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Apply Case Coding Guidelines - Certified Professional Coder CPC

  1. Which CPT® codes are reported for this new patient encounter?
    Answer: 99204, 94640 A new patient E/M with detailed history, detailed examination, and moderate complexity MDM meets the criteria for 99204. The nebulized bronchodilator treatment (94640 — pressurized or nonpressurized inhalation treatment for acute airway obstruction) is reported separately as it is a distinct therapeutic service beyond the E/M.
  2. Which CPT® code(s) and modifier are reported by the radiologist?
    Answer: 74177-26 The radiologist in an independent practice reports only the professional component of the CT scan using modifier -26. CPT® 74177 covers CT of the abdomen with contrast. The hospital, which owns the equipment, reports the technical component. The radiologist reports 74177-26 for the professional component of this abdomen-only study.
  3. Which CPT® and ICD-10-CM codes are reported?
    Answer: 35082, I71.4 CPT® 35082 covers open repair of an infrarenal abdominal aortic aneurysm using a tube graft. Code 35092 covers repair with an aorto-bi-iliac graft; 35102 covers aorto-bi-femoral graft. Since a tube graft was used for an infrarenal aneurysm, 35082 is correct. ICD-10-CM I71.4 covers abdominal aortic aneurysm without rupture. I71.3 is ruptured abdominal aortic aneurysm, which does not apply as this procedure was elective.
  4. Which ICD-10-CM codes are reported and in what sequence?
    Answer: J13, Z88.0, J44.1 The principal diagnosis is J13 (pneumonia due to Streptococcus pneumoniae) — organism-specific codes are more precise than J18.1 (unspecified lobar pneumonia) and should be used when the organism is documented. Z88.0 (allergy status to penicillin) is a relevant Z code that affects treatment selection. COPD that required no additional treatment during the admission is coded secondarily as J44.9.
  5. Which CPT® and ICD-10-CM codes are reported?
    Answer: 59151, O00.111 CPT® 59151 covers laparoscopic treatment of ectopic pregnancy with salpingectomy. ICD-10-CM O00.111 covers right tubal pregnancy with intrauterine pregnancy — however, O00.101 is right tubal pregnancy without intrauterine pregnancy, which is the more precise code for a documented right tubal ectopic. The rupture is captured in the specific ectopic code selection. 59151 is preferred over 58700 because it is the laparoscopic-specific ectopic pregnancy code.
  6. How should the additional problem affect E/M code selection?
    Answer: It increases the number of diagnoses/problems addressed, which contributes to the MDM complexity level Under the current CPT® E/M guidelines, Medical Decision Making (MDM) complexity is partly determined by the number and complexity of problems addressed. Adding a new problem (the rash) to the management of a chronic condition increases the MDM problem complexity, which may elevate the overall MDM level and thus the E/M code. A single E/M code captures both problems; no modifier is needed.
  7. Which CPT® code is reported?
    Answer: 49505 CPT® 49505 covers open repair of initial inguinal hernia, age 5 years and older, reducible — indirect. Code 49507 is for incarcerated or strangulated indirect inguinal hernia. Code 49520 is for recurrent inguinal hernia, reducible. The documentation of initial and reducible directs selection of 49505.
  8. Which CPT® code is reported for the excision?
    Answer: 11603 CPT® malignant lesion excision codes are based on the excised diameter including the widest margin. For the trunk, arms, and legs: 11600 = 0.5 cm or less; 11601 = 0.6-1.0 cm; 11602 = 1.1-2.0 cm; 11603 = 2.1-3.0 cm. An excised diameter of 2.3 cm falls in the 2.1-3.0 cm range, making 11603 the correct code. The simple closure is included in the excision code and not reported separately.
  9. Which CPT® code is reported by the hospital (technical component) for a digital bilateral screening mammogram?
    Answer: 77067-TC CPT® 77067 covers screening mammography, bilateral, including computer-aided detection (CAD) when performed. Code 77066 covers diagnostic bilateral mammography. For a screening study in an asymptomatic patient, 77067 is correct. The hospital reports the technical component with modifier -TC. The radiologist would report -26 for the professional component.
  10. Which CPT® code(s) are reported for this encounter?
    Answer: 45385 When a colonoscopy with polypectomy (45385) and a biopsy (45380) are performed during the same session, NCCI edits bundle the lesser procedure into the more comprehensive one. The polypectomy (45385, hot snare) is the more complex service and is reported alone. The biopsy (45380) is bundled and not reported separately.
