Question 1

A catheter was placed into the abdominal aorta via the right common femoral artery access. An
abdominal aortography was performed. The right and left renal artery were adequately visualized.
The catheter was used to selectively catheterize the right and left renal artery. Selective right and left
renal angiography were then performed, demonstrating a widely patent right and left renal artery.
What CPT® coding is reported?

Accepted Answer

D

Explanation: The procedure described is a bilateral selective catheterization of the renal arteries. CPT® code 36252 accurately reports "Selective catheter placement(s), bilateral...renal artery(s)...". This code includes the work of the initial abdominal aortogram ("with or without flush aortogram"). The radiological supervision and interpretation (S&I) is coded separately. The scenario documents both an abdominal aortography and bilateral selective renal angiography. While the S&I for the aortogram (75625) is typically bundled into the S&I for the more specific bilateral selective renal angiography (75724), 75724 is not offered as an option. Given the choices, 75625 represents the S&I for the aortogram that was explicitly performed. The -26 modifier correctly identifies the professional component. Therefore, 36252, 75625-26 is the best available answer.

Question 2

A patient presents to the labor and delivery department for a planned cesarean section for triplets.
She is at 37 weeks gestation. She is given a continuous epidural for the delivery.
What anesthesia coding is reported?

Accepted Answer

D

Explanation: The procedure described is a planned cesarean section. According to the CPT® codebook, the correct code for anesthesia for a cesarean delivery only is 01961. This code is used for scheduled or planned cesarean sections where the patient has not been in labor. The administration of a continuous epidural is the method of anesthesia and is included in the service described by 01961. The fact that the patient is delivering triplets does not alter the selection of the CPT code, although it may be accounted for in the billing of anesthesia base units.

Question 3

A 55-year-old patient with suspected liver cancer was seen by the physician to obtain a biopsy. The
special biopsy needle was placed using ultrasonic guidance. The physician obtained a small tissue
sample from the liver, which was then sent to pathology.
What CPT® codes are reported?

Accepted Answer

D

Explanation: The procedure described is a percutaneous needle biopsy of the liver, which is correctly reported with CPT® code 47000. The physician used ultrasonic guidance to place the needle, which is a separate, reportable service. CPT® code 76942 is used for ultrasonic guidance for needle placement. The -26 modifier (Professional Component) is appended to 76942 to indicate that the physician provided only the supervision and interpretation for the guidance, and does not own the equipment, which is typical in a facility setting.

Question 4

The surgeon performs Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract on a 45-year-old patient. What CPT® code is reported?

Accepted Answer

B

Explanation: The procedure described is an anastomosis (surgical connection) of an extrahepatic biliary duct to the gastrointestinal tract using a Roux-en-Y limb. CPT® code 47780, Anastomosis, Roux-en-Y, of extrahepatic biliary duct and gastrointestinal tract, precisely matches this description. The key elements from the operative report—"Roux-en-Y," "anastomosis," and "extrahepatic biliary duct"—are all explicitly included in the descriptor for code 47780, making it the correct choice.

Question 5

A patient suffers a ruptured infrarenal abdominal aortic aneurysm requiring emergent endovascular
repair. An aorto-aortic tube endograft is positioned in the aorta and a balloon dilation is performed
at the proximal and distal seal zones of the endograft. The balloon angioplasty is performed for
endoleak treatment.
What CPT® code does the vascular surgeon use to report the procedure?

Accepted Answer

A

Explanation: The procedure described is an endovascular repair of a ruptured infrarenal abdominal aortic aneurysm using an aorto-aortic tube endograft. CPT® code 34702 is the correct code as it specifically describes this procedure for a ruptured aorta. The code descriptor for 34702 includes all associated angioplasty performed from the renal arteries to the aortic bifurcation, which covers the balloon dilation performed to treat the endoleak at the seal zones.

Question 6

A 45-year-old has a dislocated patella in the left knee after a car accident. She taken to the hospital
by EMS for surgical treatment. In the surgery suite, the patient is placed under general anesthesi
a. After being prepped and draped, the surgeon makes an incision above the knee joint in front of
the patella. Dissection is carried through soft tissue and reaching the patella in attempt to reduce the
dislocation. When the patella is exposed, it is severely damaged due to cartilage breakdown. The
tendon is dissected and using a saw the entire patella is freed and removed. The tendon sheath is
closed with sutures.
What procedure code is reported for this surgery?

Accepted Answer

D

Explanation: The procedure described is an open treatment for a patellar dislocation, as indicated by the surgical incision. The documentation explicitly states, "the entire patella is freed and removed," which constitutes a total patellectomy. CPT® code 27566 is the correct code as it describes an open treatment of a patellar dislocation, which may include a partial or total patellectomy. The modifier -LT is appended to indicate the procedure was performed on the left knee.

