1. A surgical pathology, gross and microscopic examination was performed for a colorectal polyp by a CLIA waived lab. How is this coded?
A. 88305
B. 88305QW
C. 88307
D. 88307QW
Rationale :A surgical pathology, gross and microscopic examination performed for a colorectal polyp will be coded with 88305. Since the service was performed in a CLIA waived lab, and 88305 requires modifier QW to denote a waived test, 88305QW is the appropriate CPT® code.
2. There are a variety of HCPCS Level II codes for supplies, implants, and devices. The most commonly used codes begin with which letters?
A. A, B, C, G, J, L
B. A, C, G, J, K, L
C. A, C, J, L, Q, V
D. A, C, J, L, Q, S
Rationale: There are a variety of HCPCS Level II codes for supplies, implants, and devices. The most commonly used codes begin with the letters A, C, J, L, Q, and V, followed by four numerical digits. It’s important to differentiate between these items, which are used in the clinical setting, and durable medical equipment (DME), which is distributed and charged through other channels.
3. On or after Oct. 1, 2023, how should a diagnosis of small intestinal bacterial overgrowth be coded?
A. A04.9
B. K63.8
C. K63.822
D. K63.8219
Rationale : Intestinal microbial overgrowth encompasses small intestinal bacterial overgrowth (SIBO), intestinal methanogen overgrowth (IMO), and small intestinal fungal overgrowth (SIFO) — each diagnosis is treated differently. Current coding is commonly A04.9 Bacterial intestinal infection, unspecified or K63.8 Other specified diseases of intestine. Specific codes are added to identify intestinal microbial overgrowth and its subtypes. In this case, no subtype is given, so you would report the new unspecified code K63.8219 Small intestinal bacterial overgrowth, unspecified.
3. Betty is a healthy 67-year-old woman on Medicare. Her best friend’s husband was recently diagnosed with Alzheimer’s, and now she is curious about the probability of developing the condition herself. MindX Sciences Laboratory performs the MindX Blood Test on Betty. Her provider has Betty sign an ABN. What code is reported for the test?
A. 0346U-GA
B. 0346U-GZ
C. 0289U-GA
D. 0289U-GX
Rationale : In the CPT Alphabetic Index, find Proprietary Laboratory Analyses. Find the disease by looking under Neurology, then Alzheimer Disease. You will see Gene Expression Profiling for Risk Score, which points you to 0289U. Find 0289U in Appendix O. The proprietary name matches the code. Append modifier GA to indicate that an Advance Beneficiary Notice (ABN) of Noncoverage was signed by the patient.
4. Which of the following statements about EKG coding is true?
A. The EKG CPT® codes are not scenario-dependent and can be used in all situations.
B. Insurance will only cover one interpretation of an EKG.
C. An ED physician cannot get MDM credit for reviewing a test they ordered.
D. Insurance companies always allow an EKG to be billed with an ED E/M code.
5. Rationale :What POA indicator would be assigned if the patient has a history of chronic systolic congestive heart failure and developed an exacerbation on day two in the hospitalization?
A. N
B. Y
C. N and Y
D. U
Rationale : If a patient has an acute on chronic condition present on admission (POA), and there is a combination code for it, but part of the condition is not present on admission, it would be an “N” POA. If there is not a combination code, then code the conditions separately with the acute POA “N” and chronic POA “Y.”
6. A patient has acute-on-chronic systolic CHF. The patient also has HTN and CKD stage 4. What is the proper sequencing for these conditions?
A. CHF, CKD, HTN
B. HTN, CHF, CKD
C. CKD, CHF, HTN
D. HTN, CKD, CHF
Rationale : Tabular guidelines instruct to code first the hypertension (HTN) with congestive heart failure (CHF) and chronic kidney disease (CKD). Instruction for the CKD notes to code first any associated HTN. An increase in the potential reimbursement is expected when sequenced appropriately. Most encoders will sequence the chronic conditions (CCs) and multiple chronic conditions (MCCs) to the top of the list of codes. You can sequence according to guideline instructions and still keep the CCs and MCCs at the top.
7. A patient presents to your radiology practice with lower back pain. The radiologist captures AP, PA, lateral, and oblique views. How is this coded?
A. 71046
B. 72110
C. 72114
D. 72120
Rationale : The radiologist captured four views (two bending views not captured). This is reported with CPT® code 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views.
8. Which ICD-10-CM coding category denotes alcohol abuse?
A. F10.9-F10.99
B. F10.1-F10.19
C. F10.2-F10.29
D. None of the above
ICD-10-CM coding for alcohol is categorized as:Use (F10.9-F10.99), Abuse (F10.1-F10.19), and Dependence (F10.2-F10.29).
9. A child wakes on Nov. 1 with a rash on her chest, neck, and arms after trick-or-treating the night before in a store-bought dinosaur costume. How is her contact dermatitis coded?
A. Y93.D
B. X06
C. V03.10
D. L23.2
Rationale : Rashes from costume materials or face paint are coded with L23.2 Allergic contact dermatitis due to cosmetics.
10. Based on a mammogram performed Oct. 8, 2023, the clinician documents that the patient has extremely dense tissue in both breasts. How is this observation coded?
A. R92.313
B. R92.323
C. R92.333
D. R92.343
Rationale :
Effective Oct. 1, 2023, you have a new subcategory of codes to report abnormal and inconclusive diagnostic breast images. The new subcategory, R92.3 Mammographic density found on imaging of breast, is subdivided into four codes. The new codes correspond to the Breast Imaging Reporting and Data System (BI-RADS), which classifies breast density level as Category A being no dense tissue (R92.31-), Category B being scattered areas of fibroglandular density (R92.32-), Category C being near equal combination of fatty and dense tissue (92.33-), and Category D being entirely dense tissue (92.34-). Each code requires a 6th character to specify laterality. Use 6th character 1 for the right breast, 2 for the left breast, or 3 for a bilateral diagnosis.
