Medical Coding Training: CPC® - Medical Billing RCM

2016

Medical Coding Training: CPC?

Practical Application Workbook--Answer Key

Disclaimer

This course was current when it was published. Every reasonable effort has been made to assure the accuracy of the information within these pages. The ultimate responsibility lies with readers to ensure they are using the codes, and following applicable guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient healthcare organizations.

US Government Rights

This product includes CPT?, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/ or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/ or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

AMA Disclaimer

CPT? copyright 2015 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT?, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT? is a registered trademark of the American Medical Association.

Regarding HCPCS Level II

HCPCS Level II codes and guidelines discussed in this book are current as of press time. The 2016 code set for HCPCS Level II were unavailable when published.

Clinical Examples Used in this Book

AAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees. All examples and case studies used in our study guides, exams, and workbooks are actual, redacted office visit and procedure notes donated by AAPC members.

To preserve the real world quality of these notes for educational purposes, we have not re-written or edited the notes to the stringent grammatical or stylistic standards found in the text of our products. Some minor changes have been made for clarity or to correct spelling errors originally in the notes, but essentially they are as one would find them in a coding setting.

? 2016 AAPC

2233 South Presidents Dr. Suites F-C, Salt Lake City, UT 84120 800-626-2633, Fax 801-236-2258, Revised 112315. All rights reserved.

ISBN 978-1-626882-096

CPC?, CICTM, COCTM, CPC-P?, CPMA?, CPCOTM, and CPPM? are trademarks of AAPC.

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2016 Medical Coding Training: CPC Practical Application Workbook--Answer Key

CPT? copyright 2015 American Medical Association. All rights reserved.

Contents

Chapter 1 The Business of Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 2 Medical Terminology and Anatomy Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Chapter 3 Introduction to ICD-10-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Chapter 4 ICD-10-CM Coding Chapters 1?11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter 5 ICD-10-CM Coding Chapters 12?21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Chapter 6 Introduction to CPT?, Surgery Guidelines, HCPCS, and Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Chapter 7 Integumentary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Chapter 8 Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Chapter 9 Respiratory, Hemic, Lymphatic, Mediastinum, and Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Chapter 10 Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Chapter 11 Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Chapter 12 Urinary System and Male Genital System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Chapter 13 Female Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

CPT? copyright 2015 American Medical Association. All rights reserved.

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Chapter 14 Endocrine and Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Chapter 15 Eye and Ocular Adnexa, Auditory Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Chapter 16 Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Chapter 17 Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Chapter 18 Pathology and Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Chapter 19 Evaluation and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Chapter 20 Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

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2016 Medical Coding Training: CPC Practical Application Workbook--Answer Key

CPT? copyright 2015 American Medical Association. All rights reserved.

Chapter

1

The Business of Medicine

Exercise 1

1. What type of profession might a skilled coder enter?

Answer: Consultants, educators, medical auditors

2. What is the difference between outpatient and inpatient coding?

Answer: Outpatient coders will focus on learning CPT?, HCPCS Level II, and ICD-10-CM codes. They will work in physician offices, outpatient clinics, and facility outpatient departments. Outpatient facility coders will also work with Ambulatory Payment Classifications (APCs).

Inpatient hospital coding focuses on a different subset of skills, where coders will work with ICD-10-CM and ICD10-PCS. These coders also will assign MS-DRGs for reimbursement. Outpatient coders usually will have more interaction throughout the day, and must communicate well with physicians; inpatient coders tend to have less interaction throughout the day.

3. What is a mid-level provider?

Answer: Mid-level providers include physician assistants (PA) and nurse practitioners (NP). Mid-level providers are known also as physician extenders because they extend the work of a physician.

4. Discuss the different parts of Medicare and what each program covers.

Answer:

ll Medicare Part A helps to cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare.

ll Medicare Part B helps to cover medically-necessary doctors' services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. Medicare Part B is an optional benefit for which the patient must pay a premium, and which generally requires a yearly co-pay. Coders working in physician offices will mainly deal with Medicare Part B.

ll Medicare Part C, also called Medicare Advantage, combines the benefits of Medicare Part A, Part B, and-- sometimes--Part D. The plans are managed by private insurers approved by Medicare, and may include Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), and others.

ll Medicare Part D is a prescription drug coverage program available to all Medicare beneficiaries. Private companies approved by Medicare provide the coverage.

