Deck 2: Medicine

Question 1

2-1A CHART NOTE __________________________________________________
Professional Services:
Substance: 90658 (Vaccines, Influenza, for Intramuscular Use)
Administration: G0008 (Vaccination, administration influenza virus)
ICD-10-CM DX: Z23 (Vaccination [prophylactic], encounter for)

Answer 1

The substance administered is reported with a CPT code, and the vac-cine administration for Medicare patients is reported with HCPCS National Level II codes. The specific codes used to report routine vaccinations to Medicare patients vary from one fiscal intermediary (the organization that processes the claims and issues payment to the provider) or Medicare Administrative Contractors to another. Work closely with the fiscal intermediary to ensure proper reporting.
The diagnosis and service codes must correlate; 90658, G0008, and Z23 report the specific vaccine, administration, and diagnosis for the influenza vaccination. The ICD-10-CM code to report all prophylactic vaccinations is Z23.
It is imperative when any of these services are being administered by the nurse that the coder check the medical record to ensure the clinician has clearly documented the order and the nurse has clearly documented the administration of that order before proceeding with code assignment.

Question 2

2-2A CHART NOTE __________________________________________________
Professional Services:
Substance: 90658 (Vaccines, Influenza, for Intramuscular Use), 90732 (Vaccines, Pneumococcal, Polysaccharide 23-valent)
Administration: G0008 (Vaccination, administration, influenza virus), G0009 (Vaccination, pneumococcal, polysaccharide 23-valent)

Answer 2

The substance administered is reported with a CPT code, and the vaccine administration for the Medicare patient is reported with HCPCS National Level II codes. The specific codes used to report routine vaccinations to Medicare patients vary from one fiscal intermediary (the organization that processes the claims and issues payment to the provider) or Medicare Administrative Contractors to another. Work closely with the fiscal intermediary to ensure proper reporting.
The ICD-10-CM code to report all prophylactic vaccinations is Z23.
It is imperative when any of these services are being administered by the nurse that the coder check the medical record to ensure the clinician has clearly documented the order and the nurse has clearly documented the administration of that order before proceeding with code assignment.

Question 3

2-3A CHART NOTE __________________________________________________
Professional Services:
Substance: 90710 (Vaccines/Measles/Mumps/Rubella/and Varicella)
Administration: 90471 (Administration, Immunization, One Vaccine/Toxoid)
ICD-10-CM DX: Z23 (Vaccination, [prophylactic], encounter for)

Answer 3

There is a combination drug available for MMRV (90710), so it is not correct to report the substances measles, mumps, and rubella with 90707 and the varicella with 90716 because all the substances were placed into a syringe and administered in one injection. There was only one injection reported with 90471.
The ICD-10-CM code to report all prophylactic vaccinations is Z23.

Question 4

2-4A CHART NOTE __________________________________________________
Professional Services: 96360 (Hydration, Intravenous), J7042 (Dextrose, saline [normal])
ICD-10-CM DX: E86.0 (Dehydration)

Question 5

2-5A CHART NOTE __________________________________________________
Professional Services: 96372 (Injection, Intramuscular), J0120 (Table of Drugs, Tetracycline)
ICD-10-CM DX: J06.9 (Infection, respiratory [tract], upper [acute]NOS)

Question 6

2-6A PSYCHOLOGICAL EVALUATION____________________________________
Professional Services: 90791 (Psychiatric Diagnosis Evaluation); 96118 3 2 (Testing, Neuropsychological)
ICD-10-CM DX: F07.81 (Syndrome, concussion)

Question 7

2-7A HEMODIALYSIS PROGRESS REPORT ________________________________
Professional Services:
90960 (Dialysis, End Stage Renal Disease) (For a full month of service)
ICD-10-CM DX:
Z99.2 (Status, renal dialysis [hemodialysis] [peritoneal])
I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kidney disease [CKD] or end stage renal disease [ESRD])
N18.6 (Disease, renal, end-stage [failure])
E11.21 (Diabetes, type 2, with nephropathy)
E83.39 (Hyperphosphatemia)
E83.51 (Hypocalcemia)
E03.9 (Hypothyroidism)
Z90.5 (Absence, kidney [acquired])

Question 8

2-8A HISTORY AND PHYSICAL EXAMINATION __________________________
Professional Services: 99221 (Evaluation and Management, Hospital)
ICD-10-CM DX: T85.71XA (Complication[s], catheter [device], intraperitoneal dia-lysis, infection and inflammation), K65.0 (Peritonitis, acute), I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kidney disease [CKD] or end stage renal disease [ESRD]), N18.6 (Disease/diseased, renal, with, end-stage [failure])

