2013
Medical Coding Training: CPC-H®
Instructor Resources—Volume 2
Contents
Answers for Chapter 13 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Answers for Chapter 13 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Activity 13.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Activity 13.2—Matching—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Activity 13.3—Breast Diagram—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Answers for Chapter 14 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Answers for Chapter 14 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Activity 14.1—Word Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Activity 14.2—Crossword Puzzle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Activity 14.3—Operative Reports—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Operative Report 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Operative Report 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Answers for Chapter 15 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Answers for Chapter 15 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Activity 15.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Activity 15.2—Word Search—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Activity 15.3—Respiratory Diagram—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Answers for Chapter 16 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Answers for Chapter 16 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Activity 16.1—Label Diagram—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Activity 16.2—Word Search—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Activity 16.3—Word Scramble—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Answers for Chapter 17 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Answers for Chapter 17 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Activity 17.1—Matching—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Activity 17.2—Word Search—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Answers for Chapter 18 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
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Contents
Answers for Chapter 18 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Activity 18.1—Word Search—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Activity 18.2—Matching CPT® Codes—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Answers for Chapter 19 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Answers for Chapter 19 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Activity 19.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Activity 19.2—Word Scramble—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Answers for Chapter 20 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Answers for Chapter 20 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Activity 20.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Activity 20.2—Word Scramble—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Operative Report 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Answers for Chapter 21 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Answers for Chapter 21 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Activity 21.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Activity 21.2—Matching Definitions—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Answers for Chapter 22 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Answers for Chapter 22 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Activity 22.1—Matching Definitions—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Activity 22.2—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Answers for Chapter 23 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Answers for Chapter 23 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Activity 23.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Activity 23.2—Word Search—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Answers for Chapter 24 Class Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Answers for Chapter 24 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Activity 24.1—Crossword Puzzle—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Activity 24.2—Matching CPT® Codes—Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
iv
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 13 Class Exercises
Class Exercise 13.1
1. b. Removal of dead or damaged tissue as from a wound
Rationale: Debridement is the process of removing dead tissue or eschar, dirt, foreign material, or debris from
infected skin, a burn, or a wound to promote healing and prevent or control infection.
2. c. Cavity created by localized infection that contains a purulent exudate
Rationale: An abscess is infection causing localization of pus and infected material in the
3. d. 892.0
Rationale: The diagnosis is a cut (laceration) on the foot. A laceration is an open wound. Look in the ICD-9-CM
Index to Diseases for Wound, open/foot. There is no retained foreign body so it is not considered complicated. The
correct code is 892.0. Verify code selection in the Tabular List.
4. b. 250.80, 707.15
Rationale: Look in the ICD-9-CM Index to Diseases for Ulcer, ulcerated, ulcerating, ulceration, ulcerative/
diabetes, diabetic (mellitus)/lower limb/toes 250.8x [707.15]. In the Tabular List, a fifth digit of 0 is selected for the
Type II diabetes. The manifestation code is listed second.
5. c. 942.32, 943.30, 943.20, 948.32
Rationale: Per ICD-9-CM coding guideline Section I.C.17.c.1, Sequence first the code that reflects the highest
degree of burn when more than one burn is present. Look in the ICD-9-CM Index to Diseases for Burn/chest wall
(anterior)/third degree 942.32; Burn/arm(s) third degree 943.30; Burn/arm(s)/second degree 943.20. In assigning
a code from category 948, your fourth digit code indicates the total body surface area (TBSA) involved in the
burn(s). The correct fourth digit for the question is 3, for 34% TBSA of the second and third degree burns. The
fifth digit indicates the percentage of the body surface that is involved in a third degree burn. The correct code to
report is 948.32. Class Exercise 13.2
Match the surgical term to its correct definition.
1. c Avulsion
a. The use of heat or chemicals to burn or cut
2. a Cauterize
b. Instrument for direct electrical energy through tissues for lesion destruction
3. d Cryosurgery
c. The forceful tearing away of part of body
4. b Electrocautery
d.A procedure using low temperatures for lesion removal
5. h Electrodessication
e. Constriction of a body part to cut off blood or oxygen
6. f Ligation
f. A thread of a material (eg, cotton) used to tie off a lesion
7. e Strangulation
g. The process of peeling or shaving
8. g Paring/Cutting
h.The use of monopolar high frequency electrical current for lesion removal
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1
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 13.3
1. 11402
Rationale: Look in the CPT® index for Excision/Lesion/Skin/Lesion, Benign and you are referred to code sets that
are found in code range 11400–11471. This is a lesion of the trunk; therefore, you need to look at codes 11400–
11406. Code 11402 is selected for a lesion of 1.4 cm.
2. 11603
Rationale: Look in the CPT® index for Excision/Lesion/Skin/Lesion, Malignant and you are referred to code sets
that are found in code range 11600–11646. This lesion is of the forearm; therefore, look at the range 11600–11606.
Code 11603 is used for a 3 cm lesion of the forearm.
3. 11402, 11403
Rationale: Each lesion is coded separately. Report 11402 for the 1.4 cm (1 cm + .2 cm margin + .2 cm margin)
benign lesion excision of the lower back and 11403 for the benign lesion of the thigh measuring 2.1 cm (1.7 cm +
.2 cm margin + .2 cm margin). Guidelines state each lesion is reported separately and in the outpatient hospital
setting, modifier 51 is not allowed so a modifier is not reported.
Class Exercise 13.4
1. 11056
Rationale: The key word here is paring. Look in the CPT® index for Paring/Skin Lesion/Benign Hyperkeratotic
and you are referred to 11055–11057. The correct code is 11056 for the four warts removed.
2. 10081
Rationale: Look in the CPT® index for Pilonidal Cyst/Incision and Drainage 10080–10081. Code 10081 reports a
complicated I&D.
3. 11100, 11101
Rationale: Look in the CPT® index for Biopsy/Skin Lesion 11100–11101.
4. 11643, 11602, 11602
Rationale: This case involves malignant lesions; therefore, look in the CPT® index for Excision/Lesion/Skin/
Lesion, Malignant and you are referred to code sets that are found in code range 11600–11646. Highlight the
anatomical areas in your CPT® book to make reference easier. Code 11643 is chosen for the 2.1 cm lesion removed
from the nose. Next look for chest, which is considered the trunk. Each lesion was 1.5 cm; therefore, code 11062
is then listed twice—each on a different line item. Modifier 59 is not needed as the instructions in the CPT®
guidelines indicate to report each lesion excises separately.
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2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 12032, 12013-59
Rationale: This is a repair of lacerations. Look in the CPT® index for Skin/Wound Repair/Intermediate 12031–
12057. Layered repair is noted in CPT® as an intermediate repair. The codes for intermediate repair of the arm
start at 12031. This was a repair of 3.6 cm; therefore, 12032 is chosen. The lacerations of the cheek are simple
repairs. As noted in the guidelines, these two laceration lengths are added 2.3 + 2.7 = 5.0 cm. Look in the Index
Skin/Wound Repair/Simple for 12020–12021. Repairs of the face are listed starting at 12011. This is a simple repair
of 5 cm; therefore, 12013 is correct.
The guidelines for reporting multiple repairs in CPT® direct the coder to append modifier 59 to the lesser of the
codes. Payment is based on the APC assignment which is T and will reduce the second procedures by 50 percent.
Class Exercise 13.5
1. 17110
Rationale: Look in the CPT® index for Destruction/Lesion/Skin/Benign and you are referred to 17110–17111.
There are three benign lesions. 17110 includes destruction of up to 14 lesions. Go to 17000 and HIGHLIGHT
“premalignant” and go to 17110 and HIGHLIGHT “benign lesions other than skin tags or cutaneous vascular
proliferative lesions.”
2. 11981
Rationale: Look in the CPT® index for Drug Delivery Implant 11981.
3. 14041
Rationale: For this case you need to know that a Z-plasty is listed under Tissue Transfer and Rearrangement in
your CPT® Book. Be sure to read the notes here. HIGHLIGHT that the excision of a lesion is included in these
procedures. Look in the Index for Tissue/Transfer/Adjacent/Skin 14000–14350. The correct code for the repair of
the forehead for a defect of 10.5 sq cm is 14041.
4. 15271
Rationale: Look in the Index for Skin Graft and Flap/Skin Substitute Graft 15271–15278. In the guidelines for
Skin Replacement Surgery, the coder is instructed to sum the surface area of all wounds when reporting multiple
wounds for anatomic sites grouped together. The total of the skin grafts is 15.5 sq cm; therefore, 15271 is correct.
Always choose the code by the recipient site, which in this case is the leg.
5. 15120, 11641
Rationale: Look in the CPT® index for Excision/Lesion/Skin/Lesion, Malignant and you are referred to code sets
that are found in code range 11600–11646. Code 11641 reports a 0.8 cm lesion of the face. For the split skin graft
reconstruction, look in the CPT® index for Skin Graft and Flap/Split Graft 15100–15101, 15120–15121. Code 15120
is necessary for an area of 7.2 sq cm on the face. Multiply 0.8 cm x 0.9 cm to get .72 sq. cm.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 13 Questions
1. Length, Complexity (simple, intermediate, complex), Site of repair
2. Simple, Intermediate, Complex
3. Match the term to its definition:
1.
d Comedones
a. Destruction of tissue using high frequency electric current
2.
e Ablation
b. Lacking in blood supply
3.
a Electrocautery
c. Mass of blood found in organ or tissue
4.
h Hidradenitis
d. Refers to a blackhead (pimple)
5.
j Lesion
e. Removal of a body part or the destruction of a body part
6.
c Hematoma
f. Shaving or cutting
7.
i Debridement
g. Chronic and progressive scarring and shrinkage
8.
b Avascular
h. Chronic inflammation of sweat glands
9.
g Cicatricial
i. Removal of dead and damaged tissue
10. f Paring
j. Abnormal change in the tissues
4. Stage I – Persistent focal erythema
Stage II – Partial thickness skin loss involving epidermis, dermis, or both
Stage III – Partial thickness skin loss extending through subcutaneous tissue
Stage IV – Necrosis of soft tissue extending to muscle and bone
5. Partial-thickness is confined to the skin layers; damage does not penetrate below the dermis and may be
limited to the epidermis.
6. Diameter and margins necessary to excise the lesion
7. Malignancy means the cancerous growth has invaded adjacent normal tissue and may spread to distant parts
of the body.
8. A third degree burn damages the epidermis and dermis and extends into the subcutaneous tissues. The
subcutaneous tissues might be charred white.
9. Stage refers to the removal of layers of tissue and each removed stage is divided into specimens.
10. Surgical removal of a lesion or abnormal tissue with the purpose of removing the mass in total from the
breast.
11. d. 12055, 12044-59
Rationale: All the laceration codes were repaired with layered closures which places them as intermediate repair
codes. Look in the CPT® Index for Skin/Wound Repair/Intermediate 12031–12057. The 10 cm cheek and 4 cm chin
lacerations are anatomical sites grouped together into the same code descriptor. The lengths of both lacerations
are added together (14 cm), reported with code 12055. The 9 cm laceration on the hand is reported with code
12044. Per CPT® guidelines modifier 59 is appended when more than one wound repair code is reported.
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2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
12. b. 15100, 15002
A split thickness graft is used for the lower leg (recipient site). In the CPT® Index look for Skin Graft and Flap/Split
Graft referring you to codes 15100–15101, 15120–15121. The graft harvested was 5 cm x 8 cm = 40 sq cm, reporting
code 15100. Surgical preparation of the leg wound was also performed reporting code 15002. This is indexed
under Skin Graft and Flap/Recipient Site Preparation 15002–15005.
13. d. 19103, 77031
In the CPT® Index look for Biopsy/Breast 19100–19103. The breast biopsy was performed using a biopsy device
reported with code 19103. Index There is a parenthetical instruction note under code 19103 that states, For
imaging guidance performed in conjunction with 19102, 19103 see 76492, 77012, 77021, 77031, 77032. Stereotactic
guidance was used reporting code 77031.
14. c. 17110, 11100-59, 216.6, 078.12
In the CPT® Index look for Lesion/Skin/Destruction/Benign 17110–17111, 17250. Three warts are destroyed using
cryosurgery reported with code 17110. In the CPT® Index look for Lesion/Skin/Biopsy 11100–11101. A biopsy of
the left arm was also performed reported with code 11100. Modifier 59 is appended to indicate the biopsy was
performed at a different anatomical site from the lesions that were destroyed.
For reporting the diagnosis codes in the ICD-9-CM Index to Diseases, look for Nevus/blue (M8780/0). Turn to
Appendix A in the in the ICD-9-CM codebook and under the heading Appendix A: Morphology of Neoplasms,
the digit /0 is for benign. In the Neoplasm Table look for skin/limb NEC/upper/Benign (column) referring you to
code 216.6. In the ICD-9-CM Index to Diseases, look for Wart/plantar referring you to code 078.12. 15. c. $142.73
Rationale: Refer to Addendum B for the status indicator and payment rate for the procedures. 17110 has a status
indicator T, relative weight 1.0032 and a payment rate of $71.54. 11100 has a status indicator T, relative weight
1.4998 and a payment rate of $106.96. When multiple procedures with status indicator T are performed, a multiple
procedure reduction applies to the procedure with the lowest relative weight (17110). 11100 will be paid at 100%
($106.96) and 17110 will be paid at 50% ($71.54/2=$35.77). The total payment rate will be $106.96 + $35.77 =
$142.73. On the CPC-H exam, an excerpt from Addendum B is provided so you can answer questions like this on
the exam.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 13.1—Crossword Puzzle—Answers
Instructions: Read the definitions, and then fill in the puzzle with the correct term.
1.
2.
C
R
Y
O
S
U
R
G
E
R
Y
E
G
R
E
E
N
3.
4.
F
I
R
S
T
D
A
L
E
5.
6.
H
E
T
E
R
O
G
R
M
I
A
F
T
L
V
O
A
G
7.
N
E
S
C
H
A
R
I
C
A
N
U
F
L
T
8.
S
L
O
U
G
H
A
9.
D
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2013 Medical Coding Training: CPC-H—Instructor Resources
E
R
M
I
S
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 13.2—Matching—Answers
Match the CPT® code with the correct description the corresponding letter.
CPT® Code
Description
1.
d 10080
a. Initial escharotomy incision
2.
a 16035
b. Application of skin substitute to the scalp, first 25 sq cm
3.
f 19316
c. Complex repair of the arm, 2.3 cm
4.
b 15275
d.Simple I&D of pilonidal cyst
5.
g 11951
e. Debridement, subcutaneous tissue
6.
c 13120
f. Mastopexy
7.
j
g. Subcutaneous injection of 2.3 cc of collagen
8.
e 11042
h.Paring of three corns
9.
i 15822
i. Upper eyelid blepharoplasty
10.
h 11056
j. Excision of a benign lesion on the leg, measuring 0.8 cm
11401
Activity 13.3—Breast Diagram—Answers
This page may be used to produce an overhead for the answer sheet.
Lactiferous
ducts
Pectoralis
muscle
Fat
Nipple
Gland
lobules
CPT® copyright 2012 American Medical Association. All rights reserved.
Sideview schematic
of female breast
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 14 Class Exercises
Class Exercise 14.1
Using your medical dictionary, define the following:
1. Closed sac of fibrous tissue found between some tendons and the bones under them
2. Movement that causes the end of the bone to move in a circular motion
3. Tube shaped sheath that lines the compartment where some tendons pass-through, such as those found
around the ankle and wrist
4. Partial or complete removal of a limb or other protruding body part
5. Surgical repair of cartilage
6. Mucus filled cyst of the tendon sheath and most common in the wrist
7. Method used to reduce features by inserting a pin or wire through the bone and applying force or traction,
usually by attaching weights
8. First repair immediately after injury
9. Displacement of a body part from its normal location
10. Fibrous material surrounding a gelatinous center, located in between the vertebrae that act as shock absorbers
Class Exercise 14.2
1. 737.11
Rationale: In the Index to Diseases look for Kyphosis/due to or associated with/radiation 737.11.
2. 737.34
Rationale: In the Index to Diseases look for Scoliosis/thoracogenic 737.34.
3. 718.71
Rationale: In the Index to Diseases look for Dislocation/joint/developmental 718.7x. Look in the Tabular List for
the fifth digit “1” for shoulder region. The correct code is then 718.71.
4. 754.35
Rationale: In the Index to Diseases look for Dislocation/hip/congenital/with subluxation of other hip 754.35.
Then check the Tabular List to verify.
5. 820.13
Rationale: In the Index to Diseases look for Fracture/femur/neck/base/open 820.13. Always verify your code in
the Tabular List.
8
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
6. 733.93
Rationale: In the Index to Diseases look for Fracture/stress/fibula 733.93. Verify your answer in the Tabular List.
7. 726.33
Rationale: In the Index to Diseases look for Bursitis/elbow 726.33. Verify your answers in the Tabular List.
8. 802.26
Rationale: In the Index to Diseases look for Fracture/mandible/body/symphysis 802.26. Verify code in the
Tabular List.
9. 844.1
Rationale: In the Index to Diseases look for Tear/ligament—see also Sprain, by site. Next look for Sprain/
collateral, knee (medial) (tibial) 844.1
10. 807.03
Rationale: In the Index to Diseases look for Fracture/rib(s) (closed) 807.0x. Go to the Tabular List for the 5th digit
“3” for three ribs.
Class Exercise 14.3
1. 24516
Rationale: Look in the CPT® Index for Fracture/Humerus/Shaft 24500–24505, 24516. 24516 is the correct code to
report for using the intramedullary implant and locking screws.
2. 27752
Rationale: Look in the CPT® Index for Fracture/Tibia/Shaft/with Manipulation 27752, 27760–27762, 27810. 27752
is correct code to report for the tibial shaft fracture.
3. 29550
Rationale: Look in the CPT® Index for Strapping/Toes 29550. Only need to report code 29550 once since the code
descriptive states “toes.”
4. 29075
Rationale: Look in the CPT® Index for Cast/Ambulatory/Short Arm - 29075. The removal of the cast applied by
the same physician is not billable.
5. 23655
Rationale: Look in the CPT® Index for Dislocation/Shoulder/Closed Treatment with Manipulation—23650, 23655.
6. 25431
Rationale: Look in the CPT® Index for Nonunion Repair/Carpal 25431, 25440. Code 25431 is correct to report for
repair being performed on the carpal bone.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 14 Questions
1. Open reduction with internal fixation
Rationale: The acronym ORIF stands for Open reduction with internal fixation.
2. 735.0
Rationale: In the Index to Diseases look for Hallux/valgus (acquired) 735.0.
3. a. 844.9, E917.0, E007.3, E849.4
Rationale: This is an acute injury; need to report a traumatic injury code. In the Index to Diseases look for
Sprain/knee 844.9. In the Index to External Causes look for Striking against/object/in/sports E917.0; Look for
Activity/baseball E007.3; Accident (to)/occurring (at) (in)/park E849.4.
4. c. 21242-50, 524.60
Rationale: Look in the CPT® index under Arthroplasty/Temporomandibular Joint, and you are referred to 21240–
21243. Donor allograft was used; therefore, the correct code is 21242. The donor graft, an allograft, is included
in the description of the code for the arthroplasty. It is, therefore, not reported separately. The arthroplasty CPT®
code is a unilateral code and requires modifier 50 to report bilateral procedures. The arthrocentesis that was
performed on the left side is not reported, because it is included in the arthroplasty of the same joint.
ICD-9-CM code for TMJ syndrome is reported with 524.60. Jaw pain is a symptom of the TMJ syndrome and is
not reported in addition to the TMJ. Look in the Index to Diseases for Syndrome/temporomandibular joint-paindysfunction (TMJ) NEC, and you are referred to 524.60
For 5–12 match the definitions with the terms.
5. e Evacuation of bone and tissue that creates a shallow depression
a. Curettage
6. g Surgical repair of cartilage
b. Arthrodesis
7. b Surgical immobilization of a joint
c. Tenodesis
8. f Removal of a vertebral body
d. Dislocation
9. a Removal of tissue by scraping e. Saucerization
10. h Puncturing of joint to remove fluid
f. Corpectomy
11. d Body part displaced from normal position
g. Chondroplasty
12. c Surgical fixation of a tendon to a bone
h. Arthrocentesis
10
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
For 13–17 match the codes to the eponyms.
13. d Code 28294
Joplin procedure
Rationale: In the CPT® codebook look for code 28294. Its code descriptive has eg, Joplin type procedure
indicating this type of procedure is reported with this code.
