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CCS Practice Exam Questions and answers, 100% Accurate, rated A+. A 12-year-old boy was seen in an ambulatory surgical center for pain in his right arm. The x-ray showed fracture of ulna. Patient... underwent closed reduction of fracture right proximal ulna and an elbow-tofinger cast was applied. What diagnostic and procedure codes should be assigned? S52.101AUnspecified fracture of upper end of right radius, initial encounter for closed fracture S52.101BUnspecified fracture of upper end of right radius, initial encounter for open fracture S52.001AUnspecified fracture of upper end of right ulna, initial encounter for closed fracture S52.001BUnspecified fracture of upper end of right ulna, initial encounter for open fracture 0PSH0ZZReposition right radius, open approach 0PSK0ZZReposition right ulna, open approach 24670Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without manipulation 24675Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); with manipulation 25560Closed treatment of radial and ulnar shaft fractures; without manipulation 29075Application, cast; elbow to finger (short arm) a. S52.101A, S52.001A, 0PSK0ZZ b. S52.101B, S52.001B, 0PSH0ZZ c. S52.101B, S52.001B, 25560, 29075 d. S52.001A, 24675 - ✔✔-Correct Answer: D The patient has a fracture of the right proximal ulna and closed reduction is necessary. In the ICD-10-CM Code Book, under Fracture, ulna, proximal, the coder is referred to Fracture, ulna, upper end. The term "manipulation" is used to indicate reduction in CPT. According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure (AMA CPT Professional Edition 2020, 182). (Note: Since this is an ambulatory surgery center case, CPT codes are assigned rather than ICD-10-PCS codes.) A laparoscopic tubal ligation is completed. What is the correct CPT code assignment? 49320Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 58662Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 58670Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 58671Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) a. 49320, 58662 b. 58670 c. 58671 d. 49320 - ✔✔-Correct Answer: B The code that best reports the tubal ligation is 58670 Laparoscopy, surgical; with fulguration of oviducts because there are no clips or excision of lesion completed during the procedure (CPT Assistant Nov. 1999, 29; March 2000, 10). Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What conditions should have codes assigned? O30.003Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester O30.009Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester O60.14X0Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified O60.14X1 Preterm labor third trimester with preterm delivery third trimester, fetus 1 O60.14X2Preterm labor third trimester with preterm delivery third trimester, fetus 2O80Encounter for full-term uncomplicated delivery Z3A.3030 weeks gestation of pregnancy Z37.0Single live birth Z37.2Twins, both liveborn a. O80, Z3A.30, Z37.0 b. O30.003, O60.14X0, Z3A.30, Z37.2 c. O60.14X1, O60.14X2 O30.003, Z3A.30, Z37.2 d. O80, O30.009, Z3A.30, Z37.2 - ✔✔-Correct Answer: C A code for preterm labor and delivery is assigned for each fetus since both babies were born preterm as noted in Coding Clinic. Additionally, a code from category O30, Multiple gestations, must be assigned (Leon-Chisen 2020, 325; AHA Coding Clinic 2016 2nd Quarter, 10-11). A patient with acute respiratory failure, hypertension, and congestive heart failure is admitted for intubation and ventilation. The patient's heart failure is stable on current medications. What are the correct diagnosis codes and sequencing? I10Essential hypertension I11.0Hypertensive heart with heart failure I50.9Heart failure, unspecified J96.00Acute respiratory failure, unspecified whether with hypoxia or hypercapnia J96.20Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia a. J96.00, I11.0, I50.9 b. I50.9, J96.00, I10 c. J96.20, I10, I50.9 d. I50.9, J96.20, I11.0 - ✔✔-Correct Answer: A The patient was admitted and treated for respiratory failure. The other conditions present are also coded. The classification presumes a causal relationship between hypertension and congestive heart failure unless the physician documents otherwise (Leon-Chisen 2020, 228-231; CMS 2020a, Section I.C.10.b., 53, Section I.C.9.a, 46; AHA Coding Clinic 2017 1st Quarter, 47). A 64-year-old female was discharged with the final diagnosis of acute renal failure and hypertension. What coding guideline applies? a. Use combination code of hypertension and chronic renal failure. b. Use separate codes for hypertension and chronic renal failure. c. Use separate codes for hypertension and acute renal failure. d. Use combination code for hypertension and acute renal failure. - ✔✔-Correct Answer: C There is not a combination code for acute renal failure and hypertension. Acute kidney failure is not the same as chronic kidney disease (CMS 2020a, Section I.C.9. 