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LESSON ASSIGNMENTS 7
EXAMINATION—LESSONS 1, 2, AND 3 29
iii
INTRODUCTION
I ns tructions
The health care industry is growing at an amazing rate, and
many insurance companies, physicians’ offices, hospitals,
and other health care organizations urgently need qualified
staff to manage the workload. Among other duties, medical
office personnel are often responsible for generating and pro-
cessing medical claims. This crucial task involves translating
diagnoses, symptoms, procedures, and other health-related
information into numerical or alphanumeric codes. This
conversion process is commonly referred to as coding.
truction s
This part of your program provides you with detailed instruc-
tions to walk you through the coding process. The material
will lead you step-by-step through a wide range of coding
procedures, offering invaluable tips and suggestions along
the way. Your textbook also offers quite a number of practi-
cal exercises to assist you in mastering the fine points of the
coding process. At the same time, you’ll have a chance to
become familiar with a broad variety of medical terms, fur-
ther increasing your skill.
The material related to medical coding might seem complicated
at first—after all, you’re being asked to learn a new “language.”
As you proceed, however, you’ll find yourself growing more
and more comfortable with the terms and procedures used
by health care professionals every day. By the time you
finish the course, you’ll have gained many of the skills you
need to land a great job in the health care industry!
OBJECTIVES
When you complete this part of your program, you’ll be able to
n Discuss the differences between ICD-9-CM, CPT, and
HCPCS Level II codes
1
n Properly code services, conditions, and procedures using
ICD-9-CM and CPT specifications
2 Instructions to Students
As you proceed through the text, you’ll see that each chapter
includes a series of coding exercises. These exercises typically
follow the presentation of new information, and are designed
to provide you with an immediate and practical means of
applying what you’ve learned. Complete each exercise in
the order in which it appears.
The back portion of Understanding Medical Coding includes
several helpful study resources. The textbook’s glossary
(pages 593–605) provides an alphabetical listing of important
terms, accompanied by their definitions. A detailed index of
the subjects discussed in your textbook can be found on
pages 607–619. Once you’re done studying Understanding
Medical Coding, you can use these resources to refer back
to any topic you wish to review.
Each of your textbook assignments is geared to assist you in
developing a solid working knowledge of coding procedures and
medical terms. A great deal of technical information will be
presented to you, so take your time absorbing all the details.
You’ll need to dedicate both time and concentration to work
through the textbook exercises. To get the most out of this
essential part of your program, it’s a good idea to schedule sev-
eral study periods throughout each week. As you proceed
through the program, you’ll soon discover the rewards of the
effort you put into your study.
Instructions to Students 3
PROGRAM MATERIALS
This part of your program provides you with the following
materials:
1. This study guide, which includes an introduction to your
textbook, plus
n A lesson assignment page, which lists the schedule
of the study assignments in your textbook and
lesson exams
4 Instructions to Students
A STUDY PLAN
Work through this study guide one assignment at a time. Keep
your ICD-9-CM and CPT manuals on hand as you make your
way through your lessons, as you’ll need them to complete the
exercises in each assignment.
Once you’ve finished all of the assignments included in each
lesson, you’ll be ready to complete the examination. Before
you attempt to complete this exam, make sure you’ve read all
of the assigned material and have completed all the assigned
exercises. To get the most out of your studies, follow these
steps to completing your assigned work:
Step 1: Carefully note the pages where your assigned reading
begins and ends. These pages are identified in the
Lesson Assignments section of this study guide.
Step 2: Skim through the assigned pages (in both the study
guide and the textbook) to get a general idea of their
content. Try to develop an overall perspective on the
concepts and skills being taught and practiced in
each assignment.
Step 3: Carefully read through the study guide’s assigned
pages. These pages contain background information
about the material covered in each textbook module.
Step 4: Read the assigned pages in your textbook, and take
notes on any important points or terms that you feel
are especially significant.
Step 5: When you feel you’ve mastered all of the material
presented in each assignment, proceed to your next
study guide assignment. Repeat steps 1–4 for the
remaining assignments in each lesson.
Step 6: Once you’ve finished all the assignments and self-
checks, proceed to the next section. If the next
item in your study guide is an examination, care-
fully complete it. Take your time with the exam. As
you work, feel free to refer to your textbook, the
study guide, and any notes you may have taken.
Repeat steps 1–6 for the remaining lessons in your
study guide.
Instructions to Students 5
Remember, at any point in your studies, you can e-mail
your instructor for further information or clarification.
Your instructor can answer questions, provide additional
information, and further explain any of your study materials.
You should find your instructor’s guidance and suggestions
very helpful.
Now look over your lesson assignments and begin your study
of medical coding with Lesson 1, Assignment 1.
6 Instructions to Students
Lesson 1: Coding Fundamentals
For: Read in the Read in
A s s ignments
study guide: the textbook:
ignment s
Assignment 5 Pages 24–25 Pages 125–180
7
NOTES
8 Lesson Assignments
Coding Fundamentals
Your first lesson begins with an overview of coding concepts,
Lesson 1
terms, and procedures. You’ll learn about the different levels
of standardized codes, as well as why accurate coding is
an essential element of reporting medical conditions and
treatments. You’ll begin to work directly with the ICD-9-CM
manual, looking up codes and using them to create medical
reports. You’ll also be introduced to the HCPCS Level II man-
ual, an essential part of the coding arsenal.
ASSIGNMENT 1
Read through the following material in your study guide. After
you’ve read the study guide commentary, read pages 1–10 of
your textbook Understanding Medical Coding.
Introduction to Coding
Medical coding is a process of converting medical terms into
standardized numeric and alphanumeric equivalents that
are defined by national and international health agencies.
Reliance on standardized coding systems greatly expedites
the processing of health insurance claims, so patients and
health care practitioners can be reimbursed more quickly.