14. c Code 27422
Campbell, Goldwaite type procedure
Rationale: In the CPT® codebook look for code 27422. Its code descriptive has eg, Campbell, Goldwaite type
indicating this type of procedure is reported with this code.
15. a Code 28290
Silver procedure
Rationale: In the CPT® codebook look for code 28290. Its code descriptive has eg, Sliver type procedure indicating
this type of procedure is reported with this code.
16. e Code 27888
Pirogoff procedure
Rationale: In the CPT® codebook, look for code 27888. Its code descriptive has eg, Syme, Pirogoff type procedure
indicating this type of procedure is reported with this code.
17. b Code 28297
Lapidus procedure
Rationale: In the CPT® codebook look for code 28297. Its code descriptive states Lapidus-type procedure
18. Casting and strapping is coded with 29000–29584 depending on the type of casting or strapping. An E/M
visit could also be coded based on low, medium, or high levels of resources utilized. Payment for supplies
are included in the procedure or service performed; however, the supplies are still reported separately by the
facility.
19. b. 25248, 881.02, E920.8, E016.1
Rationale: Look in your CPT® Index for Wrist/Removal/Foreign Body—25040, 25101, 25248. Code 25248
describes exploration and removal of deep foreign body, forearm or wrist.
In the Index to Diseases look for Wound, open/wrist/complicated 881.02. In the Index to Diseases under the main
term Wound, open there is an instructional note that states, Complicated includes wounds with foreign body.
This is not a superficial foreign body since the thorn was imbedded. Look in the Index to External Causes for Cut/
by/object, edged, pointed, sharp—see category E920.x. The correct code is E920.8. The descriptor includes plant
thorn. Next Look in the Index to External Causes for Activity/gardening and you are referred to E016.1. Check
your codes in the Tabular List.
20. a. 26055, 727.03
Rationale: Look in the CPT® index for Trigger Finger Repair and you are referred to 26055. Look in the Index to
Disease for Trigger finger and you are referred to 727.03.
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11
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
21. d. 10060, 680.3
Rationale: Look in the CPT® Index for Furuncle/Incision and Drainage and you are referred to 10060–10061.
Look in the Index to Disease for Furuncle/axilla and you are referred to 680.3, which is confirmed in the Tabular
List. Note: A4550 for supplies has a status indicator of B which indicates the supplies are not recognized by OPPS
when submitted on an outpatient hospital Part B bill type.
22. c. 25565-RT, 813.23
Rationale: In the CPT® Index look for Fracture/Radius/Shaft/with Manipulation 25565, 25605. Code 25565 is
correct to report for the radial and ulnar shaft fractures. First cast application in included with fracture care
treatment and not separately reported. In the Index to Diseases look for Fracture/radius/shaft (closed)/with ulna
(shaft) 813.23.
23. a. 29065-LT, 812.21, E812.1
Rationale: Fracture care treatment was not performed only the application of the cast by the ER physician. In
the CPT® Index look for Cast/Ambulatory/Long Arm 29065. In the Index to Diseases look for Fracture/humerus
(closed)/shaft 812.21. In the Index to External Causes look for Collision/motor vehicle (on public highway) (traffic
accident) E812.x; your fourth digit is 1 to indicate the patient was the passenger.
24. c. 26605 x 2, 815.09, E880.9, E849.6
Rationale: In the CPT® Index look for Fracture/Metacarpal/with Manipulation 26605–26607. Code 26605 is the
correct code for the closed reduction of the metacarpal bones. The code descriptive states to report this code for
“each bone.” Code 26605 will be reported twice since two metacarpal bones were reduced back to alignment. In
the Index to Diseases look for Fracture/metacarpus, metacarpal (bones(s)), of one hand (closed)/multiple sites
815.09. In the Index to External Causes look for Fall, falling/from, off/stairs, steps E880.9; look for Accident (to)/
occurring (at) (in)/office (building) E849.6.
25. b. 22520, 22522, 72291, 72291-59, 733.13
Rationale: Vertebroplasty was performed on T6 and T11. Look in the CPT® Index for Vertebral/Body/Repair/
Injection/Thoracic 22520, 22522. Code 22520 is reported for T6, and the add-on code 22522 is reported for T11.
Modifier 50 is not reported with these codes because the word “bilateral” is in its code descriptor. See instructions
below these codes to use 72291, 72292 for radiological supervision and interpretation. Code 72291 is reported
for the fluoroscopic guidance per vertebral body.Modifier 59 is reported on the second 72991 code to indicate
fluoroscopic guidance for the second vertebral body. In the Index to Diseases look for Fracture/vertebra, vertebral/
compression, not due to trauma 733.13.
12
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 14.1—Word Search
Find the words in the grid. Words can go horizontally, vertically, and diagonally in all directions.
Y
M
O
T
C
E
P
R
O
C
D
M
W
T
T
A
R
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H
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P
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M
L
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L
R
H
Z
R
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G
L
Y
Q
R
C
G
N
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N
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D
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Z
B
H
Q
G
A
R
J
K
L
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B
B
W
D
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T
V
M
F
L
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D
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K
C
N
M
H
Y
P
E
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X
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N
A
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D
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M
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L
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L
J
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A
M
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N
P
A
U
Z
L
X
U
V
T
M
C
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D
N
B
N
N
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C
H
E
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K
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Y
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F
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Y
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Z
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K
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Z
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F
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Y
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B
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L
CPT® copyright 2012 American Medical Association. All rights reserved.
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13
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 14.2—Crossword Puzzle
1.
B
I
2.
A R
3.
T H R O D E
C
O
T M J
H
T
O
I
R
C R A
A
I
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T A
L
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4.
R
7.
S
S
K E
6.
O
P
C
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C A
Z A
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O N
T
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8.
L E
O
T E R
C
L
S
5.
I
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T S
O
N
14
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 14.3—Operative Reports—Answers
Distribute the operative report to the students and have them code the CPT®/HCPCS and diagnosis codes for the
procedures.
Operative Report 1
CPT® 27235
ICD-9-CM 820.21
Rationale: This is a percutaneous pinning of a left femoral neck fracture. Look in the CPT® Index for Fracture/
Femur/Neck/Percutaneous Fixation 27235. Code 27235 Percutaneous skeletal fixation of femoral fracture, proximal
end, neck is correct. For the diagnosis, look in the ICD-9-CM Index to Diseases for Fracture/femur/neck/
intratrochanteric 820.21. Verify in the Tabular List.
Operative Report 2
CPT® 23044
ICD-9-CM 998.59
Rationale: Look in the CPT® Index for Incision/Shoulder Joint 23040–23044. Code 23044 Arthrotomy,
acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body describes
the procedure. The excision of the granulomatous tissue is included in the procedure. In the ICD-9-CM Index to
Diseases look for Infection/postoperative wound 998.59. Verify in the Tabular List.
CPT® copyright 2012 American Medical Association. All rights reserved.
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15
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 15 Class Exercises
Class Exercise 15.1
1. d. Larynx
Rationale: The larynx is also referred to as the voice box. It connects the nasopharynx to the trachea, covered by
the epiglottis during swallowing to prevent aspiration.
2. b. Bronchioles
Rationale: The passage of airflow to the lungs is the nose, trachea, bronchi, bronchioles, alveoli.
3. a. Parietal pleura
Rationale: The outer layer of the pleura is the parietal pleura. The inner layer of the pleura is the visceral pleura.
4. c. Diaphragm
Rationale: Inhalation occurs when the diaphragm contracts or moves down: The air pressure in the thoracic
cavity is reduced, allowing air to flow into the lungs. During exhalation, the diaphragm is relaxed and pushes air
out of the chest.
5. a. Upper left quadrant of the abdomen
Rationale: The spleen is located in the left upper quadrant of the abdomen.
Class Exercise 15.2
1. 799.01
Rationale: Look in the Index to Diseases for Asphyxia, asphyxiation 799.01. Verify in the Tabular List.
2. 493.90
Rationale: Look in the Index to Diseases for Asthma 493.9x. Go to the Tabular List to find the 5th digit. The 5th
digit is “0”, because there is no mention of status asthmaticus or exacerbation.
3. 496
Rationale: This can be found in the Index to Diseases under Disease/pulmonary/diffuse obstructive (chronic) 496
or Disease/lung/obstructive (chronic) (COPD) 496. Verify in the Tabular List.
4. 786.02
Rationale: Look in the Index to Diseases for Orthopnea 786.02. Verify in the Tabular List.
5. 784.7
Rationale: Look in the Index to Diseases for Epistaxis 784.7. Verify in the Tabular List.
16
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
6. 786.07
Rationale: Look in the Index to Diseases for Wheezing 786.07. Verify in the Tabular List.
7. 464.01
Rationale: Look in the Index to Diseases for Laryngitis/with/obstruction 464.01. Verify in the Tabular List.
8. 466.19
Rationale: Look in the Index to Diseases under Bronchiolitis/with/bronchospasm or obstruction 466.19.
9. 457.1
Rationale: Look in the Index to Diseases under Lymphedema-see also Elephantiasis 457.1. Verify in the Tabular List.
10. 200.74
Rationale: Look in the Index to Diseases under Lymphoma/large cell. You are referred to 200.7 which requires a
5th digit. Turn to code 200.7 in the Tabular List. The fifth digit to identify axilla is 4. The correct code is 200.74
Class Exercise 15.3
1. 31255, 461.2
Rationale: The report shows bilateral ethmoidectomy performed using sinus endoscopy. Look in the CPT® Index
for Sinus/Sinuses/Ethmoidectomy 31254–31255. During this procedure the anterior and posterior ethmoids were
removed which is defined as a total procedure.
For the ICD-9 code look in the Index to Diseases for Sinusitis/acute/ethmoidal 461.2. Verify in the Tabular list.
(Note: Recurrent acute is not the same as chronic)
2. 38510-50, 38525-50, 201.18
Rationale: Biopsies are taken from the cervical and axillary nodes bilaterally. Look in CPT® Index for Biopsy/
Lymph Nodes/Open-38500, 38510–38530. The codes are selected based on the site of the biopsies. Report 38510
for the deep cervical biopsies. Report 38525 for the axillary biopsies. Append modifier 50 to both codes because
the procedures were performed bilaterally. In the Index to Disease, look up Granuloma/Hodgkin’s and you are
referred to 201.1. Refer to the Tabular List, fifth digit “8” identifies multiple sites. 3. 31560, 478.33
Rationale: Look in CPT® under Arytenoidectomy /Endoscopic 31560. Code 31560 describes the procedure. For
the diagnosis, look in the Index to Diseases for Paralysis/vocal cord/bilateral 478.33. Verify in the Tabular List.
4. 30140, 478.0
Rationale: Look in the CPT® index for Turbinate/Excision 30130–30140. The procedure is reported with 30140,
the incision is made on the inferior border of the turbinates and a resection is performed. An excision involves
fracturing of the turbinates. In the Index to Diseases, refer to Hypertrophy/turbinate 478.0.
CPT® copyright 2012 American Medical Association. All rights reserved.
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17
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 31254-50, 31256-50, 31276-50, 473.8, 471.8
Rationale: The report shows bilateral ethmoidectomy and maxillary antrostomy by sinus endoscopy. Look in
the CPT® Index for Sinus/Sinuses/Ethmoid/Excision/with Nasal/Sinus Endoscopy - 31254–31255. Also look in
the same section for Maxillary/Incision 31020–31032, 31256–31267. Also note that tissue was removed from the
frontal sinuses on both sides. Look in the CPT® Index for Sinus/Sinuses/Frontal/Exploration/with Nasal/Sinus
Endoscopy 31276. Modifier 50 must be used for all codes, because all procedures were bilateral.
For the diagnoses codes look in the Index to Diseases for Pansinusitis 473.8 and Polyposus/accessory sinus 471.8.
Verify your codes in the Tabular List.
Answers for Chapter 15 Questions
1. Maxillary, frontal, ethmoid, sphenoid
Rationale: There are four pairs of sinuses (paranasal sinuses) in the respiratory system. All are located in and
around the nasal-oral cavities. The frontal sinuses are located above the eyes on the interior or medial aspect.
The ethmoid sinuses are located directly below the frontal sinuses, between the eyes and the nose. The sphenoid
sinuses are located behind the ethmoid sinuses (behind the nose, and the eyes), and the maxillary sinuses are
located in the cheekbones, under the eyes.
2. Direct, indirect, and fiberoptic
Rationale: Indirect laryngoscopy involves the use of mirrors and lights to view the larynx. Direct laryngoscopy
is an examination of the back of the throat and vocal cords using a laryngoscope. Fiberoptic laryngoscopy allows
better visualization of the throat using a flexible tube.
3. Intranasal, extranasal, and endoscopic
Rationale: There are three approaches for nasal sinus surgery. Intranasal is the approach through the nose.
Extranasal involves an incision to gain access. Endoscopic is the use of an endoscope through the nose to gain
access.
4. Antrostomy
Rationale: Antrostomy is an incision in the sinus to improve drainage.
5. Alveolar sacs
Rationale: Alveoli (air sacs): The primary units for the exchange of oxygen and carbon dioxide in the lungs.
6. b. 31205
Rationale: Look in the CPT® Index for Sinus/Sinuses/Ethmoid/Excision 31200–31205. The procedure is
performed by an extranasal approach.
7. d. None
Rationale: In the outpatient hospital setting, there is no additional reimbursement for the facility when additional
physician work is required. A modifier is not reported by the facility in this case.
18
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
8. a. 31605
Rationale: Look in the CPT® Index for Tracheostomy/Emergency 31603–31605. The incision is made near the
cricothyroid membrane.
For 9-13, match the definition with the term.
9. d. Discharge from the nose (runny nose)
Rhinorrhea
Rationale: Rhinorrhea is discharge from the nose.
10. a. Removal of a lung
Pneumonectomy
Rationale: Pneumonectomy is removal of a lung.
11. e. Nosebleed
Epistaxis
Rationale: Epistaxis is the medical term for a nose bleed.
12. b. Procedure involves making a puncture into the pleural cavity to remove fluid
Thoracentesis
Rationale: Thoracentesis is a puncture in the pleural cavity to remove fluid.
13. c. Labored breathing
Dyspnea
Rationale: The medical term for labored breathing is dyspnea.
14. 31631
Rationale: Look in the CPT® Index under Bronchoscopy/Stent Placement 31631, 31636-31637. The procedure
involves dilation of the trachea and stenting. The other codes referred to in the index are stenting and dilation of
the bronchus.
15. 32606
Rationale: Look in the CPT® Index under Thoracoscopy/Biopsy 32604, 32606, 32607-32609. The biopsy is taken
from the mediastinal space.
16. 31643
Rationale: Look in the CPT® Index under Bronchoscopy/Catheter Placement/Intracavitary Radioelement 31643. 17. 31000
Rationale: Look in the CPT® Index under Lavage/Maxillary Sinus 31000. CPT® copyright 2012 American Medical Association. All rights reserved.
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19
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
18. b. 31625, 31635, 934.9, 519.19
Rationale: In this case, two procedures are performed; biopsy of the bronchial lesion and removal of a foreign
body. Look in the CPT® Index under Bronchoscopy/Biopsy 31625-31629, 31632-31633 and Bronchoscopy/Foreign
Body Removal 31635. The procedure planned is a laryngoscopy. Review of the description of the procedure reveals
the provider visualized the trachea and bronchi which is a bronchoscopy. The location of the biopsy dictates code
selection. There is one code to report removal of a foreign body via bronchoscopy. The exact location of the foreign
body is not specified but we know it is in the respiratory tract. In the Index to Diseases, look up Foreign Body/
entering through orifice/respiratory tract 934.9. For the next diagnosis, look up Lesion. There is not a subterm for
bronchi. Under organ or site NEC you are referred to see Disease, site. Under Disease/bronchi you are referred to
519.19. Verify in the Tabular List.
19. c. 30320, 932
Rationale: Look up Rhinotomy/Lateral 30118, 30320. The procedure is performed to remove a foreign body. In the
Index to Diseases, look up Foreign body/entering through orifice/nose (passage) 932. Verify in the Tabular List.
20. a. 32405, 77002, 162.3
Rationale: The procedure performed is a needle biopsy of a lung lesion using fluoroscopic guidance. In the CPT®
Index look up Biopsy/Lung/Needle 32405. A parenthetical note following 32405 instructs to report the radiologic
supervision and interpretation separately. The results of the biopsy confirm small cell carcinoma. In the Index
to Diseases, look up Carcinoma, small cell. The morphology code ending in 3 indicates this is a primary site
malignancy. In the neoplasm table, look up lung/upper lobe and in the primary column you are referred to 162.3.
Verify in the Tabular List.
21. d. 38700, 196.0, 145.3
Rationale: In the CPT® Index, look up Lymphadenectomy/Suprahyhoid 38700. The indication the cancer has
spread means the neoplasm of the lymph node is secondary to the primary site of the soft palate. In the neoplasm
table look up lymph, lymphatic/neck because the suprahyhoid is in the neck area and refer to the code in the
secondary column. The primary cancer is reported as an additional diagnosis. From the neoplasm table, look up
palate/soft. Verify the codes in the Tabular List. 22. a. 38525-50, 785.6, V10.3
Rationale: In the CPT® Index, look up Biopsy/Open 38500, 38510-38530. The location determines the correct
code. The procedure was performed on the axillary lymph nodes and is described as deep. Modifier 50 is
appended for a bilateral procedure. In the Index to Diseases, look up Lump and you are referred to Mass/lymph
nodes. Verify in the Tabular List.
23. c. $3040.23
Rationale: Refer to Addendum B from January 2013 on the CMS website at http://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html
to determine the payment rate. In the CPT® Index, look up Sinus/Sinuses/Endoscopic/Surgical. The partial
ethmoidectomy is reported with 31254 which is assigned SI T. The removal of the maxillary sinus is reported
with 31267 which is assigned SI T. Both procedures have a payment rate of $2026.82. The procedures are subject
to the multiple procedure reduction. The total payment rate (Medicare and patient responsibility is $3040.23
(2026.82+2026.82/2)). On the CPC-H exam, an excerpt from Addendum B is provided so you can answer
questions list this on the exam.
20
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
24. b. $4581.15
Rationale: Refer to Addendum B from January 2013 on the CMS website at http://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html to
determine the payment rate. In the CPT® Index, look up Lymphadenectomy/Cervical and Axillary. The cervical
procedure is reported with 38720 which is assigned SI T and $1820.00 payment rate. The superficial axillary
procedure is reported with 38740 which is assigned SI T and $3,671.15 payment rate. The procedure with the
highest payment rate is reimbursed 100% and the additional procedure is subject to the multiple reduction is paid
at 50%. The total payment rate according to Medicare is $4581.15 (3671.15+1820.00/2). On the CPC-H exam, an
excerpt from Addendum B is provided so you can answer questions list this on the exam.
25. a. $713.56
Rationale: Refer to Addendum B from January 2013 on the CMS website at http://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html to
determine the payment rate. In the CPT® Index, look up Biopsy/Mediastinum/Needle. The correct code is 32405.
The fluoroscopic guidance is reported separately with code 77002. Code 32405 is assigned SI T and payment rate
$713.56. Code 77002 is assigned SI N which means it is a packaged procedure and there is not a separate payment.
The total payment rate is $713.56 according to Medicare. On the CPC-H exam, an excerpt from Addendum B is
provided so you can answer questions list this on the exam.
Activity 15.1—Crossword Puzzle—Answers
1.
3.
B
R
E
A
2.
L O B E C T O M Y
P
5.
B
R
4.
I
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T
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L
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T H O R A C E N T E S
8.
H
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CPT® copyright 2012 American Medical Association. All rights reserved.
G
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21
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 15.2—Word Search—Answers
Using your CPT® book, find the correct codes in the grid for the clues below. Codes can go horizontally, vertically, and
diagonally in all eight directions.
9
6
4
0
6
5
2
3
6
6
7
1
3
5
1
0
3
1
3
9
2
5
4
0
1
5
5
1
1
4
0
0
4
5
6
0
2
2
7
0
2
2
3
3
0
0
3
1
0
3
5
3
4
2
1
0
8
3
0
4
6
5
3
3
1. Intranasal biopsy
2. Therapeutic injection into turbinates
3. Repair of nasal vestibular stenosis
4. Total intranasal ethmoidectomy
5. Epiglottidectomy
6. Indirect laryngoscopy with biopsy
7. Carinal reconstruction
8. Chemical pleurodesis
9. Tube thoracostomy with water seal
10. Total pneumonectomy
22
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 15.3—Respiratory Diagram—Answers
Label the sinuses.
b. Ethmoid air
cells (sinus)
d. Frontal sinus
c. Sphenoid
sinus
a. Maxillary
sinus
Illustration source: OptumInsight
a. Maxillary sinus
b. Ethmoid sinus
c. Sphenoid sinus
d. Frontal sinus
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 16 Class Exercises
Class Exercise 16.1
1. a. Coronary arteries
Rationale: The coronary arteries are the network of blood vessels carrying oxygen and nutrient-rich blood to the
heart.
