Sunday, July 30, 2017

Medicine Section CPC Model Questions

CPC PRACTICE EXAM C

1. Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area of skin where the excisions of the tumor will be performed using Mohs micrographic surgery technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue blocks which were also cut and stained for microscopic examination. The entire base and margins of the excised pieces of tissue were examined by the surgeon. No tumor was identified after the final stage of the microscopically controlled surgery. What procedure codes are reported?

a) 17313, 17314, 17314
b) 17313, 17315
c) 17260, 17313, 17314
d) 17313,17314, 17315

2. 45 year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT code(s) is (are) reported?

a) 14060
b) 11642, 14060
c) 11642, 15115
d) 15574

3. 24 year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT code is. -

a) 56405
b) 10061
c) 11004
d) 11042

4. 76 year-old female had a recent mammographic and ultrasound abnormality in the 6 o’clock position of the left breast. She underwent core biopsies which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hookwire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o'clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, we performed a generous excisional biopsy around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology. Once hemostasis was assured, digital palpation of the depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound was closed in 2 layers with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local anesthetic was infiltrated for postoperative analgesia. What CPT and ICD-10-CM codes describe this procedure?

a) 19100, N63
b) 19285, C50.912
c) 19120, R92.8
d) 19125, D24.2

5. The patient is a 66 year-old female who presents with Dupuytren's disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren's disease right ring digit and palm. An extensile Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code(s) is (are) used?

a) 26123-RT, 26125-F7
b) 26121-RT
c) 26035-RT
d) 26040-RT





6. This is a 32 year-old female who presents today with sacroilitis. On the physical exam there was pain on palpation of the left and right sacroiliac joint and fluoroscopic guidance was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 ml of bupivacaine at 0.5% was injected into the left and right sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. The correct CPT code(s) is (are). -

a) 20611
b) 27096-50, 77012
c) 27096-50
d) 27096, 27096-51, 77012

7. PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee The patent was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT and ICD-10-CM codes should be reported?

a) 29880-RT, M23.203, M65.80, M94.261, M22.41
b) 29881-RT, M23.211, M65.861, M94.261, M22.41
c) 29881-RT, M23.221, M65.861, M94.261, M22.41
d) 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41

8. A 61 year-old gentleman with a history of a fall while intoxicated suffered a blow to the forehead and imaging revealed a posteriorly displaced odontoid fracture. The patient was taken into the Operating Room, and placed supine on the operating room table. Under mild sedation, the patient was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy was performed to gently try to reduce the fracture. It did reduce partially without any change in the neurologic examination. More manipulation would be necessary and it was decided to intubate and use fiberoptic technique. The anterior neck was prepped and draped and an incision was made in a skin crease overlying the C4-C5 area. Using hand-held retractors, the ventral aspect of the spine was identified and the C2-C3 disk space was identified using lateral fluoroscopy. Using some pressure upon the ventral aspect of the C2 body, we were able to achieve a satisfactory reduction of the fracture. Under direct AP and lateral fluoroscopic guidance, a Kirschner wire was advanced into the C2 body through the fracture line and into the odontoid process. This was then drilled, and a 42 millimeter cannulated lag screw was advanced through the C2 body into the odontoid process. What procedure code is reported?

a) 22505
b) 22326
c) 22315
d) 22318

9. The patient is a 51 year-old gentleman who has end-stage renal disease. He was in the OR yesterday for a revision of his AV graft. The next day the patient had complications of the graft failing. The patient was back to the operating room where an open thrombectomy was performed on both sides getting good back bleeding, good inflow. Select the appropriate code for performing the procedure in a post-operative period. -

a) 36831-76
b) 36831
c) 36831-78
d) 36831-58

10. The patient is a 77 year-old white female who has been having right temporal pain and headaches with some visual changes and has a sed rate of 51. She is scheduled for a temporal artery biopsy to rule out temporal arteritis. A Doppler probe was used to isolate the temporal artery and using a marking pen the path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade scalpel the skin was opened in the preauricular area and dissected down to the subcutaneous tissue where the temporal artery was identified in its bed. It was a medium size artery and we dissected it out for a length of approximately 4 cm with some branches. The ends were ligated with 4-0 Vicryl, and the artery was removed from its bed and sent to Pathology as specimen. What CPT code is reported?

