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Another Medical Coding Review Questions

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
        Help!  

Question
Answer
Symbol for a new code   Bullet  
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Test for Hepatitis B   Hepatitis B surface antigen  
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Treatment for gout   Allopurinol  
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Term for full thickness removal of skin lesion   Excision  
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Key factors in E & M   History, examination, and medical decision making  
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Factors affecting the DRG   Diagnosis, Procedure, age, sex, disposition, birthweight of the newborn  
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Basis of HCPCS modifier II   Anatomical site  
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Treatment for Herpes   Acyclovir (zovirax)  
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Symbol for revised code   triangle  
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Patient with polydipsia and polyuria   Diabetes type 2  
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Code for induced abortion resulting in a liveborn   Early onset of delivery  
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Code for renal calculus with hematuria   Code renal calculus only 592.0  
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What are CPT codes ending in 99   Unlisted procedure  
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Definition of complicated wound   Infected, with foreign body, delayed healing or delayed treatment  
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What is a significant procedure   Surgical in nature, with surgical risk, with anesthetic risk, and requires specialized training  
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What are G codes   Temporary codes for emerging technology and codes for professional service with no CPT code yet  
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Modifier if patient is seen in the ER by a Cardiologist and a Podiatrist   27  
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How to code bilateral procedure in ICD-9   Code twice  
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How to code bilateral procedure in CPT   With modifier -50  
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How to code incomplete procedure in ICD-9   Up to the extent of the procedure  
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How to code incomplete procedure in CPT   Code as done with modifier -52  
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Who maintains the CPT book   AMA  
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CPT code for Clo-test   43239  
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How would you code EGD up to the ileum   44376  
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What diagnosis is an indication for EPS ( electrophysiological study)   Sinus node dysfunction  
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CPT code for treatment of non-union fibula   27726  
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What is case mix INDEX   Average relative weight  
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What is audit trail   Chronological list of those who access the EHR electronic health record or EMR Electronic medical record  
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What is ABN (advanced beneficiary notice)   Notice given to the Patient prior to the procedure telling him that if the insurance does not pay, the patient has to pay  
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What is EMTALA (Emergency medical treatment and labor act)   All emergency cases must be treated at the ER even if not financially capable  
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What Hospital department is involved in Emtala   Risk management and compliance  
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What is APC   Ambulatory payment classification - the reimbursement system for outpatient  
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What id UHDDS   Uniform hospital discharge data set  
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What is OSHPD   Office of the statewide hospital planning and development  
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In what part of the Medical Record would you see the size of the lesion in excision   Operative report  
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In what part of the Medical Record would a Physician write a note when the Chart is already complete   Addendum  
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What is the purpose of Physician Query   To clarify documentation  
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What are M codes   Morphology codes for study of type of cells and behavior of neoplasm  
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Modifier to be used if submitting two codes, one of which is a part of the other procedure and is not coded unless done in a separate session or different excision site   59  
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Who allows insurance companies to transfer Patient's info to another facility without Patient's consent   HIPAA  
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What is the meaning of DRG creep   Coding of diagnosis or procedure which is not present or not documented in order to increase the DRG  
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What is debulking   Partial excision or removal of tumor done if Cancer is unresectable  
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What is benchmarking   Process of comparing a data to a standard  
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What is a DATA STRUCTURE   Dictionary of data elements  
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What are J codes   Codes for medications that cannot be self-administered  
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What are the four organizations that make up the Cooperating Parties for the ICD-9-CM   AMA AHIMA NCHS MS  
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Treatment for thrush   Nystatin  
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Test for Syphilis   Wasserman or VDRL  
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What is blood transfusion hepatitis   Hepatitis C  
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What enzymes are elevated in acute MI   CPK-MB & troponin  
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Anemia associated with bone marrow failure   Aplastic anemia  
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What bones are involved in epicondylar fracture   Humerus and femur  
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Positive serology for AIDS in a 7 month old baby   795.71 Inconclusive positive serology for AIDS  
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What condition is associated with elevated HbNP   CHF  
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When can you code late effect first   When followed by manifestation code  
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In what instance is the manifestation coded   When preceded by late effect code  
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What auxiliary procedure is coded in CABG   39.61 extra-corporeal circulation or cardio-pulmonary bypass machine  