Proper coding also helps prevent the submission of erroneous
or fraudulent insurance claims, while providing a wide
range of health care organizations with accurate statistics
on disease, mortality, and treatments.
Health care employees responsible for coding are expected
to be familiar with two different coding systems:
n The Health Care Financing Administration Common
Procedural Coding System (commonly referred to
as HCPCS ), made up of two manuals: the Current
Procedural Terminology (CPT) and National Coding
Manual
9
A career in medical coding can involve many jobs, from
coding for doctors’ offices and hospitals to educating new
coders. It’s therefore likely that you’ll hold more than one
kind of coding position during your career. Opportunities
in this field will increase in the coming years.
Most coders have a combination of formal education and
on-the-job experience. Although not all coders are required
to be certified, certification is recommended and leads to
more opportunities and higher pay. Three institutions offer
certification for coders. The organization you choose will
depend on what you want from your career. However,
choosing one organization doesn’t prevent you from
choosing another in the future.
Computer skills are necessary for today’s coding environment.
Though you’ll receive training on the job for the particular
billing program used by each office, a familiarity with basic
applications and the Internet will make your learning process
much easier. Knowledge of medical terminology, anatomy,
and physiology is also helpful in this field.
Insurance fraud and abuse are partly responsible for increased
premiums and rising health care costs. The Health Insurance
Portability and Accountability Act (HIPAA) and the Omnibus
Budget Reconciliation Act (OBRA) both have detection and
penalty measures in place to help prevent fraud and abuse.
The only way to avoid even the appearance of wrongdoing is
to follow meticulous record-keeping practices and to continu-
ously update your knowledge of current coding regulations.
Purchasing updated coding materials every year, participating
in continuing-education seminars, reading coding newsletters
and Internet sites regularly, and scrupulously documenting
patient charts are crucial to this job.
ICD-9-CM
Assignment 2 focuses primarily on the ICD coding system,
which was originally created by the World Health Organization
for collecting and analyzing statistics relating to diseases and
treatments. The system is currently in its ninth revision, with
a tenth revision due for publication in the near future. Now
regularly used to track diagnoses and procedures performed
in a hospital setting, ICD-9-CM codes provide the highest
degree of specificity in describing medical conditions and
procedures.
The ICD-9-CM system is contained in three separate volumes.
Volume 1 consists of a tabular numerical listing of diagnostic
codes, while Volume 2 provides an alphabetical listing of
diagnostic codes. Volume 3 consists of both a tabular and
alphabetical lists of medical procedures, most of which
are performed in a hospital setting. All three volumes are
contained in one book.
Hospital patients may present a variety of symptoms and
conditions upon admission. The first—and most important—
step in ICD-9-CM coding therefore involves determining the
primary condition that led a patient to seek hospital care.
This primary condition is commonly referred to as the principal
diagnosis, while the process of distinguishing the principal
diagnosis is known as sequencing.
Once you’ve determined the principal diagnosis, you can find
the appropriate ICD-9-CM code by looking up the main term
of the diagnosis in Volume 2 of the ICD-9-CM manual. The
main term represents the most basic aspect of a disease or
condition. For example, the main term of a diagnosis involving
a broken arm would be “fracture.” The anatomical location
of a diagnosed condition—in this case, “arm”—is never used
as a main term.
Lesson 1 11
You can really grasp the specificity of ICD-9-CM when you
examine the number and variety of subterms and modifiers
associated with most main terms. Subterms provide more
precise details about main term conditions. For example, the
list of subterms associated with main term “fracture” covers
several pages, and includes a wide assortment of locations,
causes, and related conditions. In most cases, you’ll find the
appropriate ICD-9-CM code listed alongside a subterm of the
main term.
After you locate the correct ICD-9-CM code in the alphabetical
index, verify the code in the tabular list in Volume 1 of the
ICD-9-CM manual. The tabular list is divided into 17 sections,
while the codes themselves are broken down into categories,
subcategories, and subclassifications.
n Category codes consist of three digits, and may represent
either the main term of a single disease or condition or a
group of several similar diseases.
Lesson 1 13
ASSIGNMENT 3
Read through the following material in your study guide. After
you’ve read the study guide commentary, read pages 85–101 in
Understanding Medical Coding.
Lesson 1 15
Intravenous administration includes all methods, such as
gravity infusion, injections, and timed pushes. When several
routes of administration are listed, the first listing is the most
common method. A VAR posting denotes various routes of
administration and is used for drugs commonly administered
into joints, cavities, or tissues, as well as topical applications.
Listings posted with OTH alert the coder to other administra-
tion methods, such as suppositories or catheter injections.
A dash (—) in a column signifies that no information is
available for that particular listing.
HCPCS Level II provides an even higher degree of specificity
through the use of alphanumeric modifiers that may be
appended to the five-digit national code. These modifiers
may be used to identify service providers, anatomic sites, or
other pertinent details. For example, the modifier -T1 is used
to specify the second toe of the left foot. The modifier -QN
identifies ambulance services provided directly by a service
provider. You can find a partial list of HCPCS Level II
modifiers in Appendix A of the CPT manual.
Lesson 1 17
HCPCS Self-Check
Check your understanding of what you’ve learned about HCPCS codes by completing the
self-check below.
1. Which of the following groups of letters is used to indicate temporary HCPCS Level II codes?
a. A, C, K c. J, V, E
b. G, K, Q d. H, M, P
2. Which of the following statements best represents the main difference between CPT and
HCPCS codes?
3. In the Table of Drugs, the abbreviation _______ is used to indicate medications that are
typically administered into joints, cavities, or tissues.
a. OTH c. CAV
b. JOI d. VAR
4. Service providers, anatomic sites, and other important details are indicated by attaching
_______ modifiers to the end of a five-digit HCPCS code.
a. five-digit c. alphanumeric
b. alphabetical d. three-digit
a. D. c. M.
b. 5. d. J.
