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Certified Coding Specialist (CCS) Exam Preparation/83 Questions and answers
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Certified Coding Specialist (CCS)Exam Preparation/83 Questions and
answers
.In order to accurately code a cardiac catheterization, what needs to be
determined based on a review of the documentation?
a. The approach and the side of the heart (chambers) into which the catheter
was inserted
b. The approach, the side of the heart (chambers) into which the catheter
was inserted, as well as any additional procedures performed
c. The duration of the procedure
d. If there is documentation of the procedure in the medical record that
stents are considered - -b. The approach, the side of the heart (chambers)
into which the catheter was inserted, as well as any additional procedures
performed
-(OPPS)
outpatient prospective payment system - -outpatient prospective payment
system (OPPS).
-1. Assign the code(s) for bronchoscopy with bilateral transbronchial biopsy
for each lobe of each lung.
31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when
performed; with transbronchial lung biopsy(s), single lobe
31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when
performed; with transbronchial needle aspiration biopsy(s), trachea, main
stem and/or lobar bronchus(i)
31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when
p - -c. 31628, 31632
31628: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when
performed; with transbronchial lung biopsy(s), single lobe
31632: Bronchoscopy, rigid or flexible, including fluoroscopic guidance,
when performed; with transbronchial lung biopsy(s), each additional lobe
In contrast to question 28, the code description for the transbronchial biopsy
includes the specification that the biopsy is in a single lobe. An additional
CPT code is needed (as opposed to a modifier) to denote the bilateral aspect
of the biopsy. CPT code 31632 is an "add-on" code, which means it is coded
,in addition to the primary procedure code (CPT Assistant 2005; May 2008,
15; Feb. 2010, 6; April 2010, 5; AMA CPT Professional Edition 2017, 181).
-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. What diagnostic and procedure
codes should be assigned?
S52.101A Unspecified fracture of upper end of right radius, initial encounter
for closed fracture
S52.101B Unspecified fracture of upper end of right radius, initial encounter
for open fracture
S52.001A Unspecified fracture of upper end of right ulna, i - -d. S52.001A,
24675
S52.001A: Unspecified fracture of upper end of right ulna, initial encounter
for closed fracture.
24675: Closed treatment of ulnar fracture, proximal end (eg, olecranon or
coronoid process(es) ); with manipulation
**The patient has a fracture of the right proximal ulna and closed reduction
is necessary. In the ICD-10-CM codebook, under Fracture, ulna, proximal, the
coder is referred to Fracture, ulna, upper end. The term "manipulation" is
used to indicate reduction in CPT (AMA CPT Professional Edition 2017, 104).
[Note: Since this is an ambulatory surgery center case, CPT codes are
assigned, rather than ICD-10-PCS codes.]
-A 35-year-old woman has hypertension with acute renal failure and stage 3
chronic kidney disease. What code would be assigned?
a. N17.9, Acute kidney failure, unspecified
b. I13.2, Hypertensive heart and chronic kidney disease with heart failure
and with stage 5 chronic kidney disease, or end stage renal disease
c. I50.9, Heart failure, unspecified
d. N17.9, Acute kidney failure, unspecified and I12.9, Hypertensive chronic
kidney disease with stage 1 through stage 4 chronic kidney disease, or u - -
d. N17.9, Acute kidney failure, unspecified and I12.9, Hypertensive chronic
kidney disease with stage 1 through stage 4 chronic kidney disease, or
unspecified chronic kidney disease and N18.3, Chronic kidney disease, stage
3 (moderate)
**Code the hypertension with stage 3 chronic kidney disease. In this case,
both hypertension and chronic kidney disease are documented and a
combination code is used. Also the code for the stage 3 chronic kidney
disease must be assigned due to the "code also" note. The acute renal
,failure is identified with a separate code (HHS 2017, Section I.C.9.a., 40; HHS
2017, Section I.C.14.a., 53).
-A 45-year-old female with chronic ulcerative enterocolitis and steroid
induced osteoporosis due to long-term steroid therapy. What codes should
be assigned?
