CPC exam prep

Medical coding CPC and CCS Exam sample test questions

1. Colonoscopy with a snare polypectomy of a sigmoid polyp

A. 45385

B. 45380

C. 45380, 45385

D. 45380, 45385-59

2. Excision of a right breast mass following needle localization

A. 19120

B. 19125

C.19123

D.19124

3. Excision of a 1.5 malignant melanoma of the arm: excised margin 1.0 cm : 11603

A. 11601

B. 11062

C. 11603

D. 11064

 

4. Cystourethroscopy with bilateral ureteral catheterization and bilateral retrograde pyelograms.

A. 52005, 74420-26

B. 52005, 74420-26, 74420-26

C. 52204, 74420-26

D. 52310

5. Cystourethroscopy with replacement of Double J stent.

A. 52310

B. 52332

C. 52310, 52332

D. 52005

6. Repair of a recurrent preperitoneal hernia

A. 49505

B. 49570

C. 49521

D. 49561

7. An endoscope was entered into the mouth and traversed till pyloric channel and removed. What is the procedure?

A.43234

B. 43200

C. 43202

D. 43226

8. Repair of superficial 3.5 cm laceration of the eyebrow. What are the CPT and ICD procedure codes?

A. 12013, 08.81

B. 12013, 86.59

C. 12002, 86.59

D. 12002, 08.81

9. Application of aluminum splint to fractured index finger in ER.

A. 29130

B. 29125

C. 29515

D. Aluminum finger splint is pre-fabricated splint hence not coded

10. I&D of a buttocks abscess with packing:

A. 10060

B. 10061

C. 10081

D. 10081

11. The patient comes in with acute alcohol intoxication. The patient is an alcoholic.

A.303.00

B.303.90

C.305.00, 303.90

D.303.50, 303.93

12. A HIV patient comes in for the treatment of Pneumocystis pneumonia

A. 136.3, V08

B. 042

C. V08, 136.3

D. 042, 136.3

13. Open wound ankle with tendon injury.

A. 891.0

B. 891.1

C. 891.2

D. 890.0

14. The pregnant patient comes in for routine supervision. The patient has asthma.

A. V22.1, 648.83, 493.90

B. V22.1, 648.93, 493.90

C. V22.1, 493.90

D. V22.1

15. A patient comes into ER due to disruption of suture. The patient was treated in the ED with sutures to a 2 cm wound which he sustained on the hand due to fall. The physician again sutured the area. What are the ICD and CPT codes for this visit?

A. 882.0, 12001

B. 882.1, 12001

C. 998.33, 12020

D. 998.33, 12001

16. The patient had a MI ten weeks ago. The patient now comes with chest pain. The physician diagnoses states “Old MI with symptoms”

A. 412

B. 414.8

C. 410.92

D. 410.91

17. The patient delivered a baby by cesarean section one week age. The patient now comes in with breakdown of cesarean wound.

A. 998.32

B. 674.24

C. 674.14

D. 998.33

18. Anxiety and depression 

A. 300.4

B. 300.00, 311

19. Hemoccult positive stool 

A. 792.1

B. 578.1

20. The patient has abdominal pain. The patient had a delivery of a live born baby five weeks ago. The patient was given pain medications and discharged home.

A. 648.94, 789.00

B. 789.00

C. 648.93, 789.00

D. 789.09

21. Acute and chronic bronchitis with COPD

A. 466.0, 490, 496

B. 466.0, 491.20

C. 491.20, 466.0

D. 466.0, 491.21

22. Chronic obstructive asthma with acute exacerbation 493.22

A. 493.93

B. 493.22

C. 493.91

D. 493.20

23. The patient can to the hospital say he is feeling anxious. The physician documented “unhappiness” in the final impression.

A. 311

B. 300.00

C. 313.1

D. 309.0

24. The patient comes with an injury to right hand. After examination, the physician documented the final diagnoses as “infected fracture of the shaft of radius”

A. 813.31

B. 813.21

C. 813.20

D. 813.30

25. The patient comes in with fatigue and weakness. The physician documented the final diagnoses as anemia, leucopenia, thrombocytopenia, and pancytopenia.

A. 285.9, 287.5, 288.50

B. 284.1

C. 285.9, 287.5, 288.50, 284.1

D. 288.50, 284.1

26. A patient comes in with cough and fever. The physician documents the final diagnoses as URI and pharyngitis.

A. 465.9, 462

B. 465.9

C. 462

D. 465.9, 462, 780.60

28. Patient came with blood in stool and the diagnosis is likely external hemorrhoids.

A. 578.1, 455.3

B. 455.5

C. 578.1, 455.5

D. 455.8

29. The patient came with rhinorrhea. The patient is having a history of asthma. The physician states the final impression as allergic rhinitis.

A. 493.00

B. 477.9, 493.90

C. 472.9, 493.90

D. 471, 493.90

30. Candidial diaper rash.

A. 691.0

B. 691.0, 112.3

C. 112.3

31. ARF + HTN 

A. 493.90, 584.9

B. 584.9, 401.9

32. Diabetic ketoacidosis.

A. 250.10

B. 250.13

C. 250.12

D. 250.80

ICD 9 CM PROCEDURE CODING QUESTIONS

 