Question 7

A 4-year-old, critically ill child is admitted to the PICU from the ED with respiratory failure due to an
exacerbation of asthma not manageable in the ER. The PICU provider takes over the care of the
patient and starts continuous bronchodilator therapy and pharmacologic support with cardiovascular
monitoring and possible mechanical ventilation support.
What is the E/M code for this encounter?

Accepted Answer

D

Explanation: The patient is 4 years old and meets critical-care criteria (acute respiratory failure requiring continuous bronchodilator therapy, cardiovascular monitoring, and possible mechanical ventilation). CPT instructs that initial inpatient pediatric critical-care services for children aged 2 through 5 years are reported with 99471. Codes 99291-99292 are used for critical care of patients older than the pediatric range defined in CPT, while 99285 is an emergency-department service and not reportable once the child is admitted to the PICU. Code 99475 applies to children 6-11 years. Therefore, 99471 is the single, most specific E/M code for this encounter.

Question 8

A witness of a traffic accident called 911. An ambulance with emergency basic life support arrived at
the scene of the accident. The injured party was stabilized and taken to the hospital. What HCPCS
Level II coding is reported for the ambulance's service?

Accepted Answer

B

Explanation: A0429 designates “Ambulance service, basic life support, emergency transport.” Because the crew provided BLS care in response to a 911 call, the transport meets CMS’s definition of an emergency BLS run (CMS Pub-100-04, Ch. 15 §30.2). Modifier pair −SH indicates origin Scene of accident (S) and destination acute-care Hospital (H) (§20.1). Modifier QN is used when the ambulance is furnished directly by a provider of services (e.g., a hospital-based ambulance responding to 911) (§30.2.7). Therefore the complete code is A0429-QN-SH.

Question 9

A 30-year-old patient with a scalp defect is having plastic surgery to insert tissue expanders. The
provider inserts the implants, closes the skin, and increases the volume of the expanders by injecting
saline solution. Tissue is expanded until a satisfactory aesthetic outcome is obtained to repair the
scalp defect.
What CPT® code is reported?

Accepted Answer

A

Explanation: The procedure described is the initial placement of tissue expanders in the scalp to facilitate future repair of a defect. CPT® code 11960, "Insertion of tissue expander(s) for other than breast, including subsequent expansion," accurately captures this service. The code specifies a location "other than breast" (the scalp, in this case) and includes the initial insertion as well as the subsequent injections (e.g., saline) to expand the device, as detailed in the operative note.

Question 10

A 5-year-old is brought to the QuickCare in the ED to repair two lacerations: a 3 cm laceration on her
right arm and 2 cm laceration on her nose. Her arm is repaired with a simple one-layer closure with
sutures. Her nose is repaired with a simple repair using tissue adhesive, 2-cyanoacrylate.
How are the repairs reported?

Accepted Answer

C

Explanation: According to the CPT® guidelines for Repair (Closure), the use of tissue adhesive as the sole material for a simple laceration repair is not reported with a separate CPT code. This service is considered part of the Evaluation and Management (E/M) service provided. Therefore, the 2 cm laceration on the nose repaired with tissue adhesive is not coded. The 3 cm simple laceration on the arm, repaired with sutures, is coded. The CPT code series for simple repairs of the extremities is 12001-12007. Code 12002 represents a simple repair of the extremities measuring 2.6 cm to 7.5 cm, which accurately describes the 3 cm arm laceration.

Question 11

A mother brings her 2-year-old son to the pediatrician's office because he stuck a bead up his left
nostril. The pediatrician uses a nasal decongestant to open the blocked nostril and removes the bead
with nasal forceps.
What CPT® coding is reported?

Accepted Answer

C

Explanation: The procedure performed was the removal of a foreign body (bead) from the patient's left nostril in an office setting. CPT® code 30300, "Removal foreign body, intranasal; office type procedure," accurately describes this service. The use of nasal forceps is the method for this office-based removal. The application of a nasal decongestant is considered an integral part of the procedure and is not coded separately. Since the procedure was performed on only one nostril (unilateral), no modifier is necessary.

Question 12

A couple presents to the freestanding fertility clinic to start in vitro fertilization. Under radiologic
guidance, an aspiration needle is inserted (by aid of a superimposed guiding-line) puncturing the
ovary and preovulatory follicle and withdrawing fluid from the follicle containing the egg.
What is the correct CPT® code for this procedure?

Accepted Answer

D

Explanation: The procedure described is the retrieval of oocytes (eggs) by puncturing the ovarian follicle and aspirating the contents. CPT® code 58970, "Follicle puncture for oocyte retrieval, any method," accurately represents this service. The phrase "any method" indicates this code is appropriate regardless of the specific technique used for retrieval. The use of radiologic guidance is a distinct service and is reported separately (e.g., with 76948 for ultrasonic guidance). Therefore, 58970 is the correct code for the primary surgical procedure of oocyte retrieval.

