Instructor's GuideAC210610: Basic CPT/HCPCS ExercisesPage 1 of 101Answer KeyChapter 1Introduction to Clinical Coding1.1: Self-Assessment Exercise1.The patient is seen as an outpatient for a bilateral mammogram.CPT Code: 77055-50Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is thecorrect code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate whenCPT code descriptions differentiate between unilateral and bilateral.2.Physician performs a closed manipulation of a medial malleolus fracture—left ankle.CPT Code: 27766-LTThe code represents an open treatment of the fracture, but the physician performed a closedmanipulation. Correct code: 27762-LT3.Surgeon performs a cystourethroscopy with dilation of a urethral stricture.CPT Code: 52341The documentation states that it was a urethral stricture, but the CPT code identifies treatment ofureteral stricture. Correct code: 522814.The operative report states that the physician performed Strabismus surgery, requiring resection of themedial rectus muscle.CPT Code: 67314The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle ishorizontal. Correct code: 673115.The chiropractor documents that he performed osteopathic manipulation on the neck and back(lumbar/thoracic).CPT Code: 98925Note in the paragraph before code 98925, the body regions are identified. The neck would be thecervical region; the thoracic and lumbar regions are identified separately. Therefore, three bodyregions are identified. Correct code: 98926
Instructor's Guide6.AC210610: Basic CPT/HCPCS ExercisesPage 2 of 101The surgeon performs a colonoscopy with removal of a polyp by hot biopsy forceps.CPT Code: 45384The documentation supports this CPT code selection.7.A 45-year-old patient has a repair of a recurrent, incarcerated inguinal hernia.CPT Code: 49507The documentation supports the selection of the code for “recurrent” not “initial.” Correct code:495218.The surgeon performs an ERCP with endoscopic retrograde removal of a stone from the biliary duct.CPT Code: 43269Code 43269 identifies ERCP for removal of a foreign body. Correct code: 432649.The surgeon performs an excision of a 1.5 cm deep intramuscular soft tissue tumor of the scalp.CPT Code: 21011CPT distinguishes between an “intramuscular” soft tissue tumor excision from subcutaneous. Code21011 is for a subcutaneous tumor, which does not match the documentation. Correct code: 2101310.The physician performs a fine needle aspiration biopsy of the testis.CPT Code: 54500Note the parenthetical statement beneath code 54500 that states: “(For fine needle aspiration, see10021, 10022).” A coder would need further documentation to determine if the biopsy was performedwith imaging guidance (CPT code 10022) or without imaging guidance (10021).
Instructor's GuideAC210610: Basic CPT/HCPCS Exercises1.2: Crossword PuzzlePage 3 of 101
Instructor's GuideAC210610: Basic CPT/HCPCS ExercisesPage 4 of 101Chapter 2Application of the CPT System2.1: Matching Exercise1. Complete list of modifiers (D)A.Appendix B2. Complete list of add-on codes (C)B.Category II code3. 82525 Copper (E)C.Appendix D4. Complete list of recent additions,deletions and revisions (A)D.Appendix A5. 1119F Initial evaluation for condition (B)E.Pathology and Laboratory code2.2: Referencing CPT Assistant Exercises1.Refer to note below CPT code 29530. In the Professional Edition of CPT twhat does the following noteindicate? CPT Assistant Feb 96:3, April 02:13Answer: This note refers the coder to the February 1996 edition of CPT Assistant (page 3) and April2002 (page 13) for additional information about use of this code.2.The surgeon removed three (3) stones from the ureter. Is it appropriate to report code 50945 (Laparoscopy,surgical; ureterolithotomy) for each stone removed from the ureter?Answer: No. Code 50945 is intended to be reported once per surgical session, regardless of thenumber of stones removed (CPT Assistant, September 2006).3.If a physician performs an arthroscopy with joint debridement in the anterior compartment (CPT code29846), and through different portals performed an arthroscopy complete synovectomy in the posteriorcompartment (CPT code 29845), can both procedures be separately reported during the same operativesession appending modifier 59?Answer: No. From a CPT coding perspective it would not be appropriate to report both codes ifperformed within the same wrist during the same operative session, regardless of how many timesthe arthroscope is inserted into the wrist. Arthroscopy of all compartments, radioiulnar, radiocarpaland midcarpal, anterior or posterior, are considered inclusive components of codes 29840-29847.Therefore, it would not be appropriate to report for different compartments (CPT Assistant,December 2003).