6. When providing supplies and/or services to Medicare and Medicaid patients, the use of HCPCS
national codes is
a. optional. c. unnecessary.
b. mandatory. d. voluntary.
After you’ve finished Lesson 1, take the time to review all the
study assignments. Then, proceed to Lesson 2.
Lesson 1 19
NOTES
Lesson 2
Chapters 4 and 5 make up Lesson 2. In these chapters, you’ll
learn how to use the CPT manual in general and then delve
into the knowledge needed for Evaluation and Management
coding. E/M coding, as it’s often referred to, has become very
important in the industry. Almost every physician and health
care provider who sees patients uses these codes in practice.
Like the HCPCSII, the CPT manual holds codes to which fees
are linked. It’s essential to the financial health of the practice
and to compliance with coding regulations to be able to choose
accurate and appropriate codes.
ASSIGNMENT 4
Read through the following material in your study guide.
After you’ve read the study guide commentary, read
pages 103–124 of your textbook Understanding Medical
Coding.
21
The CPT manual is the Level I coding manual for the HCPCS
system of coding. This manual is divided into three categories:
Category I Established procedures/services
Category II Data research/performance tracking
Category III Emerging technology
The codes in the CPT manual are grouped by specialty. You’ll
find that, when coding for a specialty, the majority of the
codes you use will be in one or two sections of the manual.
Although you may occasionally stray from these sections,
most physicians use many of the same codes over and over
again and usually stay within the codes in their specialties.
Just about everyone uses E/M codes, but besides these,
ophthalmologists mainly stick to the Eye and Ocular Adnexa
section (65091–68899), radiologists use the codes ranging
from 70010–79999, and anesthesiologists stick to codes
starting with “0” (00100–01999). Go through your CPT man-
ual and see if you can identify the specialties that go with
each section.
The CPT manual uses many symbols, and knowing what they
mean is crucial to accurate coding. These symbols will alert
you to extended definitions of a code, revised or new codes,
and special circumstances related to a service or procedure.
One new symbol you’ll see in 2010 is #. This symbol indicates
that a code is listed out of numerical sequence. For the 2010
manual, some codes were moved so they could be grouped
with similar procedures. Instead of renumbering many items,
they simply moved the procedure codes and inserted clear
notes where the code was moved to and from. Be on the look-
out for these. An example is code 46220.
Guidelines and descriptions are found at the beginning of
many sections of the CPT manual. It’s very important to read
this information before coding within a section, since it
explains the codes listed and sometimes may help refine a
search or lead to a more appropriate code.
Lesson 2 23
ASSIGNMENT 5
Read through the following material in your study guide. After
you’ve read the study guide commentary, read pages 125–180
of your textbook Understanding Medical Coding.
Lesson 2 25
NOTES
Lesson 3
Lesson 3 examines the CPT codes used to describe procedures
involving anesthesia and general surgical treatments. This
fascinating section of your course provides you with the tools
you need to code anesthesia and general surgery procedures,
as well as a valuable overview of various anatomical systems
of the human body. Although later lessons will take a deeper
look at procedures associated with specific anatomical sites
and systems, Lesson 3 gives you a head start on learning
specialized medical terminology.
ASSIGNMENT 6
Read through the following material in your study guide. After
you’ve read the study guide commentary, read pages 181–208 of
your textbook Understanding Medical Coding.
27
General surgery is a term used to describe operations on a
wide range of anatomical systems. These include the respira-
tory, cardiovascular, lymphatic, auditory, ocular, nervous, and
digestive systems, as well as the male and female reproductive
systems. Surgical procedures associated with each system are
grouped together in separate sections of the CPT manual.
Each of these sections is organized into subsections identifying
the various organs that make up a particular system, as
well as the surgical procedures performed on each organ.
For example, the Respiratory System/Surgery section of the
CPT manual is divided into four subsections: Nose, Larynx,
Trachea and Bronchi, and Lungs and Pleura. The Nose sub-
section is subdivided into a variety of surgical categories,
including incision, excision, removal of a foreign body, and
repair. Within each surgical category, you’ll find a list of
specific procedures, along with the appropriate codes.
HCPCS Level II modifiers are frequently used when reporting
general surgical procedures, to provide an additional level of
detail. Accuracy and specificity are especially important when
filing claims for general surgery. To report unilateral proce-
dures performed on the lungs, for example, you’ll need to
append the left side (-LT) and right side (-RT) modifiers to
each instance of the surgical code. Otherwise, an insurance
company or other third-party payer may incorrectly deny a
claim on the supposition that duplicate procedures have
been reported.
After you’ve finished Lesson 3, take the time to review all
of the study assignments. Then, take the examination for
Lessons 1, 2, and 3.
Examination
Examinat io n
EXAMINATION NUMBER:
38189701
Whichever method you use in submitting your exam
answers to the school, you must use the number above.
When you feel confident that you have mastered the material
in Lessons 1, 2, and 3, go to http://www.takeexamsonline.com
and submit your answers online. If you don’t have access to
the Internet, you can phone in or mail in your exam. If you’re
unable to take the exam by telephone or online, please call
Student Services and request the special answer sheet and mail
in your exam. Submit your answers for this examination as soon
as you complete it. Do not wait until another examination is ready.
2. What code should you use for an office visit for an estab-
lished patient if the level of history and examination is
detailed and the decision making is of moderate complexity?
A. 99203 C. 99213
B. 99204 D. 99214
29
3. What convention in the Alphabetic Index tells you to look elsewhere before assigning
a code?