2. b. Systemic
Rationale: Systemic circulation supplies nourishment to tissue located throughout the body, with the exception of
the heart and lungs.
3. d. SA node
Rationale: The sinoatrial (SA) node is located in the right atrium by the superior vena cava and it is the normal
pacemaker of the heart. It generates an impulse between 60-100 tipmer per minute.
4. c. Tricuspid
Rationale: The tricuspid valve is located between the right atrium and right ventricle
5. a. Epicardium
Rationale: The epicardium (or visceral pericardium) covers the heart’s surface and extends to the the great vessels.
Class Exercise 16.2
1. 428.21
Rationale: In the Index to Diseases look for Failure, failed/heart/systolic/acute directs you to 428.21.
Verify code in the Tabular List.
2. 426.12
Rationale: In the Index to Diseases look for Block/atrioventricular (AV)/Mobitz (incomplete)/type II directs you
to 426.12 Verify code in the Tabular List.
3. 394.0
Rationale: In the Index to Diseases look for Stenosis/mitral (valve) directs you to 394.0
Verify code in the Tabular List.
4. 779.82
Rationale: In the Index to Diseases look for Tachycardia/newborn directs you to code 779.82.
Verify code in the Tabular List.
24
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 746.86
Rationale: In the Index to Diseases look for Block/heart/congenital directs you to code 746.86.
Verify code in the Tabular List.
6. 427.5
Rationale: In the Index to Diseases look for Arrest, arrested/cardiac directs you to code 427.5.
Verify code in the Tabular List.
7. 404.91, 585.4
Rationale: In the Index to Diseases look for Hypertension, hypertensive/cardiorenal (disease)/heart failure/stage
I through stage IV or unspecified/Unspecified (column) directs you to code 404.91. In the Tabular List there is an
instructional note under each fifth digit listed. Under the fifth digit 1 the instructional note states, Use additional
code to identify the stage of chronic kidney disease (585.1-585.4, 585.9); report code 585.4 for CKD stage IV. The
type of heart failure is not known, so it is not reported.
8. 414.12
Rationale: In the Index to Diseases look for Dissection/artery, arterial/coronary directs you to 414.12. Verify code
in the Tabular List.
9. 427.31
Rationale: In the Index to Diseases look for Fibrillation/atrial (established) (paroxysmal) directs you to 427.31.
Verify code in the Tabular List.
10. 414.06
Rationale: In the Index to Diseases look for Arterisclerois, arteriosclerotic/coronary (artery)/native artery/of
transplanted heart directs you to code 414.06. Verify code in the Tabular List.
11. 164.1
Rationale: In the Index to Diseases look for Neoplasm/ Pericardium/Malignant/Primary (column) directs you to
164.1. Verify code in the Tabular List.
12. 424.0
Rationale: In the Index to Disesases look Barlows’ syndrom (meaning mitral valve prolapse) directs you to code
424.0. Verify code in the Tabular List.
13. 424.1
Rationale: In the Index to Diseases look for Stenosis/aortic (valve) directs you to 424.1.
Verify code in the Tabular List.
14. 428.31
Rationale: In the Index to Diseases look for Failure, failed/heart/diastolic/acute directs you to code 428.31.
Verify code in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
15. 424.0
Rationale: In the Index to Diseases look for Prolapse, prolapsed/mitral valve directs you to code 424.0. Verify
code in the Tabular List.
Class Exercise 16.3
1. 33228, 996.01, 426.13
Rationale: In the CPT® Index look for Pacemaker, Heart/Replacement/Pulse Generator directs you to codes
33227–33229. 33228 is the correct code to report for the dual chamber pacemaker. Two diagnosis codes are
reported. The first diagnosis code to report is the battery malfunction. In the Index to Diseases look for
Complication/pacemaker/cardiac directs you to code 996.01. The second diagnosis code to report is for the AV
block. In the Index to Diseases look for Block/atriventricular (AV)/Mobiz (incomplete)/type I (Wenckebach’s)
directs you to code 426.13. Verify codes in the Tabular List.
2. 33208, 427.0
Rationale: In the CPT® Index look for Pacemaker, Heart/Insertion directs you to codes 33206–33208. Code 33208
is correct for electrodes being placed in the both the atrium and ventricle. In the ICD-9-CM Index to Diseases
look for Tachycardia/paroxysmal/supraventricular directs you to code 427.0.
3. 33224, 996.04, 428.0
Rationale: In CPT® Index look for Pacemaker, Heart/Insertion/Electrode directs you to many sets of codes
33202–33203, 33216–33217, 33224–33225. When reviewing the codes, 33224 is correct to select for the left
ventricular lead and replacement of the exisiting generator with a new one. Two diagnosis codes are reported. The
first diagnosis code is for the malfunction of the dual cardioverter-defibrillator pulse generator. In the ICD-9-CM
Index to Diseases look for Complications/mechanical/ device/cardiac/automatic implantable defibrillator 996.04.
The second diagnosis code is for the CHF. In the Index to Diseases look for Failure, failed/heart/cogemstive
directs you to code 428.0.
Class Exercise 16.4
1. 34501, 443.9
Rationale: In the CPT® Index look for Valvuloplasty/Femoral Vein directs you to code 34501. In the Index to
Diseases look for Diseases/peripheral/vascular directs you to code 443.9.
2. 35875, 444.22
Rationale: In the CPT® Index look for Thrombectomy/Bypass Graft/Fistula directs you to code 35875–35876.
Code 35875 is correct since this is not a revison of the arterial graft. In the ICD-9-CM Index to Diseases look for
Thrombosis/femoral (vein)/artery directs you to code 444.22.
26
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
3. 33215, 996.01
Rationale: In the CPT® Index look for Repositioning/Electrode/Heart directs you to codes 33215, 33226. 33215
is correct to report for just the repositioning of the ventricular electrode; there was no removal, insertion and/or
replacement of an existing generator that was also performed to report 33226. In the Index to Diseases look for
Complications/mechanical/electrode NEC/cardiac directs you to code 996.01.
Class Exercise 16.5
1. 37220, 36140-59, 75710-59, 440.21
Rationale: The report states that images were taken for diagnostic angiogram and possible angioplasty. Code
37220 includes catheterizing the vessel, the angioplasty, and the imaging performed. In the CPT® Index look
for Angioplasty/Iliac Artery/Intraoperative. The diagnostic angiography was performed prior to the decision
for angioplasty; therefore, it is reported separately. The access from the left femoral artery is a nonselective
catheterization of the left external iliac. Report 36140-59 and 75710-59 for the left extremity angiogram with
modifier 59 to show them separate from 37220. In the CPT® Index look for Catheterization/Extremity Artery
36140. The Angiography look for Angiography/Leg Artery directs you to codes 73706, 75635, 75710-75716. 75710
is reported for the angiography performed on one leg. The diagnosis is 440.21 Arteriosclerosis of the extremity with
claudication. In the ICD-9-CM Index to Diseases look for Cluadication, intermittent/due to atherosclerosis directs
you to 440.21.
2. 36223-LT, 433.10
Rationale: The left common carotid artery is the first order off the aorta. In the CPT® Index look for
Catheterization/Carotid Artery directs you to codes 36100, 36221–36224, 36227–36228. Code 36223-LT is correct
for the catheter tip placed in the left common carotid artery and angiography was performed including the
extracranial carotid circulation and intracranial carotid circulation. In the ICD-9-CM Index to Diseases look for
Stenosis/artery NEC/carotid—see Narrowing/artery NEC/ carotid directs you to 433.1x. In the Tabular List the
fifth digit to select is 0 because there is no documentation of a cerebral infarction.
3. 37606, 442.81
Rationale: In the CPT® Index look for Ligation/Artery/Carotid direct you to codes 37600–37606, 61609–61612.
37606 is the correct code for ligation of the common carotid artery. In the ICD-9-CM Index to Diseases look for
Aneurysm/carotid artery (common) (external)/extracranial portion directs you to code 442.81.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 16 Questions
1. Localized dilation of an artery due to a congenital defect or weakness of the vessel wall.
2. Arterial, Venous, Pulmonary, Portal, Lymphatic
3. Oxygenated
4. The innominate artery
5. c. 33215, 996.01
Rationale: In the CPT® Index look for Repositioning/Electrode/Heart directs you to codes 33215, 33226. 33215
is correct to report for just the repositioning of the ventricular electrode; there was no removal, insertion and/or
replacement of an existing generator that was also performed to report 33226. In the ICD-9-CM Index to Diseases
look for Complications/mechanical/electrode NEC/cardiac directs you to code 996.01.
6. a. 36561, 36590, 996.74, 453.83, 185
Rationale: Two procedure codes are reported. The first procedure code is for the tunneled venous catheter that is
connected to a port. In the CPT® Index look for Central Venous Catheter Placement/Insertion/Central/Tunneled
with Port directs you to codes 36560–36561, 36556. Code 36561 is correct for the patient is over 5-years-old and
it is a tunneled catheter. The second procedure code is for the removal of Port-a-Cath device removed from the
left arm. In the CPT® Index look for Device/Venous Access/Removal directs you to code 36590. In the ICD-9-CM
index look for Complications/vascular/device, implant, or graft NEC directs you to code 996.74. Then look for
Thrombosis, thrombotic/upper extremity (acute) directs you to code 453.83. Look for Neoplasm/prostate (gland)/
Malignant/Primary (column) directs you to 185.
7. d. 93458, 794.39, 414.01 , V45.82
Rationale: In the CPT® Index look for Cardiac Catheterization/Left Heart/with Ventriculography directs
you to codes 93452, 93458–93459. 93458 is correct for the left and right coronary angiography and left heart
catheterization with ventriculography. A SPECT is a nuclear imaging test. The patient had an abnormal one. In
the ICD-9-CM Index to Diseases look for Findings, (abnormal), without diagnosis/function study/cardiac directs
you to code 794.30. In the Tabular List under category code 794 these set of codes include radioisotope: scans,
uptake studies, and scintiphotography. 794.39 is the correct code to report because we know the type of scan
performed; code 794.30 is for an unspecified scan. In the ICD-9-CM Index to Diseases look for Ateriosclerosis/
coronary/native artery directs you to code 414.01; because the patient does not have a history of a CABG. The
patient does have a stent, in the Index to Diseases look for Status (post)/angioplasty, percutaneous transluminal
coronary directs you to code V45.82.
8. 424.1
Rationale: In the Index to Diseaes look for Stenosis/aortic (valve) directs you to code 424.1.
Verify code in the Tabular List.
9. 428.0
Rationale: In the Index to Diseases look for Failure, failed/heart/congestive directs you to code 428.0.
Verify code in the Tabular List.
10. 424.0
Rationale: In the Index to Diseases look for Insufficiency, insufficient/mitral (valve) directs you to code 424.0.
Verify code in the Tabular List
28
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 16.1—Label Diagram—Answers
Use the illustration to label the parts of the heart, 1–12, as the blood circulates through.
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29
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 16.2—Word Search—Answers
Find the words in the grid. Words can go horizontally, vertically, and diagonally in all directions.
N
G
F
M
U
I
D
R
A
C
I
R
E
P
R
Y
O
V
K
F
T
W
R
T
R
N
Z
V
D
C
M
S
I
N
A
N
G
I
N
A
V
J
Z
A
J
O
I
R
S
G
G
K
X
N
P
L
J
R
F
D
T
H
M
T
R
N
T
V
D
V
X
D
G
M
L
C
F
W
Y
C
E
Y
C
M
L
I
P
M
C
K
E
O
T
N
O
R
V
Q
R
A
V
S
B
R
N
L
E
K
B
M
C
Q
O
C
R
E
T
R
X
N
O
L
Z
R
B
Z
A
A
I
L
Y
M
X
M
E
B
D
X
K
Y
N
R
R
U
D
Q
M
N
J
D
M
N
L
H
E
R
P
N
D
D
R
G
C
K
E
E
U
Z
E
E
L
E
Z
B
I
R
A
G
K
M
F
B
L
S
N
V
C
L
M
C
U
X
C
T
A
M
P
T
N
G
V
T
M
X
V
T
M
J
T
K
S
L
M
E
D
I
A
S
T
I
N
U
M
V
R
30
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 16.3—Word Scramble—Answers
Read each question or statement and then arrange the letters in each row to find the answer.
1. Can be implanted temporarily or permanently in patients with conduction disorders.
Pacemaker
2. Involves inserting a catheter with a cutting device into a narrow blood vessel to enlarge the lumen by mechanical
removal of the intima and plaque material.
Atherectomy
3. This procedure is used to withdraw harmful substances such as circulate immune complexes (CIC) from the
patient’s peripheral blood.
Therapeutic apheresis
4. This is considered one of the primary lymphoid organs.
Bone marrow
5. These are thick, high pressure vessels that accommodate blood pumped out from the heart.
Arteries
6. The upper chambers of the heart (atria) are also called the:
Holding tanks
CPT® copyright 2012 American Medical Association. All rights reserved.
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31
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 17 Class Exercises
Class Exercise 17.1
1. b. Right upper quadrant
Rationale: The gallbladder is located in the right upper quadrant of the digestive area.
2. b. Liver
Rationale: Bile is produced by the liver and aids in the digestive process.
3. a. Cardia, fundus, body, and antrum
Rationale: The stomach has four sections: Cardia, fundus, body and antrum that plays a large part in the
secondary digestion process.
4. b. Opening into the duodenum
Rationale: The pyloric sphincter is the opening between the stomach and duodenum.
5. d. Cholecystotomy
Rationale: The root word cholecyst means gallbladder and the suffix ectomy means excision or surgical removal.
Class Exercise 17.2
1. 550.92
Rationale: Look in the Index to Diseases for Hernia/inguinal 550.9X. Go to the Tabular List for the fifth digit 2 =
bilateral
2. 550.90
Rationale: Look in the Index to Diseases for Hernia/inguinal you will see (sliding) 550.9X. Go to the Tabular List
for the 5th digit “0.”
3. 552.29
Rationale: Look in the Index to Diseases for Hernia/spigelian/with/obstruction 552.59. Verify in the Tabular List.
4. 756.72
Rationale: Look in the Index to Diseases for Omphalocele 756.72. Verify the code in the Tabular List.
5. 553.00
Rationale: Look in the Index to Diseases for Hernia/femoral (unilateral) 553.00. Verify in the Tabular List.
32
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
6. 455.0
Rationale: Look in the Index to Diseases for Hemorrhoids/internal 455.0 Verify code in the Tabular List.
7. 575.10
Rationale: Look in the Index to Diseases for Cholecystitis 575.10. Verify code in the Tabular List.
8. 530.81
Rationale: GERD is the acronym for gastroesophageal reflux disease. In the Index to Diseases look for Disease,
diseased/gastroesophageal reflux (GERD) 530.81. Verify code in the Tabular List.
9. 211.3
Rationale: In the Index to Diseases look for Polyp, polypus/colon 211.3. Verify code in the Tabular List.
10. 577.0
Rationale: In the Index to Diseases look for Pancreatitis 577.0. Verify code in the Tabular List.
Class Exercise 17.3
1. 42821
Rationale: Look in the CPT® Index for Tonsillectomy 42820–42826. Check the range of codes and you will see
42821 Tonsillectomy and adenoidectomy; age 12 and over.
2. 42220, 42826
Rationale: Look in the CPT® Index for Palatoplasty 42145, 42200–42225. Check the range of codes and you
will see 42220 Palatoplasty for cleft palate; secondary lengthening procedure. Look in the CPT® Index for
Tonsillectomy 42820–42826. Check the range of codes and you will see 42821 Tonsillectomy and adenoidectomy;
age 12 and over.
3. 43456
Rationale: Look in CPT® Index for Esophagus/Dilation 43450–43458. This is a retrograde dilation, which means
that the patient must have a gastrostomy. Check the range and you will see 43456 Dilation of esophagus, by balloon
or dilator, retrograde.
4. 43220
Rationale: Look in the CPT® Index for Endoscopy/Esophagus/Dilation 43220, 43226, 43248–43249. Check the
range of codes and you will see that 43220 Eosphagoscopy, rigid or flexible; with balloon dilation (less than 30 mm
diameter) is the correct code.
CPT® copyright 2012 American Medical Association. All rights reserved.
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33
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 45380
Rationale: Look in the CPT® Index for Colonoscopy/Proximal to Splenic Flexure/with Biopsy and you are
directed to 45380, 45392. 45392 includes transendoscopic ultrasound guidance which was not performed making
45380 the correct code. There is also a code for control of bleeding (45382); however, this is only to be reported if
the bleeding occurs spontaneously or as a result of traumatic injury. When the bleeding is due to the biopsy, this
code is not reported separately.
6. 74249
Rationale: Look in the CPT® Index for X-Ray/Intestines, Small and you are given range 74245, 74249–74251.
Check the range of codes and you will see 74249 is correct for the barium and double contrast and with small
intestine.
7. 74328
Rationale: The acronym ERCP stands for endoscopic retrograde cholangiography. You are being asked for
the radiologic code for the ERCP, not the procedure code. In the CPT® Index look for Endoscopy/Bile Duct/
Catheterization 74328, 74330. 74328 is the correct code for the biliary ductal system only.
Class Exercise 17.4
1. 43251
Rationale: EGD is the acronym for esophagogastroduodenoscopy; also known as an upper gastrointestinal
endoscopy, examining the esophagus, stomach and duodenum. Look in the CPT® Index for Endoscopy/
Gastrointestinal/Upper/Removal 43247, 43250–43251. Check the range of codes and 43251 is for removal of
polyps by snare technique.
2. 46250
Rationale: Find in your CPT® Index look for Hemorrhoids/Excision—See Hemorrhoidectomy.
Hemorrhoidectomy/External 46250. 3. 42700
Rationale: Look in the CPT® Index for Incision and Drainage/Abscess/Tonsil 42700.
4. 43249
Rationale: EGD is the acronym for esophagogastroduodenoscopy; also known as an upper gastrointestinal
endoscopy. Look in the CPT® Index for Endoscopy/Gastrointestinal/Upper/Dilation 43245, 43248–43249. 43249 is
correct for balloon dilation of esophagus less than 30mm diameter.
34
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 17 Questions
1. c. 46288, 565.1
Rationale: In the CPT® Index look for Fistula/Anal 46288. In the ICD-9-CM Index look for Fistula/anus, anal
(inflectional) (recurrent) 565.1.
2. a. 15830, 278.1
Rationale: In the CPT® Index look for Excision/Skin/Excess 15830, 15832–15839, 15847. Reviewing the code range
code 15830 is correct for removing excessive skin formthe abdominal area. In the ICD-9-CM Index to Diseases
look for Adiposity/localized 278.1.
3. d. 49402-78
Rationale: In the CPT® Index look for Foreign Body Removal/Peritoneal Cavity 49402. Modifier 78 is the correct
modifier to append because the patient had an uplanned return to surgery during the postoperative period to
perform a procedure that is related to the initial procedure and is being performed by the same surgeon.
4. d. 45385, 211.3
Rationale: In the CPT® look for Colonoscopy/Proximal to Splenic Flexure/with Removal/Polyp 45384–45385.
45385 is correct because the polyps were removed by snare technique. In the ICD-9-CM Index to Diseases look for
Polyp, polypus/colon 211.3.
5. c. 43239, 535.00, 535.10
Rationale: Inthe CPT® Index look for Endoscopy/Gastrointestestinal/Upper/ Biopsy 43239. According to
ICD-9-CM coding guideline, Section I.B.10, If the same condition is described as both acute (subacute) and
chronic, and separate subentries exist in the Alphabetical Index at the same indentation level, code both and
sequence the acute (subacute) code first. In the ICD-9-CM Index to Diseases look for Gastritis/acute 535.5x
and then chronic 535.1x; the fifth digit for both codes is 0 because there is no documentation that supports
hemorraghe.
6. a. 44180, 568.0
Rationale: In the CPT® Index look for Adhesions/Intestinal/Enterolysis/ Laparoscopic 44180. In the ICD-9-CM
Index to Diseases look for Adhesion(s), adhesive/intestine 568.0.
