30000 Series (10Q) - Try Free Quiz
1. What is the difference between anterior nasal packing versus posterior nasal packing procedure codes?
A. None, they are the same codes
B. Posterior packing is done in the larynx, whereas anterior packing is done at the back of the throat
C. There are no nasal packing procedure codes in the CPT manual
D. Anterior packing is applied pressure and gauze and posterior packing is the insertion of a balloon into the back of the nasal cavity
2. A 3-year-old male presented to the pediatrician’s office after the patient’s mother discovered that the boy had inserted a jelly bean into his nose. The mother, when trying to remove the jelly bean, ended up pushing the bean further into the patient’s nose to the point that it is no longer visible. Upon presentation, the patient was extremely agitated and anxious, and was experiencing pain and swelling in the left nasal sinus. The pediatrician determined that due to the patient’s emotional state and the depth of the jelly bean, the patient would have to be anesthetized in order to remove it. The pediatrician admitted the patient into the hospital and performed the removal of the foreign body under general anesthesia. At one point, a lateral rhinotomy was considered but ruled out, as the physician was finally able to grasp the foreign body. How should the pediatrician code for this service?
A. 99214 -57, 30310 B. 99392 -57, 30310 C. 30310 D. 99214 -57, 30320
3. A patient with chronic sinus pain and swelling presented to the office for a diagnostic endoscopy of the nasal sinuses. During the procedure, the surgeon excised two polyps on the left sphenoid sinus. What is the correct code for this procedure?
A. 31231, 31235
B. 31231, 31237
C. 31235
D. 31237
4. A 2-month-old male with diphtheria presented to the hospital with severe respiratory distress. The emergency department physician performed a pulse oximetry and discovered that the patient’s blood oxygen level was in the 60’s. The on-call physician ordered an emergency endotracheal intubation to restore oxygen flow to the infant. Once the airflow was established, care was transferred to the on-call pediatrician. What is the appropriate code for the emergency department procedure(s)?
A. 31500, 94760-51
B. 31500, 94761
C. 31603, 94761
D. 31603, 94760 -51
5. A 47-year-old male patient with advanced cancer of the lower left mandible presented to the hospital for surgical removal of the lower left jawbone with secondary insertion of mandibular prosthesis. In order to perform surgery, the patient had to be intubated through a tracheostomy. After anesthesia, the surgeon performed the tracheostomy by incising the cricothyroid membrane horizontally along the trachea and inserting the intubation device. The surgeon completed the primary surgical procedure on the patient’s mandible. What is the correct code for the intubation?
A. 31605
B. 31600
C. No code would be used for the intubation
D. 31603
6. You can find codes for cardiovascular services in the three different chapters within the CPT manual. They are:
A. Surgery, Anesthesia, and Medicine
B. Surgery, Medicine, and Laboratory
C. Medicine, Radiology, and Evaluation and Management
D. Surgery, Radiology, and Medicine
7. What term is used for the two-layered protective membrane that surrounds the heart and the roots of the great vessels?
A. Pleura B. Pericardium C.Atrium D. Atrium
8. In the electrical conduction system of the heart, the sinoatrial node is located in the right atrium near the superior vena cava. It serves as the normal pacemaker of the heart. There is another node, which is located in the right atrium on the septal wall. This node slows the impulses of the heart so that the atria can fill with blood before it contracts. What is the name of this node?
A. Sinoatrial Node
B. Bundle of His
C. Purkinje Fibers
D. Atrioventricular Node
9. A pacemaker or pacing cardioverter-defibrillator that has pacing and sensing functions in three or more chambers of the heart is considered a:
A. Multiple Lead B. Dual Lead C. Single Lead D. Triple Lead
10. A cardiovascular surgeon implanted a temporary pacemaker system in a patient with cardiac arrhythmia. The implanted system contained transvenous dual chamber pacing electrodes. What is the correct code for the procedure?