A. Note C. Summary
B. Cross-reference term D. Abbreviation
4. The letter _______ designates a temporary HCPCS Level II code for durable medical
equipment only.
A. G C. K
B. Q D. J
5. The reason given by a patient for seeking health care is referred to as the
A. chief complaint. C. brief history.
B. primary diagnosis. D. morbidity factor.
8. In the Alphabetic Index to Procedures of the ICD-9-CM manual, locate the correct code
for “ligation and stripping of varicose veins in the lower limb.” Verify the code in the
Tabular List. The code is
A. 38.50. C. 38.58.
B. 38.53. D. 38.59.
9. One of the factors used to determine CABG procedure codes is the number
of _______ involved.
A. catheters C. vessels
B. organs D. physicians
11. A 50-year-old new female patient has had a sore throat and head congestion for five
days. The physician performs an expanded problem-focused history and examination
and straightfoward medical decision making. What is the correct code for this service?
A. 99201 C. 99212
B. 99202 D. 99213
12. A discharge summary contains the diagnosis “acute ethmoidal sinusitis.” Which of the
following codes represents the correct entry for this diagnosis?
A. 461.2 C. 473.2
B. 461.9 D. 473.9
13. Which one of the following subcategories of the E/M section has separate codes for
new and established patients?
A. Office or Other Outpatient Services
B. Hospital Observation Services
C. Initial Inpatient Consultation
D. Emergency Department Services
14. Which of the following initial inpatient consultation codes is used in situations involving
an expanded problem focused history and examination and straightforward medical
decision making?
A. 99251 C. 99253
B. 99252 D. 99254
15. Which of the following E codes take priority over all other E codes?
A. Cataclysmic events C. Suicide and self-inflicted injury
B. Transport accidents D. Child or adult abuse
18. The chief complaint, a brief history of present illness, and a problem-specific review of
systems are documented in what type of history level for E/M coding?
A. Detailed C. Expanded problem focused
B. Brief D. Comprehensive
19. An attending physician asks a specialist to see a patient about a specific problem and
to advise him regarding treatment. This situation is called a
A. confirmatory consultation. C. transfer of care.
B. referral. D. consultation.
20. When coding late effects, the code for the _______ is usually sequenced first.
A. original cause C. modifier
B. residual condition D. complication
21. Provide a code for the following situation: initial admission to hospital for observation
care with a detailed history and examination and moderate decision making.
A. 99217 C. 99219
B. 99218 D. 99220
22. What is the main term in the diagnosis “pituitary gland hypofunction”?
A. Ablation C. Gland
B. Pituitary D. Hypofunction
23. A physician provides an office consultation for a new patient. The history and
examination levels are comprehensive and the medical decision making is of
high complexity. What is the correct code for this situation?
A. 99254 C. 99244
B. 99255 D. 99245
24. Provide the ICD-9-CM and CPT codes for a history and physical examination of a single
liveborn delivered in hospital by caesarian section.
A. V30.00, 99430 C. V30.02, 99432
B. V30.01, 99460 D. V30.03, 99433
26. In the Tabular List, where would you find alternative terms and explanatory phrases?
A. In square brackets C. In double braces
B. After a colon D. In parentheses
28. According to the Tabular List for code 463, which one of the following conditions is
excluded from the code?
A. Follicular tonsillitis C. Septic sore throat
B. Acute viral tonsillitis D. Septic tonsillitis
29. Which of the following range of codes is located in the Evaluation and Management
section of the CPT manual?
A. 90001–90699 C. 89000–89999
B. 99201–99450 D. 80600–88999
31. The _______ medical decision-making category includes minimal diagnoses, minimal
complexity of data, and minimal risk of complications.
A. straightforward C. low complexity
B. simple D. uncomplex
34. Which of the following codes is used for initial neonatal critical care?
A. 99477 C. 99468
B. 99469 D. 99472
35. When coding, you should always use the Tabular List to
A. verify the codes you’ve located in the Alphabetic Index.
B. locate codes not found in the Alphabetic Index.
C. find the range of codes for a particular disease.
D. determine if there are any cross references for the code.
36. How many bulleted topics must be included in documentation relating to a detailed
psychiatric analysis?
A. 1–5 C. 7
B. 6 D. Any 12
37. Which of the following categories is used to code heart conditions caused by hypertension?
A. 429 C. 402
B. 425 D. 405
38. Which of the following codes would be used for a one-hour initial therapeutic
intravenous infusion under the supervision of a physician?
A. 96365 C. 96367
B. 96366 D. 96369
39. In the Alphabetic Index to Procedures in the ICD-9-CM manual, locate the correct code
for “open drainage of the chest by incision.” Verify the code in the Tabular List.
A. 34.09 C. 34.04
B. 34.05 D. 34.01
40. Which of the following range of codes is used to report Emergency Department Services?
A. 99271–99280 C. 99289–99297
B. 99281–99288 D. 99298–99305
41. Which of the following physical status modifiers would be used to code a patient with a
mild systemic disease?
A. P1 C. P3
B. P2 D. P4
44. Which of the following code ranges is used to report a coronary bypass graft using
veins only?
A. 33510–33516 C. 33517–33523
B. 33533–33545 D. 33533–33536
45. Which of the following HCPCS Level II modifiers is used to indicate a procedure
performed on the thumb of the left hand?
A. -FA C. -FT
B. -F1 D. -L1
47. Which of the following range of codes is used to describe laparoscopic removal of
the gallbladder?
A. 47562–47564 C. 56340–56342
B. 47611–47620 D. 56345–56347
49. In addition to the CPT codes, _______ are frequently used when reporting general
surgical procedures to provide better detail.
A. modifiers C. physician signatures
B. ICD-9-CM codes D. anesthesiologist reports
50. Which of the following procedures involves inserting an endoscope past the third part
of the duodenum?
