Q38. An elderly patient comes into the emergency department (ED) with shortness of breath. An ECG is performed The final diagnosis at discharge is impending myocardial infarction.
According to ICD-10-CM guidelines, how is this reported?

Q39. A 30-year-old patient with a scalp defect is having plastic surgery to insert tissue expanders. The provider inserts the implants, closes the skin, and increases the volume of the expanders by injecting saline solution.
Tissue is expanded until a satisfactory aesthetic outcome is obtained to repair the scalp defect.
What CPT code is reported?

Q40. A mother brings her 2-year-old son to the pediatrician’s office because he stuck a bead up his left nostril. The pediatrician uses a nasal decongestant to open the blocked nostril and removes the bead with nasal forceps.
What CPT coding is reported?

Q41. A cardiologist attempted to perform a percutaneous transluminal coronary angioplasty of a totally occluded blood vessel. The surgeon stopped the procedure because of an anatomical problem creating risk for the patient and preventing performance of the catheterization.
What modifier is appended to the procedure code?

Q42. Patient has esotropia of the right eye and presents to operating suite for strabismus surgery. The physician resects the medial rectus horizontal and lateral rectus muscles of the eye and secures them with adjustable sutures. Extensive scar tissue is noted, due to a previous surgery involving an extraocular muscle. Extraocular muscle is isolated, and the muscle is freed from surrounding scar tissues.
What CPT codes are reported for this surgery?

Q43. A patient is diagnosed with diabetic polyneuropathy.
Using ICD-10-CM coding guidelines, what ICD-10-CM coding is reported?

Q44. A patient with malignant lymphoma is administered the antineoplastic drug Rituximab 800 mg and then 100 mg of Benadryl.
Which HCPCS Level II codes are reported for both drugs administered intravenously?

Q45. A 65-year-old man had a right axillary block by the anesthesiologist. When the arm was totally numb, the arm was prepped and draped, and the surgeon performed tendon repairs of the right first, second, and third fingers. The anesthesiologist monitored the patient throughout the case.
What anesthesia code is reported?

Q46. Mr. Roland has difficulty breathing and congestion with a productive cough. The physician takes frontal and lateral view chest X-rays in the office (the equipment is owned by the physician group). The physician reads the X-rays and determines a diagnosis of walking pneumonia. The physician’s interpretation is placed in the patient’s chart.
How does the physician bill for the chest X-ray?

Q47. Day 1 – A provider admits the patient to observation care for type 2 diabetes mellitus with hyperglycemia.
The provider orders a HbA1c, a urine (microalbumin), and kidney function lab tests.
Blood sugar is high and poorly controlled. The provider discusses the case with the patient’s endocrinologist.
The provider prescribes an IV insulin drip, along with SQ insulin and keeps the patient in observation overnight.
Day 2 – Patient is in observation care and the provider orders a blood glucose test. The patient’s glucose levels have improved. The provider places an order for the dietitian to see the patient.
Provider
documents spending a total time of 25 minutes with the patient.
Day 3 – Patient has a blood glucose test. The patient’s glucose level is back to normal. The provider documents spending 15 minutes with the patient. The provider discharges the patient.
What E/M coding is reported by the physician for the patient in observation care?

Q48. This 27-year-old male has morbid obesity with a BMI of 45 due to a high calorie diet. He has decided to have an open Roux-en-Y gastric bypass. The patient is brought to the operating room and placed in supine position. A midline abdominal incision is made. The stomach is mobilized, and the proximal stomach is divided and stapled creating a small proximal pouch in continuity with the esophagus. A short limb of the proximal bowel of 155 cm is divided. It is brought up and anastomosed to the gastric pouch. The other end of the divided bowel is connected back into the distal small bowel to the short limb’s gastric anastomosis to restore intestinal continuity. The abdominal incision is closed.
What are the procedure and diagnosis codes for this encounter?