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How would you control access to the network   Identification, authorization, and authenthication  
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How would you check the productivity of the Coders   Coder ID, number of charts coded and time frame  
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How would you improve the function of the Medical records   Audit and monitoring  
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If they did both Diagnostic and Surgical endoscopy, which are you going to code   Surgical only  
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What is coded if they did catheterization of the first, second, and third order   Third  
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What is being treated if Patient is receiving potassium   Hypokalemia  
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How would you code Italicized codes   Secondary  
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What do you call the series of terms in parenthesis following the main term   Non-essential modifiers  
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What is the POA if the diagnosis is present on admission   Y  
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What is required to obtain a copy of the patient's Medical Record   Signed consent of release of medical information  
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What software computes the DRG   Grouper  
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Test for level of anticoagulant   PTT and INK  
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What is case mix index   Average relative weight  
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What are outliers   Cases requiring more resources than usual or those who stay in the Hospital longer than the average LOS (length of stay)  
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What is SNOMED   Acronym for systematized numenclature of medicine  
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What disposition will affect the Post-discharge transfer rule   Discharge to home health within 3-5 days after discharge  
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The term encounter is applicable to what setting   All setting  
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What is called as infectious hepatitis   Hepatitis A  
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What is blood transfusion hepatitis   Hepatitis C  
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What is serum hepatitis   Hepatits B  
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What is anemia due to bone marrow failure   Aplastic anemia  
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code for anemia due to blood loss   285.1  
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Post-operartive anemia   285.9  
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Autoimmune hemolytic anemia   283.0  
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Female infertility due to chronic PID (pelvic inflammatory disease)   628.8 614.4  
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Delivery complicated by Spinal headache   668.2 349.0  
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Contusion and laceration of eyebrow   784.32  
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What organ is involved in ossicular chain reconstruction   Middle ear  
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What is the definition of principal diagnosis   The condition established AFTER STUDY to be the main reason the patient was admitted  
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What is the principal procedure   The procedure done for definitive treatment rather than the one done for diagnostic or exploratory purposes  
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What is a significant procedure   A procedure that is: a) surgical in nature b) carries a surgical risk or anesthetic risk requires specialized training  
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What are the criteria for reporting additional diagnosis   Code all diagnosis that affect patient care in terms of requiring: a) clinical evaluation b) therapeutic treatment c) diagnostic procedures d) extended length of hospital stay e) increased nursing care or monitoring  
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When is CARDIAC ARREST used as principal diagnosis   If the patient came in cardiac arrest at the ER and died or was admitted and died and there is no cause or etiology of the arrest, the cardiac arrest is the principal diagnosis. If there is a cause, the cause is the principal diagnosis. If the patient wa  
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What condition is associated with elevated uric acid   Gout  
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What condition is associated with elevated ammonia in the blood   Alcoholic encephalopathy  
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CPT for PICA with insertion of coronary stent   92980 * one code only because the code indicates with or without therapeutic intervention which is the PTCA  
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CPT code for Insertion of one coronary stent   92980  
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CPT code PTCA   92982  
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What condtition is associated with elevated CPK MM   Musculo-skeletal injury  
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What enzymes are elevated in acute MI   CPK-MB and Troponin  
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What enzymes are elevated in acute pancreatitis   Amylase and lipase  
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What is the meaning of Puerperium   Post-partum  
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Up to when is the newborn period   28 days  
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In CABG what auxiliary procedure are you going to code   39.61  
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Code for CABG with saphenous vein graft to the circumflex and obtuse marginal branch and LIMA (left internal mammary artery to the LAD   36.12 36.15  
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What part of the tibia is the tibial plateau   Upper part  
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What bones has epicondyle   Femur and humerus  
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What bones are involved in trimalleolar fracture   Tibia and fibula (ankle)  
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Up to when is the post-partum period   6 weeks  
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Code for Positive serology for AIDS adult   V08.0  
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In CPT When are you going to add the length of the lesion   Same anatomic group and same classification of repair  
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What are the factors affecting the DRG   Diagnosis principal and secondary, procedure, sex, age, disposition, birthweight of neonates  
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Positive serology for AIDS newborn   795.71 non-conclusive serologic test for AIDS  
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Inpatient- Chest pain due to possible angina   Angina 413.9  
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Anemia associated with bone marrow failure   Aplastic anemia  
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What is the treatment for hypothyroidism   Synthroid  
