease
D. Progressed disease
Rationale:
The principal diagnosis is the main reason (condition) after study that brought the patient to the hospital. Do not confuse the principal diagnosis with the primary diagnosis. Principal diagnosis is not necessarily the first-listed diagnosis, rather it’s the main diagnosis or reason for the hospital visit that drives reimbursement. A primary diagnosis is assigned on the outpatient side of treatment.
Question 5
A 60-year-old gentleman with diabetes mellitus and peripheral neuropathy (nerve damage) presents on May 1, 2025, for routine foot care. The patient experiences a loss of sensation in his feet and is at high risk for developing foot ulcers or infections. The healthcare provider performs nail trimming as part of his patient’s routine foot care. The provider documents trimming all the nails on both feet. What is the procedure code reported?
A. 11719
B. 11721
C. G0127
D. Non-covered service
Rationale:
Trimming is a reduction in length of the normal or thickened/elongated toenails using clippers or an electric burr tool and reported to Medicare with CPT 11719 for non-dystrophic nails.
Question 6
Which place of service would NOT be an appropriate setting in which to report psychotherapy for crisis codes G0017 and G0018?
A. 04 Homeless Shelter
B. 12 Home
C. 11 Office
D. 03 School
Rationale:
HCPCS Level II codes G0017 and G0018 include any place of service at which the non-facility rate applies, excluding the office setting.
Question 7
What modifier should be used to indicate the presence of two Class B findings for a patient with peripheral neuropathy undergoing routine foot care?
A. Q5
B. Q7
C. Q8
D. Q9
Rationale:
Modifiers provide additional information about the service rendered and can affect reimbursement. Modifier Q8 represents two Class B findings that qualify the patient for coverage of routine foot care.