a) 37609
b) 37605
c) 36625
d) 37799

11. 50 year-old female has recurrent lymphoma in the axilla. Ultrasound was used to localize the lymph node in question for needle guidance. An 11 blade scalpel was used to perform a small dermatotomy. An 18 x 10 cm Biopence needle was advanced through the dermatotomy to the periphery of the lymph node. A total of 4 biopsy specimens were obtained. Two specimens were placed an RPMI and 2 were placed in formalin and sent to laboratory. The correct CPT code(s) is (are). -

a) 10022
b) 38500, 77002-26
c) 38505, 76942-26
d) 38525, 76942-26

12. Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower quadrant transverse incision was made upon entry to the abdomen. In the right lower quadrant there was a large amount of pus consistent with a right lower quadrant abscess. Intraoperative cultures anaerobic and aerobic were taken and sent to microbiology for evaluation. Irrigation of the pus was performed until clear. The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was taken down and tied using 0-Vicryl ties and the appendix fell off completely since it was already ruptured with tissue paper thin membrane at the base. There was no appendiceal stump to close or to tie, just an opening into the cecum; therefore, the appendiceal opening area into the cecum was tied twice using figure of 8 vicryl sutures. Omentum flap was tacked over this area and anchored in place using interrupted 3-0 Vicryl sutures to secure the repair. What CPT and ICD-10-CM codes are reported?

a) 44950, K35.89
b) 44960, 49905, K35.3
c) 44950, 49905-51, K35.2
d) 44970, K37

13. 15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was digitalized. No significant adenoid tissue was felt. The tonsils were then removed bilaterally by dissection. The uvula was a huge size because of edema, a part of this was removed and the raw surface oversewn with 3-0 chromic catgut. Which CPT code(s) is (are) reported?

a) 42821
b) 42825, 42104-51
c) 42826, 42106-51
d) 42842

14. 34 year-old male developed a ventral hernia when lifting a 60 pound bag. The patient is in surgery for a ventral herniorrhaphy. The abdomen was entered through a short midline incision revealing the fascial defect. The hernia sac and contents were able to easily be reduced and a large plug of mesh was placed into the fascial defect. The edge of the mesh plug was sutured to the fascia. What procedure code(s) is (are) reported?

a) 49560
b) 49561, 49568
c) 49652
d) 49560, 49568

15. 25 year-old female in the OR for ectopic pregnancy. Once the trocars were place a pneumoperitoneum was created and the laparoscope introduced. The left fallopian tube was dilated and was bleeding. The left ovary was normal. The uterus was of normal size, shape and contour. The right ovary and tube were normal. Due to the patient’s body habitus the adnexa could not be visualized to start the surgery. At this point the laparoscopic approach was terminated. The pneumoperitoneum was deflated, and trocar sites were sutured closed. The trocars and laparoscopic instruments had been removed. Open surgery was performed incising a previous transverse scar from a cesarean section. The gestation site was bleeding and all products of conception and clots were removed. The left tube was grasped, clamped and removed in its entirety and passed off to pathology. What code(s) is (are) reported for this procedure?

a) 59150, 59120
b) 59151
c) 59121
d) 59120

16. 23 year-old who is pregnant at 39-weeks and 3 days is presenting for a low transverse cesarean section. An abdominal incision is made and was extended superiorly and inferiorly with good visualization of the bladder. The bladder blade was then inserted and the lower uterine segment incised in a transverse fashion with the scalpel. The bladder blade was removed and the infant's head delivered atraumatically. The nose and mouth were suctioned with the bulb suction trap and the cord doubly clamped and cut. The placenta was then removed manually. What CPT and ICD-10-CM codes are reported for this procedure?

a) 59610, O34.211, Z37.0, Z3A.39
b) 59510, O64.1XX0, Z37.0, Z3A.39
c) 59514, O82, Z37.0, Z3A.39
d) 59515, O82, Z37.0, Z3A.39