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What condition is associated with high TSH   Hypothyroidsm  
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What condition is associated with high PSA   BPH or Ca of PROSTATE  
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Colonoscopy with biopsy of the transverse colon and polypectomy of the recto-sigmoid with snare   453.85 453.80-59 * two codes because biopsy and polypectomy was on different site  
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Colonoscopy with biopsy of the transverse colon polyp followed by removal of the same polyp by snare   45385 *one code only because biopsy and polypectomy was on the same site  
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What is called serum Hepatitis   Hepatitis B  
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Exploratory laparotomy with incidental appendectomy   54.11 47.19  
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Hepatitis associated with blood transfusion   Hepatitis C  
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Exploratory laparotomy with appendectomy and drainage of abscess of appendix   47.09  
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What is mutually exclusive edit   Submission of two codes which are improbable to be performed at the same session  
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What is unbundling   Submission of two codes one of which is a component of the comprehensive code  
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What do you call the series of terms in parenthesis following the main term   Non-essential modifier  
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What is a starred procedure   Includes limited services  
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What is a surgical package   Includes pre-operative, operative and post-operative care  
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What is Case mix index   Average relative weight  
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Case mix   The complexity of the population of patients or the types of patients treated  
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What is the term for full thickness removal of skin lesion   Excision which includes local anesthesia and simple closure  
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What is hypokalemia and the treatment for hypokalemia   Low potassium tx- K-dur  
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What condition is associated with SIADH   Hyponatremia (low sodium)  
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Key components of the E & M   History, examination, medical decision making  
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What is a stress fracture   Fracture due to repetitive trauma  
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compression fracture of the lumbar spine due to osteoporosis   Pathological fracture 733.13 733.00  
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Inter-trochanteric fracture of the femur due to multiple myeloma   Pathological fracture 733.14 203.00  
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If a fracture is not stated as open or closed, how is the fracture coded   Closed  
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What are the terms synonymous with open fracture   Compound fracture, missile or gunshot or puncture, infected or foreign body  
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Treatment for CHF   Lasix and Digoxin  
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What are M codes   Morphology for histology and behavior of neoplasm  
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complicated wound   Infected, foreign body, delayed healing, delayed treatment  
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Exploratory laparotomy with liver biopsy   54.11 50.12 54.12  
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Seizure   780.39  
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Seizure disorder   345.90  
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Seizure, recurrent   345.90  
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Patient with ESRD and diabetes came in for Catheter placement and underwent Hemodialysis   V56.0 585.6 250.00 38.95 39.95  
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CLO-TEST   43239  
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EGD with PEG   43246  
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EGD up to the ileum   44376  
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Removal of skin tags 16 lesions   11200 11201  
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Destruction of pre-malignant lesion of the skin by cryosurgery 17 lesions   17004  
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Treatment of non-union of fibula   27226  
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Laparoscopic Nissen fundoplasty   43820  
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Repair of inguinal hernia with mesh in a patient with previous inguinal hernia repair   49520  
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Arthroscopy knee with medial meniscectomy and lateral chondroplasty   29881 29877-59  
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Colonoscopy with biopsy of the transverse colon polyp and polypectomy of the ascending colon with snare   45385 45380-59  
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Excision of scar arm 2X6 cm with closure by split-thickness graft   15002 15110  
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Destruction pre-malignant lesion of skin by cryotherapy 5 lesions   17000 17003 17003 17003 17003  
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Destruction lumbar nerve by radiofrequency ablation   L2, L3, & L3 64622 64623 64623  
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TURP   52601  
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PTC A with insertion of stent right coronary artery   92980 RT  
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Colonoscopy with bx of transverse colon polyp followed by polypectomy of the same polyp by snare.   45385 45380-59  
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Injection steroid transforaminal Cl and C2   64479 64480  
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TURP with incision of bladder neck   60.29 57.19  
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Bilateral hip replacement   81.51 81.51  
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Auto immune hemolytic anemia   283.0  
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Encounter for drug monitoring for Coumadin in a patient with atrial fibrillation   V58.83 V58.61 427.31  
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Female infertility due to chronic PID (pelvic inflammatory disease)   628.8 614.4  
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Respiratory failure and coma after ingestion of alcohol   980.0 518.81 780.00U  
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what is stress fracture   Fracture due to repetitive trauma  
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What is spontaneous fracture   This is considered pathological fracture  
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What is the code for amphetamine and heroin dependency   Use the combination code 304.70 dependency with combination of drug with opiod  
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Is respiratory insufficiency coded separately with COPD   NO. it is part of COPD and asthma.  