2-3, 46-47; Leon-Chisen 2020, 262). A patient was discharged from the same-day-surgery unit with the following diagnoses: posterior subcapsular, mature, incipient, senile cataract right eye, diabetes mellitus, hypertension, and was treated for mild acute renal failure. Which codes are correct? E11.36Type 2 diabetes mellitus with diabetic cataract E11.29Type 2 diabetes mellitus with other diabetic kidney complication E11.9Type 2 diabetes mellitus without complications H25.9Unspecified age-related cataract H25.21Age-related cataract, morgagnian type, right eye H25.041Posterior subcapsular polar age-related cataract, right eyeI10Essential hypertension I12.9Hypertensive chronic kidney disease with stage 1 through stage 4, or unspecified chronic kidney disease N17.9Acute kidney failure, unspecified a. H25.21, E11.29, I12.9, N17.9 b. E11.36, H25.041, I10, N17.9 c. H25.9, E11.29, I12.9, N17.9 d. H25.041, E11.9, I12.9 - ✔✔-Correct Answer: B The patient has posterior subcapsular, mature, incipient, senile cataract right eye, diabetes mellitus, hypertension, acute renal failure. The hypertension and diabetes are not related to the renal failure as it is acute and not chronic. Because of this, no combination code is assigned for hypertension, diabetes and chronic renal failure. However, the diabetes and cataract are related conditions which are coded using a combination code. The classification presumes a relationship between diabetes and cataracts (CMS 2020a, Sections I.A.15, 12-13 and I.B.9., 15; AHA Coding Clinic 2016 2nd Quarter, 36-37; AHA Coding Clinic 2019 2nd Quarter, 30). 145 Correct0 Wrong1 Unanswered45 Current Procedural Terminology (CPT) defines a separate procedure as which of the following? a. Procedure considered an integral part of a more major service b. Provision of anesthesia c. Procedure that requires an add-on code d. A surgical procedure performed in conjunction with an E&M visit - ✔✔-Correct Answer: A When a procedure is designated as a separate procedure in the CPT code book and it is performed in conjunction with another service, it is considered an integral part of the major service. The CPT code description includes "separate procedure." The intention is not to provide payment for a procedure that is already integral to any given procedure (Smith 2020, 68-69; AMA CPT Professional Edition 2020, 72- 73). Documentation from the nursing or other allied health professionals' notes can be used to provide specificity for code assignment for which of the following diagnoses? a. Body mass index (BMI) b. Malnutrition c. Aspiration pneumonia d. Fatigue - ✔✔-Correct Answer: A The physician must establish the diagnosis—obesity or morbid obesity—and the additional information can be pulled from ancillary documentation to establish the correct code assignment for body mass index (BMI) (CMS 2020a, Section I.B.14, 17-18). A laparoscopic cholecystectomy was performed. What is the correct ICD-10-PCS code? 0FB40ZZExcision of gallbladder, open approach 0FB44ZZExcision of gallbladder, percutaneous endoscopic approach 0FT40ZZResection of gallbladder, open approach 0FT44ZZResection of gallbladder, percutaneous endoscopic approach a. 0FB40ZZ b. 0FT40ZZ c. 0FT44ZZ d. 0FB44ZZ - ✔✔-Correct Answer: C A cholecystectomy includes complete removal of the gallbladder; therefore, the correct root operation is Resection. Since the procedure is specified as a laparoscopic cholecystectomy, the approach is percutaneous endoscopic (Leon-Chisen 2020, 247-248). Carcinoma of multiple overlapping sites of the bladder. Diagnostic cystoscopy and transurethral fulguration of bladder lesions over the dome and posterior wall (1.9 cm.) was completed. A biopsy was taken of a lesion in the lateral wall. What modifier should be added to the biopsy procedure code? a. -50, Bilateral procedure b. -51, Multiple procedures c. -59, Distinct procedural service d. -99, Multiple modifiers - ✔✔-Correct Answer: C The surgery is done on two distinct areas within the bladder with two distinct approaches. The biopsy is not of the area that was resected and warrants the use of -59 (CPT Assistant Sept. 2001; CPT Professional Edition 2020, Appendix A). A bronchoscopy with multiple biopsies of the left bronchus was completed and revealed adenocarcinoma. What, if any, modifier should be added to the procedure code billed by the facility? a. -59, Distinct procedural service b. -51, Multiple procedures c. -76, Repeat procedure or service by same physician d. No modifiers should be reported - ✔✔-Correct Answer: D The procedure is reported with code 31625, the description of which indicates biopsy of single or multiple sites. When reporting this code, it is not necessary to indicate multiple procedures as the code itself does that (AMA CPT Professional Edition 2020, Appendix A). A patient is admitted with fever and urinary burning. Urosepsis is suspected. The discharge diagnosis is Escherichia coli, urinary tract infection; sepsis ruled out. Which of the following represents the diagnoses to report for this encounter and the appropriate sequencing of the codes for those conditions? a. Fever, urinary