A. 33210
B. 33211
C. 33216
D. 33217
30,000 SERIES (36 QUESTIONS) – ANSWER KEY & RATIONALE
1. Answer: D - The difference between anterior nasal packing versus posterior nasal packing procedure codes is that anterior packing applies pressure and gauze to the front of the nose, and posterior packing inserts a balloon into the back of the nasal cavity. Posterior packing includes packing the nose with gauze and applying pressure to the posterior aspect of the nasal cavity. This can include inserting a balloon to the back of the throat, which is inflated to block blood from draining into the back of the throat.
2. Answer: A - The pediatrician should code for this service with 99214, for the office visit evaluation and management service. This code should be appended with modifier -57 to indicate that this procedure resulted in a decision for surgery, which was performed later that day. Code 30310, for the removal of the foreign body under general anesthesia, also needs to be included to bill for the removal of the jelly bean from the nose. Code 30320 is incorrect because it includes the removal of a foreign body by lateral rhinotomy. Although the pediatrician considered the lateral rhinotomy, it was not performed, and therefore cannot be billed on the claim.
3. Answer: D - The correct code for this procedure is 31237 (Nasal/Sinus Endoscopy, Surgical; with Biopsy, Polypectomy or Debridement). Code 31235 describes only a diagnostic endoscopy, which would have been the case had the physician not excised the polyps. The diagnostic endoscopy was converted to a surgical endoscopy; therefore the only code that needs to be included on the claim is the surgical endoscopy, which in this case is 31237. Code 31231 only codes for a diagnostic endoscopy, not surgical.
4. Answer: A - The appropriate code for the emergency department procedures are 31500 for (Intubation, Endotracheal, Emergency Procedure) and 94760, for the pulse oximetry. The pulse ox was a multiple procedure, so it should be appended with modifier -51. Code 31603 is not the appropriate code because it refers to a tracheostomy. These two procedures are often confused in coding but the code for an endotracheal intubation is within the larynx section and the code for the tracheostomy is within the trachea section.
5. Answer: C - No code should be used for the intubation procedure. The correct code in this case is 31600 (Tracheostomy, Planned (Separate Procedure)).This code is designated as a separate procedure, so it should only be reported if it was the only procedure performed during a surgical session. The primary procedure performed was the mandibular excision and reconstruction; therefore the tracheostomy should be bundled into the major procedure. The intubation should not be reported separately.
6. Answer: D - You can find codes for cardiovascular services within the surgery, radiology, and medicine chapters. Cardiovascular codes are located throughout the CPT manual. Invasive surgical procedures, such as heart transplants and some cardiac catheterization codes are located within the surgery chapter. Radiological guidance for cardiovascular services such as catheterizations are located within the radiology chapter, Other cardiovascular codes are found within the medicine chapter, which contains procedure codes for non-invasive or less invasive services such as: cardiovascular stress tests and programming of pacemakers.
7. Answer: B - The term used for the two-layered protective membrane that surrounds the heart and the roots of the great vessels is the pericardium. In order to perform some open cardiac procedures, the surgeon must puncture or remove the pericardium in order to access the heart. The pleural sac is the membrane that surrounds each one of the lungs. The atrium is a chamber of the heart and the aorta is the large vessel at the top of the heart.
8. Answer: D-The atrioventricular node is located in the right atrium on the septal wall. This node slows the impulses of the heart so that the atria can fill with blood before it contracts. The bundle of his is a group of muscle fibers in the center of the heart on the septum. The bundle of his receives electrical impulses that branch off to the right and left. The Purkinje fibers lie across the surface of the ventricles and give the final signal for the ventricles to contract.
9. Answer: A - A pacemaker or pacing cardioverter-defibrillator that has pacing and sensing functions in three or more chambers of the heart is considered a multiple lead system. Pacemaker or cardioverter-defibrillator systems have electrical stimulation leads that help shock the heart into rhythm. Depending on the individual needs of the patient, some systems may have only one lead, while others may have two, three, or more electrical leads. Correct code selection depends on how many leads the system has.
10. Answer: B - The correct code for this procedure is 33211 (Insertion or Replacement of Temporary Transvenous Dual Chamber Pacing Electrodes). Codes 33216 and 33217 are in appropriate because they are used for permanent pacemaker systems. Code 33210 is also in appropriate because it is used for a single chamber pacemaker.