Question 9

2-8B CAPD PROGRESS NOTE __________________________________________
Professional Services: 90945 (Dialysis, Peritoneal)
ICD-10-CM DX: I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kid-ney disease [CKD] or end stage renal disease [ESRD]), N18.6 (Disease/diseased, renal, with, end-stage [failure]), T85.71XA (Complication[s], catheter [device], intraperi-toneal dialysis, infection and inflammation), K65.0 (Peritonitis, acute)

Question 10

2-8C DIALYSIS PROGRESS NOTE ________________________________________
Professional Services: 90945 (Dialysis, Peritoneal)
ICD-10-CM DX: I12.9 (Hypertension/hypertensive, kidney, with, stage 5 chronic kidney disease [CKD] or end stage renal disease [ESRD]), N18.6 (Disease/diseased, renal, with, end-stage [failure]), T85.71XA (Complication[s], catheter [device], intraperitoneal dialysis, infection and inflammation), K65.0 (Peritonitis, acute)

Question 11

2-8D THORACIC MEDICINE AND CAPD NOTE __________________________
Professional Services: 90945 (Peritoneal Dialysis)
ICD-10-CM DX: I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kidney disease [CKD] or end stage renal disease [ESRD]), N18.6 (Disease/diseased, renal, with, end-stage [failure]), T85.71XA (Complication[s], catheter [device], intraperitoneal dialysis, infection and inflammation), K65.0 (Peritonitis, acute), B95.0 (Streptococcus/streptococcal, as cause of disease classified elsewhere)

Question 12

2-8E DIALYSIS PROGRESS NOTE ________________________________________
Professional Services: 90945 (Peritoneal Dialysis)
ICD-10-CM DX: I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kidney disease [CKD] or end stage renal disease [ESRD]), N18.6 (Disease/diseased, renal, with, end-stage [failure]), T85.71XA (Complication[s], catheter [device], intraperitoneal dial-ysis, infection and inflammation), K65.0 (Peritonitis, acute), B95.0 (Streptococcus/ streptococcal, group, A as cause of disease classified elsewhere)

Question 13

2-8F DIALYSIS PROGRESS NOTE ________________________________________
Professional Services: 90945 (Dialysis, Peritoneal)
ICD-10-CM DX: I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kid-ney disease [CKD] or end stage renal disease [ESRD]), N18.6 (Disease/diseased, renal, with, end-stage [failure])

Question 14

2-8G DISCHARGE SUMMARY __________________________________________
Professional Services:
99238 (Evaluation and Management, Hospital, Discharge)
ICD-10-CM DX:
T85.71XA (Complication[s], catheter [device], intraperitoneal dialysis, infection and inflammation)
K65.0 (Peritonitis, acute)
B95.0 (Streptococcus/streptococcal, group, A as cause of disease classified elsewhere)
I12.0 (Hypertension, hypertensive, kidney, with, stage 5 chronic kidney disease [CKD] or end stage renal disease [ESRD])
N18.6 (Disease/diseased, renal, with, end-stage [failure])

Question 15

2-9A DUPLEX CAROTID ARTERY STUDY ________________________________
Professional Services: 93880-26 (Vascular Studies, Arterial Studies [Non-Invasive], Extracranial)
ICD-10-CM DX: I47.2 (Tachycardia, ventricular [paroxysmal])

Question 16

2-10A DUPLEX CAROTID ARTERY STUDY ________________________________
Professional Services: 93880-26 (Duplex Scan, Arterial Studies, Extracranial)
ICD-10-CM DX: I69.351 (Sequelae [of], stroke, hemiplagia), I69.320 (Sequelae [of], stroke, aphasia), I65.22 (Occlusion/occluded, artery, carotid)

Question 17

2-11A ARTERIAL DOPPLER TEST________________________________________
Professional Services: 93922-26 (Vascular Studies, Arterial Studies [Non-Invasive], Extremities)
ICD-10-CM DX: M79.605 (Pain[s], limb, lower), E11.9 (Diabetes, type 2)

Question 18

2-12A VASCULAR LABORATORY REPORT, ARTERIAL DOPPLER TEST ________
Professional Services: 93924-26 (Vascular Studies, Arterial Studies [Non-Invasive], Extremities)
ICD-10-CM DX: M79.606 (Pain[s], limb, lower), I25.10 (Arteriosclerosis/ arteriosclerotic, coronary [artery])