Q49. A 46-year-old female is admitted to the hospital by her urologist for a left ureteral calculus. The urologist visits her again on day two and performs a low for number and complexity of problems addressed, minimal for amount and/or complexity of data to be reviewed and analyzed, and moderate for risk of complications.
What E/M service is reported for day two?

Q50. A patient is having X-ray imaging of his abdomen following a traumatic episode. A decubitus, supine, and erect views are performed on the abdomen.
What CPTis reported?

Q51. Patient is diagnosed with dacryocystitis, which is the inflammation of?

Q52. Miranda is in her provider’s office for follow up of her diabetes. Her blood sugars remain at goal with continuing her prescribed medications.
When referring to the MDM Table in the CPTcode book for number and complexity of problems addressed at the encounter, what type of problem is this considered?

Q53. A 43-year-old female with a history of joint pain and fatigue presents to the office with swollen salivary glands. Patient agrees to have a labial gland biopsy performed in office. Patient is numbed with a local anesthetic. Then an incision is made on the lower labial mucosa and tissue samples from the salivary gland are removed with tweezers. The incision is sutured. Pathology report findings are consistent with Sjogren’s syndrome.
What CPTcode is reported?

Q54. A mother brings her 2-year-old son to the pediatrician’s office because he stuck a bead up his left nostril. The pediatrician uses a nasal decongestant to open the blocked nostril and removes the bead with nasal forceps.
What CPT coding is reported?

Q55. A cardiologist uses the hospital’s equipment for a cardiac stress test as he doesn’t own equipment for the test. He supervises the test and provides the interpretation and report of the test.
What CPT codes are reported?

Q56. View MR 099407
MR 099407
Emergency Department Visit
Chief Complaint: VOMITING.
This started just prior to arrival and is still present. He has had nausea and vomiting. No diarrhea, black stools, bloody stools or abdominal pain. Pt is diabetic and has been having elevated blood sugars (320 mg/dL).
REVIEW OF SYSTEMS: Unobtainable due to patient’s altered mental status.
PAST HISTORY: Poorly controlled diabetes mellitus, with history of poor compliance.
Medications: See Nurses Notes.
Allergies: PCN.
SOCIAL HISTORY: Nonsmoker. No alcohol use or drug use.
ADDITIONAL NOTES: The nursing notes have been reviewed.
PHYSICAL EXAM
Appearance: Lethargic. Patient in mild distress.
Vital Signs: Have been reviewed-tachycardic.
Eyes: Pupils equal, round and reactive to light.
ENT: Dry mucous membranes present.
Neck: Normal inspection. Neck supple.
CVS: Tachycardia. Heart sounds normal. Pulses normal.
E D. Course: Insulin IV drip per protocol, at 10 units/hr.
Zofran 8 mg 01:33 Jul 13 2008 IVP.
Phenergan 25 mg IVP. 07:52. Discussed case with physician. Dr. X. Reviewed test results. Agreed upon treatment plan. Physician will see patient in hospital.
Total critical care time: 45 min.
Disposition: Admitted to Intensive Care Unit. Condition: stable.
Admit decision based on need for monitoring and IV hydration and medications.
CLINICAL IMPRESSION: Vomiting, diabetic ketoacidosis, probable diabetes insipidus.
What E/M code is reported for this encounter?

Q57. A 78-year-old patient experiencing intermittent asthma with exacerbation is in her pulmonologist’s office for a pulmonary function test. The pulmonologist tests for spirometry, vital capacity, breathing capacity, and flow volume capturing the measurements before and after administering a bronchodilator.
What CPTand ICD-10-CM codes are reported?

Q58. From a left femoral access, the catheter is placed within the proper hepatic artery, dye is injected, and imaging is obtained. A stenosis within this artery is identified. A percutaneous transluminal angioplasty is performed on the proper hepatic (visceral) artery in the outpatient radiology department.
What CPTcoding is reported?

Q59. Patient had polyps removed on a previous colonoscopy. The patient returns three months later for a follow-up examination for another colonoscopy. No new polyps are seen.
What diagnosis coding is reported for the second colonoscopy?