CPT? copyright 2015 American Medical Association. All rights reserved.



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The Business of Medicine

Chapter 1

5. Evaluation and management services are often provided in a standard format such as SOAP. What does SOAP represent?

Answer:

S: Subjective--The patient's statement about his or her health, including symptoms.

O: O bjective--The provider assesses and documents the patient's illness using observation, palpation, auscultation, and percussion. Tests and other services performed may be documented here as well.

A: A ssessment--Evaluation and conclusion made by the provider. This is usually where the diagnosis(es) for the services are found.

P: P lan--Course of action. Here, the provider will list the next steps for the patient, whether it is ordering additional tests, or taking over the counter medications, etc.

6. What are five tips for coding operative reports?

Answer:

1. Diagnosis code reporting--Use the post-operative diagnosis for coding unless there are further defined diagnoses or additional diagnoses found in the body or findings of the operative report. If a pathology report is available, use the findings from the pathology report for the diagnosis.

2. Start with the procedures listed--For the coder who is new to coding a procedure, one way of quickly starting the research process is by focusing on the procedures listed in the header. Read the note in its entirety to verify the procedures performed. Procedures listed in the header may not be listed correctly and procedures documented within the body of the report may not be listed in the header at all; however, it will help a coder with a place to start.

3. Look for key words--Key words may include locations and anatomical structures involved, surgical approach, procedure method (debridement, drainage, incision, repair, etc.), procedure type (open, closed, simple, intermediate, etc.), size and number, and the surgical instruments used during the procedure.

4. Highlight unfamiliar words--Words you are not familiar with should be highlighted and researched for understanding.

5. Read the body--All procedures reported should be documented within the body of the report. The body may indicate a procedure was abandoned or complicated, possibly indicating the need for a different procedure code or the reporting of a modifier.

7. What is medical necessity and what tool can you refer to for the medical necessity of a service?

Answer: The term "medical necessity" relates to whether a procedure or service is considered appropriate in a given circumstance. Tools to determine medical necessity include National Coverage Determinations (NCDs), Local Coverage Determinations (LCD), and commercial Medical Policies.

8. What are some common reasons Medicare may deny a procedure or service?

Answer:

ll Medicare does not pay for the procedure/service for the patient's condition. ll Medicare does not pay for the procedure/service as frequently as proposed. ll Medicare does not pay for experimental procedures/services.

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2016 Medical Coding Training: CPC Practical Application Workbook--Answer Key

CPT? copyright 2015 American Medical Association. All rights reserved.

Chapter 1

The Business of Medicine

9. Under the Privacy Rule, the minimum necessary standard does not apply to what type of disclosures?

Answer:

ll Disclosures to or requests by a healthcare provider for treatment purposes. ll Disclosures to the individual who is the subject of the information. ll Uses or disclosures made pursuant to an individual's authorization. ll Uses or disclosures required for compliance with the HIPAA Administrative Simplification Rules. ll Disclosures to the U. S. Department of Health and Human Services (HHS) when disclosure of information is

required under the Privacy Rule for enforcement purposes. ll Uses or disclosures that are required by other law.

10. What are the seven key actions of an internal compliance plan?

Answer:

ll Conduct internal monitoring and auditing through the performance of periodic audits. ll Implement compliance and practice standards through the development of written standards and procedures. ll Designate a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards. ll Conduct appropriate training and education on practice standards and procedures. ll Respond appropriately to detected violations through the investigation of allegations and the disclosure of incidents

to appropriate government entities. ll Develop open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or

fraudulent conduct and (2) community bulletin boards, to keep practice employees updated regarding compliance activities. ll Enforce disciplinary standards through well-publicized guidelines.

CPT? copyright 2015 American Medical Association. All rights reserved.



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