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Is bronchospasm coded separately if there is asthma   NO, it is part of asthma, bronchitis, COPD, and asthma  
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What is the code for COPD and acute bronchitis   491.22 exacerbation is included  
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What is the code for hypertensive cardiovascular disease with chronic renal failure   404.90+ 585.9  
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What is non-excisional debridement   Debridement using water, gauze, or blunt instrument  
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What is excisional debridement   Debridement done by either the physician, nurse, or therapist using a cutting instrument. Note: sharp debridement is coded as non-excisional debridement  
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When is delivery considered normal   When there is no complication during the hospital stay; delivery is through the vagina, Full term (37-40 weeks); cephalic presentation (headfirst); baby is single, healthy, no manipilation was done. Episiotomy and anesthesia are part of normal delivery.  
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What is the code for fiberoptic bronchoscopy with biopsy if the specimen showed the alveoli   bronchoscopy with biopsy of lung 33.27 because the alveoli is the lung tissue  
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Abdominal pain due to both gastritis and angina   PDX is either gastritis or angina.  
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Abdominal pain due to gastritis versus angina   PDX is abdominal pain and code both conditions  
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Gastitis and angina   either condition can be PDX. Code both conditions  
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What is the principal diagnosis in the following cases: A 33 yr old male was admitted with abdominal pain. The patient was discharged with the Final diagnosis of; 1. Gastritis versus angina   either condition can be PDX. Code both condition  
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When are you going to code lysis of adhesions   Lysis of adhesion is the freeing of organs from adhesive bands or fibrous tissue. Lysis of adhesions is usually part of a procedure and the only time it is coded is when there is significant or extensive adhesion. Manual or digital lysis of adhesion and l  
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How do you code post-operative ileus   997.4+560.1  
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How do you code post-operative pneumonia and post-operative atelectasis   997.3 + 486 for the pneumonia 997.3 + 518.0 for the atelectasis  
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How do you code post-operative anemia   285.9 only. Don't' code 998.11 complication code unless the MD documents that It is complicating the procedure. There is always some blood loss in surgery and this is part of the procedure  
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In arthroscopy of the knee, how many codes are needed if lateral and medial meniscectomy with chondroplasty were done, (same compartment)   One only. 29880. There is a combo code for both lateral & medial meniscectomy  
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What are the three compartments of the knee   medial, lateral, and patello-femoral compartments  
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When coding inpatient chart, can you code abnormal findings in the X-ray or lab   NO, unless the physician documents any significance to the finding. However, findings can be use to further clarify a code. Ex: X-ray can be use to code the specific site of the fracture  
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In diverticulosis or diverticulitis of the colon, is perforation part of the code   yes, don't code separately. However the presence of abscess is coded separately (abscess of the intestine)  
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When are you going to use the 5th digits continous, episodic, or in remission inAlcohol and drug abuse and dependency   only when the pattern of use is documented. Otherwise use unspecified 5th digit 0  
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How do you code cocaine dependency and marijuana dependency   Code with the combination code 304.80  
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What is the PDX in a pregnant patient with AIDS and pneumocystis carinni pneumonia   The PDX is the pregnancy code. Pregnancy code has a sequencing priority over all other conditions  
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What is the PDX for a patient with AIDS admitted with pneumocystis carinii pneumonia   PDXis AIDS because PCP is AIDS-related disease with an HIV symbol at the tabular  
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In repair of wounds, when do you add the length of the wound repaired   If they are of the same classification( simple, intermediate, or complex) and they are of the same anatomic group  
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In excision of benign or malignant lesions, when do you add the length of the lesion together   Do not add the length of the lesions. Code each lesion separately. Length of lesions are added only if there is only one incision done for all the lesions  
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How many codes do you need for repair of inguinal hernia or umbilical hernia with mesh   ONE only. This includes the repair of the hernia and the use of the mesh.  