Instructor's Guide4.AC210610: Basic CPT/HCPCS ExercisesPage 5 of 101The surgeon removed a non-tunneled central venous access catheter. CPT provides codes for removal of atunneled devices (36589-36590), but the note under code 36590 states, “Do not report these codes forremoval of non-tunneled central venous catheters.” Should the coder assign an unlisted code?Answer: No. The work required for non-tunneled central venous access catheter is considered to beinherent in the evaluation and management visit in which it is performed (CPT Assistant, December2004).2.3: Application of CPT Exercises1.The physician performs a synovial biopsy of the metacarpophalangeal joint. Using the Alphabetic Index,what key word(s) lead you to the coding selection? What is the correct code?Answer (several entries in index):Synovium, Biopsy, Metacarpophalangeal Joint .Biopsy, Metacarpophalangeal Joint . Metacarpophalangeal Joint, Biopsy, Synovium . 2.261052610526105The surgeon performed a radical resection of a 0.5cm lesion of the back. The malignant neoplasm extendedinto the soft tissue. Refer to the term “Lesion” in the alphabetic index. What guidance does the AlphabeticIndex provide? What is the correct code?Answer: Under the term “Lesion,” there is no entry for back. The note under Lesion states to “SeeTumor.” From the term “Tumor” in the Alphabetic Index, the coder is directed to Back/Flank andRadical Resection 21936.3.After an injection of Lidocaine, the surgeon performed a percutaneous tenotomy (Achilles tendon). Refer to27605-27606. What is the correct code assignment?Answer: Lidocaine is a local anesthesia; therefore, code 27605 is assigned.4.Using cryosurgery, the surgeon removed four (4) dermatofibromas of the leg. Refer to CPT codes 1700017250. What would be the correct code assignment?Answer: Dermatofibromas are benign. Code 17110 should be assigned.5.Refer to codes 57550-57556. The surgeon performed an excision of a cervical stump, vaginally, with repairof an enterocele. What is the correct code assignment?Answer: 57556. The description for this code would be: Excision of cervical stump, vaginal approach;with repair of enterocele.6.Insertion of a Foley catheter (temporary)Index: Insertion, Catheter, urethra(Foley is a type of urinary catheter.)Code: 517027.Biopsy of lacrimal sacIndex: Biopsy, lacrimal sacCode: 68525
Instructor's Guide8.AC210610: Basic CPT/HCPCS ExercisesIncision and drainage, hematoma, floor of the mouth, masticator spaceIndex: Abscess, Mouth, Incision and drainageCode: 41018Page 6 of 101
Instructor's GuideAC210610: Basic CPT/HCPCS ExercisesPage 7 of 101Chapter 3Modifiers3.1: Matching ExerciseMatch the following modifiers with the appropriate description.1. 3P (C)A.Physical status (anesthesia) modifier2. F4 (B)B.HCPCS National modifier3. 73 (D)C.Category II modifier4. P5 (A)D.CPT Modifier Approved for HospitalOutpatient Use only5. 53 (E)E.CPT Modifier not Approved forHospital Outpatient Use3.2: Select the Modifier Exercises1.Patient is seen in the physician’s office for his yearly physical (CPT code 99395- Preventive MedicineE/M). During the exam, the patient requests that the physician remove a mole on his shoulder. What CPTmodifier would be appended to the 99395 to explain that the E/M service was unrelated to excision of themole?Answer: Modifier 252.Patient is seen in a radiology clinic for an X-ray of the arm (73090). The films are sent to anotherradiologist (not affiliated with the clinic) to interpret and write the report. What HCPCS Level II modifierwould be appended to the CPT code for the services of the radiology clinic?Answer: TC for Technical Component3.A surgeon performed an esophageal dilation (43453) on a 4-week-old newborn who weighed 3.1 kg. WhatCPT modifier would be appended to CPT code to describe this special circumstance?Answer: 63 Procedure Performed on Infants less than 4 kg4.The surgeon performed a tenolysis, extensor tendon of the right index finger (26445). What HCPCS LevelII modifier should be appended to the CPT code?Answer: F6 Right hand, second digit5.A planned arthroscopic meniscectomy of knee was planned for a patient. During the procedure, the scopewas inserted but the patient went into respiratory distress and the procedure was terminated. What CPTmodifier would be appended to the CPT code (29880) for the physician’s services?Answer: 53 Discontinued Procedure. This modifier would be appended to the planned procedure forphysician services.