7. b. 381.10, 474.12, 42830, 69436
Rationale: In the ICD-9-CM Index to Diseases look for Otitis/media/chronic/serous (simple) 380.10;
Hypertrophy, hypertrophic/ adenoids 474.12. In the CPT® Index look for Adenoidectomy—See Adenoids,
Excision; Excision/Adenoids 42820–42821, 42830–42831, 42835–42836. Reviewing the codes, 42830 is correct for
the removal of only the adenoids and the patient being under 12-years-old. Look for Ventilating Tube/Insertion
69433. When you review 69433 code descripition it is reported for local or topical anesthesia. The question has
general anesthesia, looking at 69436 is the correct code to report.
8. d. 46916, 078.11
Rationale: In the CPT® Index look for Anus/Lesion/Destruction 46900–46917, 46924. When reviewing the
range of codes, 46916 is the correct code for the removal of the condylomas being removed by liquid nitrogen
(cryosurgery). In the ICD-9-CM Index to Diseases look for Condyloma NEC 078.11.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
9. a. 40820, 528.2
Rationale: In the CPT® Index look for Lesion/Mouth/Vestibule/Destruction 40820. In the ICD-9-CM Index to
Diseases look for Aphthae, aphthous/oral 528.2. Verify code selection in the Tabular List.
10. a. 43450-74, 530.3
Rationale: In the CPT® Index look for Esophagus/Dilation 43450, 43453, 43456, 43458. 43456 is correct for the dilation of the esophagus by dilator. Modifier 74 is correct to append to indicate the procedure was not performed due to an
extenuating circumstance after giving anesthesia in an ASC setting. In the Index to Diseases look for Stricture/esophagus (corrosive) (peptic) 530.3.
Match the type of hernia to its description:
11. c Femoral
a. Protruding properitoneal fat
12. d Omphalocele
b. Protrusion occurs at the incision site following abdominal surgery
13. e Spigelian
c. Wall of the peritoneal organ protrudes to form a portion of the hernial sac
14. a Ventral
d. Intestine protrudes along the femoral canals
15. b Sliding inguinal
e. Contents protrude into the base of the umbilical cord (congenital)
16. 43205, 456.0, 571.5
Rationale: In the CPT® Index look for Esophageal Varices/Ligation 43205, 43244, 43400. Code 43205 is the
correct code to report for endoscopic band ligation for esophageal varices. In the ICD-9-CM Index to Diseases
look for Varix/esophagus (ulcerated)/bleeding 456.0. Look for Cirrhosis, cirrhotic/liver 571.5. Hematemesis is not
coded because that is a sign/symptom of the esophageal varices.
17. 46230, 455.9
Rationale: In the CPT® Index look for Anus/Excision/Tag 46220, 46230. 46230 is correct to report because more
than on tag was removed. In the ICD-9-CM Index to Diseases look for Tag/hemorrhoidal 455.9.
18. 43450, 530.3
Rationale: In the CPT® Index to Diseases look for Esophagus/Dilation 43450, 43453, 43456, 43458. 43450 is
correct for unguided dilator. In the ICD-9-CM Index to Diseases look for Stricture/esophagus (corrosive) (peptic)
530.3.
19. 49561-50, 49568, 552.21
Rationale: In the CPT® Index look for Hernia Repair/Incisional/Initial/ Incarcertated 49561. Look for Hernia
Repair/Incisional/Implantation, Mesh or Prosthesis 49568. Modifier 50 is correct to append because there were
bilateral hernias that were repaired. In the ICD-9-CM Index to Diseases look for Hernia, hernial/incisional/
obstruction 552.21.
20. 46250, 455.4
Rationale: In the CPT® Index look for Hemorrhoidectomy/External Complete 46250. In the ICD-9-CM Index to
Diseases look for Hemorrhoids/thrombosed NEC/external 455.4
36
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
21. 45384, 211.3
Rationale: In the CPT® Index look for Colonoscopy/Proximal to Splenic Flexure/ with Removal/Polyp 45384–
45385. 45384 is correct for the polyps removed by hot biopsy. In the ICD-9-CM Index to Diseases look for Polyp,
polypus/colon 211.3.
22. 43450, 787.20
Rationale: In the CPT® Index look for Esophagus/Dilation 43450, 43453, 43456, 43458. 43450 is correct for the
esophagus dilation is performed by bougie. ICD-9-CM Index to Diseases look for Dysphagia 787.20.
23. 43239, 535.00
Rationale: In the CPT® Index look for Endoscopy/Gastrointestinal/Upper/Biopsy 43239 (endoscope examined
the esophagus, stomach and duodenum and stomach was biopsied). In the ICD-9-CM Index to Diseases look for
Gastritis/acute 535.0x; fifth digit is 0 because there is no documentation that supports a hemorrhage.
24. 42821, 474.10
Rationale: In the CPT® Index look for Adenoids/Excision/with Tonsils 42820–42821. Review the codes, 42821
is correct for removal of both tonsils and adenoids for a 27-year-old patient. In the ICD-9-CM Index to Diseases
look for Hypertrophy, hypertrophic/adenoids (inflectional)/and tonsils 474.10.
25. 45380, 558.9
Rationale: This is a colonoscopy because the scope entered the anal orfice. In the CPT® Index look for
Colonoscopy/Proximal to Splenic Flexure/with Biopsy 45380, 45392. 45380 is correct because the biopsies were
not taken with transendoscopic ultrasound. In the ICD-9-CM Index to Diseases look for Colitis (acute) 558.9.
Ulcerative colitis is not reported because it is suspected.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 17.1—Matching—Answers
Match the CPT® code with the correct description by drawing a line to the corresponding letter.
38
CPT® Code
Description
1. 43239
a. Flexible sigmoidoscopy with endoscopic ultrasound examination
2. 44100
b. Introduction of long gastrointestinal tube (eg, Miller-Abbott)
3. 44397
c. Excision of single external papilla or tag, anus
4. 45341
d. EGD with biopsy
5. 47011
e. Biopsy of intestine by capsule, tube, peroral (1 or more specimens)
6. 48511
f. P
ercutaneous biliary duct stone extraction via T-tube tract, basket, or
snare (eg, Burhenne technique)
7. 47630
g. Percutaneous external drainage of pseudocyst of pancreas
8. 46220
h. Percutaneous drainage of abscess or cyst, 1 or 2 stages
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 17.2—Word Search—Answers
Find the words in the grid. Words can go horizontally, vertically, and diagonally in all directions.
C Q D R L Y C T L K Q Z P L F T N C
A P N T K Y
L T T
J
P K E F L M G A
I F N T Z B
X C R
J
L F X A L K Z
R Q N M J
D M M H L T
N K C T L V M X N J
L Y Y Z G C L N
O N L A N I
T H G I
H L D L G V U R B N D B Y P
C T M N M I
O G D K N Y U N N G L
P B
B A F T G X L Q H R P X P Z U P
Y F
L L M P
Z W P L P T G L L
H Y
P O G A
S T R
T T X G B N W Q R M T A R U F R A T
F P
E M B Z C R
L V R M F C M H B Q M P R H P N A I
W R Q H M K
I
G G M G W T M C X G L Y R
Z M Q I Q I
U G N I
Z N N L K D
R R E O
J
Z F H
Z M I K M C T R L K T C
P H L Q W L
J
I
I
J N K N L O
J M Y
C S L D Q P B H
K X G C H M N R H
F P D N G I K V H B Z G
F C Y T H E F L L Y X R
Review the nine regions of the abdomen. Locate each region within the grid.
The nine regions are: epigastric, umbilical, hypogastric, right hypochondriac, left hypochondriac, right lumbar, left
lumbar, right inguinal, and left inguinal.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 18 Class Exercises
Class Exercise 18.1
1. c. Bladder
Rationale: The bladder is a hollow, muscular, expandable organ collecting urine.
2. a. Scrotum
Rationale: The scrotum holds the testicles outside the body.
3. c. Urethra
Rationale: At the time of urination, the bladder muscles will tighten and squeeze urine form the bladder into the
urethra. The urethra is the outlet for urine to exit the body.
4. d. Vas deferens
Rationale: The vas deferens is a muscular tube that transports semen from the epididymis into the pelvis.
5. a. Prepuce
Rationale: Prepuce (foreskin) is surgically removed during circumcision.
Class Exercise 18.2
1. 590.2
Rationale: Look in the Index to Diseases for Abscess/renal (see also Abscess, kidney) 590.2. Verify in the Tabular List.
2. 753.12
Rationale: Look in the Index to Diseases for Disease/polycystic (congenital)/kidney or renal 753.12.
Verify in the Tabular List.
3. 131.03
Rationale: Look in the Index to Diseases for Trichomoniases/prostate 131.03.
4. V42.0
Rationale: Look in the Index to Diseases for Status/transplant/kidney V42.0. Verify in the Tabular List.
5. 592.0
Rationale: Look in the Index to Diseases for Calculus/kidney 592.0. Verify in the Tabular List.
40
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
6. 185
Rationale: Look in the Index to Diseases for Neoplasm/prostate (gland)/Malignant/Primary (column) 185. Verify
in the Tabular List.
7. 593.5
Rationale: Look in the Index to Diseases for Hydroureter 593.5. Verify in the Tabular List.
8. 753.0
Rationale: Look in the Index to Diseases for Absence/kidney(s)/congenital 753.0. Verify in the Tabular List.
9. 588.1
Rationale: Look in the Index to Diseases for Diabetes/insipidus/nephrogenic 588.1. Verify in the Tabular List.
10. 403.00, 585.9
Rationale: Look in the Index to Diseases for Nephrosclerosis and you are referred to see also Hypertension,
kidney 403.90. Look in the Hypertension Table for Hypertension/with/chronic kidney disease/stage 1 through
stage IV or unspecified. Go to Column Malignant 403.00. Check the Tabular List and you are instructed to code
the type of renal failure. From the Index to Diseases look up Failure/renal/chronic 585.9. Verify in the Tabular
List.
Class Exercise 18.3
1. 50945, 592.1
Rationale: CPT®: Look in the CPT® Index for Ureterolithotomy/Laparoscopy 50945. Verify in the listing.
ICD-9-CM: Look in the Index to Diseases for Calculus/ureter 592.1. Verify in the Tabular List.
2. 50394, 74425, 593.72
Rationale: CPT®: Look in the CPT® Index for Pyelography/Injection 50394. Also see Pyelography 74400, 74425. Look at the listing for 50394 and you will see the parenthetical note to use 74425 for radiological supervision and
interpretation. The facility services are reported on a UB 04; therefore, modifier TC is not necessary.
ICD-9-CM: Look in the Index to Diseases for Reflux/vesicoureteral/with/reflux nephropathy/bilateral 593.72.
3. 50080, 76000, 592.0
Rationale: CPT®: Look in the CPT® Index for Kidney/Removal/Calculus and you are referred to a range of codes.
Review the codes in the listing, code 50080 reports removal of a stone up to 2 cm percutaneously (needle). There is
a parenthetical note that directs you to report 76000, 76001 for fluoroscopic guidance. Code 76000 is used because
there is no mention of fluoroscopy time.
ICD-9-CM: Look in the Index to Diseases for Calculus/kidney 592.0.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
4. 50081, 76000, 592.0
Rationale: CPT®: Look in the CPT® Index for Nephrostolithotomy/Percutaneous 50080–50081. 50081 is correct
because the stone removed was over 2 cm.
ICD-9-CM: Look in the Index to Diseases for Calculus/kidney 592.0.
5. 55700, 76942, 592.0
Rationale: CPT®: Look in the CPT® Index for Prostate/Biopsy 55700–55706. 55700 is the correct because needle
biopsy was performed with out transperineal, stereotactic template. There is a parenthetical note under code
55700 that instructs if imaging guidance is performed, use 76942. Ultrasound guidance is used, code 76942 is
reported.
ICD-9-CM: In the Index to Diseases look for Elevation/prostate specific antigen (PSA) 790.93.
Answers for Chapter 18 Questions
1. 52601, 600.91, 788.20, 598.9, 596.0 Rationale: Look in the CPT® Index for TURP and you are directed to see Prostatectomy, Transurethral.
Prostatectomy/Transurethral directs you to see 52601, 52630. 52630 sepcifies residual or regrowth of obstructive
prostate tissue which is not mentioned in this scenario. 52601 includes the meatotomy and dilation. BPH stands
for benign prostatic hyperplasia. Look in the ICD-9-CM Index to Diseases for Hyperplasia/prostate/with urinary
retention 600.91. In the Tabular List, there is a note to use an additional code of 788.20 for urinary retention. In
the Index to Diseases, Stenosis/urethra 598.9. The vesical neck is the bladder neck. Look in the Index to Diseases
for Stenosis/bladder neck 596.0. Verify code selection in the Tabular List.
2. d. 51702, 788.20
Rationale: Look in the CPT® Index for Insertion/Catheter/Bladder and you are directed to 51045, 51701–51703.
Looking at the descriptions, 51702 is for a Foley Catheter. Look in the ICD-9-CM Index to Diseases for Retention/
urine NEC 788.20. Verify code selection in the Tabular List.
3. b. 52260, 595.1
Rationale: Look in the CPT® Index for Cystourethroscopy/Dilation/Bladder and you are directed to 52260, 52265.
52265 is for local anesthesia. The scenario states general anesthesia so 52260 is reported. Look in the Index to
Diseases for Cystitis/chronic/interstitial 595.1.
4. c. 53852, 600.20
Rationale: Look in the CPT® Index for Prostate/Destruction/Thermotherapy/Radio Frequency 53852. Look in the
ICD-9-CM Index to Diseases for Adenoma/prostate (benign) 600.20. Verfiy code selection in the Tabular List.
5. a. 54150
Rationale: Look in the CPT® Index for Circumcision/Surgical Excision/Neonate 54150, 54160. Because a device is
used, 54150 is the correct code. The nerve block is included in 54150 and is not reported separately.
42
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
6. b. 52000, 55700
Rationale: In the CPT® Index look for Index for Prostate/Biopsy 55700–55706. 55700 is correct for percutaneous
(needle) biopsy. The cystoscopy code can be reported because it is not bundled in the prostate biopsy.
7. c. 52240
Rationale: In CPT® Index look for Fulguration/Cystourethroscopy with/Tumor 52234–52235, 52240, 52250.
52240 is correct because it was a large bladder tumor. Cystourethroscopy, 52000, is not reported because it is an
integral component of code 52240.
8. c. 55040, 55250
Rationale: In the CPT® Index look for Vasectomy 55250. Look for Hydrocele/ Excision/Unilateral/Tunica
Vaginalis 55040.
For questions 9–12, match the term to the definition.
9. c Dilation
a. Surgical formation of an opening into the urinary bladder
10. d Lithotripsy
b. Surgical cutting of obstructive adhesions affixed to the urethra
11. b Urethrolysis
c. Stretching of body tube
12. a Cystostomy
d. Crushing of a calculus
13. 52005, 591
Rationale: In the CPT® Index look for Catheterization/Ureter/Endoscopic directs you to a range of codes. Review
the codes, 52005 is correct because it is a cystourethroscopy (cystoscopy) with ureteral catheterization. In the
ICD-9-CM Index to Disesases look for Hydronephrosis 591.
14. 50543, 593.9
Rationale: In the CPT® Index look for Nephrectomy/Partial/Laparoscopic 50543. In the ICD-9-CM Index to
Diseases look for Mass/kidney (see also Disease, kidney) 593.9.
15. 52320, 52282, 592.1
Rationale: In the CPT® Index look for Cystourethroscopy/Removal/Calculus directs you to range of codes. 52320
is correct because a ureteral calculus was removed by a cystouretheroscope. In the CPT® Index look for Stent/
Indwelling/Insertion/Ureter 50605, 52282, 53855. 52282 is correct because the urethral stent was placed by a
cystourethroscope. In the ICD-9-CM Index to Diseases look for Calculus/ureter 592.1 16. 52235, 239.4, 595.82, E879.2
Rationale: In CPT® Index look for Bladder/Tumor/Resection 52234–52240. 52235 is correct because the size of
the tumor was 2.1cm. In the ICD-9-CM Index to Diseases look for Tumor—see also Neoplasm, by site, unspecified
nature; Neoplasm/bladder (urinary)/Unspecified (column) 239.4. Look for Cystitis/radiation 595.82. In the
Tabular List there is an instructional note under code 595.82, Use additional E code to identify cause. In the Index
to External Causes look for Radiation/abnormal reaction to medical test or therapy E8972.
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43
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
17. 52601
Rationale: Look in the CPT® Index for Prostate/Excision Transurethral 52402, 52601, 52630. 52601 is correct
because its code description lists all the elements in the question. 18. 54640, 608.23
Rationale: In the CPT® Index look for Orchiopexy/Inguianl Approach 54640. In the ICD-9-CM Index to Diseases
look for Torsion/appendix/testis 608.23.
19. 54056, 222.1
Rationale: In the CPT® Index look for Lesion/Penis/Destruction/Cryosurgery 54056. In the CPT® Index look for
Papilloma—see also Neoplasm, by site, benign; Neoplasm/penis/Benign (column) 222.1
Match the term to the definition.
20. c Nephrostomy a. Removal of a calculus from the kidney through a surgically created passageway
between the skin and the pelvis of the kidney
21. f Vesicourethropexy
b. Surgical opening into the kidney to remove a stone or calculus
22. d Urethropexy c. Surgically created passageway between the kidney and the skin
23. a Pyelostolithotomy
d.Surgical fixation of the urethra
24. b Nephrolithotomy e. Surgical reconstruction or revision of the renal pelvis to drain and decompress
the kidney
25. e Pyeloplasty f. Surgical fixation of the bladder and the urethra
44
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 18.1—Word Search—Answers
Find the words in the grid. When you are done, the unused letters in the grid will spell out a hidden message. Pick them
out from left to right, top line to bottom line. Words can go horizontally, vertically, and diagonally in all directions.
C
Y
S
T
O
S
C
O
P
Y
U
R
Y
I
T
X
N
A
R
Y
S
Y
Y
S
T
E
M
Y
R
E
N
M
N
X
N
S
T
K
L
L
O
T
I
P
E
L
B
H
H
P
R
H
X
P
T
S
G
O
P
X
G
M
Z
I
T
K
Y
Y
S
A
O
R
H
G
D
Z
G
R
K
E
X
H
O
L
N
H
R
H
T
T
C
T
L
I
H
G
R
P
E
T
E
M
Q
K
X
O
T
P
D
E
H
O
M
E
C
Z
R
Z
S
H
M
R
D
N
P
L
U
R
T
K
K
T
L
T
Y
D
K
J
E
E
S
U
O
H
O
N
N
I
A
P
B
K
N
Y
C
W
M
M
M
Y
F
L
D
N
D
K
N
P
L
L
Y
K
Y
H
B
K
J
F
C
L
F
V
E
V
E
S
I
C
A
L
N
E
C
K
N
Y
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 18.2—Matching CPT® Codes—Answers
Match the code with the correct description by drawing a line to the corresponding letter.
CPT® Code
Description
1. 50021
a. Insertion of tandem cuff
2. 52450
b. Percutaneous drainage of perirenal or renal abscess
3. 53444
c. Complete TURP
4. 51880
d. Transurethral incision of prostate
5. 51100
e. Aspiration of bladder by needle
6. 52601
f. Drainage of Skene’s gland abscess
7. 50686
g. Closure of cystostomy
8. 53060
h. Manometric studies through ureterostomy or indwelling ureteral catheter
46
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 19 Class Exercises
Class Exercise 19.1
1. c. Uterus
Rationale: Root words metr/o and metri/o mean “uterus.”
2. b. Skene’s glands
Rationale: Bartholin’s glands (also called the greater vestibular glands) are located slightly inferior and to either
side of the vaginal introitus. Skene’s glands (also called the lesser vestibular glands, or paraurethral glands) are
located on the anterior wall of the vagina around the lower end of the urethra.
3. b. An oocyte or egg
Rationale: The fimbriae, or fingers, near the ovaries, help capture the ovum (egg or oocyte) at ovulation as they
make their way into the tubes, and to the uterus. 4. a. Opening in the cervix
Rationale: The opening in the cervix communicates with the vagina and is known as the os or external os.
5. d. Vagina
Rationale: The vagina is a tubular, muscular canal leading from the uterus to outside the body.
Class Exercise 19.2
1. V25.2
Rationale: Look in the ICD-9-CM Index to Diseases for Sterilization, admission for V25.2. Verify in the Tabular List.
2. 174.3
Rationale: Look in the Neoplasm Table for breast/lower-inner quadrant. Verify in the Tabular List.
