20000 Series (10Q) - Try Free Quiz
1. What is the difference between biopsy codes located in the integumentary section and those found in the musculoskeletal section?
A. The biopsy codes found in the integumentary section are only for codes related to malignant neoplasms
B. There are no biopsy codes found in the musculoskeletal section
C. The codes in the musculoskeletal system include biopsies for bone only, whereas the biopsy codes found in the integumentary section include codes for biopsies of subcutaneous structures including bone
D. The biopsy codes found in the integumentary section are for biopsies of the skin and subcutaneous structures whereas the biopsy codes found in the musculoskeletal section are for deeper structures
2. A physician took an impression of a 47-year-old woman’s left orbital socket and created a custom prosthesis. What is the correct code for this service?
A. 21076 B. 21089 -LT C. 21088 -LT D. 21077 -LT
3. The physician performed an arthroscopy of TMJ with biopsy of soft tissue. What is the appropriate CPT code?
A. 29800 B. 29804 C. 29704 D. 21010
4. PROCEDURAL NOTE PATIENT: Trohoske, Janine AGE: 62 DATE: 01/13/2017 PREOPERATIVE DIAGNOSIS: Degenerative Disc Disease POSTOPERATIVE DIAGNOSIS: Degenerative Disc Disease PROCEDURE: Arthrodesis of L4-L2 utilizing autogenous bone graft An anesthetized patient was placed in the prone position on the operating table and draped in the usual manner. An incision was made along the spinal column, from the area of the L1 to L5, and skin and subcutaneous tissues were pinned back to allow access to the L4-L2 vertebral spaces. A separate fascial incision was made to obtain morselized bone graft segments for arthrodesis procedure. Posterior arthrodesis was then performed along the L4-L2 vertebrae. No additional fixation or instrumentation was placed. Incision was then closed, stapled together, and dressed with a sterile dressing. What is the appropriate code for this procedure?
A. 22612, 20937
B. 22612, 22614
C. 22612, 22614 (X2), 20937
D. 22612, 22614 (X2), 20936
5. A physician excised the head of the humeral bone and replaced it with the appropriate implant. What is the correct code for this procedure?
A. 23195 B. 23470 C. 23195, 23470 D. 23472
6. A physician performed the following trigger point injections: Two injections into the flexor carpi muscle One injection into the extensor carpi muscle Three injections into the triceps brachii One injection into the biceps brachii What is the correct code for these injections?
A. 20553 (X7)
B. 20553
C. 20552 (X2), 20553 (X5)
D. 20552, 77021
7. A patient suffered a comminuted fracture of the right arm due to a crush injury. The physician implanted three pins in a single plane above the fracture and two pins and one wire along the same plane under the fracture location on the humerus of the right arm. What is the correct code for this service?
A. 20690 B. 20962 C. 20690 (X6) D. 20692 (X6)
8. PROGRESS NOTE
PATIENT: FINKE, ISABEL AGE: 15 DATE: 3/14/2015
NOTE: The patient states that she was riding her bicycle on the side of the road when a large dog ran out in front of her and forced her to crash into a drainage ditch. The patient hit her left arm on a cement drain pipe, suffering an oblique fracture to her left radius. The fracture was set with manipulation of the radial shaft. The arm was then casted in the usual fashion. The patient tolerated the procedure well and was asked to return to the office in one month for follow up x-ray and removal of the cast. How should you code for this fracture repair?
A. 25505 B. 25500 C. 25515 D. 25535
9. The patient returned to the office one month later for removal of cast on her left lower arm. The original attending physician removed the cast. The physician also examined the arm and determined that no further casting or follow-up was necessary. What is the appropriate code for this service?
A. 25250
B. 99214
C. No code would be reported
D. 29799
10. What code would you use to report the enlargement and exploration of a penetrating 5 cm stab wound to the upper thigh, with ligation of minor muscular blood vessel, and appropriate intermediate closure?
A. 12032 B. 20103, 12032 C. 20103 D. 12031
20,000 SERIES (37 QUESTIONS) – ANSWER KEY & RATIONALE
1. Answer: D - The difference between biopsy codes located in the integumentary section and those found in the musculoskeletal section is that the biopsy codes found in the integumentary section are for biopsies of the skin and subcutaneous structures whereas the biopsy codes found in the musculoskeletal section are for deeper structures. Both of the sections include codes for biopsies, but all of the codes in the musculoskeletal section are for deeper structures underlying skin and subcutaneous structures such as muscles and bones.
2. Answer: D - The correct code for this service is 21077 (Impression and Custom Preparation; Orbital Prosthesis). According to the CPT guidelines, code 21077 is used when a physician or other qualified health care professional designs and prepares the prosthesis. The modifier -LT should be appended to indicate that the prosthesis was created for the left orbital socket.
3. Answer: B - The appropriate CPT code is 29804 (Arthroscopy, Temporomandibular Joint, Surgical). The temporomandibular joint is also referred to as the TMJ. Code 29800 is used for a diagnostic arthroscopy with or without an synovial biopsy, but the biopsy performed in this procedure was a soft tissue biopsy. Code 21010 is only used if the procedure was an open procedure. In this case, the procedure was not considered an arthroscopic procedure.
4. Answer: C - The appropriate codes for this procedure are 22612 (Arthrodesis, Posterior or Posteriolateral Technique, Single Level; Lumbar) and add-on code 22614 (X2) (Additional Level of Arthrodesis). There were three levels of arthrodesis, L4, L3, and L2, so each level needs to be reported, which can be accomplished by using one 22612 and two 22614 codes. The additional code 20937 needs to be included on the claim to account for the morselized fascial bone graft performed at the same time as the primary procedure.
5. Answer: B - The correct code for the procedure is23470 (Arthroplasty, Glenohumeral Joint; Hemiarthroplasty). Notes under code 23195 (Resection, Humeral Head) state that the appropriate way to report replacement of the humeral head with implant is with code 23470 only.
6. Answer: B - The correct code for these injections is with 20553 (Injection(s); Single or Multiple Trigger Point(s), 3 or More Muscle(s)).20553 is the only code that needs to be reported because it allows for the multiple injections of each muscle and it allows (for three or more muscles). There were four muscles injected, two of which were injected multiple times.
7. Answer: A - The correct code for this service is 20690 (Application of a Uniplane (Pins or Wires in 1 Plane), Unilateral, External Fixation System). Although multiple pins were placed, the code description referred to multiple pins and/or wires. The pins/wires were placed along the same plane, making the fixation device a single plane, rather than multiple planes.
8. Answer: A - You should code for this fracture repair with code 25505 (Closed Treatment of Radial Shaft Fracture; with Manipulation).The fracture was set with manipulation; therefore the code 25500 is not appropriate. Code 25500 does not include manipulation of the fracture, while code 25505 does. Code 22515 is also inappropriate because the fracture repair was closed and code 22515 is used for an open repair of the fracture.
9. Answer: C - No code should be reported for this service. According to CPT guidelines, the removal of a cast should only be reported when the application of the cast was performed by one physician and the removal of the cast by another physician. The physician who removed the cast was the same that applied the cast so no service should be reported.
10. Answer: B - You would use codes 20103 (Exploration of Penetrating Wound; Extremity) and 12032 (Repair, Intermediate, Wounds of Scalp, Axillae, Trunk and/or Extremities; 2.6 cm to 7.5 cm). According to CPT guidelines, the exploration of the penetrating wound should be coded in addition to the wound repair because the procedure required a “ligation or coagulation of minor subcutaneous and/or muscular blood vessel(s)” The intermediate repair should be coded separately because the wound exploration code does not include closure of the wound after dissection.