- A patient received a 12 sq. cm. dermal tissue substitute of human origin, dermagraft. This treatment was completed due to a burn on the abdomen. How would you report the supply?
- Q4105 x12
- During an emergency room visit, Sally was diagnosed with pneumonia.
She was admitted to the hospital observation unit and treated with 500 mg of
Zithromax through an IV route. How would you report the supply of this drug?
- J1190 x 2
- J2020 x 2
- Alice had to have a replacement for her soft interface in her protective helmet. How would you report this supply?
- Which code describes an addition to the lower extremity, knee disarticulation, and leather socket?
- A nursing home’s x-ray machine was not working. A portable x-ray machine and personnel was transported to the nursing home to test nine patients. How would you report the transportation of equipment?
- R0070 x 9
- What modifier would best describe a blepharoplasty to the upper right eyelid?
- When using the CPT index to locate procedures, which of the following are considered primary classes for main entries?
- Procedure or service; organ or other anatomic site; condition; synonyms, eponyms, and abbreviations
- Abbreviations; signs and symptoms, anatomic site; and code assignment
- Conventions; code ranges; modifying terms
- Procedure or service; modifiers; clinical examples; and definitions
- Which of the following code and modifier combinations are correct?
- None of the above
- 66-year-old Medicare patient, who has a history of ulcerative colitis, presents for a colorectal cancer screening. The screening is performed via barium enema. What HCPCS Level II code is reported for this procedure?
- G0106 B. G0105 C. G0120 D. G0121
- The patient presents to the office for an injection. Joint prepped using sterile technique. Muscle group location: gluteus maximus. Sterilely injected with 1 cc Kenalog-40, 2 cc Marcaine and 2 cc lidocaine 2%. Sterile bandage applied. Choose the HCPCS Level II code for this treatment.
|A. J3301 x 4|
|C. J3300 x 40|
|11. 10 year-old-male sustained a Colles’ fracture in which the pediatrician performs an application of short arm fiberglass cast. Identify the HCPCS Level II code that would be reported.
12. 35-year-old-female is having an IUD insertion. The IUD type: Mirena. The HCPCS Level II code is:
- “a” You can find this answer by referring to the Table of Drugs in the HCPCS Level II manual.
- “a” You can find this answer in the index of the HCPCS Level II manual under Helmet, head.
- “b” You can find this answer in the index of the HCPCS Level II manual under Prosthetic additions, lower extremity. Once you find this code range, review the codes to determine the correct code.
- “d” You can find this answer in the index HCPCS Level II manual under Transportation, x-ray (portable). Review of code R0075, indicates “. . . more than one patient seen.”
- “c” Modifier -E3 describes upper right eyelid. You can find this modifier in the HCPCS Level II manual or the front inside cover of the CPT Professional Edition.
- “a” You can find the four primary classes of main entries listed at the beginning of the index section in the CPT Professional Edition.
- “d” The coding concepts for modifiers are complicated. In this question none of the codes and modifier combinations are correct. All of the codes listed in this question are add-on codes. Modifier descriptors are also incorrect with the codes listed: -25 could be attached only to an evaluation and management code, -21 could only be appended to the highest level evaluation and management code within a given category, and modifier -51 should not be attached to add-on codes. See the definitions of these modifiers in Appendix A of the CPT Professional Edition.
- C This patient is qualified by Medicare to be a high risk by having a history of ulcerative colitis. A note is found under code G0105 that states: An individual with ulcerative enteritis or a history of a malignant neoplasm of the lower gastrointestinal tract is considered at high-risk for colorectal caner, as defined by CMS. This eliminates multiple choices A and D. The screening was performed via barium enema eliminating multiple choice B.
- A The injection given is Kenalog eliminating multiple choices C and D. Kenalog-40 provides 40 mg of triamcinolone acetonide. Code J3301 is reported for 10 mg so it will have to be reported four times to cover 40 mg. If 1cc Kenalog-10 was given, J3301 is only reported once since that provides 10 mg of triamcinolone acetonide.
- A The patient being 10 years-old that is getting a short arm fiberglass cast guides you to code Q4012.
- B HCPCS code J7302 is reported specifically for the Mirena intrauterine contraceptive device.
- D Local Coverage Decisions are Medicare Administrative Contractor rules that link procedure codes to diagnoses that are not considered medically necessary for a specific procedure. Most LCDs also provide a list of diagnosis codes for which a procedure may be covered; however, because other issues factor into payment, coverage is not guaranteed. Modifier guidelines and fee schedule information is included in the annual Medicare Physician Fee Schedule.
- B. Look up the description for each code. G0168 reports a wound closure using tissue adhesives.
- C. In this scenario we are selecting a code to report the refill of insulin pump. J1815 reports insulin but not for a pump. J1817 is insulin through a pump which is the correct code. J1817 reports 50 units. Two units are reported to account for 100 units of the insulin.
- B. The only code provided as an option that describes an event recorder is C1764. The other code options are for generators, pacemakers, or cardioverter-defibrillators.
- C. To select the correct code for casting supplies, you need to know the type, material and age of the patient. In this case the patient is a 12-year-old, which eliminates Q4011 and Q4012. The cast is made of fiberglass, which makes Q4010 the correct answer.