Question 19

2-13A ELECTRICAL CARDIOVERSION __________________________________
Professional Services: 92960 (Cardioversion)
ICD-10-CM DX: I48.92 (Flutter, atrial or auricular)

Question 20

2-14A ULTRASOUND, LOWER EXTREMITIES ____________________________
Professional Services: 93970-26 (Vascular Studies, Venous Studies, Extremity)
ICD-10-CM DX: R60.0 (Edema, legs)

Question 21

2-15A COGNITIVE FUNCTION ASSESSMENT ____________________________
Professional Services: 96116 × 2 (Neurology, Higher Cerebral Function, Cognitive, Function Tests)
ICD-10-CM DX: F03 (Dementia, senile, depressed or paranoid type)

Question 22

2-16A BEHAVIOR ASSESSMENT ________________________________________
Professional Services: 96150 × 3 (Evaluation and Management, Health Behavior, Assessment)
ICD-10-CM DX: F98.8 (Nail, biting)

Question 23

2-17A INFUSION ______________________________________________________
Professional Services: 96413 (Chemotherapy, Intravenous, Infusion), J9050 (Table of Drugs, Carmustine)
ICD-10-CM DX: Z51.11 (Encounter, chemotherapy for neoplasm), C90.00 (Myeloma [multiple])

Question 24

2-18A PHOTODYNAMIC THERAPY ______________________________________
Professional Services: 96567 × 3 (Photodynamic Therapy for Lesion), J7308 × 3 (Aminolevulinic acid, topical)
ICD-10-CM DX: L57.0 (Keratosis, actinic)

Question 25

2-19A PHYSICAL THERAPY EVALUATION ________________________________
Professional Services: 97161 (Physical Medicine/Therapy/Occupational Therapy, Evaluation, Physical Therapy)
ICD-10-CM DX: Z51.89 (Aftercare), M17.10 (Osteoarthritis, knee), Z47.89 (Aftercare, following surgery, orthopedic NEC)

Question 26

2-20A PHYSICAL THERAPY EVALUATION ________________________________
Professional Services: 97163 (Physical Medicine/Therapy/Occupational Therapy, Evaluation, Physical Therapy)
ICD-10-CM DX: Z51.89 (Aftercare), G80.0 (Quadriplegia, congenital, spastic), Z99.3 (Dependence, on, wheelchair)

Question 27

2-20B PHYSICAL THERAPY EVALUATION ________________________________
Professional Services: 97760 × 2 (Physical Medicine/Therapy/Occupational Therapy, Orthotics Training)
ICD-10-CM DX: Z46.89 (Fitting, orthopedic device [brace]), G80.0 (Quadriplegia, congenital, spastic)

Question 28

2-20C PHYSICAL THERAPY EVALUATION ________________________________
Professional Services: 97164 (Physical Medicine/Therapy/Occupational Therapy, Evaluation, Physical Therapy)
ICD-10-CM DX: Z51.89 (Aftercare), G80.0 (Quadriplegia, congenital, spastic), Z99.3 (Dependence, on, wheelchair)

Question 29

2-21A OFFICE PROCEDURE ____________________________________________
Professional Services: 11750-TA, 11750-51-T5 (Nails, Excision)
ICD-10-CM DX: L60.0 (Ingrowing, nail [finger] [toe])

Question 30

2-21B CLINIC PROGRESS NOTE ________________________________________
Professional Services: 99024 (Post-Op Visit)
ICD-10-CM DX: Z48.817 (Aftercare, following surgery, skin and subcutaneous tissue)