1. Repair of ventral hernia with application of adhesion barrier.

A. 53.59

B. 99.77

C. 53.59, 99.77

D. 53.75

2. Colonoscopy with a biopsy of large intestine

A. 45.25

B. 45.23, 45.14

C. 45.14

D. 44.14

3. Cystouretheroscopy with bilateral retrograde pyelograms.

A. 57.32, 87.74

B. 57.93, 87.74

C. 60.94, 87.74

D. 56.33, 87.74

4. PTCA of single coronary vessel with insertion of a drug eluting stent.  

A. 00.65, 36.07, 00.45, 00.40

B. 00.66, 36.07, 00.45, 00.40

C. 00.66, 36.07, 00.46, 00.40

D. 00.66, 36.07, 00.45, 00.41

5. Diagnostic aspiration of Liver.

A. 50.11

B. 50.19

C. 50.13

D. 50.14

6. Wedge biopsy of liver.

A. 50.11

B. 50.19

C. 50.12

D. 50.14

7. A patient came with burn on his hand. Physical exam showed necrosis. The necrosis of hand was excised.

A. 86.28

B. 96.59

C. 88.22

D. 77.6

 BILLING, ANATOMY, AND PHYSIOLOGY QUESTIONS

1. Can we bill EKG for hypertension. 

A. Yes

B. No

  

2. Incision of vein

A. Phlebotomy

B. Arteriotomy

C. Rhinotomy

D. Dermatome

3. Repair of nose defect

A. Arthroplasty

B. Vasectomy

C. Rhinoplasty

D. Dermatoplasty

 

4. Abscess of bone

A.  Osteomyelitis

B. MRSA

C. Cellulitis

D. Osteocalasis

Medical coding CPC and CCS Exam sample test

How to code a tick bite ?

A patient presents to the clinic with tick bite and the tick still present into the skin. The physician examines the injury and removes the tick with a forcep. What are the diagnosis and procedure codes we would use for this visit?

Tick bite is a non-venomous insect bite and is coded to injury --> Superficial by site (Plus the 4th digit as 4 or 5 as necessary depending upon if there is an associated infection at the site of injury ); and an E code which will always be E906.4 for tick bite.

For example tick bite one the face with removal of tick with a forceps will have following codes:
911.4      Tick bite of face
E906.4    E Code for Tick bite
98.22      Nonoperative removal of foreign body from skin of head and neck 
E/M code

Providers usually removes the tick with a forcep and/or any other method which would not require an incision into the skin. Hence CPT codes for the procedure are not required as removal of foreign body from skin without incision is included in E/M as per CPT guidelines. We can assign ICD procedure code 98.2x for removal of foreign body from the skin without incision depending upon the anatomic site of the injury.

The site of tick bite can get infected and the provider may sometimes document the diagnoses of cellulitis along with the tick bite. In such cases, two codes are required to code the visit completely. One code for tick bite infected and another code for the infection which will be cellulitis in this case. Also the selection of principal diagnosis would depend upon the reason for visit.

In rare situations where the physician removes the foreign body with an incision into the skin, CPT 10120 along with an E/M code with modifier 25 can be coded.  

Some coders confuse tick bite with 989.5(tick paralysis) which is a different condition and not relevant at this visit.

What is the ICD 9 code for "renal cyst"

ICD 9 index for renal cyst directs to Cyst, Kidney(congenital) as shown below:

kidney (congenital) 753.10

acquired 593.2

So the question is when there is no documentation that the cyst is congenital what should a coder do?

The answer lies in the ICD 9 coding conventions. ICD 9 coding conventions and rules are based on documentation. If the documentation does not exist then the we need to follow default values.

The thumb rule is that for certain conditions like kidney cyst where the index shows the options like above, the coders is suppose to code 753.10 by default if there is no documentation that the cyst is acquired. If there is documentation that the cyst is acquired then the coders can code 593.2.

So this is a documentation issue and hence we can code 753.10 for renal cyst if there is no documentation that the cyst is acquired.

What is the ICD 9 code for decreased renal function?

There is no direct code for decreased or impaired renal function in ICD 9, however if we look at the notes give below the ICD code 593.9 we will find the term "acute renal insufficiency."

The term "acute renal insufficiency" means decreased renal function or impaired renal function. Hence 593.9 would be the most appropriate code for decreased renal function or impaired renal function.

ICD 9 code 794.4 is not suitable for the diagnoses of impaired renal function as it talks about the lab results and not the condition of the kidney.

Nasogastric or Orogastric tube placement CPT Codes

CPT codes for Nasogastric or Orogastric tube placement (43752) and gastric intubation with aspiration and lavage (43753) are physician only codes as mentioned in the procedure description.These codes should not be used when the respective services are not performed by the physician. Most of the times these services are performed by nurses and cannot be coded as per CPT code description.

43752 also includes fluoroscopic guidance and supervision and interpretation and hence no additional fluoroscopic S&I codes are required when reporting this service.

43752  Naso-or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance 
43753 Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (eg, for gastrointestinal hemorrhage), including lavage if performed

What is the ICD code for Past Medical History of Shingles ?

Shingles is a chronic disease and there is no cure for it. The disease once acquired will remain for life the same like diabetes and hypertension.

In the outpatient setting, if the patient is on medications for shingles then we can code singles even if it is not treated during the current visit. In the inpatient setting active treatment or medical management is required to code any condition.

Hence code 053.9 would be best if the patient is not having any complications else one can select an appropriate code from 053 categories depending upon the complications.

What is the diagnoses code for tortuous colon?

If we search the ICD 9 index for the term "tortuous" the index directs us to "Distortion" and distortion of colon per ICD index leads to the code 751.5 Congenital Anomaly of Intestine which should be the code for tortuous colon.

ICD 9 CM code 560.2 represent a condition called Volvulus, which is an acute condition resulting in torsion of the intestine. Volvulus (560.2) is not a chronic or congenital condition and is different from Tortuous Colon 751.5.  Patients with tortuous colon will have difficulty having colonoscopy because of a tortuous colon.


ICD Index
 Tortuous
    organ or site, congenital NEC - see Distortion


560.2 Volvulus
Torsion of intestine, bowel, or colon