A. ERCP C. EGD
B. Esophagoscopy D. Ileoscopy
Lesson 4
In Lesson 4, you’ll begin using both the ICD-9-CM and
the CPT manuals to describe diagnoses and procedures.
By focusing on specific anatomical systems, your textbook
assignments are designed to ease you gradually into the
process of using both manuals to code reports. Your first
area of exploration will be the integumentary system, which
is comprised of the skin, nails, hair, sebaceous glands, and
sweat glands. After you’ve thoroughly familiarized yourself
with the terms, procedures, and codes associated with this
system, you’ll have a chance to learn about conditions and
procedures associated with the musculoskeletal system.
ASSIGNMENT 7
Read through the following material in your study guide.
After you’ve read the study guide commentary, read pages
209–243 of your textbook Understanding Medical Coding.
n Nails
n Repair
n Destruction
n Breast
37
Each subheading contains several categories that describe
procedures appropriate to each subheading of the integu-
mentary system. Under the Destruction subheading, for
example, you’ll find the following categories:
n Destruction, Benign or Premalignant Lesions
n Other Procedures
Orthopedics
Unlike other types of procedures, CPT codes for reporting
musculoskeletal system procedures are often determined on
the basis of treatment method. An open treatment of a radial
shaft fracture, for example, involves surgical opening of the
fracture site. The associated CPT code is 25515. A closed
treatment of the same type of fracture, which is accomplished
without surgically entering the fracture site, would be coded
25500 if no manipulation were necessary, and 25505 if the
physician needed to manipulate the bone.
Several other aspects need to be considered when determining
the appropriate code for orthopedic procedures. For example,
procedures performed on soft tissue—such as excision of a
ganglion cyst—are located in different areas of the Musculo-
skeletal section of the CPT manual than procedures performed
on bone.
Since treatments for traumatic injury are usually coded
differently than treatments for medical conditions, the reason
for treatment will also play a decisive role. The code for hip
replacement to alleviate osteoarthritis, for instance, is located
under the Repair, Revision and/or Reconstruction category of
the Pelvis and Hip Joint subheading of the Musculoskeletal
subsection of the CPT manual. By contrast, the code for hip
replacement performed as a result of fracture is located under
the Fracture and/or Dislocation category.
You’ll also want to be sure you’ve identified the most specific
anatomical site on which a procedure was performed.
Vertebral treatments, for example, are coded differently
depending on whether the procedure was performed on the
lumbar, thoracic, or cervical vertebrae. In addition, when
coding procedures performed on multiple sites in the same
area—such as repairing fractures to several fingers—you
must either indicate the number of specific sites treated or
Lesson 4 39
enter the code multiple times. The method will depend on
the code itself. Different codes require different procedures.
A final factor to consider is whether treatment required the
insertion of pins, screws, or wires to immobilize an area—
a procedure commonly referred to as fixation—or grafting.
Some procedures, such as reconstruction of the midface,
specifically list bone grafts. When grafting or fixation isn’t
specifically identified, you may need to list the appropriate
code separately.
Note: Exercise 8-3 in your textbook lists spaces for the
numbers of codes in each category. The code expansions
have affected question 2 in that exercise. This question
now requires two ICD-9-CM codes, one ICD-9-CM Volume 3
code, and two CPT codes.
After you’ve finished Lesson 4, take the time to review all the
study assignments. Then, move on to Lesson 5 in Medical
Coding, Part 2. The examination for Lesson 4 is included in
that study guide.
Chapter 1
A n s we r s
Exercise 1-1
Research only
Exercise 1-2
Research only
Exercise 1-3
Research only
Chapter 2
Exercise 2-1
1. Senile cataract
2. Carcinoma of the breast
3. Mitral valve prolapse
4. Urinary cystitis
5. Hypertensive cardiovascular disease (can be located
under either main term)
6. Sudden infant death syndrome
7. Nontoxic thyroid goiter
8. Sickle cell anemia (can be located under either
main term)
9. Acute situational depression
10. Upper respiratory tract infection
11. Sore throat
12. Migraine headache
41
13. Chronic lower back pain
14. Rectal mass
15. Left ureteral calculus
Exercise 2-2
1. 346.90
2. 428.0
3. 250.03
4. 410.11
5. 820.8
6. 558.9
7. 530.20
8. 411.89
9. 351.0
10. 244.9
11. 788.20
12. 331.0
13. 042
14. 780.2
15. 339.10
16. 463
17. 729.5
18. 784.7
19. 300.02
20. 710.3
Exercise 2-3
1. 51.22 (open) or 51.23 (laparoscopic). The coder should
review the medical record to determine whether this was
an open or laparoscopic procedure.
2. 45.13
42 Answers
3. 86.59
4. 53.14 (The laparotomy isn’t coded because it’s an
operative approach.)
5. 85.21 (The coder should review the pathology report
to see whether this is a benign or malignant lesion.)
6. 50.11
7. 60.29
8. 89.52
9. 06.2
10. 51.23
Exercise 2-4
1. Diagnoses: 218.9, 617.1
Procedures: 68.49, 65.29
2. Diagnosis: 722.10
Procedure: 80.51
Question for physician: Findings indicated an osteo-
arthritic spur. Is this significant enough to code?
3. Diagnoses: 574.00, V64.41
Procedure: 51.22
Exercise 2-5
1. Sign
2. Symptom
3. Sign
4. Sign
5. Sign
6. Sign
7. Symptom
8. Sign
9. Symptom
10. Sign
Answers 43
Exercise 2-6
1. 794.31
2. 786.50
3. 780.60
4. 795.5
5. 783.21
6. 794.2
7. V08
8. 795.19
9. 790.22
10. 795.39
Exercise 2-7
1. Diagnoses: 430 (the cause of the CVA is coded, so code
436 isn’t coded), 342.90 (since the aphasia had cleared, it
wouldn’t normally be coded). The hemiplegia is present
on discharge and will require home care, so it should
be coded.
