If the Dr. Didn't Say It, It Didn't Happen
1. An axillary view might be included in an X-ray of what part of the skeleton?
B - The axillary view is an X-ray view taken of the shoulder.
20. A patient 14 weeks pregnant is coming back to her obstetrician’s office for a repeat transabdominal ultrasound to measure fetal size and to confirm abnormalities seen in a previous scan. The obstetrician documented the ultrasound results in the medical record. What CPT® code is reported by the obstetrician?
C - 76816 The patient is coming back for a follow-up (repeat) ultrasound to re-evaluate conditions affecting the fetus seen on the last ultrasound scan. No modifier 26 is needed because the ultrasound and the interpretation of the results were performed in the obstetrician’s office. In the CPT® Index, look for Ultrasound/Pregnant Uterus to find the code range.
31. 37-year-old has multilevel lumbar degenerative disc disease and is coming in for an epidural injection. Localizing the skin over the area of L5-S1, the physician uses the transforaminal approach under fluoroscopy guidance for needle positioning. The spinal needle is inserted, and the patient experienced paresthesias into her left lower extremity. The anesthetic drug is injected into the epidural space. What CPT® code(s) is/are reported?
B - 64483 In the CPT® Index, look for Nerves/Injection/Anesthetic. You are referred to 01991-01992 or 64400-64530. You can also find this under Epidural/Injection/Transforaminal. Review the codes to choose appropriate service. Code 64483 is the correct code, because the anesthetic was injected into the epidural space in one single level (L5-S1) using the transforaminal approach. Imaging guidance is included in the procedure and not reported separately.
41. Myocardial Perfusion Imaging—Office Based Test Indications: Chest pain. Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion. Findings: This is a technically fair study. There were no stress induced electrocardiographic changes noted. There are no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%. Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. What CPT® code(s) is/are reported?
B - 78452 Tomographic myocardial perfusion imaging was performed. In this procedure the patient receives an intravenous injection of a radionuclide, which localizes in nonischemic tissue. SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. In the CPT® Index, look for Heart/Myocardium/Perfusion Study 78451-78454. A single study SPECT was performed, 78451. The MPI was performed at rest and exercise (which is stress), reporting code 78452 for multiple studies.
50. A patient presents to OR for a craniotomy with evacuation of a hematoma. What is the CPT® code for the anesthesiologist’s services? a. 00210 b. 61312 c. 00211 d. 61314
C
2. Which anatomic position has the patient lying at an angle instead of lying flat or directly on their side?
D - The oblique position is a slanted position where the patient is lying at an angle that is neither prone nor supine.
21. Tomographic axial images (CT or CAT scan) through the abdomen were obtained without administration of intravenous contrast. This showed a 3-cm diameter mass in the upper pole of the right kidney abutting the liver. Cryoablation of the lesion was performed utilizing 2 freezing cycles with good cosmetic results. What CPT® codes are reported?
C - 50250, 77013-26 A kidney (renal) mass, not tumor, is being destroyed (ablation) by freezing (cryoablation) the lesion to remove it. This procedure was performed under CT (computed tomography) guidance to ablate parenchymal (vital organ-example: kidney) tissue. Look in the CPT® Index for Ablation/Cryosurgical/Renal Mass directing you to 50250. The CT guidance is found in the Index under Ablation/CT Scan Guidance 77013. Modifier 26 denotes the professional service.
32. A patient is taken to the inpatient cardiac cath lab and 1% Lidocaine is infused into the skin of the right groin. The artery is punctured with a needle and a guidewire with a catheter is advanced into the abdominal aorta. The guidewire is removed. Contrast medium is injected through the catheter and abdominal aortography is performed. What CPT® code(s) is/are reported for the physician’s services?
B - 36200, 75625-26 The physician gains access to the aorta through the right groin (femoral artery). The procedure is reported with 36200. In the CPT® Index, look for Catheterization/Aorta. Abdominal aortography is performed, which is reported with 75625. In the CPT® Index, look for Aorta/Aortography or see Aortography/Aorta Imaging. The services were provided by the physician in the inpatient setting. Append modifier 26 to indicate the professional component.
42. After intravenous administration of 5.1 millicuries Tc-99m DTPA, flow imaging of the kidneys was performed for approximately 30 minutes. Flow imaging demonstrated markedly reduced flow to both kidneys bilaterally. What CPT® code is reported?
B - 78701 The nuclear imaging test follows the blood as it flows to the kidneys identifying any obstruction and to determine the rate at which the kidneys are filtering. The scenario does not document the function of the tubes and ducts. In the CPT® Index, look for Nuclear Medicine/Diagnostic/Kidney/Vascular Flow directing you to code range 78701-78709.