K50.00 Crohn's disease of small intestine without complications
K51.00 Ulcerative pancolitis without complications
M81.0 Age-related osteoporosis without current pathological fracture
M81.8 Other osteoporosis without current pathological fracture
T38.0X5A Adverse effects of glucocorticoids and synthetic analogues, initial
encounter
Z79.52 L - -a. K51.00: Ulcerative pancolitis without complications.
M81.8:Other osteoporosis without current pathological fracture. T38.0X5A:
Adverse effects of glucocorticoids and synthetic analogues, initial encounter.
Z79.52:Long term (current) use of systemic steroids
**The ulcerative colitis and osteoporosis should be coded as well as the
adverse effect and long term use of the steroid (HHS 2017, Section I.C.19.e,
74).
** In order to determine the correct procedure code, the lengths of the
wounds repaired with the same type of closure are added together (AMA CPT
Professional Edition 2017, 75, Surgery/ Integumentary Section directions).
[Note: Since this is an emergency department visit, CPT codes are assigned,
rather than ICD-10-PCS codes.]
-A 55-year-old patient has hypertensive heart disease with congestive heart
failure. What code would be assigned?
a. I15.8, Other secondary hypertension
b. I11.0, Hypertensive heart disease with heart failure and I50.9, Heart
failure, unspecified
c. I50.9, Heart failure, unspecified and I15.0, Renovascular hypertension
d. N18.6, End stage renal disease - -b. I11.0, Hypertensive heart disease
with heart failure and I50.9, Heart failure, unspecified
** There is a cause and effect relationship established between the
hypertension and the congestive heart failure. A separate code for the
congestive heart failure is assigned based on the "code also" note (HHS
2017, Section I.C.9.a., 40).
-A 70-year-old patient has congestive heart failure and hypertension with
end-stage renal disease. What codes would be assigned?
, a. I11.0, Hypertensive heart disease with heart failure
b. I13.2, Hypertensive heart and chronic kidney disease with heart failure
and with stage 5 chronic kidney disease, or end stage renal disease, I50.9,
Heart failure, unspecified, and N18.6 End stage renal disease
c. I50.9, Heart failure, unspecified, I12.0, Hypertensive chronic kidney
disease with stage 5 chronic - -b. I13.2, Hypertensive heart and chronic
kidney disease with heart failure and with stage 5 chronic kidney disease, or
end stage renal disease,
I50.9, Heart failure, unspecified, and
N18.6 End stage renal disease
**Code the CHF as well as hypertension with end stage kidney disease. In
this exercise, both hypertension and chronic kidney disease are documented
and for this reason code a combination code. The combination code for
hypertensive heart disease is used in this case as a causal relationship
between the hypertension and the CHF is presumed. According to the 2017
Guideline I.A.15, a causal relationship is presumed between conditions linked
by the term "with" in both the Alphabetic Index and the Tabular List. When
looking in the index under Hypertension, the coding professional is ultimately
referred to cardiorenal with heart failure with stage 5 or end stage renal
disease. In the Tabular List, code also notes indicate to code the type of
heart failure and the stage of renal
-A bronchoscopy with biopsy of the left bronchus was completed and
revealed adenocarcinoma. What, if any, modifier should be added to the
procedure codes?
a. -50, Bilateral procedure
b. -51, Multiple procedures
c. -LT, Left side
d. No modifiers should be reported. - -d. No modifiers should be reported.
Because the lungs are paired organs, it may seem as though modifier -50
would be appropriate. However, a modifier would not be assigned because
the bronchus is not a paired organ, and the bronchus is the location of the
procedure, not the lungs. Similarly, it might seem as though modifier -LT
would be assigned, but again, this would not be assigned as the bronchus is
not a paired organ. In order to assign the correct modifier, it is important to
note that paired organs include ears, eyes, nostrils, kidneys, lungs, ovaries,
and such (CPT Assistant May 2003).
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