2. Diagnoses: 574.00, 401.9, 714.0, 250.00, V45.81, 51.23
(This previous bypass “Status Post CABG” is significant,
especially since the patient is having surgery.)
3. Diagnoses: 042, 276.51, 558.9
4. Diagnoses: 042, 481, 176.0
5. Diagnoses: 038.42, 599.0, 041.4
Question for physician: Renal insufficiency (593.9) is
noted as positive in the ER findings but isn’t mentioned
in the remainder of the discharge summary. Should it
be coded?
6. Diagnoses: 410.21, 412 (The patient had a previous
infarction three years ago that’s separate from the cur-
rent illness, but does have an impact on treatment at
this time, so it’s normally coded.)
44 Answers
Exercise 2-8
1. 250.70 785.4
2. 250.80 707.9
3. 250.40 581.81
4. 250.53 366.41
5. 250.41 581.81
6. 250.50 362.01
7. 250.11
8. 648.80
9. 648.00 250.00
10. 251.0
Exercise 2-9
1. V70.3
2. V16.0
3. V01.82
4. V25.02
5. V17.3
6. V14.0
7. V22.2
8. V72.31, V76.47
9. V04.81
10. V20.2
11. V82.81
12. V01.81
13. V61.10
14. V15.85
15. V70.4
Answers 45
Exercise 2-10
1. Diagnosis: V23.2, supervision of high-risk pregnancy
with history of miscarriage
Question for physician: Are there any current problems
such as bleeding, contractions, and so forth that should
be coded?
2. Diagnoses: 751.61, 774.5 (The coder should review the
radiology report to determine the type of procedure
performed and the proper code.)
3. Diagnoses: V30.1, 765.18, 765.28
4. Diagnoses: 666.22, V27.0
Exercise 2-11
1. Diagnosis: 153.5
Procedures: 47.09, 45.72
2. Diagnoses: 185, 198.5. Sequencing of these two
malignancies would depend on the circumstances
of admission.
3. Diagnosis: 201.90 (This code is for an unspecified site of
Hodgkin’s disease. The coder should review the medical
record and biopsy results to determine whether a more
specific code can be used.)
Procedure: 40.11
4. Diagnosis: 188.9
5. Diagnoses: 162.9, 198.3 (Sequencing of these two
malignancies would depend on the circumstances
of admission.)
6. Diagnosis: 233.1
7. Diagnoses: 174.5, 197.0 (Sequencing depends on
circumstances.)
8. Diagnosis: 210.1
9. Diagnosis: 141.9
10. Diagnoses: 188.3, 197.5 (Sequencing depends on
circumstances.)
11. Diagnoses: 174.9, 196.3 (Sequencing depends on
circumstances.)
46 Answers
12. Diagnoses: 174.9, 196.3, 197.0 (Sequencing depends on
circumstances.)
13. Diagnosis: 176.9
14. Diagnosis: 213.0
15. Diagnosis: 173.3
16. Diagnosis: 174.9 (The coder should review the pathology
report and other documentation in the medical record to
determine a more exact location of the carcinoma within
the breast.)
Procedure: 85.43
Exercise 2-12
1. 850.9, E819.0
2. 873.42, E916, E908.9
3. 883.0, E920.5
Exercise 2-13
1. 826.0
2. 733.13, 733.01
3. 808.41, 250.00
4. 821.29
5. 802.5
6. 813.23, 873.42, E819.1, E849.5
Exercise 2-14
1. 944.20, 944.10, E924.0
2. 947.0, 947.2, 948.00
3. 692.71
4. 945.06, E898.1
5. 941.12
Answers 47
Exercise 2-15
1. 983.9, E864.3
2. 964.2, E858.2, 459.0
3. 969.0, E854.0, 780.4
Exercise 2-16
1. 276.8, E944.3
2. 708.0, E930.4
3. 780.09, E933.0
4. 785.0, E933.0
5. 995.0, E930.0
Exercise 2-17
1. Diagnosis: 996.61
2. Diagnoses: 558.1, 153.9, E879.2
Exercise 2-18
1. 138
2. 438.21
3. 716.17, 824.8
4. 389.12, 139.8 (late effect of disease classifiable to code
055.9)
5. 348.9, 326, 324.0
Chapter 3
Exercise 3-1
1. E1231–E1238
2. A5105, A5112
48 Answers
3. Notice the index lists many medications for the term
Depo. The index doesn’t always list the brand name
(Depo-Provera), and you may need to use the Table of
Drugs, the Physicians’ Desk Reference, or the package
insert of the medication.
a. To select the code, you need documentation to sup-
port contraceptive versus other medical indication.
Exercise 3-2
1. G0107 Colorectal cancer screening, fecal occult blood
test 1–3 simultaneous determinations
Exercise 3-3
The amount of medication that’s rendered must be
documented, and the medical necessity is required for
reimbursement purposes. Certainly, who/licensure,
where, and how rendered would be better charting
for medical standards. To select the code, we must
have the amount that’s given each date of service.
Rocephin 1 Gm injection IM, RUQ, csm is much
better documentation.
Exercise 3-4
1. J0150 × 2 (The code quantity is per 6 mg. Since dosage
is more than 6 mg, use × 2 for quantity.)
2. J0152
Answers 49
3. J2353 × 180 (The quantity is reported per amount given,
even if the payer has limitations for the amount.)
