Coding Applications Test

What is the code for a tunneled centrally inserted central venous catheter, without pump or port, in a 72-year-old patient? CPT Code:

Selected Answer:
36558
Correct Answer:

36558
Rationale: The coder should begin by locating the main term “Insertion” and then the subterm “Venous.” After reviewingthe codes in the tabular list the coder should select 36558 because this is a “72 year old patient.”

Question 2
Needs Grading

CPR (Cardiopulmonary resuscitation)
CPT code:

Selected Answer:
92950
Correct Answer:

92950
Rationale: The coder should refer to the CPT manual Index and reference the main term “Cardiopulmonary Resuscitation” and only one code is given. The coder should verify the code in the CPT tabular list to confirm the correct code of 92950.

Question 3
Needs Grading

Placement of a dual-chamber pacemaker.
Using a standard technique, the left infraclavicular subcutaneous pacemaker pocket was created with sharp and blunt dissection. The 2 j-tipped guidewires were advanced through a left subclavian vein using standard left subclavian venotomy under fluoroscopic guidance. The peel-away sheaths and introducers were advanced over the guidewires, and the guidewires were removed. The pacemaker leads were advanced under fluoroscopic and electrophysiologic guidance into the right ventricular apex and right atrial appendage. The pacemaker leads were seen to function adequately in vivo and were sutured in place with 0 silk. The leads were connected to the pulse generator, which was delivered into the wound in the usual fashion; 2-0 Vicryl suture was used to close the deep tissue layer and a 4-0 running subcuticular suture was used to close the skin. There were no complications of the procedure. CPT Code:

Selected Answer:
Correct Answer:

Rationale: The coder should refer to the CPT manual index and locate the main term “Insertion” then the subterm “Pacemaker”, then sub-subterm “heart”. The coder is given the code range 33206-33208. After reviewing the codes on the tabular list of the CPT. The coder should select 33208 because the “leads were advanced through the right ventricular apex and right atrial appendage.”

Question 4
Needs Grading

PREOPERATIVE DIAGNOSIS: Right hemothorax
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Placement of anterior chest tube
PROCEDURE: The patient was draped and prepped in the usual manner. The area was infiltrated with 1% lidocaine. A 1-cm incision was made in the second intercostal space about 7 cm to the right of the midline in the anterior chest and a 20-F chest tube was passed. Good tidal volume was confirmed. The chest tube was anchored using 1-0 silk. The area was dressed and the chest tube placed on suction. The patient tolerated the procedure well. Complications-none. CPT Code:

Selected Answer:

Correct Answer:

Rationale: The coder should refer to the CPT manual locate the main term “Thoracostomy”, then the subterm “Tube, with/without water seal”. After reviewing the code in the tabular list the coder is correct in selecting

Question 5
Needs Grading

A five-vessel coronary artery bypass using two arteries and three vein grafts. (Separate the codes with a comma in your response as follows: XXXXX, XXXXX.) CPT Code , CPT Code

Selected Answer:
33519, 33534
Correct Answer:

33534, 33519
Rationale: The coder should refer to the CPT manual index to being. Locate the main term “Coronary Artery Bypass Graft”, then the subterm “Arterial” the coder is given 33533-33536. After reviewing the code choices the coder must choose 33534 because the cases states “two arteries.” The coder should return to the index and locate the main term “Coronary Artery Bypass Graft” again, this however the coder will locate the subterm “Arterial-Venous” because the arteries and veins are being treated. The coder is given the code range 33517-33523. After reviewing the codes the codes the coder must select 33519 because it states 3 veins in the case.

Question 6
Needs Grading

Abdominal aortogram.
The right groin was prepped and draped in the usual fashion. Seldinger technique was used to enter the femoral artery. A 6-French sheath was placed. A pigtail catheter was introduced in the upper abdominal aorta, and an AP aortogram was done using the DSA cut film technique using 20 cc of Omnipaque. Results: The abdominal aorta appears mildly irregular above and below the renal arteries, with no significant stenosis. (Separate the codes with a comma in your response as follows: XXXXX, XXXXX.) CPT Codes: (Surgery Code) , (Radiology Code) – Modifier

Selected Answer:
36200,75625,-26
Correct Answer:

36200, 75625-26
Rationale: The coder should refer to the CPT manual index and locate the main term “Catherization” because the cases states “A pigtail catheter was introduced in the upper abdominal aorta.” The coder should then locate area of the body being catheterized, which is the “aorta.” Even though the case says “abdominal aorta” that is the area they are going through to access the aorta. The coder is given a code range of36160-36215. The should then verify the code in the CPT manual tabular list. After reviewingthe codes in the tabular area. The coder would the code 36200. The coder would then refer back to the CPT index and locate the main term “Aorta.” Because the patient had an aortogram, the coder should locate the subterm “Aortography.” The coder is given the code range 75600-75630. After reviewing the codes in the tabular list the coder should select 75625.The coder should then append a -26 to the code to iindicate the physician interpretation or “results” of the recording.

Question 7
Needs Grading

Use HCPCS Level II modifier w/ CPT code.
PTCA of left anterior descending coronary artery.
A 6-French JL4 guiding catheter was used, and a 014 extra-support wire was passed through the LAD obstruction and “entered” the distal vessel. This was first dilated with a 3-mm20 CrossSail balloon, subsequently with a 3.5 10 cutting balloon (arteriectasis). With the cutting balloon, there were four inflations at 6-7 atmospheres and up to 1-minute inflation times. The balloon was withdrawn, and angiography showed the vessel to be wide open with mild irregularities and less than 15% narrowing remaining. There was no distal embolism. There was no dissection noted. There was normal TIMI flow. The case was then terminated at this point and balloons, catheters, and wires were removed, and the patient was sent to her room in good condition. CPT Code: ,

Modifier:

Selected Answer:
92920-LD
Correct Answer:

92920-LD
Rationale: The coder should refer to the CPT manual index and locate the acronymn “PTCA” the coder is directed to see “Percutaneous Transluminal Angioplasty.” After this is located the case states that the coronary artery is being repaired. The coder is given a code range of 92920-92924. After reviewing the code range in the CPT manual tabular list the coder should select 92920 “single vessel” because the case states only the “Left Anterior Descending artery”was widened. Then add the “LD” Modifier to the code.

Question 8
Needs Grading

Percutaneous Lung Biopsy
CPT code:

Selected Answer:
31628
Correct Answer:

32405
Rationale: The coder should refer to the CPT manual index. Locate the main term “Pneumoncentesis”, then the subterm “Lung.” The coder should then refer to the CPT tabular list to verify the code provided. After reviewing the code the coder should choose 32405.

Question 9
Needs Grading

Diagnostic thoracoscopy of the pericardial sac, with biopsy caused by chronic rheumatic pericarditis. CPT Code(s):

Selected Answer:
32604
Correct Answer:

32604
Rationale: The coder should refer to the CPT manual index. Locate the main term “Thoracoscopy”, then the subterm “Diagnostic” because the case states this “with biopsy”, so the coder would choose the the sub-subterm “with biopsy” for which codes 32602, 32604, 32606 are given. The coder should then refer to the CPT tabular list to verify the codes. After reviewing the codes the coder should choose 32604 because it states “pericardial sac with biopsy.”

Question 10
Needs Grading

Cervical tracheoplasty
CPT :

Selected Answer:
31750
Correct Answer:

31750
Rationale: The coder should refer to the CPT manual index and locate the main term “Tracheoplasty” and then locate the subterm “Cervical.” The coder is given the code 31750. After reviewing the code in the CPT tabular list the code choice is correct.