17. 55 year-old female has a symptomatic rectocele. She had been admitted and taken to the main OR. An incision is made in the vagina into the perineal body (central tendon of the perineum). Dissection was carried underneath posterior vaginal epithelium all the way over to the rectocele. Fascial tissue was brought together with sutures creating a bridge and the rectocele had been reduced with good support between the vagina and rectum. What procedure code should be reported?

a) 45560
b) 57284
c) 57250
d) 57240

18. A craniectomy is being performed on a patient who has Chiari malformation. Once the posterior inferior scalp was removed a C-1 and a partial C-2 laminectomy was then performed. The right cerebellar tonsil was dissected free of the dorsal medulla and a gush of cerebrospinal fluid gave good decompression of the posterior fossa content. Which CPT code is reported?

a) 61322
b) 61345
c) 61343
d) 61458

19. Under fluoroscopic guidance an injection of a combination of steroid and analgesic agent is performed on T2-T3, T4-T5, T6-T7 and T8-T9 on the left side into the paravertebral facet joints. The procedure was performed for pain due to thoracic root lesions. What are the procedure codes?

a) 64479, 64480 x 3, 77003
b) 64490, 64491, 64492 x 2, 77003
c) 64520 x 4, 77003
d) 64490, 64491, 64492

20. An entropion repair is performed on the left lower eyelid in which undermining was performed with scissors of the inferior lid and inferior temporal region. Deep sutures were used to separate the eyelid margin outwardly along with stripping the lateral tarsus to provide firm approximation of the lower lid to the globe. The correct CPT code is. -

a) 67914-E4
b) 67924-E2
c) 67921-E2
d) 67917-E1

21. The patient is here to follow up on her atrial fibrillation. Her primary care physician is not in the office. She will be seen by the partner physician that is also in the same group practice. No new problems. A problem focused history is performed. An expanded problem focused physical exam is documented with the following, Blood pressure is 110/64. Pulse is regular at 72. Temp is 98.6F Chest is clear. Cardiac normal sinus rhythm. Medical making decision is straightforward. Diagnosis: Atrial fibrillation, currently stable. What E/M code is reported for this service?

a) 99201
b) 99202
c) 99212
d) 99213

22. Documentation of a new patient in a doctor’s office setting supports a detailed history in which there are four elements for an extended history of present illness (HPI), three elements for an extended review of systems (ROS) and a pertinent Past, Family, Social History (PFSH). There is a detailed examination of six body areas and organ systems. The medical making decision making is of high complexity. Which E/M service supports this documentation?

a) 99205
b) 99204
c) 99203
d) 99202

23. A 2 year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedures to report for the ER physician?

a) 99291-25, 36555, 31500
b) 99291-25, 36556, 31500, 82803
c) 99285-25, 36556, 31500, 82803
d) 99475-25, 36556

24. 2 year-old is coming in with his mom to see the pediatrician for fever, sore throat, and pulling of the ears. The physician performs an expanded problem focused history. An expanded problem focused exam. A strep culture was taken for the pharyngitis and came back positive for strep throat. A diagnosis was also made of the infant having acute otitis media with effusion in both ears. The medical decision making was of moderate complexity with the giving of a prescription. What CPT and ICD-10-CM codes are reported?

a) 99212, J02.9, H66.93
b) 99213, J02.0 H65.93
c) 99212, J02.0 H65.193
d) 99213, J02.0 H65.193

25. A very large lipoma is removed from the chest measuring 8 sq cm and the defect is 12.2 cm requiring a layered closure with extensive undermining. MAC is performed by a medically directed Certified Registered Nurse Anesthetist (CRNA). Code the anesthesia service. -

a) 00400-QX-QS
b) 00400-QS
c) 00300-QS
d) 00300-QX-QS

26. PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal. The patient is placed on heart and lung bypass during the procedure. Anesthesia time: 6:00 PM to 12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and anesthesia time?

a) 00567, 6 hours
b) 00566, 6 hours
c) 00567, 5 hours and 30 minutes
d) 00566, 5 hours and 30 minutes

27. A CT density study is performed on a post-menopausal female to screen for osteoporosis. Today’s visit the bone density study will be performed on the spine. Which CPT code is reported?