3. 633.01
Rationale: Look in the ICD-9-CM Index to Diseases for Pregnancy/abdominal/with intrauterine pregnancy
633.01. Verify in the Tabular List.
4. 642.13
Rationale: Look in the ICD-9-CM Index to Diseases for Pregnancy/complicated (by)/renal disease or failure/with
secondary hypertension 642.1x. Look in the Tabular List for the 5th digit. A 5th digit of 3 indicates an antepartum
condition.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 646.83
Rationale: Look in the ICD-9-CM Index to Diseases for Pregnancy/complicated (by)/fatigue 646.8x. Look in the
Tabular List for the 5th digit. A 5th digit of 3 indicates an antepartum condition.
6. 789.03
Rationale: Look in ICD-9-CM Index to Diseases for Pain/abdominal, 789.0x. Look in the Tabular List for the 5th
digit. A 5th digit of 3 indicates the RLQ (right lower quadrant). The correct code is 789.03.
7. 668.10
Rationale: Look in the ICD-9-CM Index to Diseases for Arrest/cardiac/complicating/anesthesia/obstetric 668.1x.
Look in the Tabular List to verify this is used for cardiac arrest following anesthesia in labor and delivery. A 5th
digit of 0 is assigned because the episode of care is not specified.
8. 671.44, 453.40
Rationale: Look in the ICD-9-CM Index to Diseases for Clot (blood)/vein and you are directed to see also
Thrombosis. Look for Thrombosis, thrombotic/puerperal, postpartum, childbirth/deep (vein) and you are
directed to 671.4x. In the Tabular List, 5th digit 4 indicates it is postpartum. You are also directed to use an
additional code to identify the deep vein thrombosis. Look in the ICD-9-CM Index to Diseases for Thrombosis,
thrombotic/vein/deep and you are directed to 453.40. Verify in the Tabular List.
Class Exercise 19.3
1. b. Surgical repair of the vagina
Rationale: Colporrhaphy is the surgical repair of the vagina. The “-rrhaphy” part of the word comes from the
Greek “raphe” meaning suture. The enterocele sac is cut and constricted; the uterosacral ligaments and endopelvic
fascia are brought into surgical proximity—approximating—of the rectum.
2. b. Most hysteroscopies
Rationale: While most hysterscopies are allowed as outpatient in a hospital, they are not covered in an ASC. Most
abdominal hysterectomies are considered inpatient only procedures.
3. d. 57288
Rationale: If the tendons supporting the urethra have been stretched, an additional procedure may be needed to
create a sling to support the urethra (coded from the vagina section if performed transvaginally [57288].
4. b. 57461
Rationale: Loop excision is also referred to as loop electrosurgical excision procedure, or LEEP (57522, or
57461 colposcopically). When performing a LEEP, the physician will use a loop electrode to remove a portion
of the cervix. The procedure is both a biopsy and a treatment for dysplasia following an abnormal Pap smear.
Documentation should indicate whether a colposcopy is used. Documentation of LEEP alone is insufficient to
assign a code.
5. c. 58100
Rationale: Endometrial biopsy is sampling of the endometrial lining. Code 58100 reports an endometrial biopsy
without dilation.
48
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 19 Questions
1. d. 59821, 632
Rationale: The 18th week of gestation indicates the second trimester. Look in the CPT® Index for Abortion/
Missed/Second Trimester and you are directed to 59821. For the diagnosis, look in the ICD-9-CM Index to
Diseases for Abortion/missed and you are directed to 632. The notes under 632 verify this is the correct code.
2. d. 58554
Rationale: Look in the CPT® Index for Hysterectomy/Vaginal/Removal Tubes/Ovaries and you are directed to
58262–58263, 58291–58292, 58552, 58554. The uterus is 325 g, and the procedure is laparoscopic making the range
58553–58554. The bilateral salpingo-oophorectomy indicates removal of ovaries and fallopian tubes, making
58554 the correct code. Because the description has tube(s) and ovary(s), a modifier 50 is not used to indicate a
bilateral procedure.
3. d. 99283, 58301
Rationale: The provider performed both a mid-level ED visit and the removal of the intrauterine device (IUD).
Mid-level ED visit is coded with 99283. For the removal of the IUD, look in the CPT® Index for Removal/
Intrauterine Device (IUD) and you are directed to 58301. 4. b. 57065
Rationale: Look in the CPT® Index for Destruction/Lesion/Vagina/Extensive and you are directed to 57065. 5. c. 58558, 626.2, 618.01
Rationale: Look in the CPT® Index for Hysterscopy/Surgical with Biopsy and you are directed to 58558. Looking
at the description of 58558, it includes with or without D&C. For the diagnosis, look in the ICD-9-CM Index
to Diseases for Menorrhagia (primary) and you are directed to 626.2. Then look for Cystocele/female/midline
and you are directed to 618.01. In the Tabular List, category 618 states, “Use additional code to identify urinary
incontinence…” however, there is no mention of urinary incontinence so this is not coded.
6. b. 57513, 233.1
Rationale: Look in the CPT® Index for Cervix/Cauterization/Laser Ablation and you are directed to 57513. Look
in the ICD-9-CM Index to Diseases for Dysplasia/cervix (uteri)/CIN III and you are directed to 233.1.
7. b. 58670
Rationale: Look in the CPT® Index for Tubal Ligation/Laparoscopic and you are directed to 58670. 8. c. 57022, 665.74
Rationale: Look in the CPT® Index for Hematoma/Vagina/Incision and Drainage and you are directed to 5702257023. This is a pospartum patient indicating 57022 is the correct code. Look in the ICD-9-CM Index to Diseases
for Hematoma/vagina/complicating delivery (remember, pregnancy covers the pospartum period) and you are
directed to 665.7x. In the Tabular List, a fifth digit of 4 indicates a postpartum condition or complication. The
correct ICD-9-CM code is 665.74.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
9. d. $261.92
Rationale: 99283 has a status indicator of V and a payment rate of $143.36. Status indicator V indicates this is
paid under OPPS at a separate APC payemnt. 58301 has a status indicator of T and a payment rate of $118.56.
T indicates a significant procedure where multiple procedure reduction applies. This is the only procedure
performed, so there is no reduction. $143.36 + $118.56 = $261.92
10. 57288, 625.6
Rationale: Transobturator tape operation is a sling operation. Look in the CPT® Index for Sling Operation/Vagina
and you are directed to 57287–57288. This was a sling operation for stress incontenance making 57288 the correct
code. For the diagnosis, look in the ICD-9-CM Index to Diseases for Incontinence/stress (female) and you are
directed to 625.6. Verification in the Tabular list confirms code selection.
For questions 11–15, match the eponym to the appropriate description.
11. c Down syndrome
(John Langdon Haydon Down)
12. e Zellweger syndrome
(Hans Zellweger)
13. b Hurler syndrome
(Gertrude Hurler)
14. a Asperger’s syndrome
(Hans Asperger)
15. d Tourette syndrome
(George Gilles de la Tourette)
50
2013 Medical Coding Training: CPC-H—Instructor Resources
a. Persuasive developmental disorder characterized by autistic-like
behavior and marked deficiencies in social and communication skills,
despite normal intelligence and language ability.
b. Autosomal recessive lysosomal storage disorder affecting
mucopolysaccharide metabolism
c. Trisomy-21—a third chromosome on or translocation of the 21st
chromosome
d. Inherited neurological disorder characterized by repeated involuntary
movements and uncontrollable vocal sounds called tics.
e. Damage to the white matter of the brain.
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 19.1—Crossword Puzzle—Answers
Activity 19.2—Word Scramble—Answers
Read each question or statement and then arrange the letters in each row to find the answer.
1. Lining of the abdominal cavity
Peritoneum
2. A flexible ring placed in the vagina, helps support the pelvic floor and treat prolapse.
Pessary
3. The main body, or fundus, of the uterus, above the cervix.
Corpus Uteri
4. Intentional termination of the pregnancy
Induced abortion
5. The distal ends of the fallopian tubes
Infundibulum
6. Period of time from the termination of labor to complete involution of the uterus, usually defined as 42 days
Puerperium
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 20 Class Exercises
Class Exercise 20.1
Match the gland to the anatomical location with the aid of an anatomy book.
1.
e
Adrenal glands
a. In a small bony cavity at the base of the brain
2.
d
Parathyroid gland
b. Anterior neck below the skin and muscle layer
3.
a
Pituitary gland
c. In the mediastinum of the chest
4.
c
Thymus gland d. Posterior side of the thyroid gland and imbedded in the connective tissue
5.
b
Thyroid gland
e. On top of each kidney
Rationale: The adrenal (or suprarenal) glands sit directly atop the kidneys, one per side (“adrenal” means “near
the kidneys”). There are four parathyroid glands. They are found on the posterior surface of the thyroid gland. The
pituitary gland (hypophysis cerebri) is located just under the hypothalamus of the brain, which controls it. The
thyroid gland is located anteriorly in the neck, just below the thyroid cartilage, or “Adam’s Apple.”
Match the gland to its function with the aid of an anatomy reference or a medical dictionary.
6.
c
Adrenal medulla
a. E
xerts chemical control over the human body by maintaining
homeostasis
7.
d
Thyroid gland
b. Control of the body’s calcium levels
8.
a
Neuroendocrine glands
c. Th
e main function of this gland is the secretion of adrenaline
(epinephrine). It acts by raising blood glucose levels; increases blood
pressure, heart rate, sweating, respiratory rate and other activities
regulated by the sympathetic nervous system.
9.
e
Pituitary gland
d. Regulate the body’s overall metabolism
10.
b
Parathyroid glands
e. Control the activity of many other endocrine glands
Rationale: Each portion (and sub-portion) of the adrenal glands performs a distinct function. The adrenal glands
are responsible primarily for releasing stress hormones, including cortisol from the cortex and adrenaline and
norepinephrine from the medulla, among other hormones. The thyroid gland controls how quickly the body uses
energy, makes proteins, and determines sensitivity of the body to other hormones. Parathyroid glands maintain
the body’s calcium level for proper functioning of the nervous and muscular systems. In some instances, the
endocrine and nervous systems monitor and adjust each other’s activities to create desired changes in the body.
The term “neuroendocrine system” is sometimes used to describe the cooperation of both systems towards
regulation of bodily functions. The pituitary gland is considered the “master gland” and regulates a wide variety
of functions including: growth, metabolism, milk production and uterine contractions in pregnant women.
52
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 20.2
1. 255.41
Rationale: Look in the ICD-9-CM Index to Diseases look for Addison’s/disease and you are directed to 255.41.
Code selection is confirmed in the Tabular List.
2. 252.01
Rationale: Look in the ICD-9-CM Index to Diseases look for Hyperpathyroidism/primary and you are directed to
252.01. Code selection is confirmed in the Tabular List.
3. 252.01
Rationale: Look in the ICD-9-CM Index to Diseases look for Hyperplasia, hyperplastic/parathyroid (gland) and
you are directed to 252.01. Code selection is confirmed in the Tabular List.
4. 250.60, 357.2
Rationale: Look in the ICD-9-CM Index to Diseases look for Neuropathy, neuropathic/diabetic and you are
directed to 250.6x [357.2]. There is no mention of the type of diabetes, so the default is Type II, fifth digit 0.
When verifying the codes in the Tabular List there are instructional notes to indicate which order both codes are
reported.
5. 250.50, 362.07, 362.01
Rationale: Look in the ICD-9-CM Index to Diseases look for Edema, edematous/macula/diabetic 250.5x [362.07].
There is no mention of the type of diabetes, so the default type is Type II, fifth digit 0. In the Tabular List, code
362.07 has a note indicating another code for diabetic retinopathy must always be used with diabetic macular
edema. The ICD-9-CM Guidelines I.C.3.a.4.(a) states diabetic macular edema is only present with diabetic
retinopathy. Look in the ICD-9-CM Index to Diseases for Retinopathy/diabetic and you are directed to 250.5x
[362.01].
Class Exercise 20.3
1. 723.1
Rationale: Look in the ICD-9-CM Index to Diseases look for Cervicalgia or Pain/neck and you are directed to
723.1. Code selection is confirmed in the Tabular List.
2. 331.4
Rationale: Look in the ICD-9-CM Index to Diseases look for Hydrocephalus. Obstructive is listed in parenthesis
meaning it is a nonessential modifer and does not affect code selection. Hydrocephalus directs you to 331.4. In
the Tabular List, category 331 states to use an additional code, where applicable, to identify dementia. It is not
applicable in this case.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
3. 721.1
Rationale: Look in the ICD-9-CM Index to Diseases look for Spondylosis/cervical, cervicodorsal/with
myelopathy and you are directed to 721.1. Code selection is confirmed in the Tabular List.
4. 722.71
Rationale: Look in the ICD-9-CM Index to Diseases look for Myelopathy/due to or with/intervertebral disc
disorder/cervical, cervicothoracic and you are directed to 722.71. Code selection is confirmed in the Tabular List.
5. 322.0
Rationale: Look in the ICD-9-CM Index to Diseases look for Meningitis/nonpyogenic NEC and you are directed
to 322.0. Code selection is confirmed in the Tabular List. 6. 951.2
Rationale: Look in the ICD-9-CM Index to Diseases look for Injury/nerve/trigeminal and you are directed to
951.2. This section of ICD-9-CM codes excludes accidental puncture or laceration during a medical procedure.
Code selection is confirmed in the Tabular List.
7. 730.11
Rationale: Look in the ICD-9-CM Index to Diseseas look for Osteomyelitis/chronic or old and you are directed
to 730.1x. The fifth digit of 1 indicates the shoulder region. In the Tabular List there is an instructional note under
730.1 to use an additional code to identify major osseous defect, if applicable. It is not applicable in this case.
8. 349.81
Rationale: Look in the ICD-9-CM Index to Diseases look for Rhinorrhea/cerebrospinal (fluid) and you are
directed to 349.81. Code selection is confirmed in the Tabular List.
9. 192.1
Rationale: Look in the Neoplasm Table for meninges. Cerebral is in parenthesis indicating it is a nonessential
modifier and does not affect code selection. The malignant column directs you to 192.1. Code selection is
confirmed in the Tabular List.
10. 346.00
Rationale: Look in the ICD-9-CM Index to Diseases look for Migraine/classic(al) and you are directed to 346.0x.
There is no mention of intractable migraine or migrainosis making the fifith digit 0 the correct code. Code
selection is confirmed in the Tabular List.
54
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 20.4
1. 60271, 226
Rationale: Look in the CPT® Index for Thyroidectomy/Total/Cervical Approach and you are directed to 60271.
Verification of this code confirms it includees substernal thyroid and that it is performed via cervical approach.
In the ICD-9-CM codebook, look in the Neoplasm Table for thyrdoid (gland) and select the code from the benign
column.
2. 60100, 246.2
Rationale: Look in the CPT® Index for Thyroid Gland/Needle Biopsy and you are directed to 60100. Verification
of this code confirms it is for a percutaneous needle biopsy of the thyroid. Look in the ICD-9-CM Index to
Diseases for Cyst/thyroid (gland) and you are directed to 246.2. Verification in the Tabular List confirms code
selection.
3. 60502, 275.42
Rationale: Look in the CPT® Index for Parathyroid Gland/Exploration and you are directed to code range
60500–60505. Code 60502 indicates a re-exploration and is approved for OPPS. It is not approved for the ASC.
Look in the ICD-9-CM Index to Diseases for Hypercalcemia, hypercalcimic (idiopathic) and you are directed to
275.42. Verification in the Tabular List confirms code selection. Class Exercise 20.5
1. l Optic (II)
a.Sense of smell
2. k Trochlear (IV)
b.Controls movement of four of the six muscles of the eyeball, the upper eyelid,
and the muscles that constrict the pupils
3. j c. Responsible for chewing, biting, and sideways movement of the jaw;
sensations of pain, temperature, and touch on the face, scalp, sinuses, and
interior of the nose and mouth
Abducens (VI)
4. h Glossopharyngeal (IX)
d.Controls facial muscles around the eyes, forehead, external ear, and mouth;
sensation of taste; and certain salivary and lacrimal (tear) glands
5. g Accessory (XI)
e. Responsible for sensations and movements for all of the organs of the chest
and abdomen as well as the larynx, pharynx, and palate
6. f f. Responsible for tongue movements affecting speech and swallowing
Hypoglossal (XII)
7. e Vagus (X)
g.Responsible for shoulder movements, head rotation, swallowing, visceral
movements, and voice production
8. i h.Responsible for swallowing, secretion of saliva, Vestibulochoclear (VIII)
sensations of the throat and taste sensations for the back of the tongue
Acoustic
9. d Facial (VII)
i. Responsible for hearing and balance
10. c Trigeminal (V)
j. Controls movement of the lateral rectus muscle of the eye, one of the six
muscles of the eyeball
11. b Oculomotor (III)
k.Controls movement of the superior, oblique muscle of the eyeball
12. a Olfactory (I)
l. Vision, extends from the retina to the optic chiasma
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 20.6
1. 64420 and drug if pass-through, 338.3, 198.5, 185
Rationale: Look in the CPT® Index for Intercostal Nerve/Injection/Anesthetic and you are directed to 64420–
64421. We know to look for anesthetic because it is a nerve block. An injection of a neurolytic agent would be
for destruction. 64420 indicates a single nerve. Look in the ICD-9-CM Index to Diseases for Pain(s)/due to/
malignancy (primary) (secondary) and you are directed to 338.3. ICD-9-CM Guideline I.C.6.a.5. states to code the
pain as the primary diagnosis when the reason for the visit is pain control management. Both the primary and
secondary cancers also need to be coded. Look in the Neoplasm Table for rib. Since this is the metastic cancer, use
the code from the secondary column (198.5). This would go before the primary cancer because the pain control
is for the secondary cancer. Then, the primary prostate cancer should be coded. Look in the Neoplasm Table for
prostate and use the code from the primary column (185).
2. 64493-50, 64494-50, 724.2
Rationale: Look in the CPT® Index for Injection/Paravertebral Facet Joint/Nerve/with Image Guidance and you
are directed to code range 64490–64495. L1-L2 and L2-L3 indicates two levels. 64493 is reported for the first
level, and 64494 is reported for the second level. Parenthetical instructions below the heading of Paravertebral
Spinal Nerves and Branches indicate to add a modifier 50 if the procedure is performed bilaterrally. Flouroscopic
guidance is not reported because it is included in the code description. Look in the ICD-9-CM Index to Diseases
for Pain/lumbar region and you are directed to 724.2. Verification in the Tabular List confirms code selection.
3. 64493-50, 338.29, 722.52
Rationale: Look in the CPT® Index for Injection/Paravertebral Facet Joint/Nerve/with Image Guidance and you
are directed to code range 64490–64495. Even though two facet joints are mentioned, L4 and L5, these types
of codes are reported by level. One level was injected, L4-L5. 64493 is reported for the one level. Parenthetical
instructions below the heading of Paravertebral Spinal Nerves and Branches indicate to add a modifier 50
if the procedure is performed bilaterrally. Flouroscopic guidance is not reported because it is include in the
code description. The reason for the encounter is for pain control/pain management. The ICD-9-CM guideline
for Category code 338, Section I.C.6.a.1.(a), is followed. Look in the ICD-9-CM Pain(s)/chronic directs you to
338.29. Look in the ICD-9-CM Index to Diseases for Degeneration, degenerative/disc disease—see Degeneration,
intervertebral disc; Degeneration/invertebral disc/lumbar, lumbarsacral directs you to 722.52. Verification in the
Tabular List confirms code selection.
For questions 4–10, match the term to the definition.
4. d Syrinx
a. A drug or substance used to eliminate the sensation of pain
5. f Malformation
b. Part of the peripheral nervous system
6. b Somatic nerve
c. A network of nerves
7. e Cauda equina
d. A synonym for fistula
8. c Plexus
e. Th
e end of the spinal cord, including the nerve roots of those nerves below the first
lumbar nerve
9. a Anesthetic agent
f. Failure of proper or normal development
10. g Decompression
g. Removal of pressure
56
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 20 Questions
1. b. 61050, 784.0, 780.39, 780.1
Rationale: In the CPT® Index look for Puncture/Cisternal—See Cisternal Puncture which directs you to code
61050–61055. 61050 is correct because only the puncture was performed. Fluoroscopic guidance (77002) was not
performed with the cisternal puncture. In the ICD-9-CM Index to Diseases look for Headache 784.0; Look for
Seizure(s) 780.39; Look for Hallucination (gustatory) 780.1.