4. J1890
Exercise 3-5
IA Intra-arterially
IV Intravenous
IM Intramuscular
IT Intrathecal
SC Subcutaneously
INH Inhaled solution via IPPB
INJ Injection not otherwise specified
VAR Variously, into joint, cavity tissue or topical
OTH Into catheter or suppositories
Oral Oral per drops
Chapter 4
Exercise 4-1
False
Exercise 4-2
1. Semicolon (;)—Used to save space in the description to
avoid repetition in the descriptor portion of the code.
Example: 99238
2. Plus sign (+)—Used for add-on codes. Example: 01953
3. Revised code ()—Description of the code has changed
from the previous year. Example: 67901
4. New code (•)—New code for the current year. Example:
50592
5. New or revised wording ()—Alerts to wording or
content change. Frequently seen in Guidelines.
Example: 76394
50 Answers
6. Reference to CPT publications (Â)—Alerts to any changes
recently published in other books or newsletters. Example:
11021
7. Modifier 51 exempt ([[ )—Normally added to second and
subsequent surgeries. The symbol means the code may be
listed as a secondary code without the use of a modifier.
Example: 35600
8. Moderate sedation (~)—Included in the performance of
a procedure. An additional conscious sedation code isn’t
selected. Example: 44360
Exercise 4-3
The surgical guidelines are listed on page 52 of the
2010 AMA CPT. They’re usually located just after CPT
code 01999 for non-AMA publications.
Exercise 4-4
The term separate procedure means a procedure is com-
monly part of another code. Don’t report in addition to
the code that it may be considered an integral part of
the code. If the procedure is independently performed,
unrelated, or distinct, modifier -59 is attached to the
code. Select modifier -59 for a different session, different
encounter, different procedure, different site or organ
system, separate incision/excision, separate lesion, or
separate injury.
Exercise 4-5
1. A modifier is selected to indicate special circumstances
or variances from the description of the base code.
2. Modifiers are placed following the CPT code. An example
is 99215-25. The hyphen isn’t typically entered on the
claim and is used just for visual clarification.
Exercise 4-6
57105 Biopsy of the vaginal mucosa; extensive requiring
suture (including cysts) is selected. If the procedure is
performed using a colposcopy, a different code would be
selected. If the cyst is excised in its entirety, a different
code would be selected.
Answers 51
Exercise 4-7
1. Laparoscopy, surgical; with bilateral total pelvic lym-
phadenopathy and periaortic lymph node sampling
(biopsy), single or multiple.
2. The codes are 99201–99499, located in the front of
the AMA/CPT, in the Evaluation/Management section
of the CPT.
Chapter 5
Exercise 5-1
No answers; research practice only.
Exercise 5-2
1. A new patient is one who hasn’t received any professional
services from the physician or another physician of the
same specialty who belongs to the same group practice
within the past three years.
2. An established patient is one who has received profes-
sional service from the physician or another physician of
the same specialty who belongs to the same group practice
within the past three years. (The on-call paragraph states
that you use the same code “as the absent physician”
would use. In other words, if the patient is established,
while on call, select established, not new patient.)
3. History, exam, and decision making
4. Counseling, coordination of care, nature of presenting
problem, and time
5. The chief complaint typically contains a concise statement
describing the symptom, problem, condition, diagnosis, or
other factor that’s the reason for the encounter, usually in
the patient’s own words.
6. History of present illness
7. Location, quality, severity, timing, context, modifying
factors, and associated signs and symptoms related to
today’s problem
52 Answers
8. No, only information significantly related is considered
for code selection.
9. Review of systems
10. ROS data define the problem, clarify the differential
diagnoses, and identify testing of baseline data that
might affect management options.
11. Chief complaint, brief history, and present illness
12. CC, HPI, and problem-pertinent system review
13. Expanded problem-focused history. The ROS is two
systems: constitutional and genitourinary. There are
no further questions regarding musculoskeletal, neuro-
logical, skin, for example, that may influence testing and
diagnosing. Past history and family and social history
aren’t stated. (AMA/CPT, 1995, and 1997)
14. Detailed history
15. Complete history
Exercise 5-3
1. Exam of the ENMT limited, Lymph limited affected, and
Respiratory limited asymptomatic is performed. AMA/CPT
and 1995=EPF; OR 1997 CMS Exam of oropharynx. Exam
of lymph neck doesn’t meet criteria as only the neck is
examined, and the criteria require two areas. Exam
Auscultation of the lungs, two elements are completed. PF
exam for 1997. OR 1997 ENT specialty exam oropharynx,
lymph, respiratory for three elements completed, PF exam.
2. AMA/CPT and the 1995 are single-specialty complete
examinations of the ENMT examinations. 1997 CMS exam
oropharynx, otoscopic, lymph doesn’t meet criteria, respi-
ratory auscultation, cardiac auscultation, skin. Exam of
ENMT, Lymph, Respiratory, Cardiac, Skin, no credit for
Temp; Extended exam affected area, plus additional symp-
tomatic, Detailed. 1995 is also Detailed, however, credit
is given for the Temp as Constitutional exam. 1997 CMS
Oropharynx, otoscopic, lymph doesn’t meet criteria, respi-
ratory auscultation, cardiac auscultation, skin is history
not defined in the exam as noted today, Temp is only one
of three vitals, so criteria aren’t met. Four elements are
Answers 53
met, PF exam. 1997 ENT oropharynx, otoscopic, lymph,
respiratory, cardiac, skin is history, Temp is only one,
requires three vitals. Five elements met, PF exam. In
reality, the physician probably did assess the skin when
the mother described the rash the day prior; however,
this information isn’t documented. If the skin assess-
ment was documented, the examination would have
increased a level to an EPF exam, meeting six elements
for the ENT exam.
3. AMA/CPT and the 1995 are single-specialty complete
examinations of the ENMT examinations. 1997 CMS exam
oropharynx, otoscopic, lymph doesn’t meet the criteria,
respiratory auscultation, cardiac auscultation, skin,
Temp is only one of three vitals, so criteria aren’t met.