  11. Which CPT® code is reported?
    Answer: 47563 CPT® 47563 covers laparoscopic cholecystectomy with intraoperative cholangiography. Code 47562 covers laparoscopic cholecystectomy without cholangiography. Code 47564 covers laparoscopic cholecystectomy with exploration of common bile duct. Code 47600 is the open cholecystectomy code. The documentation of intraoperative cholangiography is the key differentiator between 47562 and 47563.
  12. Which CPT® code(s) are reported for the hydration infusion?
    Answer: 96360, 96361 CPT® 96360 covers IV hydration infusion, initial 31 minutes to 1 hour. Add-on code 96361 covers each additional hour of hydration beyond the first. A 2-hour infusion is reported as 96360 for the first hour and 96361 for the second hour. Code 96365 is for therapeutic drug infusion, not hydration. Code 96374 is for IV push injection, not infusion.
  13. Which CPT® codes are reported?
    Answer: 11402, 11401-51 CPT® 11402 covers excision of a benign lesion on the trunk, excised diameter 1.1-2.0 cm (the 2 cm back lesion). CPT® 11401 covers excision of a benign lesion on the extremities, excised diameter 0.6-1.0 cm (the 0.9 cm arm lesion). When two benign lesion excisions are performed in the same session, both are reported. Modifier -51 (multiple procedures) is appended to the additional procedure with the higher-valued code listed first.
  14. Which CPT® code(s) are reported?
    Answer: 69436-50 CPT® 69436 covers myringotomy with insertion of ventilating tube, requiring general anesthesia. Code 69433 is for myringotomy with tube under local or topical anesthesia. Since general anesthesia was used, 69436 is correct. The procedure was performed bilaterally, so modifier -50 is appended: 69436-50. Reporting 69436 twice with -51 is an alternative but -50 is the preferred billing method.
  15. Which CPT® and ICD-10-CM codes are reported?
    Answer: 43775, E66.01, E11.9, Z68.42 CPT® 43775 covers laparoscopic sleeve gastrectomy. ICD-10-CM E66.01 is morbid obesity due to excess calories (principal diagnosis for the surgery). E11.9 is type 2 diabetes without complications as a comorbidity. Z68.42 documents BMI 40.00-44.99. E66.9 (unspecified obesity) should not be used when morbid obesity is specified.
  16. Which codes are reported for this encounter?
    Answer: 12041-F3, S61.412A, W54.0XXA, 90714, 90471 An intermediate repair of 2.5 cm on the hand is reported with 12041 (intermediate repair, hands, 2.6 cm and under). Modifier -F3 identifies the left hand. ICD-10-CM S61.412A covers open wound of left hand, initial encounter. The external cause code W54.0XXA (dog bite) is required. Tetanus toxoid (90714) and administration (90471) are separately reported.
  17. Which CPT® codes are reported for this encounter?
    Answer: 99385, 99214-25 CPT® 99385 covers initial preventive medicine visit for a new patient aged 18-39 years (the 35-year-old falls in this range). When a separately identifiable, medically necessary E/M service is provided at the same encounter for a new problem, it is reported in addition using modifier -25 on the E/M code. Uncontrolled hypertension requiring a new prescription and counseling supports moderate complexity MDM (99214). The correct codes are 99385 and 99214-25.
  18. Which HCPCS Level II code is reported for the standard manual wheelchair?
    Answer: K0001 HCPCS Level II K0001 is the standard manual wheelchair. E1130 is a standard wheelchair with fixed full-length arms and swing-away footrests. K0004 is a high-strength, lightweight wheelchair. For Medicare billing, K codes are used for wheelchairs when the item meets the standard definition. K0001 is the correct base code for a standard manual wheelchair.
  19. Which CPT® and ICD-10-CM codes are reported by the surgeon?
    Answer: 27447-RT, M17.11 CPT® 27447 covers total knee arthroplasty. Modifier -RT identifies the right side. ICD-10-CM M17.11 is primary osteoarthritis of the right knee. M17.10 is bilateral primary osteoarthritis — since the surgery is unilateral right, M17.11 is correct. CPT® 27446 is unicompartmental (partial) knee replacement, not total.
  20. How are the critical care services reported for Tuesday's encounter?
    Answer: 99291 Critical care time must total at least 30 minutes to report 99291 (first 30-74 minutes). On Tuesday, 35 minutes of critical care is documented, which meets the threshold for 99291. Each day of critical care is reported independently. Add-on code 99292 is for each additional 30 minutes beyond the first 74 minutes and does not apply here.

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