2. a. 62269, 77002, 336.0
Rationale: In the CPT® Index look for Spinal Cord/ Needle Biopsy directs you to code 62269. There is a
parenthetical instructional note, For radiological supervision and interpretation, see 76942, 77002, 77012. 77002
is reported because fluoroscopic guidance was used. In the ICD-9-CM Index look for Syringomyelia directs you to
336.0.
3. c. 63030-50, 721.3
Rationale: Hemilaminectomy is the same as laminotomy. In the CPT® Index look for Hemilaminectomy directs
you to codes 63020–63044. 63030 is correct to report because the lumbar space was the area the procedure was
performed on. There is a parenthetical instructional note, For bilateral procedure, report 63030 with modifier 50.
In the ICD-9-CM Index look for Spondylosis/lumbar, lumbosacral directs you to code 721.3
4. b. 64410, 786.8
Rationale: In the CPT® index look for Injection/Nerve/Neurolytic Agent directs you to range of codes. Review the
codes, 64410 is correct because that is specific to the phrenic nerve. In the ICD-9-CM Index to Diseases look for
Hiccough directs you to code 786.8.
5. d. 28080, 355.6, 907.5
Rationale: In the CPT® Index look for Neuroma/Excision/Foot 28080. In the ICD-9-CM Index to Diseases look
for Neuroma/Mortons’ 355.6. The nueroma was due to an injury, in the Index to Diseases look for Late/effects(s)
(of)/injury/nerve NEC/lower limb and pelvic girdle (Injury classifiable to 956) directs you to code 907.5.
6. d. 60210, 245.2
Rationale: In the CPT® Index look for Thyroidectomy/Partial directs yo to codes 60210–60225. Code 60210 is
correct because only a part of a lobe was removed with the isthmus. In the ICD-9-CM Index to Diseases look for
Thyroiditis/chronic (nonspecific) (sclerosing)/lymphocytic directs you to code 245.2.
7. a. 62284, 72265, 724.2
Rationale: In the CPT® Index look for Myelography/Injection Procedure directs you to code 62284. The
radiologist also interpreted the films, look for Myelography/Spine/Lumbosacral directs you to code 72265. In the
ICD-9-CM Index to Diseases look for Pain(s)/low back directs you to code 724.2.
8. a. 64822, 354.2
Rationale: In the CPT® Index look for Sympathectomy/Atery/Ulnar directs you to code 648.22. In the ICD-9-CM
Index to Diseases look for Lesion(s)/nerve (see also Disorder, nerve); Disorder/nerve/ulnar directs you to code
354.2.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
9. Steroids, peptides, amines
Rationale: Hormones are grouped into three classes based on their structure, steroids, peptides and amines.
10. The ACTH stimulation test (codes 80400–80406, 82024).
Rationale: Addison’s disease occurs when the adrenal glands do not produce enough of the hormone cortisol and
in some cases, the hormone aldosterone. The diseases related to the deficiency are due to autoimmune disorders,
in which the immune system makes antibodies attacking the body’s own tissues or organs, slowly destroying
them. The ACTH stimulation test (CPT® codes 80400–80406 and 82024) is the most specific test for diagnosing
Addison’s disease.
11. Deep brain stimulation refers to high-frequency electrical stimulation of anatomic regions deep within the
brain utilizing electrosurgically implanted electrodes.
Rationale: Deep brain stimulation codes can be found in the CPT® codebook with codes 95978–95979.
12. e
Rationale: The term autonomic nervous system refers to nerves working automatically. The nerves of the
autonomic nervous system innervate and regulate gland cells, smooth muscles (eg, stomach, bladder, blood
vessels, and the heart muscle). There are two distinct branches of the autonomic nervous system: sympathetic and
parasympathetic. These two divisions act in an opposing manner to counteract each other and keep homeostasis
(equilibrium) in the body.
For questions 13–16, match the term to the description:
13. d Craniectomy
a. Premature closure of cranial sutures resulting in malformation of the skull in
relationship to those sutures that closed early
14. a Craniosynostosis
b. Surgical correction and/or plastic repair of a defect in the skull
15. b Cranioplasty
c. Surgical creation of an opening into the skull for operating on the underlying tissues
16. c Craniotomy
d.Surgical removal of section of bone (bone flap) from the skull for operating on the
underlying tissues; bone flap is not replaced at the end of the procedure
The definitions are incomplete without the suffix. Fill in the blank adding the suffix to the terms.
17. Ventriculocisternostomy—Creation of an artificial opening between the ventricles of the brain and the cisterna
magna.
18. Neuroplasty—Plastic repair of a nerve, which usually involves the freeing of entrapped nerve tissue.
19. Osteophytectomy—The surgical removal of an outgrowth of bone or of a bony protuberance.
20. Chemonucleolysis—Nonsurgical treatment for herniation of an intervertebral disc that involves the injection of
chymopapain into the nucleus pulposus.
21. Corpectomy—Surgical removal of the vertebral body.
58
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 20.1—Crossword Puzzle—Answers
1.
H Y
4.
F
A
C
2.
P E R T H Y R O I
E
5.
P
R
I
E
T
P
H
E
E
R
7.
C R
T
O
M
6.
O
P
T
T
O
Y
CPT® copyright 2012 American Medical Association. All rights reserved.
I
S M
S
C
E
C
H
A N I O T O M Y
L
C
R
O
O C C
D I
I
A
R
A
T
8.
3.
M
Y
P I
T A L
D
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59
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 20.2—Word Scramble—Answers
Read each question or statement and then arrange the letters in each row to find the answer.
1. The pineal gland secretes this hormone
melatonin
2. One of the hormones that the pancreatic islets secretes is
glucagon
3. This disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases,
the hormone aldosterone
Addison’s disease
4. Head trauma that may result in loss of consciousness for five minutes or less and may include retrograde amnesia
concussion
5. This bone is located behind the eye
ethmoid
6. This cranial nerve’s function is to control movement of the superior, oblique muscle of
the eyeball
oculomotor
Operative Report 1
64721, 354.0
Rationale: The median nerve is decompressed by freeing the nerve inside the carpal tunnel. In the CPT® Index
look for Carpal Tunnel/Median Nerve Neuroplasty which directs you to code 64721. In the ICD-9-CM Index to
Diseases look for Carpal tunnel syndrome directs you to code 354.0.
60
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 21 Class Exercises
Class Exercise 21.1
1. Sclera
Rationale: Sclera is the white outer skin of the eye, and is covered with a thin protective layer of conjunctiva.
2. Six
Rationale: Each eye has six muscles that work in tandem to direct the gaze up and down and from side to side as
we focus on an object.
3. Limbus
Rationale: The cornea meets the sclera in a ring called the limbus, also known as the sclerocorneal junction.
Often, physicians will reference the limbus when describing the site of incision in eye surgery.
4. Malleus, incus, and stapes
Rationale: The tympanic membrane vibrates to telegraph its message to the middle ear, where the malleus picks
up the vibration, and transfers it to the incus and stapes. These three tiny bones, the ossicles, carry the message to
the oval window and round window in the vestibule of the inner ear and into the cochlea, where perilymph fluid
vibrates and creates nerve impulses to the cochlear nerve.
5. Sound waves
Rationale: In the context of the ear, conduction refers to the transfer of sound waves.
Class Exercise 21.2
1. 368.11
Rationale: Look in the Index to Diseases for Vision/loss/sudden 368.16; however, when you check the Tabular
List, you see this leads to psychophysical visual disturbances. Look up and you will see 368.11 Sudden visual loss.
2. 367.52
Rationale: Look in the Index to Diseases for Ophthalmoplegia – see also strabismus/internal (complete) (total)
367.52. Verify in the Tabular List.
3. 366.13
Rationale: Look in the Index to Diseases for Cataract/senile/anterior subcapsular polar 366.13. Verify in the
Tabular List.
4. 372.00
Rationale: Look in the Index to Diseases for Conjunctivitis/acute 372.00. Verify in the Tabular List.
5. 368.03
Rationale: Look in the Index to Diseases for Amblyopia/refractive 368.03. Verify in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
6. 379.23
Rationale: Look in the Index to Diseases for Hemorrhage/vitreous (humor) (intraocular) 379.23. Verify in the
Tabular List.
7. 250.51, 362.03
Rationale: Look in the Index to Diseases for Diabetes/retinopathy/nonproliferative. You are referred to 250.5
[362.03]. The fifth digit on the code for diabetes identifies the type of diabetes and whether it is controlled
or uncontrolled. The proper code is 250.51 because the patient has Type I diabetes and it is not stated as
uncontrolled. Verify in the Tabular List.
8. 362.10
Rationale: Look in the Index to Diseases for Retinopathy (background) 362.10. Verify in the Tabular List.
9. 362.83
Rationale: Look in the Index to Diseases for Edema/retina (localized) (macular) (peripheral) 362.83. Verify in the
Tabular List.
10. 367.31
Rationale: Look in the Index to Diseases for Anisometropia (congential) 367.31. Verify in the Tabular List.
Class Exercise 21.3
1. 383.01
Rationale: Look in the Index to Diseases for Abscess/mastoid/subperiosteal 383.01. Verify in the Tabular List.
2. 381.20
Rationale: Look in the Index to Diseases for Otitis/media/chronic/mucoid, mucous (simple) 381.20.
Verify in the Tabular List.
3. 380.12
Rationale: Look in the Index to Diseases for Ear/swimmer’s acute 380.12. Verify in the Tabular List.
4. 386.41
Rationale: Look in the Index to Diseases for Fistula/round window (internal ear) 386.41.
Verify in the Tabular List.
5. 389.03
Rationale: Look in the Index to Diseases for Loss/hearing/conductive/middle ear 389.03.
Verify in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 21.4
1. 67311, 378.00
Rationale: When a muscle is detached and re-attached, it is considered a resection procedure. The lateral rectus
muscle is a horizontal muscle. Strabismus surgery is performed to correct missalignment of the eye muscles. Look
in the CPT® Index for Eye Muscles/Repair/Strabismus/See Strabismus. Under Strabismus/Repair/One horizontal
muscle and you are directed to 67311. Look in the Index to Diseases for Esotropia (nonaccommodative) and you
are directed to 378.00. Verify in the Tabular List.
2. 66984-LT, 366.9
Rationale: Look in the CPT® Index for Phacoemulsification/Removal/Extracapsular Cataract and you are
directed to 66982, 66984. There is no mention of complex devices or techniques, making 66984 the correct code.
Code 66984 includes the lens implant. Modifier LT is used to report the left eye. Look in the Index to Diseases for
Cataract and you are directed to 366.9. There is no further specification on the cataract making 366.9 the correct
code. Verification in the Tabular List confirms code selection.
3. 67107, 361.9
Rationale: This is repair of a detached retina. In the CPT® Index, look under Retina/Repair/Detachment/by
Scleral Buckling 67107–67108, 67112–67113. Refer to the codes. Lamellar scleral dissection is reported with 67107.
Look in the Index to Diseases for Detachment/retina and you are directed to 361.9. Verify in the Tabular List.
4. 68761-50, 375.15
Rationale: The inferior puncta is part of the lacrimal system. Look in the CPT® Index for Lacrimal Punctum/
Closure/by Plug and you are directed to 68761. Because this is a bilateral procedure, modifier 50 is added.
Remember, in the facility, when a procedure is performed on both the right and left sides, instead of using RT and
LT modifiers, the procedure is reported on one line item with modifier 50. Look in the Index to Diseases for Dry/
eye 375.15. Verify in the Tabular List.
5. 65275, 918.1
Rationale: Look in the CPT® Index for Cornea/Repair/Wound/Nonperforating and you are directed to 65275.
Looking at the description of the code, the removal of the metal is included. In the ICD-9-CM Index to Diseases,
look for Laceration/cornea/superficial and you are directed to 918.1. Verfication in the Tabular List confirms code
selection.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 21.5
1. 69300-50, 744.29
Rationale: The procedure involves the surgical repair of prominent ears. Look in the CPT®Index for Otoplasty
69300. Append modifier 50 because the procedure is performed bilaterally. In the Index to Diseases, look up
Prominence/auricle (ear) (congenital) 744.29. Verify in the Tabular List.
2. 42830, 69436-50, 474.12, 381.10
Rationale: In the CPT® Index, look up Adenoids/Excision 42830–42836. The procedure involves the adenoids
only. The age of the patient is required for proper code choice. This is an intial procedure which is a primary
procedure. The insertion of the ventilation tubes requires the creation of an opening which is a tympanostomy.
Code selection is determined based on the type of anesthesia. Look up Tympanostomy/General Anesthesia 69436.
Append modifier 50 because the procedure is performed bilaterally. In the Index to Diseases, look up Otitis/
media/chronic/serous. Verify in the Tabular List.
3. 69436-RT, 381.81
Rationale: A myringotomy is an insertion in the eardrum. In this case the opening is created to insert a
ventialating tube which is reported as a tympanostomy. Look in the CPT® Index for Tympanostomy/General
Anesthesia 69436. Modifier RT is appended to report the procedure in the right ear. ETD is Eustachian tube
dysfunction. In the Index to Diseases, look up Dysfunction/Eustachian tube 381.81. Verify in the Tabular List.
4. 69660-LT, 382.9
Rationale: Look in the CPT® Index for Stapedectomy. You are referred to 69662, 69661 and 69660. The procedure
does not involve a revision of a prevision procedure or a footplate drill out. The correct code is 69660. Modifier LT
is reported because the procedure is performed on the left ear. The use of the operating microscpope is bundled
according to NCCI edits. In the Index to Diseases, look up Otitis/media. Verify in the Tabular List.
5. 69930-LT, 389.9
Rationale: In the CPT® Index look for Cochlear Device/Implantation 69930. The use of the operating microscope
is a bundled procedure. Modifier LT is appended because the procedure is performed on the left ear. In the Index
to Diseases, look up Deafness. There is not a subterm for profound. Verify the default code in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 21 Questions
1. d. 67228, 250.50, 362.03
Rationale: In the CPT® Index, look up Photocoagulation/Treatment/Retinopathy 67228–67229. The code
selection is based on the patient’s age. We know the patient is an adult because the patient is diagnosed with an
adult onset of Type II diabetes. In the Index to Diseases, look up Diabetes, diabetic/retinopathy/nonproliferative.
You are referred to 250.5 [362.03]. The diabetes is Type II and is not stated as uncontrolled. The fifth digit is 0.
Verify in the Tabular List.
2. c. 67820-E2, 374.05
Rationale: The provider removes eyelashes using forceps. In the CPT® Index, look up Eyelashes/Trichiasis
Correction/Epilation/by Forceps Only 67820. The procedure is performed on the left lower eyelid which is
reported with modifier E2. In the Index to Diseases, look up Trichiasis/eyelid. Verify in the Tabular List.
3. b. 67801-E3, 373.2
Rationale: In the CPT® Index look up Chalazion/Excision/Same lid 67801. Although multiple lesions are excised,
the lesions were on the same lid. Modifier E3 is appended to identify the right upper lid. In the Index to Disesases,
look for Chalazion. Verify in the Tabular List.
4. c. 66170-LT, 365.11
Rationale: In the CPT® Index, look up Trabeculectomy ab Externo/in Absence of Previous Surgery 66170. This is
the correct code because the surgery is docuemeted as initial meaning the patient has not had surgery previously.
Modifier LT is appended to report the procedure is performed on the left eye. In the Index to Diseases, look for
Glaucoma/simple (chronic). Verify in the Tabular List.
5. a. 67311-RT, 67320-RT
Rationale: In the CPT® Index, look up Strabismus/Repair/One Horizontal Muscle and Transposition. You are
referred to 67311 and 67320. Code 67320 is an add-on code reported with 67311. Modifier RT is appended to both
codes to report the procedure is performed on the right eye. 6. d. 69401, 381.51
Rationale: In the CPT® Index, look up Eustachian Tube/Inflation/without Catheterization 69401. In the Index to
Diseases, look up Salpingitis/ear/acute. Verify in the Tabular List. 7. c. 14060, 173.11
Rationale: The canthus is the corner of the eye where the upper and lower eyelids meet. Although the procedure
is performed on the eye, it only involves the skin which is reported with a code from the integumentary system.
According to CPT® coding guidelines, lesion excisions repaired with a rotational flap are included with the flap
procedure. In the CPT® Index, look for Skin Graft and Flap/Tissue Transfer 14000–14350. The anatomic site and
size determine the proper code. In the Index to Diseases look up Carcinoma/basal cell (see also Neoplasm, skin,
malignant). In the neoplasm table look up Skin/eyelid/basal cell in the primary column. Verify in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
8. 69433-50, 381.20
Rationale: In the CPT® Index, look up Typamostomy/Local Anesthesia 69433. Modifier 50 is appended because
the procedure is performed bilaterally. In the Index to Diseases, look up Otitis/media/mucoid, mucus/chronic
(simple). Verify in the Tabular List.
9. c. 250.51, 366.41
Rationale: In the Index to Diseases look up Diabetes, diabetic/cataract. You are referred to 250.5 [366.41]. The
diabetes is documented as Type I and not stated as uncontrolled. The correct fifth digit is 1. Verify both codes in
the Tabular List.
10. b. 42830, 69436-50, 381.10, 474.12
Rationale: In the CPT® Index, look up Adenoids/Excision 42830–42836. This is an initial procedure on a child
younger than age 12. The next procedure is found under Tympanostomy/General anesthesia. Modifier 50 is
appended to report a bilateral procedure. In the Index to Disesases, look up Otitis/media/serous/chronic (simple).
For the next code refer to Hypertrophy/adenoids. Verify the codes in the Tabular List.
11. c. 68720-LT, 68720-RT, 375.53
Rationale: In the CPT® Index, look for Dacryocystorhinostomy/Lacrimal Sac/Nasal Cavity Fistualization 68720.
Modifier LT and RT are appended to report the procedure was performed on the right and left eye. Payers have
different preferences for modifiers. If reported to Medicare, append modifier 50 instead of modifier RT and LT. In
the Index to Diseases, look for Stenosis/lacrimal/canaliculi. Verify in the Tabular List. 12. c. 69511
Rationale: In the CPT® Index, look up Mastoidectomy/with Tympanoplasty/Radical 69511. Because the procedure
involves the removal of the eardrum and middle ear it is a radical procedure.
13. c. 69801
Rationale: In the CPT® Index, look up Labyrinthotomy/Transcanal 69801. When you refer to the code
description, it includes multiple drug perfusions.
14. b. 381.01
Rationale: In the Index to Diseases look up Otitis/media/serous. There is no subterm for acute under serous.
Verify in the Tabular List.
15. 65114-RT
Rationale: During this procedure, the provider removes all of the eye contents which is an exenteration. In the
CPT® Index, look for Exenteration/Orbit/Removal of Orbital Contents/with Muscle or Myocutaneous Flap 65114.
Modifier RT is appended to indicate the procedure was performed on the right eye.
16. ED Facility 99283, Surgery 65210-RT
Rationale: The facility E/M is identified as mid-level which is reported with 99283. To locate the code for the
surgeon’s service, refer to Eye/Removal/Foreign Body/Conjuctival Embedded 65210. Modifier RT is appended to
report the right eye.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
17. 15823-50 or 15823-E1, 15823-E3, 374.87
Rationale: In the CPT® Index, look up Blepharoplasty 15820-15823. The procedures are performed on the upper
lids and the lids are weighted down which is obstructing vision. Report with modifier 50 or the modifiers for the
upper right and left eyelids (E1, E3). In the Index to Diseases, look up Dermatochalasis. Verify in the Tabular List.
18. 67415-LT, 379.92
Rationale: The provider performs an aspiration and injection. The injection alone would be coded with 67500
but this is integral to procedure 67415 so you do not report 67500 in this situation. In the CPT® Index, look up
Aspiration/Orbital Content 67415. Modifier LT is appended to report the procedure is performed on the left eye.
In the Index to Diseases, look up Mass/eye. Verify in the Tabular List.
19. 67810-E4, 239.2
Rationale: In the CPT® Index, look up Biopsy/Eyelid/Margin 67810. The procedure is performed on the right lower
eyelid which is reported with modifier E4. The diagnosis has not been confirmed. This is reported as an unspecified
neoplasm. In the neoplasm table refer to Skin/eyelid in the unspecified column. Verify in the Tabular List.