Five elements are met, PF exam. 1997 ENT oropharynx,
otoscopic, lymph respiratory, cardiac, skin, Temp is only
one, requires three vitals. Six elements met, EPF exam.
The statement of noncontributory doesn’t satisfy the 1997
examination elements, so it doesn’t affect the selection.
Exercise 5-4
1. Number of diagnoses or management options, amount
and/or complexity of data to be reviewed, risk of compli-
cations and/or morbidity or mortality. Two of three
components of decision making must match in selecting
the correct level.
2. No
3. a. The 50 percent coordination of care rule applies.
No history, exam, or decision making needs to
be charted.
b. 99214
Exercise 5-5
New patient:
1. 99201
2. 99203
3. 99202
Established patient:
1. 99214
54 Answers
Exercise 5-6
1. The code is 99233 because you need only two of three
components to meet or exceed the requirements, and the
history and exam meet the level 3 requirements.
2. 99214. For second-day observation services, use “office
or other outpatient services” codes for an established
patient.
3. 99234
Exercise 5-7
1. 99221
2. N/A (Level of history not high enough even to code
level 1 initial inpatient visit.)
3. 99221
4. 99231
Exercise 5-8
1. Opinion requested by another physician, regarding
a specific problem, initiate care only, written report
advising care recommendations
2. 99243
3. 99253
Exercise 5-9
1. 99282. If the ER doctor already saw the patient, he
would code for the ER visit. Another doctor coming in
to see him can code only for an established patient out-
patient visit.
2. 99213
Exercise 5-10
99291 × 1
99292 × 2
Answers 55
Exercise 5-11
99441–99443, depending on the time it took. Note: You
can’t code for this at all if the patient has seen the doc-
tor in the past seven days or will see the doctor in the
next 24 hours.
Exercise 5-12
1. 99396
2. 99396, 99213-25
Chapter 6
Exercise 6-1
1. B
2. E
3. C
4. F
5. A
6. D
Exercise 6-2
Items 1–6: All of these forms of sedation are covered by
codes 99143–99150. The code is determined by the age
of the patient and the length of time sedated.
Exercise 6-3
1. 00832-P2
2. 01220-P1
3. 00172, 99100
4. 00944-P2
5. 01622-P2
56 Answers
Exercise 6-4
1. 30901
2. 30903
3. 30110-50
4. 31238
5. 31535
6. 31622
7. 32422
8. 31090
9. 31530
10. 32420
Exercise 6-5
1. 45380
2. 42821
3. 46221
4. 43456
5. 49505-RT (You can’t code separately for mesh implanta-
tion for an inguinal hernia repair—only for ventral or
incisional hernia repair.)
6. 47562
7. 47605
8. 44960
9. 45385
10. 43263
Exercise 6-6
1. 55706
2. 55250
3. 66984-LT
4. 69210
Answers 57
5. 69090
6. 69420
7. 54520
8. 50590
9. 61760
10. 63030
Chapter 7
Exercise 7-1
ICD-9-CM 702.0
CPT 11442
Exercise 7-2
ICD-9-CM 705.83
CPT 11450
Exercise 7-3
CPT 12005-LT (total of 16.5 cm)
ICD-9-CM: 891.0 open wound leg; 881.00, open
wound forearm; 882.0, open wound hand; E007.3
playing baseball
Exercise 7-4
CPT 12032
ICD-9-CM: 890.0 open wound thigh; E928.8 “other”
accident
58 Answers
Exercise 7-5
Preoperative: 707.9 (Lesions can be coded as neoplasms
only after a pathology determination. As a preoperative
diagnosis, you must code it as an ulcerative lesion of
the skin.)
Postoperative: 173.2
Lesion site measurement 1.3 cm × 1 cm × 1.5 cm =
1.95 cm
Adjacent tissue measurement 1.5 cm × 2 cm = 3.0 cm
Total square cm code selection 4.95 cm
CPT code 14060—no cartilage or derma fascia grafting
is provided. The tissue transfer code includes the exci-
sion of the lesion.
ICD-9-CM 173.2
Exercise 7-6
ICD-9-CM 873.30 (The description of “complicated”
includes delayed healing. There’s no entry for “skin
of nose,” so you have to indicate “unspecified site.”)
CPT 15120
Exercise 7-7
ICD-9-CM 174.4
CPT 19290, 19125
Chapter 8
Exercise 8-1
1. 812.01, 79.11, 23675
2. 825.22, 825.23, 79.27, 28465 q=2 (This CPT code can be
used for cuboid, navicular, or any of the three cuneiform
bones. Code once for each bone treated.)
3. 813.41, 79.02, 78.13, 25606
4. 836.3, 79.76, 27552
5. 733.19, 733.00, 79.09, 27194
6. 820.21, 81.52, 27236
Answers 59
Exercise 8-2
1. 711.01, 041.7, 80.13, 80.11, 23031, 25031
2. 717.41, 80.6, 80.7, 80.86, 29881
3. 203.00, 713.2, 77.62, 23184
4. 715.26, 715.25, 278.01, 81.54, 27447-50
5. 717.9, 719.16, 80.16, 27301
Exercise 8-3
1. 721.1, 80.51, 63075
2. 722.10, 724.02, 03.09, 63047, 63048 (This CPT code
is for each segment, not interspace, so you need two
codes: 63047 for C1 and 63048 for C2.)
3. 738.4, 81.04, 22810, 22846
4. 721.2, 721.3, 722.11, 80.51, 03.09, 81.05, 77.79,
63046, 22610, 22614, 20930
Exercise 8-4
1. 996.40, 81.08, 77.79, 22630, 20931
2. 730.03, 041.4, 77.03, 83.49, 20005, 24136
60 Answers