Instructor's GuideAC210610: Basic CPT/HCPCS ExercisesPage 8 of 1013.3: Coding/Modifier Case StudiesCase Study # 1The surgeon performed a carpal tunnel release (median nerve) on the left and right wrist.Index: Carpal Tunnel syndromeCode(s): 64721-50 (modifier for bilateral)Case Study # 2A 45-year-old male is brought to the endoscopy suite for diagnostic EGD. Patient is prepped. After movingthe patient to the procedure room, and prior to initiation of sedation, he develops significant hypotension, andthe physician cancels the procedure. Code for hospital services.Index: Endoscopy, Gastrointestinal, Upper, ExplorationCode(s): 43235 -73 Diagnostic EGD (modifier for Discontinued outpatient procedure prior toanesthesia administration)Case Study # 3The surgeon performed a tonsillectomy and adenoidectomy on a 25-year-old male. Four hours after leavingthe surgery center, the patient presents to the clinic with a 1-hour history of bleeding in the throat. Thebleeding site was located; however, it was in a location that could not be treated outside the OR. The patientwas taken back to the OR for control of postoperative bleeding.Index: Tonsillectomy and Hemorrhage, ThroatCode(s):42821: Tonsillectomy and adenoidectomy, age 12 years or older42962-78 Control oropharyngeal hemorrhage with secondary surgical intervention (modifier forreturn to OR for a related procedure during the postoperative period)Case Study # 4Patient presented for capsule endoscopy of the GI tract. The ileum was not visualized.Index: Gastrointestinal Tract, Imaging, IntraluminalCode(s): 91110-52 GI tract imaging, intraluminal (Modifier for reduced services. The capsuleendoscopy should include visualization from the esophagus through ileum.)
Instructor's GuideAC210610: Basic CPT/HCPCS ExercisesPage 9 of 101Chapter 4SurgeryPart IAnswers to the exercises in this section will not apply modifier 51 (multiple procedures) or sequencing for claimssubmission. The focus of these exercises is to practice accurate assignment of CPT codes without regard to payerguidelines. The answers will include use of lateral modifiers (such as RT, FA) and Modifier 50 for bilateral. For thepurposes of instruction, this book uses a dash to separate each five-character CPT code from its two-charactermodifier. However, dashes are not used in actual code assignments and reimbursement claims.Integumentary System ExercisesSource: National Cancer Institute. n.d. VisualsOnline. Don Bliss, artist. d 4362.4.1: Medical Terminology ReviewMatch the medical terms with the definitions.1.biopsy (C)2.basal cell carcinoma3.cryosurgery (A)4.debridement5. lipoma (E)(B)(D)A.freeze tissueB.removal of damaged tissue fromwoundC.removal of a piece of tissue forexaminationD.malignant neoplasmE.benign neoplasm
Instructor's GuideAC210610: Basic CPT/HCPCS ExercisesPage 10 of 1014.2: Clinical ConceptsFill in the blanks for the following scenarios. Choose from one of the two answers provided in parentheses.22.214.171.124.5.The physician uses a laser to remove a lesion of the back. For coding purposes, this would be classified as(excision or destruction).The surgeon removes a 2.0 cm seborrheic keratosis of the neck. The lesion would be defined as(benign or malignant).The physician sutured a 3 cm x 2 cm superficial laceration of the knee. The wound required removal ofgravel and dirt. For coding purposes, this would be classified as: (simple orintermediate repair).The skin graft required harvesting healthy skin from the patient’s right thigh to cover the defect of the arm.This type of graft is called: (autograft, allograft or xenograft).The 3.0 cm lipoma extended into the tendon of the shoulder. The code for this procedure would be selectedfrom the chapter (integumentary or musculoskeletal).4.3: Integumentary System Coding DrillFor all coding exercises, review the documentation and underline key term(s). Identify the terms used to look up thecode selection in the Alphabetic Index. Assign CPT codes to the following cases. If applicable, append CPT/HCPCSLevel II modifiers. In some cases, the student will be prompted to answer questions about the case study.1.With the use of a YAG laser, the surgeon removed a 2.0 cm Giant congenital melanocytic nevus of the leg.Pathology confirmed that the lesion was premalignant.Index:Lesion, Skin, Destruction, Premalignant (Note that laser is classified as destruction and themorphology of the lesion is premalignant.)Code(s):17000 Destruction, premalignant; first lesion2.Operative Note: After local anesthesia