20. 15823-50, 67908-E1 or 15823-E1, 15823-E3, 67908-E1, 374.30, 374.87
Rationale: In the CPT® Index, look up Blepharoplasty 15820–15823. The procedures are performed on the upper
lids and the lids are weighted down which is obstructing vision. Report with modifier 50 or the modifiers for the
upper right and left eyelids (E1, E3). Mueller’s muscle repair with sutures (67908) was only performed on the left
upper lid. Modifer E1 is appended to report the procedure is performed on the upper left eyelid. In the Index to
Diseases, look up Ptosis/eyelid and Dermatochalasis which is the “hooding” of the eyelids which is excessive skin.
Verify both codes in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 21.1—Crossword Puzzle—Answers
1.
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6.
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Activity 21.2—Matching Definitions—Answers
Match the term with the correct definition by drawing a line to the corresponding letter.
Term
68
Definition
1. Penetrating transplant
a. Bulging protrusion of the eyeball’s vascular coating
2. Paracentesis
b. Vascular tunic between the sclera and retina
3. Staphyloma
c. Infection of the perichondrium of the pinna
4. Choroid
d. Full-thickness corneal transplant
5. Perichondritis
e. Inversion of the margin of the eyelid
6. Myringotomy
f. Performed for the removal of aqueous humor from the anterior chamber
7. Canaloplasty
g. Surgical incision of the tympanic membrane
8. Entropion
h. Repair of the external ear
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 22 Class Exercises
Class Exercise 22.1
1. Anterior/posterior and posterior/anterior, these are positioning terms for radiology services and the
description of the direction an X-ray travels through the body.
2. Body part is rotated so that it does not produce a frontal AP/PA projection.
3. Lying down on a horizontal surface; central ray is parallel to the surface.
4. Side of the patient that is closest to the film.
5. Forearm or hand is turned so that the palm is directed downward.
Class Exercise 22.2
1. Orders for X-rays may be received in multiple formats. A written order may be found on a prescription pad,
a radiology requisition form, a fax, or a progress note. A telephone order may be called in by the treating
physician or his office staff. The treating physician may send an email to the radiology department or facility.
Even if a telephone order is sent and received, both parties must follow-up in writing on the patient’s medical
record to ensure that both the requesting and performing physicians approve the imaging study.
2. V76.11, V16.3
Rationale: Because the patient has a family history of breast cancer, she would be considered high risk. Look in
the ICD-9-CM Index to Diseases for Screening/mammogram/for high-risk patient V76.11. The code for family
history of breast cancer should also be coded to support the high risk code. Look in the Index to Diseases for
History of/family/malignant neoplasm/breast V16.3. Verification in the Tabular List confirms code selection.
3. 614.6, 628.2
Rationale: Look in the ICD-9-CM Index to Diseases for Adhesions/peritubal 614.6. In the Tabular List, below
614.6, there is a note to use an additional code to identify any associated infertility. Look in the ICD-9-CM Index
to Diseases for Infertility/origin/tubal 628.2.
4. V07.4, 733.01
Rationale: Look in the ICD-9-CM Index to Diseases for Therapy/hormone replacement (postmenopausal) V07.4.
Look in the ICD-9-CM Index to Diseases for Osteoporosis/postmenopausal 733.01. Verification in the Tabular
List confirms code selection.
5. V72.82, 715.95, V12.01
Rationale: This is a chest X-Ray for pre-operative clearance. Look in the ICD-9-CM Index to Diseases
for Examination/medical (for)(of)/pre-operative/respiratory V72.82. The surgery is being performed for
osteoarthritis. Look in the ICD-9-CM Index to Diseases for Osteoarthritis. You are directed to see also
Osteoarthrosis. Osteoarthrosis directs you to 715.9x. The Tabular List indicates a fifth digit of 5 is for the pelvic
region and thigh (she is having a hip replacement). The history of tuberculosis should also be coded. Look in the
Index to Diseases for History of/tuberculosis V12.01. Verification in the Tabular List confirms code selection.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 22.3
1. When contrast medium is administered either rectally or orally it does not qualify as with contrast for coding
selection.
2. Scout films may be performed prior to an actual imaging study with contrast or delayed imaging. Scout films
are not coded separately as they are considered part of the basic procedure.
3. MRI—imaging, and MRA—angiography. MRI is used to study the joints, soft tissues, injuries to bone,
tumors, etc. MRA is used to study the vessels and heart.
4. 73650, 825.0, E882, E849.0
Rationale: Look in the CPT® Index for X-ray/Heel 73650. Look up the code 73650 and it includes a minimum of
2 views of the calcaneus. For the ICD-9-CM, look in the Index to Diseases for Fracture/heel bone (closed) 825.0.
The patient fell off of his roof. Look in the Index to External Causes for Fall, falling/from, off/building E882. Look
in the Index to External Causes for Accident (to)/occurring/home E849.0. There is no mention of the activity so a
third E code is not necessary. Verification in the Tabular List confirms code selection.
5. 73222, 840.4
Rationale: Look in the CPT® Index for Magnetic Resonance Imaging (MRI)/Joint/Upper Extremity and you are
directed to 73221–73223. 73222 indicates an MRI with contrast. Look in the ICD-9-CM Index to Diseases for Tear,
torn/rotator cuff (traumatic) 840.4. Verification in the Tabular List confirms code selection.
Class Exercise 22.4
1. 76700
Rationale: Look in the CPT® Index for Ultrasound/Abdomen and you are directed 76700–76705. 76700 represents
a complete ultrasound of the abdomen.
2. 72126
Rationale: Look in the CPT® Index for CT Scan/with Contrast/Spine/Cervical and you are directed to 72126.
3. 62269, 77002
Rationale: Look in the CPT® Index for Biopsy/Spinal Cord/Percutaneous 62269. Look up this code and you will
see below 62269 the codes for radiological supervision and interpretation. Report 77002 Fluoroscopic guidance for
needle placement (eg, biopsy, aspiration, injection, localization device).
4. 76801, 76802, V22.0
Rationale: Look in the CPT® Index for Ultrasound/Pregnant Uterus 76801–76817. Look at this range of codes.
Code 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation,
first trimester, transabdominal approach; single of first gestation is reported. Use add-on code 76802 to report the
ultrasound for the second fetus. In the ICD-9-CM, look in the Index to Diseases for Pregnancy/supervision/
normal/first V22.0. Verification in the Tabular List confirms code selection.
70
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 32555 512.89
Rationale: Look in the CPT® Index for Thoracentesis 32554–32555. 32555 is reported for thoracentesis performed
with imaging guidance. There is a parenthetical instruction below code 32555, Do not report 32554–32557 in
conjunction with 32550, 32551, 76941, 77002, 77012, 77021, 75989..Look in the ICD-9-CM Index to Diseases for
Pneumothorax 512.89. Verification in the Tabular List confirms code selection.
Class Exercise 22.5
For questions 1–5, match the term with the definition.
1. d Field
a. Blocks placed between the radiation source and the patient to reduce exposure
2. e Fractionation
b. Radiation dosage in million electron volts = maximum energy level of the X-ray beam
3. b MeV
c. Use of three or more fields to deliver dosage
4. c Multifield
d.Geometric area defined by a collimator at the skin surface
5. a Shaped field
e. Division of total planned dose into number of smaller doses given over a period of time
6. C8918, 625.8
Rationale: Look in the CPT® Index for Magnetic Resonance Angiography (MRA)/Pelvis and you are directed to
72198. Remember that some of the MRIs and MRAs have specific C codes to be used for OPPS. In this case, the
Medicare Carriers Manual states to use a code from C8918–C8920 in place of CPT® code 72198. Looking in the
HCPCS Level II codebook, C8918 is for an MRA of the pelvis with contrast. For the ICD-9-CM, the reason for the
MRA is a mass in the right adnexa. Look in the ICD-9-CM Index to Diseases for Mass/female genital organs and
you are directed to 625.8. Verification in the Tabular List confirms code selection.
7. 77082, 733.00
Rationale: Look in the CPT® Index for DXA-See Dual X-ray Absorptiometry (DXA). Dual X-ray Absortiometry
(DXA)/Vertebral Fracture 77082. For the diagnosis, look in the ICD-9-CM Index to Diseases for Osteoporosis
733.00.
8. 76819, V28.9
Rationale: Look in the CPT® Index for Fetal Biophysical Profile and you are directed to 76818-76819. Non-stress
testing is not performed making 76819 the correct code. Look in the ICD-9-CM Index to Disease for Screening/
antenatal, of mother/specified condition NEC V28.89.
9. 78013
Rationale: Look in the CPT® Index for Thyroid Gland/Nuclear Medicine/Imaging with Flow directs you to code
78013.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 22 Questions
1. b. 70486, 473.9
Rationale: In the CPT® Index look for CT Scan/without Contrast/Face directs you to code 70486. The
“Impression” diagnoses the patient as having sinusitis. In the ICD-9-CM Index to Diseases look for Sinsusitis
directs you to code 473.9.
2. a. 76380, 461.0
Rationale: In the CPT® Index look for CT Scan/Follow-up Study guides you to code 76380. In the ICD-9-CM
Index look for Obstruction/sinus—See also Sinusitis. Look for Sinusitis/acute/maxillary directs you to code 461.0.
3. a. 72193, 789.39
Rationale: In the CPT® Index look for CT Scan/with Constrast/Pelvis directs you to codes 72193, 74177. 72193
is correct to report because only the pelvis is being scanned. In the ICD-9-CM Index to Diseases look for Mass/
pelvis, pelvic directs you to 789.3; fifth digit is 9.
4. c. 71260, 787.20
Rationale: In the CPT® Index look for CT Scan/with Constrast/Thorax directs you to code 71260. In the
ICD-9-CM Index to Diseases look for Dysphagia directs you to code 787.20.
5. b. 74160, 789.01, V10.05
Rationale: In the CPT® Index look for CT Scan/with Constrast/Abdomen directs you to codes 74160, 74177.
74160 is the correct code because only the abdomen is being scanned. In the Index to Diseases look for Pain(s)/
abdominal direct you to 789.0x; fifth digit 1 to indicate right upper quadrant. Look for History of/malignant
neoplasm (of)/colon directs you to V10.05.
6. d. 72148, 724.2
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging/Spine/Lumbar directs you to codes 72148–72149, 72158. 72148 is correct to report because
the imaging is performed without contrast. In the ICD-9-CM Index look for Pain(s)/back/low directs you to code
724.2.
7. d. 70486, 472.0, 461.0, 470
Rationale: In the CPT® Index look for CT Scan/without Constrast/Face directs you to code 70486. In the
ICD-9-CM Index to Diseases look for Sinusitis/maxillary/acute directs you to code 461.0. Look for Deviation/
septum (acquired) (nasal) directs you to code 470.
8. d. 72141, 723.0 722.91
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging (MRI)/Spine/Cervical directs you to codes 72141–72142, 72156. 72141 is correct because the
imaging is performed without contrast. In the ICD-9-CM Index to Diseases look for Stenosis/spinal/cervical
723.0; Look for Disorder/intervertebral disc/cervical, cervicothoracic 722.91. Neck Pain and numbness is not
reported separately because both are symptoms of the bulging disc and stenosis.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
9. d. 73221, 719.41
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging (MRI)/Joint/Upper Extremity directs you to code 73221–73223. 73221 is correct because the
imaging was performed without constrast. In the ICD-9-CM Index to Diseases look for pain/shoulder 719.41.
10. b. 70553, 351.0, 348.89
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging (MRI)/Brain directs you to codes 70551–70555. 70553 is correct for with and without contrast.
In the Index to Diseases look for Palsy/Bell’s 351.0; Look for Lesion(s)/brain 348.89.
11. a. 72126, 62284
Rationale: Look in the CPT® Index for CT Scan/with Contrast/Spine/Cervical directs you to code 72126. There is
a parenthetical instruction note, For intrathecal injection procedure, see 61055, 62284). 62284 is correct because it
was given for a CT scan.
12. d. 70551, 784.59, 784.0
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging (MRI)/Brain directs you to codes 70551–70555. 70551 is correct for the imaging being
performed without contrast. In the ICD-9-CM Index to Diseases look for Slurred, slurring, speech 784.59; Look
for Headache.
13. c. 78451, A9500, 786.50
Rationale: Tomographic myocardial perfusion imaging was performed. In this procedure the patient receives an
intravenous injection of a radionuclide, which localizes in nonischemic tissue. SPECT (single photon emission
computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction.
In the CPT® Index, see Heart/Myocardium/Perfusion Study 78451–78454. A single study SPECT was performed,
78451. Using your HCPCS codebook go to the Table of Drugs and Biologicals and look for Cardiolite A9500. The
code A9500 reports the dose per study. In the Index to Diseases look for Pain(s)/chest (central) 786.50.
14. a. 72141, 723.1
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging (MRI)/Spine/Cervical directs you to codes 72141–72142, 72156. 72141 is is correct because
oral contrast is not does not qualify as a study “with contrast.” In the ICD-9-CM Index look for Pain(s)/neck NEC
723.1.
15. a. 74176, 789.59,V13.89
Contrast/Abdomen directs you to code 74150, 74176, 74178. 74176 is reported for both the abdomen and pelvis.
In the ICD-9-CM Index to Diseases look for Ascites 789.59. Look for History of/disorder (of)/specified site NEC
V13.89.
16. b. 70030
Rationale:In the CPT® Index look for X-ray/Eye directs you to code 70030.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
17. b. 62284, 72265
Rationale: In the CPT® Index look for Myelography/Injection Procedure directs you to code 62284; this is for the
injection of the contrast. Look for Myelography/Spine/Lumbosacral directs you to code 72265.
18. a. 71020, 485
Rationale: 71020. When reporting on the claim form, TC is not required for most payers on the CMS UB-04. TC
would be required on the CMS-1500 form for the ASC. Reason for test—786.50 chest pain, 786.05 shortness of
breath; however, a definitive diagnosis of bronchopneumonia is made. Report only the bronchopneumonia—485
19. d. 70553, 780.39
Rationale: In the CPT® Index look for MRI—See Magnetic Resonance Imaging (MRI). Look for Magnetic
Resonance Imaging (MRI)/Brain directs you to codes 705551–70555. 70553 is correct because is correct because of
the imaging being performed first without contrast and then with contrast. In the ICD-9-CM Index to Diseases
look for Seizure(s) directs you to code 780.39.
20. b. 782.4, 441.4
Rationale: The reason for the test should be reported as the first listed diagnosis since a confirmation could not
be determined as to the cause of the jaundice. The aortic aneurysm is an incidental finding which is reported
separately. There is no defined relationship between the aneurysm and the jaundice.
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2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 22.1—Matching Definitions—Answers
Match the direction/position with its correct definition by drawing a line to the corresponding letter.
Term
Definition
1. Dorsal
a. Nearest to the point of attachment
2. Superior
b. Below, at the bottom
3. Prone
c. At or near the back surface of the body
4. Proximal
d. At or near the front surface of the body
5. Medial
e. Above, at the top
6. Ventral
f. Face down or palm down
7. Inferior
g. At the middle
8. Lateral
h. Farthest away from the point of attachment
9. Supine
i.
Face up or palm up
10.Distal
j.
To the side
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 22.2—Crossword Puzzle—Answers
1.
M
2.
C
P
O
G
4.
C A R D I O M Y O G R A P H Y
I
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5.
O
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A M O D E
76
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 23 Class Exercises
Class Exercise 23.1
1. Under OPPS, status indicatory A indicates it is a procedure code that is not covered under OPPS, but is paid
for under a fee schedule or payment system other than OPPS.
2. 80500 has a status indicator of X which indicates it is paid under OPPS. The 2013 Payment Rate for 80500 is
$23.43.
3. Cyto = cell. Cytopathology is the study and diagnosis of diseases on a cellular level.
4. Molecular diagnostics is the measurement of DNA (deoxyribonucleic acid), RNA (ribonucleic acid), proteins,
or metabolites to detect genotypes, mutations, or biochemical changes.
5. Quantitative. Qualitative testing determines the presence or absence of a drug only. Quantitative testing
identifies not only the presence of a drug, but the exact amount present.
Class Exercise 23.2
1. 173.31
Rationale: Look in the Index to Disease for Carcinoma/basal cell (see also Neoplasm, skin, malignant) 173.91. Go
to Neoplasm/skin/cheek which shows 173.30; however this does not indicate basal cell carcinoma. See reference
here—see also Neoplasm, skin, face. If you got to Neoplasm/skin/face/basal cell carcinoma/Primary, you get
173.31. You can also find this in the Neoplasm Table under Neoplasm/cheek/external/basal cell carcinoma 173.31.
2. 188.9
Rationale: The laboratory should report code 188.9, malignant neoplasm of bladder, part unspecified. It is
appropriate to code the carcinoma, in this instance, because the cytology reports the pathologist authenticated the
services as confirmation of the cell type, similar to a pathology report.
3. 172.6
Rationale: There is a confirmed diagnosis of malignant melanoma. This should be used for coding. Look in the
ICD-9-CM Index to Diseases for Melanoma/arm 172.6. Malignant is included in parenthesis next to melanoma.
Verification in the Tabular List confirms code selection.
4. V76.2, V73.22
Rationale: The Pap is negative. This patient has had cervical dysplasia in the past. So the reason for the test, is a
screening Pap test, because of a past history of cervical dysplasia; therefore, the need for another Pap. Look in the
Index for Screening/malignant neoplasm/cervix V76.2. Look in the Index for History (personal) (of)/dysplasia/
cervical V13.22. The answer then is V76.2, V13.22. 5. V73.81, V12.09
Rationale: This patient has a normal Pap; however she has been tested again because she had a positive HPV test
in the past. This is a screening. Look in the Index to Disease for Screening/HPV (human papillomavirus) V73.81.
Look in the Index under History (personal) (of)/infectious disease/specified NEC V12.09. The answer is V73.81,
V12.09.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 23.3
Fill in the blanks with the proper panel code and title:
1. hepatic function panel (80076)
2. lipid panel (80061)
3. renal function panel (80069)
4. acute hepatitis panel (80074)
5. 80051
is code has a status indicator of A which means it is not paid for under OPPS, but is paid for
Th
under a fee schedule.
Rationale: This is a blood test for electrolytes. Look in the CPT® Index for Blood Tests/Panels/Electrolyte 80051. If
you did not know how to look up this code, you could check Panels at the beginning of the Pathology section. You
will quickly see that sodium, potassium, chloride, and carbon dioxide are listed under 80051 Electrolyte panel.
Class Exercise 23.4
1. 80502
Rationale: Regular consultation codes from the E/M section of CPT® would not be used, because the pathologist
did not evaluate the patient. The pathologist fulfilled the requirements of the code in following the request and
preparing the report. Look in the CPT® Index Consultation/Clinical Pathology 80500–80502. Check the codes.
Code 80500 does not include a review of the patient’s history and medical records; therefore, the correct code is
80502.
2. 80100, 80102 x 2
Rationale: Look in the CPT® Index for Drug/Testing/Qualitative/Multiple and you are directed to code
80100, 80104. Code 80100 describes the original screen of one procedure, multiple classes of drugs using the
chromatographic method. Next, look in the CPT® index for Drug/Confirmation 80102. Code 80102 x 2 describes
the two confirmatory procedures.
3. 85610, V58.61, 427.31
Rationale: PT/INR is a prothrombin time test. Look in the CPT® Index for Prothrombin Time and you are
directed to 85610–85611. There is no mention of substitution making 85610 the correct code. Coumadin is an
anticoagulant. Look in the ICD-9-CM Index to Diseases for Long-term drug use/anticoagulants V58.61. This is
the reason for the PT/INR so it is listed first. Look in the ICD-9-CM Index to Diseases for Fibrillation/atrial and
you are directed to 427.31. Verification in the Tabular List confirms code selection.
4. 88436, 84443, 783.21, 785.0, 799.21
Rationale: Look in the CPT® Index for T4 Total and you are directed to see Thyroxine, Total. Looking for
Thyroxine/Total, you are directed to 88436. Look in the CPT® Index for Thyroid Stimulating Hormone (TSH)
and you are directed to 80418, 80438–80440, 84443. 84443 is for the TSH. The other codes referred to include
other tests or multiples of TSH. The patient is suspected of having hperthyroidism, but this is not confirmed. The
symptoms should be coded. Look in the ICD-9-CM Index to Diseases for Loss/weight (cause unknown) 783.21.
Then, look for Rapid/heart (beat) or Tachycardia and you are directed to 785.0. Last, look in the Index for Diseases
for Nervousness 799.21. Verification in the Tabular List confirms code selection.