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How many codes do you need for repair of incisional or ventral hernia with mesh   TWO one for the repair and one for the mesh or prosthes  
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How do you measure the length in tissue transfer or flap   by sq. cm. To get this, multiply the two dimension to get the sq cm. EX 2 cm X 3 cm = 6 sq cm  
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How many codes are you going to use for tissue transfer or rearrangement (Z-plasty)   one code only. The code for the tissue transfer, the excision code is included  
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What is the code for malignant pleura effusion   511.81 secondary malignant neoplasm of the pleura  
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What is the code for malignant ascites   789.51 secondary malignant neoplasm of the peritoneum  
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What is the PDX for a patient with cirrhosis of the liver and was admitted with ascites   PDXis the cirrhosis  
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What is the PDX for a patient with cancer of the breast admitted for chemotherapy   PDXis V58.11 admission for chemo. Code also the cancer of the breast 174.9  
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What is the principal DX for a patient with cirrhosis of the liver and hepatic encephalopathy   PDXis the hepatic encephalopathy  
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What is the principal DX for a patient with CAD admitted because of unstable angina and was found to have MI (myocardial infarction.)   PDX is the MI. Code also the CAD but don't code the unstable angina  
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What is the principal DX for a patient with CAD admitted for unstable angina   PDXistheCAD. 414.01 Code unstable angina as secondary DX. 411.1  
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What is the principal diagnosis for a patient admitted to rehabilitation after being treated for acute CVA or infarction   The principal DX is V57.89 and secondary DX are all the residuals of CVA EX 438.82 Do not code 438.XX with V12.59  
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What is the dominant side of a patient   In a right handed patient, the right is dominant. In a left handed patient, the left is dominant  
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What is the principal DX in poisoning   If a drug was taken incorrectly as in overdose, or taken w/alcohol or with over the counter medication it is poisoning  
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principal DX in adverse effect   If a drug was taken correctly as prescribed it is adverse effect  
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What is the principal DX an a patient admitted with alcohol dependency and withdrawal   The withdrawal is the principal diagnosis EX 291.81 or 291.0  
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In late effect what is the principal diagnosis, the late effect or the residual   The residual or the manifestation  
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What is the code for decompensated COPD   491.21 decompensated is the same as exacerbation of COPD  
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What is pathological fracture   Fracture of the bone due to weakness of the bone because of disease of the bone such as Osteoporosis, cancer of the bone as in multiple myeloma  
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When can respiratory/allure be used as principal diagnosis   If the patient came in respiratory failure and the reason for admission is the respiratory Failure, the respiratory failure is the principal diagnosis except if it caused or due to Sepsis Aids Pregnancy Poisoning Newborn  
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What is the difference between radical mastectomy and modified radical mastectomy   In radical mastectomy the major pectoral muscles are removed and in modifiied radical mastectomy only the minor pectoral muscles are removed and the major pectoral is saved  
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What is the difference between 303.00 and 303.90   In 303.90 there is alcohol dependency w/o acute intoxication In 303.00 there is alcohol dependency and acute intoxication  
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