a) 77075
b) 77080
c) 77078
d) 72081

28. The patient is 15-weeks pregnant with twins coming back to her obstetrician to have a transabdominal ultrasound performed to reassess anatomic abnormalities of both fetuses that were previously demonstrated in the last ultrasound. What ultrasound code(s) is (are) reported?

a) 76815
b) 76816, 76816-59
c) 76801, 76802
d) 76805, 76810

29. 67 year-old female fractured a port-a-cath surgically placed a year ago. Under sonographic guidance a needle was passed into the right common femoral vein. The loop snare was positioned in the right atrium where a portion of the fractured catheter was situated. The catheter crossed the atrioventricular valve with the remaining aspect of the catheter in the ventricle. A pigtail catheter was then utilized to loop the catheter and pull the catheter tip into the inferior vena cava. The catheter was then snared and pulled through the right groin removed in its entirety. What CPT and ICD-10-CM codes are reported?

a) 37200, T81.509D
b) 37197, T82.514A
c) 37193, T80.219A
d) 37217, T88.8XXA

30. 53 year-old woman with ascites consented to a procedure to withdraw fluid from the abdominal cavity. Ultrasonic guidance was used for guiding the needle placement for the aspiration. What CPT codes should be used?

a) 49083
b) 49180, 76942-26
c) 49082, 77002-26
d) 49180, 76998-26

31. Cells were taken from amniotic fluid for analyzation of the chromosomes for possible Down’s syndrome. The geneticist performs the analysis with two G-banded karyotypes analyzing 30 cells. Select the lab code(s) for reporting this service. -

a) 88248
b) 88267, 88280, 88285
c) 88273, 88280, 88291
d) 88262, 88285

32. Sperm is being prepared through a washing method to get it ready for the insemination of five oocytes for fertilization by directly injecting the sperm into each oocyte. Choose the CPT codes to report this service. -

a) 89257, 89280
b) 89260, 89280
c) 89261, 89280
d) 89260, 89268

33. A pathologist performs a comprehensive consultation and report after reviewing a patient’s records and specimens from another facility. The correct CPT code to report this service is. -

a) 88325
b) 99244
c) 88323
d) 88329

34. Patient with hemiparesis on the dominant side due to having a CVA lives at home alone and has a therapist at his home site to evaluate meal preparation for self-care. The therapist observes the patient’s functional level of performing kitchen management activities within safe limits. The therapist then teaches meal preparation using one handed techniques along with adaptive equipment to handle different kitchen appliances. The total time spent on this visit was 45 minutes. Report the CPT and ICD-10-CM codes for this encounter. -

a) 97530 x 3, I67.89, G81.91
b) 97535 x 3, G81.90, I69.959
c) 97530 x 3, I69.959, I67.89
d) 97535 x 3, I69.959

35. 10 year-old patient had a recent placement of a cochlear implant. She and her family see an audiologist to check the pressure and determine the strength of the magnet. The transmitter, microphone and cable are connected to the external speech processor and maximum loudness levels are determined under programming computer control. Which CPT code should be used?

a) 92601
b) 92603
c) 92604
d) 92562

36. A cardiologist pediatrician sends a four week-old baby to an outpatient facility to have an echocardiogram. The baby has been having rapid breathing. He is sedated and a probe is placed on the chest wall and images are taken through the chest wall. A report is generated and sent to the pediatrician. The interpretation of the report by the pediatrician reveals the baby has an atrial septal defect. Choose the CPT code the cardiologist pediatrician should report. -

a) 93303
b) 93315-26
c) 93303-26
d) 93315

37. Glomerulonephritis is an inflammation affecting which system?

a) Digestive
b) Nervous
c) Urinary
d) Cardiovascular

38. When a patient has fractured the proximal end of his humerus, where is the fracture located?

a) Upper end of the arm
b) Lower end of the leg
c) Upper end of the leg
d) Lower end of the arm

39. What is another term for when a physician performs a reduction on a displaced fracture?

a) Casting
b) Manipulation
c) Skeletal traction
d) External fixation

40. What does oligospermia mean?

a) Presence of blood in the semen
b) Deficiency of sperm in semen
c) Having sperm in urine
d) Formation of spermatozoa