78
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
5. 84153, 599.70
Rationale: PSA is a Prostate Specific Antigen. Look in the CPT® Index for Prostate Specific Antigen and you
are directed to code range 84152–84154. 84153 is for a PSA Total. Look in the ICD-9-CM Index to Diseases for
Hematuria and you are directed to 599.70. Verification in the Tabular List confirms code selection.
Class Exercise 23.5
1. 87181
Rationale: In the CPT® Index look for Pathology and Laboratory/Microorganism Identification/Senstitivity
Studies directs you to codes 87181–87190. 87181 is correct because of the agar dilution method.
2. 88040
Rationale: In the CPT® Index look for Necropsy/Forensic Exam directs you to code 88040.
3. 88304
Rationale: In the CPT® Index look for Pathology and Laboratory/Surgical Pathology/Gross and Micro which lists
Levels I-VI which are codes 88302–88309. Review the codes. 88304 is the correct code because Appendix removed
was not incidental.
4. 89230
Rationale: In the CPT® Index look for Pathology and Laboratory/Sweat Collection/Iontrophoresis directs you to
code 89230.
5. 89050
Rationale: In the CPT® Index look for Pathology and Laboratory/Cell Count Body Fluide directs you to codes
86152–86153, 89050–89051 or look for Cell Count/Body Fluid/Other than Blood directs you to codes 89050–
89051. 89050 is correct because there is no mention of the test being performed with differential count.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 23 Questions
1. a. 80100 x 2
Rationale: In the CPT® Index look for Drug/Testing/Qualitative/Multiple directs you to codes 80100, 80104.
80100 reprted twice is correct because two separate mobile phases were performed.
2. d. 83655, 83655-91
Rationale: In the CPT® Index look for Pathology and Laboratory/Chemistry/Lead directs you to code 83655.
The test was performed twice. The code is reported twice, with the second code having modifier 91 appended to
indicate that this second lab test is a repeat test.
3. b. 80500
Rationale: There are codes that are reported for a pathology consultation. In the CPT® Index look for
Consultation/Clinical Pathology directs you to codes 80500, 80502. 80500 is correct because he did not review
the patient’s history and medical records. The urine alkaloid test is not reported because the pathologist did not
perform the test.
4. d. 80051, 82947
Rationale: In the CPT® Index look for Pathology and Laboratory/Panels—See Blood Tests, Panels; Organ or
Disease-Oriented Panel. Look for Blood Tests/Panels/ Electrolyte directs you to code 80051. Glucose is the only
test not included in the Electrolyte panel and is reported separately.
5. c. 82308, 82308-91 x 3
Rationale: In the CPT® Index look for Pathology and Laboratory/Evocative/ Suppresion Test/Stimulation Panel/
Calcitonin directs you to code 80410. 82803 is not reported because this is a panel for calcitonin. It is only
reported once because calcintonin performed three times makes up the panel test.
6. a. 38220, 85097
Rationale: In the CPT® Index look for Aspiration/Bone Marrow directs you to code 38220. Look for Smear/Stain/
Bone Marrow Smear you are directed to code 85097.
7. d. 87088
Rationale: In the CPT® Index look for Culture/Bacteria/Urine directs you to codes 87086, 87088.
8. c. 88154, 88141
Rationale: In the CPT® Index look for Cytopathology/Smears/Cervical or Vagnial/Manual Screen where you will
see code 88154 listed. Look for Cytopathology/Cervical or Vaginal/Requiring Interpretation by Physician directs
you to code 88141.
9. c. 88309
Rationale: In the CPT® Index look for Pathology and Laboratory/Surgical Pathology/Gross and Micro which lists
Levels I-VI which are codes 88302–88309. Review the codes. 88309 is the correct code because the sepcimen sent
for evaluation is a tonsil tumor.
80
2013 Medical Coding Training: CPC-H—Instructor Resources
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
10. d. 88331 x 3, 88332 x 2
Rationale: In the CPT® Index look for Consultation/Surgical Pathology/ Intraoperative directs you to code 88329,
88331–88334. Code 88331 is reported three times since there are three separate specimens from the first or single
tissue block. Code 88332 is reported twice because there is a second tissue block performed on specimens 1 and 2.
11. b. 84550, 85651, 86255, 86430, 82310
Rationale: Each test is reported separately because the tests do not make up a panel code. In the CPT® Index look
for Pathology and Laboratory/Chemistry/Uric Acid/ Blood 84450; Look for Sedimentatin Rate/Blood Cell/manual
85651; Look for Antibody/Fluorescent 86255–86256; Look for Rhematoid Factor 86430–86431; Look for Calcium/
Total 82310.
12. c. 80154
Rationale: In the CPT® Index look for Drug Assay/Benzodiazepine 80154. Code 80102 is for nonquantitave
testing. This is stated in your CPT® codebook above code 80150 under the Therapeutic Drug Assays section
subheading.
13. c. 88305 x 2
Rationale: In the CPT® Index look for Pathology and Laboratory/Surgical Pathology/Gross and Micro which lists
Levels I-VI which are codes 88302–88309. Review the codes. 88305 is the correct code to report twice because two
separate sepcimens are sent in for evaluation which are a Lung, transbronchial biopsy and breast biopsy.
14. a. 86910
Rationale: In the CPT® Index look for Blood Typing/Paternity Testing 86910–86911. All three tests are not
separately reported because code 86910 includes all three tests for the paternity test.
15. c. 88027
Rationale: This is a postmortem examination of a person who died in a car car crash making it an Autopsy. In the
CPT® Index look for Autopsy/Gross and Micro Exam directs you to codes 88020–88037. 88027 is correct because
the examination is performed on the brain and spinal cord.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 23.1—Crossword Puzzle—Answers
1.
H
E
M
O
2.
P A T H O L O G Y
R
O
3.
N
4.
G
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A
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F O R E N S I C
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P
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8.
Y
M A N U A L
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2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.
Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 23.2—Word Search—Answers
Using your CPT® book, find the code sections given, then find the title in the grid. Words can go horizontally, vertically,
and diagonally in all directions.
Y
V
H
T
Y
K
Y
N
V
D
K
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V
X
G
N
M
G
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Q
C
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L
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Y
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P
F
Y
X
W
R
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N
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Y
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L
M
M
M
C
Y
N
Y
U
H
X
K
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J
X
Y
N
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M
W
F
G
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B
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J
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A
K
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A
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CPT® copyright 2012 American Medical Association. All rights reserved.
P
M
D
Y
Y
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A
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M
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F
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Y
H
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 24 Class Exercises
Class Exercise 24.1
1. 28192, 90718, 90471, 892.1, E920.8, E849.3, E019.0
Rationale: The patient had a nail removed from deep in the foot. Look in the CPT® Index for Removal/Foreign
Body/Foot and you are directed to code range 28190–28193. There is no mention of complication. There is
mention that it was deep. 28192 is the correct code. For the vaccination, look in the CPT® Index for Vaccination/
Diphtheria and Tetanus (Td) and you are directed to 90714, 90718. There is no mention of the vaccine being
preservative free making 90718 the correct code. The administration of the Td should also be reported. Look in
the CPT® Index for Administration/Immunization/One Vaccine/Toxoid and you are directed to 90471, 90473. The
injection was given intramuscular (IM) making 90471 the correct administration code.
Look in the ICD-9-CM Index to Diseases for Wound/Open. You will see a note indicating a foreign body would
be considered complicated. Wound/Open/foot/ complicated directs you to 892.1. In the Index to External Causes
look for Cut/by/Nails E920.8. Also look for Accident/occurring/construction site, any E849.3. Then, look for
Activity/walking and you are directed to E001.0. Verification in the Tabular List confirms code selection. The
vaccination diagnosis code would not be used because there is a reason for the vaccination which is the open
wound.
2. 99283-25, 90675, 90471, 90375, 96372, 881.00, E906.0
Rationale: The ED visit is mid-level (99283). This is found in the CPT® Index under Evaluation and Management/
Emergency Department 99281–99288. The wound cleaning is included in the ED visit. Look in the CPT® Index
for Vaccines/Rabies and you are directed to code range 90675-90676. 90675 reports intramuscular use. The
administration of the rabies vaccination should also be reported. Look in the CPT® Index for Administration/
Immunization/One Vaccine/Toxoid and you are directed to 90471, 90473. The injection was given intramuscular
(IM) making 90471 the correct administration code. Look in the CPT® Index for Immune Globulins/Rabies and
you are directed to code range 90375–90376. Because there is no mention of the immunoglobulin being heattreated, 90375 is the correct code. The coding guidelines preceding the codes for the immunoglobulin state to
report the administration using codes 96365–96368, 96372, 96374, 96375. Report the injection based on route.
The immunoglobulin injection given intramuscularly is reported with 96372. Modifier 25 is appended to the E/M
code because other procedures were performed (vaccination and injection).
Look in the ICD-9-CM Index for Wound/open. You will notice “puncture” is in parenthesis making it a
nonessential modifier. Wound/open/forearm directs you to 881.00. If you look under Bite(s)/animal you are
directed to “see Wound, open, by site.” The E codes should also be reported. Look in the Index to External Causes
for Bite/dog and you are directed to E906.0. Verification of the codes in the Tabular List confirms code selection.
We do not have the activity of the person or the location where the patient was when bitten so additional E codes
cannot be reported. Class Exercise 24.2
1. 90791, 300.00
Rationale: Look in the CPT® Index for Psychiatric Diagnosis/ Evaluation and you are directed 90791. There is no
mention of this being interactive making 90791 the correct code. Look in the ICD-9-CM Index to Diseases for
Disorder/anxiety and you are directed to 300.00. Verification in the Tabular List confirms code selection.
84
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
2. 90834, 297.1
Rationale: Look in the CPT® Index for Psychotherapy/Individual Patient/Family Member and you are directed to
90832–90834, 90836–90838. There is no mention of an E/M visit and the visit lasts 45 minutes making the correct
code 90834. Look in the ICD-9-CM Index to Diseases for Psychosis/paranoid/chronic and you are directed to
297.1. Verification in the Tabular List confirms code selection.
Class Exercise 24.3
1. 90911, 787.60
Rationale: Look in the CPT® Index for Biofeedback Training/Anorectal and you are directed to 90911. Look in
the ICD-9-CM Index to Diseases for Incontinence/ feces, fecal and you are directed to 787.60. Verification in the
Tabular List confirms code selection.
2. 99284-25, G0378 x 13, G0257, 786.50, 585.6
Rationale: Dialysis provided to ESRD patients may be reported by a non-certified ESRD facility when the patient
misses dialysis due to an unrelated medical emergency. This scenario meets this definition. G0257 is reported
for the hospital to receive payment under OPPS. This is found in the HCPCS Index under Dialysis/emergency
treatment G0257. Level 4 ED visit in a Type A ED is reported with 99284. This is found in the CPT Index under
Evaluation and Management/Emergency Department 99281–99288. Look in the HCPCS Index for Observation
service/per hour G0378. Modifier 25 is needed to show that the resources used for the ED visit were separate from
those used for dialysis and the observation services. The patient is admitted to observation for 13 hours which is
reported with 13 units of G0378.
Look in the ICD-9-CM Index to Diseases for Pain/Chest 786.50. We do not have any further information about
the chest pain. Look in the Index to Diseases for Disease/renal/end-stage 585.6. Class Exercise 24.4
1. 93886, 780.33, 907.0
Rationale: Look in CPT® Index for Doppler Scan/Intracranial Arteries/Complete Study. You are referred to 93886.
The patient is diagnosed with seizure disorder caused by a severe head injury. Look in the ICD-9-CM Index to
Diseases for Seizure/post traumatic, and you are referred to 780.33. The seizure disorder is a result of a severe head
injury which makes this a late effect. Look in the ICD-9-CM Index to Diseases for Late effect/injury/head and
neck/intracranial. You are referred to 907.0. Verify both code descriptions in the Tabular List.
2. 95180 x 3, 995.27
Rationale: Look In CPT™ Index to Diseases for Allergen Immunotherapy/Rapid Desensitization. You are referred
to 95180. The code description includes “each hour” so the code is reported with 3 units. For the diagnosis, look
in the ICD-9-CM Index to Diseases for Hypersensitivity and you are referred to “see also Allergy.” Under Allergy/
drug, you are referred to 995.27. Verify the code description in the Tabular List.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Class Exercise 24.5
1. 99212-25, 96372, J2510, 486
Rationale: A low level, established patient E/M service is reported with 99212. This is found in the CPT® Index
under Evaluation and Management/Office and Other Outpatient 99201–99215. A low-level E/M service is 99212.
Look in the CPT® Index for Injection/Intramuscular/Therapeutic and you are directed to 96372, 99506. 99506
is for a home visit and is not applicable for this case. 96372 is the correct code for an intramuscular injection.
Modifier 25 is used on the E/M service to show that the resources used were separate from the injection service.
You would also report the Penicillin. Look in the HCPCS Level II Table of Drugs for Penicillin G Procaine.
600,000 units given IM is reported with HCPCS Level II code J2510. Look in the ICD-9-CM Index for Pneumonia
and you are directed to 486. Verification in the Tabular List confirms code selection.
2. 96365, J3488, 733.01
Rationale: Look in the CPT® Index for Infusion/Intravenous/Diagnostic/ Prophylactic/Therapeutic and you are
directed to 96365–96368, 96379. 96365 is for the first hour. The drug should also be coded. Look in the HCPCS
Level II Table of Drugs for Reclast®. 1 mg given IV directs you to J3488. This is for 1 mg and 5 mg were given
so 5 units should be reported. The guidelines for Infusions state the flush of saline is included and not reported
separately. Look in the ICD-9-CM Index for Osteoporosis/postmenopausal and you are directed to 733.01.
Verification in the Tabular List confirms code selection.
Class Exercise 24.6
1. 97035 x 2, 724.02
Rationale: Look in the CPT® Index for Physical Medicine/Therapy/Occupational Therapy/Modalities/Ultrasound
and you are directed to 97035. The code reflects 15 minutes so 2 units are reported. Look in the ICD-9-CM Index
for Stenosis/spinal/lumbar and you are directed to 724.02. Verification in the Tabular List confirms code selection.
2. 97003, 369.25
Rationale: Look in the CPT® Index for Occupational Therapy/Evaluation and you are directed to 97003–97004.
97003 is for the initial evaluation. Look in the ICD-9-CM Index for Impaired, impairment/vision/moderate/both
eyes 369.25. Verification in the Tabular List confirms code selection.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Answers for Chapter 24 Questions
1. a. 96372, 90378 x 2
Rationale: Look in the CPT® Index for Injection/Intramuscular 96372. Next in the CPT® Index find Immune
Globulins/Respiratory Syncytial Virus 90378. Look up these codes and you will see that 90378 reports 50 mg;
therefore, 2 units are needed.
2. b. 90834
Rationale: Look in the CPT® Index for Psychotherapy/Individual Patient/Family Member 90832–90834, 90836–
90838. Code 90834 reports psychotherapy for 45 minutes. No E/M services were provided. 3. b. 92012, 92310
Rationale: Look in the CPT® Index for Ophthalmology, Diagnostic/Eye Exam/Established Patient 92012–92014.
Code 92012 reports an intermediate eye exam for an established patient. Next in the CPT® Index look for Contact
Lens Services/Fittings and Prescription 92071–92072. Code 92071 Fitting of contact lens for treatment of ocular
surface disease is correct.
4. d. 92928-LC, 92920-LD
Rationale: Look in the CPT® Index for Coronary Artery/Insertion/Stent 92928–92929. Next look in the CPT®
Index for Coronary Artery/Angioplasty 92920–92921. The notes for these codes indicate that one base procedure
can be performed in each coronary artery, so both codes must be base codes. Report 92928-LC for the stent
placement in the left circumflex, and 92920-LD for the PTCA of the left anterior descending coronary artery. The
order of the codes does not matter, because APCs will be assigned.
5. b. 93461, 93567
Rationale: Look in the CPT® Index for Cardiac Catheterization/Combined Left and Right Heart/with Left
Ventriculography 93453, 93460–93461. Code 93461 reports coronary angiography with right and left heart
catheterization including left ventriculography and bypass graft angiography. Also report the add-on code 93567
for supravalvular aortography. This is found in the CPT® Index under Cardiac Catheterization/for Supravalvular
Aortography 93567.
6. a. 93312
Rationale: Look in the CPT® Index for Echocardiography/Transesophageal 93312–93318. Code 93312 includes
probe placement, 2D images and interpretation and report. This code has both a technical and a professional
component. Modifier TC is not needed for the facility, because the claim will be billed on a UB-04.
7. a. 95028 x 3
Rationale: Look in the CPT® Index for Allergy Tests/Intradermal/Allergen Extract 95024–95028. Code 95028
Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number
of tests is correct. Report 3 units.
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
8. b. 97010, 97035, 97110
Rationale: Look in the CPT® Index for Physical Medicine/Therapy/Occupational Therapy/Modalities/Hot or
Cold Pack 97010. When you look at this code, you will see that direct patient contact is not necessary and there
is no mention of time. Next in the Index under the same heading for Physical Medicine, find Ultrasound 97035,
and Procedures/Therapeutic Exercises 97110. Look up 97035 and 97110, and you will see that both require direct
patient contact and each code represents 15 minutes. 9. a. 90960
Rationale: Look in the CPT® Index for End-Stage Renal Disease Services 90951–90970. See the notes under this
heading that indicate “In circumstances in which the patient has had a complete assessment visit during the
month and services are provided over a period of less than one month, 90951–90962 may be used according to
the number of visits performed.” There were five visits and a complete assessment was performed. Code 90960 is
correct.
10. a. 97602
Rationale: In the CPT® Index look for Wound/Debridement/Non-selective 97602. Code 97602 Removal of
devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings,
enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per
session, completely describes the procedure performed.
11. b. 96360, 96361 x 4
Rationale: Look in the CPT® Index for Hydration/Intravenous 96360–96361. Report 96360 for the first hour, and
then add-on code 96361 x 4 for the additional 4 hours. 12. b. 90834, 90853
Rationale: In the CPT® Index look for Psychotherapy/Individual Patient/Family Member 90832–90834, 90836–
90838. Psychotherapy time was 45 minutes, and an Evaluation and management services was not provided;
therefore, 90834 is correct. Next, look in the CPT® Index for Psychotherapy/Group Other than Multifamily 90853.
Code 90853 Group psychotherapy (other than of a multiple-family group) is correct. The notes under 90853 instruct
to use 90853 in conjunction with 90785 for the specified patient when group psychotherapy includes interactive
complexity. There is no mention of interactive complexity listed. Highlight the notes under Interactive Complexity
in your CPT® codebook.
13. d. 91010
Rationale: Look in the CPT® Index for Esophagus/Motility Study 78258, 91010, 91013. Code 91010 Esophageal
motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report
describes the procedure.
14. c. 96921
Rationale: Look in the CPT® Index for Dermatology/Psoriasis Laser Treatment 96920–96922. The code
description for 96920 indicates laser treatment for less than 250 sq cm. Code 96921 indicates laser treatment for
250 sq cm to 500 sq cm; therefore, this is the correct code. The initial skin test is included in 96921.
88
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
15. d. 90471, 90645, V03.81
Rationale: Look in the CPT® Index for Vaccines/Hemophilus Influenza B 90644–90648. When looking at
this code range you see 90645 Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule) for
intramuscular use. Next look in the CPT® Index for Administration/Immunization/One Vaccine/Toxoid
90471, 90473. The correct code is 90471. Do not report 90460, because this is a professional service and it is not
recognized by OPPS. For the diagnosis look in the ICD-9-CM Index to Diseases for Vaccination/prophylactic/
Hemophilus influenza, type B [Hib] V03.81.
Activity 24.1—Crossword Puzzle—Answers
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Answers and Rationales for Class Exercises, Chapter Questions, and Activities
Activity 24.2—Matching CPT® Codes—Answers
Using your CPT® book, match the code with the corresponding description by drawing a line to the appropriate letter.
CPT® Code
90
Description
1. 92592
a. Plethysmography
2. 95812
b. Cardiopulmonary resuscitation
3. 94726
c. Live typhoid vaccine, oral
4. 92950
d. Monaural hearing aid check
5. 90690
e. Laser treatment for psoriasis on area of 237 sq cm
6. 91122
f. Extended EEG monitoring, 47 minutes
7. 96920
g. Percutaneous balloon valvuloplasty for mitral valve
8. 98941
h. Anorectal manometry
9. 92987
i. CMT for three spinal regions
10.93882
j. Unilateral duplex scan of extracranial arteries
2013 Medical Coding Training: CPC-H—Instructor Resources
CPT® copyright 2012 American Medical Association. All rights reserved.