Question 13

The human shoulder is made of which three bones?

Accepted Answer

D

Explanation: The human shoulder complex, also known as the pectoral girdle, is comprised of three primary bones. These are the clavicle (collarbone), the scapula (shoulder blade), and the humerus (the long bone of the upper arm). The head of the humerus articulates with the glenoid cavity of the scapula to form the glenohumeral joint, which is the main joint of the shoulder. The clavicle and scapula provide the structural attachment of the upper limb to the axial skeleton. This anatomical knowledge is foundational for accurate medical coding of shoulder-related conditions and procedures.

Question 14

A Medicare patient that is on dialysis for ESRD is seen by the nurse for a Hep B vaccination. This
patient is given a dialysis patient dosage as part of a three-dose schedule. The nurse administers the
Hep B vaccine in the right deltoid. The physician reviews the chart and signs off on the nurse's note.
What procedure and diagnosis codes are reported for the scheduled vaccine injection for this
Medicare patient?

Accepted Answer

B

Explanation: For a Medicare patient, the administration of a Hepatitis B vaccine is reported with HCPCS Level II code G0010, not the CPT® administration code 90471. The vaccine product for a patient on dialysis is specifically described by CPT® code 90740 (dialysis or immunosuppressed patient dosage). The primary diagnosis is Z23 (Encounter for immunization) as this is the reason for the visit. The patient's underlying conditions, N18.6 (End-stage renal disease) and Z99.2 (Dependence on renal dialysis), are reported as secondary diagnoses to establish medical necessity for the specific dialysis dosage vaccine.

Question 15

View MR 099405
MR 099405
CC: Shortness of breath
HPI: 16-year-old female comes into the ED for shortness of breath for the last two days. She is an
asthmatic.
Current medications being used to treat symptoms is Advair, which is not working and breathing is
getting worse. Does not feel that Advair has been helping. Patient tried Albuterol for persistent
coughing, is not helping. Coughing 10-15 minutes at a time. Patient has used the Albuterol 3x in the
last 16 hrs. ED physician admits her to observation status.
ROS: No fever, no headache. No purulent discharge from the eyes. No earache. No nasal discharge or
sore throat. No swollen glands in the neck. No palpitations. Dyspnea and cough. Some chest pain. No
nausea or vomiting. No abdominal pain, diarrhea, or constipation.
PMH: Asthma
SH: Lives with both parents.
FH: Family hx of asthma, paternal side
ALLERGIES: PCN-200 CAPS. Allergies have been reviewed with child’s family and no changes
reported.
PE: General appearance: normal, alert. Talks in sentences. Pink lips and cheeks. Oriented. Well
developed. Well nourished. Well hydrated.
Eyes: normal. External eye: no hyperemia of the conjunctiv
a. No discharge from the conjunctiva
Ears: general/bilateral. TM: normal. Nose: rhinorrhea. Pharynx/Oropharynx: normal. Neck: normal.
Lymph nodes: normal.
Lungs: before Albuterol neb, mode air entry b/l. No rales, rhonchi or wheezes. After Albuterol neb.
improvement of air entry b/l. Respiratory movements were normal. No intercostals inspiratory
retraction was observed.
Cardiovascular system: normal. Heart rate and rhythm normal. Heart sounds normal. No murmurs
were heard.
GI: abdomen normal with no tenderness or masses. Normal bowel sounds. No hepatosplenomegaly
Skin: normal warm and dry. Pink well perfused
Musculoskeletal system patient indicates lower to mid back pain when she lies down on her back
and when she rolls over. No CVA tenderness.
Assessment: Asthma, acute exacerbation
Plan: Will keep her in observation overnight. Will administer oral steroids and breathing treatment.
CXR ordered and to be taken in the morning.
What E/M code is reported?

Accepted Answer

D

Explanation: The patient was evaluated in the Emergency Department (ED) and subsequently admitted to observation status by the same physician on the same date of service. According to CPT® guidelines, when a patient is admitted to hospital inpatient or observation care from the ED by the same physician/group, the ED service is considered part of the initial hospital/observation care service and is not reported separately. The level of service is determined by the level of Medical Decision Making (MDM). The MDM is moderate. This is based on: Problems Addressed: Moderate (one chronic illness with acute exacerbation). Data: Limited (one test ordered - CXR). Risk: High (decision for observation care). To qualify for a level of MDM, two of the three elements must be met or exceeded. This encounter meets the criteria for Moderate MDM (Moderate Problems, High Risk), which supports code 99222.

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