41. Thoracentesis is removing fluid or air from the. -

a) Lung
b) Chest cavity
c) Thoracic vertebrae
d) Heart

42. An angiogram is a study to look inside. -

a) Female Reproductive System
b) Urinary System
c) Blood Vessels
d) Breasts

43. When a person has labyrinthitis what has the inflammation?

a) Inner ear
b) Brain
c) Conjunctiva
d) Spine

44. Patient is going back to the OR for a re-exploration L5-S1 laminectomy for a presumed cerebrospinal fluid leak following a decompression procedure. A small partial laminectomy was slightly extended, however revealed no real evidence of leak. Valsalva maneuver was performed several times, no evidence of leak. There was a hematoma, which was drained. What ICD-10-CM code(s) is (are) reported by the physician?

a) G96.0
b) G97.61
c) G96.8
d) G96.0, T81.4XXA

45. A patient that has hypertensive heart disease with congestive heart failure is coded. -

a) I11.0, I50.9
b) I13.0
c) I13.0, I11.0, I50.9
d) I50.9, I11.0

46. 10 year-old-male sustained a Colles’ fracture in which the pediatrician performs an application of short arm fiberglass cast. Select the HCPCS Level II code that is reported. -

a) Q4012
b) A4580
c) A4570
d) Q4024

47. 35 year-old-female is getting a Levonorgestrel implant system with supplies. The HCPCS Level II code is. -

a) S4989
b) J7306
c) A4264
d) J7301

48. Local Coverage Determinations (LCD) are published to give providers information on which of the following?

a) Information on modifier use with procedure codes
b) CPT codes that are bundled
c) Fee schedule information listed by CPT code
d) Reasonable and necessary conditions of coverage for an item or service

49. Which place of service code should be reported on the physician’s claim for a surgical procedure performed in an ASC?

a) 21
b) 22
c) 24
d) 11

50. If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines?

a) As unspecified AMI
b) As a subendocardial AMI
c) As STEMI
d) As a NSTEMI

Monday, May 15, 2017

LIST OF MODIFIERS - CPT AND HCPCS


A Modifier Provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code


Modifier is used to give additional Information of service and also used for Payment/Reimbursement purposes.

There are two types of categories in Modifiers

  • Level I Modifiers – It consists of two numeric digits, also known as CPT Modifiers and updated by AMA(American Medical Association) annually
  • Level II Modifiers - It consists of (Alpha / Alphanumeric characters) in the sequence AA through VP, also known as HCPCS Modifiers and Updated by CMS (Centers for Medicare and Medicaid Services)

Find the Below List of Level one Modifiers:



Mod
Description
Usage
Definition
22
Increased Procedural Services

When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.
23
Unusual Anesthesia

Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. This circumstance may be reported by adding modifier 23 to the procedure code of the basic service.
24
Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period

The physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service.
25
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
(Under OPPS, modifier may be used only with E/M visit codes (with status indicator V) within the following code ranges: 0359T, 0360T, 0362T, 90945, 92002-92004, 99201, 992014, 95250,99281-99285, 99460, 99463, 99495-99496, G0101, G0175, G0245, G0246, G0248, G0249, G0379, G0380-G0384, G0402, G0463 ~~Modifier used on an E/M code when it is reported with a procedure code that has a outpatient payment status indicator (OPSI) of "S" or "T." However, this does not preclude the provider from reporting this modifier with E/M codes that are assigned to an OPSI other than the "S" or "T" as long as the procedure meets the definition of "significant, separately identifiable E/M service" (Medicare Claims Processing Manual, chapter 4, section 20.6, Integrated Outpatient Code Editor, v17.1.)
It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59.
26
Professional Component

Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
27
Multiple Outpatient Hospital E/M Encounters on the Same Date
(Modifier 27 does not replace condition code (FLs 24-30) G0. Continue to report condition code G0 for multiple medical visits that occur on the same day in the same revenue center ~Modifier should be used with E/M codes (with status indicator V) within the ranges of 90945, 92002-92014, 99201-99285, 99431, G0101, G0175, G0245, G0246, G0248, G0249, G0379 G0380-G0384, G0402, and G0463~Hospitals use this modifier on the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is a separate and distinct E/M encounter from the service previously provided on the same day in the same or different hospital setting. (Medicare Claims Processing Manual, chapter 4, section 20.6, Integrated OCE (IOCE) CMS Specifications V17.1)
For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department E/M code(s). This modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). Note: This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date. For physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see Evaluation and Management, Emergency Department, or Preventive Medicine Services codes.
32
Mandated Services

Services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure.
33
Preventive Services

When the primary purpose of the service is the delivery of an evidence based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.
47
Anesthesia by Surgeon

Regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (This does not include local anesthesia.) Note: Modifier 47 would not be used as a modifier for the anesthesia procedures.
50
Bilateral Procedure
(Modifier applies to surgical procedures (CPT codes 10040-69990) and to radiology procedures performed bilaterally.~Used to report bilateral procedures performed in the same operative session. Identify that a second (bilateral) procedure has been performed by adding modifier 50 to the procedure code. Do not report two line items to indicate a bilateral procedure.~Do not use modifier with surgical procedures identified by their terminology as "bilateral" (e.g., 27395, lengthening of hamstring tendon, multiple, bilateral), or as "unilateral or bilateral" (e.g., 52290, cystourethroscopy, with meatotomy, unilateral or bilateral).~Applies to any bilateral procedure performed on both sides at the same session.~Report only one unit of service in FL 46 when modifier 50 is reported)
Unless otherwise identified in the listings, bilateral procedures that are performed at the same session should be identified by adding modifier 50 to the appropriate 5-digit code.

Friday, May 12, 2017

CPT 93000, 93005, 93010 (EKG) Lists of Payable/Covered Diagnosis and Applicable Modifiers


93000  Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
93010  Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only
93005  Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report

Code Description

Multiple electrodes are placed on a patient's chest to record the electrical activity of the heart. A physician interprets the findings. Report 93000 for the combined technical and professional components of an ECG; 93005 for the technical component only; and 93010 for the professional component only.

Instructions and coding tips

Add a 25 modifier to your E&M service when billing in conjunction with an EKG 93000, 93005, 93010 CPT.

Use Modifier XS for 93000 when billed with 93015.
  • Excludes Acoustic cardiography (93799)
  • Excludes ECG monitoring (99354-99360 [99415, 99416])
  • Excludes ECG with 64 or more leads, graphic presentation, and analysis (0178T-0180T)
  • Excludes Echocardiography (93303-93350)
  • Excludes Use of these codes for the review of telemetry monitoring strips
  • Includes Specific order for the service, a separate written and signed report, and documentation of medical necessity
List of Payable/Covered Diagnosis:

A02.1 Salmonella sepsis
A18.84 Tuberculosis of heart
A22.7 Anthrax sepsis
A26.7 Erysipelothrix sepsis
A32.7 Listerial sepsis
A40.0 Sepsis due to streptococcus, group A
A40.9 Streptococcal sepsis, unspecified
A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus
A41.9 Sepsis, unspecified organism
A42.7 Actinomycotic sepsis
A54.86 Gonococcal sepsis
A74.81 Chlamydial peritonitis
A74.9 Chlamydial infection, unspecified
B33.3 Retrovirus infections, not elsewhere classified
B34.8 Other viral infections of unspecified site
B37.7 Candidal sepsis
B97.0 Adenovirus as the cause of diseases classified elsewhere
B97.89 Other viral agents as the cause of diseases classified elsewhere
E00.0 Congenital iodine-deficiency syndrome, neurological type
E03.4 Atrophy of thyroid (acquired)
E03.8 Other specified hypothyroidism
E07.1 Dyshormogenetic goiter
E07.89 Other specified disorders of thyroid
E07.9 Disorder of thyroid, unspecified
E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene
E08.52 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E09.51 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene
E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.10 Type 1 diabetes mellitus with ketoacidosis without coma
E13.9 Other specified diabetes mellitus without complications
E35 Disorders of endocrine glands in diseases classified elsewhere
E84.0 Cystic fibrosis with pulmonary manifestations