52. What ICD-10-CM code is reported for a routine screening mammogram?
C - Z12.31 Look in the ICD-10-CM Index to Diseases and Injuries for Screening/neoplasm (malignant) (of)/breast/routine mammogram Z12.31. ICD-10-CM only has one code to report a screening mammogram. Verify in the Tabular List Z12.31 Encounter for screening mammogram for malignant neoplasm of breast.
22. 52-year-old female is sent to radiology for a lymphangiography of both arms. The patient has swelling in both arms which is suspected to be lymphangitis and she has a history of breast cancer having a double mastectomy. What CPT® and ICD-10-CM codes are reported?
C - 75803, M79.89, Z85.3, Z90.13 Look in the CPT® Index under code Lymphangiography/Arm referring you 75801-75803. Patient is having a lymphangiography of bilateral extremities (both arms). The reason for the test is due to swelling of both arms. In the Index to Diseases and Injuries look for Swelling/arm referring you to code M79.89. Patient has history of breast cancer. In the Index to Diseases and Injuries look for History/personal (of)/ malignant neoplasm (of)/breast directing you to Z85.3. The patient had removal of both breasts. In the Index to Diseases and Injuries look for Absence/breast(s) (and nipple(s)) (acquired) directing you to Z90.1-. Verification in the Tabular List indicates a fifth character of 3 is reported for bilateral. The lymphangitis is suspected and is not a definitive diagnosis, so it is not reported.
33. A patient with thickening of the synovial membrane undergoes a fluoroscopic guided radiopharmaceutical therapy joint injection on his right knee without ultrasound. What CPT® code(s) is/are reported by the physician if performed in an ASC setting?
D - 79440-26, 20610, 77002-26 Arthrocentesis is aspiration or injection with a needle involving a joint. According to CPT® coding guidelines, when radiopharmaceutical therapy is performed, you should select a code for the injection as well as the radiological guidance. Because the injection is intra-articular, the radiopharmaceutical therapy is reported with 79440. Fluoroscopic image guidance for a joint injection is reported with 77002. Modifier 26 is appended to both radiology codes to report the professional services performed by the physician in the ASC setting. The joint injection was performed on the knee, which is considered a large joint reported with 20610. The notes in the Nuclear Medicine subsection under Therapeutic instruct you to also use the appropriate injection and/or procedure codes as well as imaging guidance. When multiple procedures are performed, they are listed in RVU order. Look in the CPT ® Index for Nuclear Medicine/Therapeutic/Radiopharmaceutical, Administration/Intra-articular directing you to 79440. Next in the CPT® Index look for Arthrocentesis/Large Joint directing you to 20610. Then look in the CPT® Index look for Needle Localization/Fluoroscopic Guidance directing you to 77002.
43. An oncology patient is having weekly radiation treatments with a total of seven conventional fractionated treatments. Two fractionated treatments daily for Monday, Tuesday and Wednesday and one treatment on Thursday. What radiology code(s) is/are appropriate for the clinical management of the radiation treatment?
A - 77427 There are seven fractions given in this patient’s weekly treatment. According to CPT® guidelines, radiation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time-period in which the services are furnished. Code 77427 is also reported if there are three or four fractions beyond a multiple of five at the end of a course of treatment, one or two fractions beyond a multiple of five at the end of a course of treatment are not reported separately.” This instruction is found in CPT® under the heading “Radiation Treatment Management” in the Radiology/Radiation Oncology Section of the Radiology Chapter. In the CPT® Index look for Radiation Therapy/Treatment Management/Weekly directing you to 77427.
53. What ICD-10-CM codes are reported for a radiotherapy session?
A - Z51.0 Look in the ICD-10-CM Index to Diseases and Injuries for Radiotherapy session Z51.0. Verify in the Tabular Z51.0 Encounter for antineoplastic radiation therapy.
4. AP and Lateral chest X-rays were performed for a cough. What CPT® and ICD-10-CM codes are reported?
B - 71020, R05 In the CPT® Index, look for X-ray/Chest and you are guided to code range 71010-71035. In looking at the descriptions, this is a 2-view chest X-ray. In the AP (Anteroposterior) position the X-ray beam enters the front of the body and exits through the back. In the lateral position, the X-ray beam enters through the side of the body. This is reported with 71020. For the ICD-10-CM, look in the Index to Diseases and Injuries for Cough, and you are directed to R05.
10. 22-year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service not usually requiring anesthesia. What modifier would be appended to the service? a. 22 b. 23 c. 47 d. 52
B