burning, urosepsis b. Fever, urinary burning, sepsis c. Escherichia coli sepsis d. Urinary tract infection, Escherichia coli - ✔✔-Correct Answer: D Symptoms are not coded when a related definitive diagnosis is present on discharge. The patient has a discharge diagnosis of urinary tract infection, secondary to E. coli. A secondary code of B96.20 is assigned to identify E. coli as the cause of the infection (CMS 2020a, Section II.A., 108). A patient was admitted to the emergency department for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. In addition to gastroenteritis, the final diagnostic statement included angina and chronic obstructive pulmonary disease. List the diagnoses that would be coded and their correct sequence. a. Abdominal pain, infectious gastroenteritis, chronic obstructive pulmonary disease, angina b. Infectious gastroenteritis, chronic obstructive pulmonary disease, angina c. Gastroenteritis, abdominal pain, angina d. Diarrhea, chronic obstructive pulmonary disease, angina - ✔✔-Correct Answer: B The abdominal pain and diarrhea are not coded as they are symptoms integral to the diagnosis of infectious gastroenteritis. Review Coding Guideline IV.D for additional information on coding of symptoms, signs, and ill-defined conditions (CMS 2020a, Section IV.D., 113). A patient was admitted to the endoscopy unit for a screening colonoscopy. During the colonoscopy, polyps of the colon were found and a polypectomy was performed. What diagnostic codes should be used and how should they be sequenced? Z12.11Encounter for screening for malignant neoplasm of colon D12.6Benign neoplasm of colon, unspecified Z86.010Personal history of colonic polyps a. Z12.11, Z86.010 b. D12.6, Z12.11, Z86.010 c. Z12.11, D12.6 d. D12.6, Z12.11 - ✔✔-Correct Answer: C The circumstances of the encounter are for a screening colonoscopy. Because of this screening, colonoscopy is listed first, followed by a code for the polyps (CMS 2020a, Section I.C.21.c.5, 97-98). The patient is admitted for chest pain and is found to have an acute inferior myocardial infarction with coronary artery disease and atrial fibrillation. After the atrial fibrillation was controlled and the patient was stabilized, the patient underwent a CABG ×2 from aorta to the right anterior descending and right obtuse, using the left greater saphenous vein which was harvested via an open approach. Cardiopulmonary bypass was utilized. The appropriate sequencing and ICD codes for the hospitalization would be: I25.10Atherosclerotic heart disease of native coronary artery without angina pectorisI21.19ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wallI22.1Subsequent ST elevation (STEMI) myocardial infarction of inferior wallI21.3ST elevation (STEMI) myocardial infarction, of unspecified siteI22.9Subsequent ST elevation (STEMI) myocardial infarction of unspecified siteI48.91Unspecified atrial fibrillationR07.9Chest pain, unspecified02100AWBypass coronary artery, one artery from aorta with autologous arterial tissue, open approach021109WBypass coronary artery, two arteries from aorta with autologous venous tissue, open approach06BQ0ZZExcision of left saphenous vein, open approach5A1221ZPerformance of cardiac output, continuous a. R07.9, I21.3, I48.91, I22.9, 02100AW, 5A1221Z b. I21.19, I48.91, I22.9, 02100AW c. I21.19, I25.10, I48.91, 021109W, 06BQ0ZZ, 5A1221Z d. I22.1, I48.91, I21.19, 021109W - ✔✔-Correct Answer: C The patient's hospitalization includes a definitive diagnosis of myocardial infarction of the inferior wall as well as the other diagnoses of coronary artery disease and atrial fibrillation. The chest pain is not coded as it is a symptom of the MI. The patient underwent CABG ×2 with cardiopulmonary bypass and harvesting of the left saphenous vein to be used as graft material. All three procedures are reportable and should be coded (Leon-Chisen 2020, 393-396, 430- 434). A patient is admitted with hemoptysis. A bronchoscopy with transbronchial biopsy of the lower lobe was undertaken that revealed squamous cell carcinoma of the right lung. Which conditions should be identified as present on admission? C34.30Malignant neoplasm of lower lobe, unspecified bronchus or lung C34.31Malignant neoplasm of lower lobe, right bronchus or lung P26.9Unspecified pulmonary hemorrhage originating in the perinatal period R04.2Hemoptysis a. C34.31, R04.2 b. R04.2 c. C34.31 d. C34.30, P26.9, R04.2 - ✔✔-Correct Answer: C The diagnosis after study (lung cancer) was present on admission. The symptom (hemoptysis) of the carcinoma should not be assigned and therefore, will not have a POA indicator. Code P26.9 would not be assigned because it is not diagnosed and only applies to the perinatal period (CMS 2020a, Appendix I, 117-121). A condition is considered present on admission when it is: a. The principal diagnosis b. In accordance with medical staff bylaws c. A condition that occurs prior to an inpatient admission d. Present within three days after admission - ✔✔-Correct Answer: [Show More]

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