Question 31

AUDIT REPORT 2.1 PSYCHOTHERAPY
Incorrect code: F33.9

Question 32

AUDIT REPORT 2.2 OPERATIVE REPORT, SWAN-GANZ
Missing code(s): I95.9

Question 33

AUDIT REPORT 2.3 ELECTROENCEPHALOGRAM
Incorrect code: 95816

Question 34

AUDIT REPORT 2.4 CHART NOTE
Incorrect codes: 99211, 90749

Question 35

AUDIT REPORT 2.5 VASCULAR LABORATORY REPORT, DUPLEX VENOUS EXAMINATION
Incorrect code: 93970

Question 36

AUDIT REPORT 2.6 PHOTODYNAMIC THERAPY
Missing code: 96567*4

Question 37

Case 2-1
LOCATION: Outpatient, Hospital
PATIENT: Gordon Monday
ORDERING PHYSICIAN: Laddie N. Noss, MD
ATTENDING/ADMIT PHYSICIAN: Laddie N. Noss, MD
RADIOLOGIST: Morton Monson, MD
PERSONAL PHYSICIAN: Ronald Green, MD
EXAMINATION: Bilateral laser-Doppler test.
CLINICAL SYMPTOMS: Peripheral angiopathy due to diabetes.
BILATERAL LASER-DOPPLER TEST: The patient is an 84-year-old man with diabetes and renal disease. He had an arterial Doppler 6 months previously that showed bilateral disease and calcified vessels. The right side showed a digital pressure of 70. The left side was more abnormal with a digital pressure of only 12. Again, vessels were calcified. On the left side, the toe pressure is 35, which is right at the borderline of healing. Transmetatarsal is at the same level. Above the ankle, paradoxically, the pressure is even a little lower at 30, which is right at our threshold. On the right side at the toe, the level is 70, which indicates a good likelihood of healing. Transmetatarsal the level is 60 and above the ankle is 50, all of which should be adequate for healing.
The laser-Doppler studies basically back up the digit pressures. The right side looks abnormal, but adequate for healing. The left side is marginal. Laser-Doppler levels look a little better than the digit pressures regarding this area.
CPT Code(s): _________________
ICD-10-CM Code(s): _________________
Abstracting Questions:
1. Does the laser description affect the CPT code selection for the Doppler scan? _________________
2. Is CPT code selection affected by type (arterial or venous) of study? _________________
3. Does bilateral versus unilateral affect CPT assignment? _________________

Question 38

Case 2-2
LOCATION: Inpatient, Hospital
PATIENT: Jo Littledove
REFERRING PHYSICIAN: James Noonar, MD
CARDIOLOGIST: Marvin Elhart, MD
INDICATIONS: Abnormal Cardiolite stress test and shortness of breath.
PROCEDURE: Right and left selective coronary angiogram, LV gram left heart, right femoral artery #6 French sheath, right femoral artery angiogram.
HEMODYNAMICS: Aortic pressure 138/57, LV 148/4. No aortic gradient on pullback.
RESULTS: Ventriculography: The LV displayed normal size with excellent contractility and no segmental wall motion abnormality. The ejection fraction is estimated at 60-80%.
Coronary Angiography
1. Right coronary artery: This is a dominant vessel. It has a shepherd's crook takeoff. Through its course the right coronary artery has no significant stenosis. Distally, it trifurcated to give rise to posterior descending artery, posterolateral branch, and a marginal branch. Through its course the right coronary artery has intimal disease from 10-20%.
2. Left main: Normal.
3. Circumflex artery: The circumflex artery is a codominant system. The circumflex in its midportion branched to give first marginal that is moderate in size, tortuous, but no significant obstructive disease, and a very large second marginal that has in its midportion 40% stenosis. Distally, it branched to give smaller marginals.
4. Left anterior descending artery: After the takeoff of the left main, has steep angulations of close to 90 degrees. Thereafter it takes off and through its course has significant tortuosity. The proximal part of the left anterior descending appears slightly hazy, probably from the angulations; the artery itself has 30% stenosis. At the level of the stenosis there are two diagonals taking off, the first of which is before the stenosis and is small, and the second one is moderate in size and has at its origin an ostial stenosis that appeared to be 60%. The left anterior descending artery is tortuous and in its midportion gave rise to another diagonal that appeared to be free of any significant disease.
IMPRESSION/CONCLUSION: Normal left ventricular systolic functions with disease involving predominantly the left anterior descending artery that appeared to be in its proximal third of 40-50% at the level of the second diagonal. Angiographically, it did not appear severely obstructed, with some mild disease involving the right coronary artery at the circumflex. At this point, my recommendation is to aggressively manage her medically, and if we are unable to control her symptoms with medications, then later on we might consider percutaneous revascularization of the left anterior descending artery. Considering her size, the location of the lesion, and the takeoff of the left anterior descending artery, this procedure is not without risk.
CPT Code(s): _________________
ICD-10-CM Code(s): _________________
Abstracting Questions:
1. What does the LV referred to in the report stand for? _________________
2. What is the definition of "circumflex"? _________________
3. The report states in point 4 that the left anterior descending artery has significant tortuosity. What does this mean? _________________