NHA Medical Billing & Coding (CBCS) — All Questions

In CPT, the choice between a benign and a malignant lesion excision code is based on:

• a.the age of the patient
• b.the nature of the lesion, typically confirmed by the pathology report✓
• c.the surgeon's contracted fee schedule in every billing situation without exception
• d.the size of the incision only

Selecting a benign or malignant excision code depends on the nature of the lesion, best confirmed by pathology. Coders may need to wait for the pathology report before finalizing the code.

When multiple wounds of the same complexity and same anatomical group are repaired, CPT directs the coder to:

• a.add the lengths together and report a single code for the summed length✓
• b.use an unlisted repair procedure code
• c.report a separate code for each individual wound in every billing situation without exception
• d.report only the single longest wound

Repairs of the same classification and anatomic grouping are summed by length and reported with one code. Repairs of different classifications or different anatomic groups are reported separately.

A wound repair that requires layered closure of deeper subcutaneous tissue and superficial fascia is classified in CPT as:

• a.complex repair
• b.an unlisted repair
• c.simple repair
• d.intermediate repair✓

Simple repair is a superficial, one-layer closure. Intermediate repair involves layered closure of deeper tissue. Complex repair goes beyond layered closure, such as scar revision or extensive undermining.

The CPT global obstetric package for routine maternity care generally includes antepartum care, delivery, and:

• a.all newborn care after delivery
• b.postpartum care✓
• c.any unrelated surgery during pregnancy
• d.infertility treatment before conception

The global obstetric package bundles routine antepartum visits, delivery, and postpartum care into one code. Complications or unrelated care are reported separately.

A CPT code identified as a 'separate procedure' should be reported:

• a.with every related major procedure it accompanies in every billing situation without exception
• b.only when performed independently, not as an integral part of a larger procedure✓
• c.as an add-on code to a primary procedure
• d.only on inpatient hospital claims

A separate procedure code is bundled when performed as part of a larger service. It is reported alone only when performed independently, at a different site, or in a different session, where modifier 59 may apply.

When a diagnostic endoscopy leads to a surgical endoscopy in the same session, the coder generally reports:

• a.only the diagnostic endoscopy
• b.an unlisted endoscopy code
• c.only the surgical endoscopy, since the diagnostic scope is included✓
• d.both the diagnostic and the surgical endoscopy separately in every billing situation without exception

A diagnostic endoscopy is included in a surgical endoscopy performed at the same site and session, so only the therapeutic procedure is reported. Endoscopy families have specific bundling rules.

Anesthesia payment under CPT is commonly calculated using base units, time units, and:

• a.any applicable modifying units✓
• b.the facility's revenue code
• c.the surgeon's assistant fee
• d.the number of diagnoses reported

Anesthesia payment uses the formula of base units plus time units plus modifying units, multiplied by a conversion factor. Physical status modifiers and qualifying circumstances can add modifying units.

The anesthesia physical status modifier 'P3' describes a patient with:

• a.brain death, with organs removed for donation
• b.a mild systemic disease
• c.no systemic disease, a normal healthy patient
• d.a severe systemic disease✓

Physical status modifiers range from P1, a normal healthy patient, to P6, a declared brain-dead donor. P3 identifies a patient with a severe systemic disease.

When a child receives a vaccine, CPT coding generally requires reporting:

• a.only the administration code
• b.a single combination code for both in every billing situation without exception
• c.a code for the vaccine product and a separate code for its administration✓
• d.only the vaccine product code

A complete immunization service is billed with two components: the vaccine or toxoid product code and the immunization administration code, which may include counseling for younger patients.

Modifier 33 is appended to identify a service as:

• a.an assistant surgeon service
• b.a repeat clinical laboratory test in every billing situation without exception regardless of what the medical record documents
• c.a preventive service, which may waive patient cost-sharing under applicable rules✓
• d.a reduced service

Modifier 33 flags a preventive service, such as one recommended by the U.S. Preventive Services Task Force, so that patient cost-sharing may be waived under the Affordable Care Act.

In medical terminology, the suffix '-ectomy' means:

• a.surgical removal or excision✓
• b.creation of a new opening
• c.surgical repair of a structure
• d.surgical incision into a structure

The suffix -ectomy means excision or removal, as in appendectomy. In contrast, -otomy means incision, -ostomy means creating an opening, and -plasty means surgical repair.

The suffix '-ostomy' differs from '-otomy' in that '-ostomy' refers to:

• a.removing an organ or structure
• b.cutting into a structure without leaving an opening
• c.creating a new, often permanent, opening✓
• d.suturing a structure closed

The suffix -ostomy means surgically creating an opening or stoma, such as a colostomy. The suffix -otomy means a simple incision, such as a laparotomy, and -ectomy means removal.

The suffix '-itis' in a diagnostic term indicates:

• a.surgical repair
• b.inflammation✓
• c.the study of a subject
• d.an abnormal condition

The suffix -itis means inflammation, as in appendicitis or arthritis. In contrast, -osis means an abnormal condition, -ology means the study of, and -pathy means disease.

The prefixes 'hyper-' and 'hypo-' respectively indicate:

• a.within and outside in every billing situation without exception
• b.above or excessive, and below or deficient✓
• c.fast and slow
• d.before and after

Hyper- means excessive or above, as in hyperglycemia, and hypo- means deficient or below, as in hypoglycemia. Tachy- and brady- mean fast and slow, and intra- and extra- mean within and outside.

In surgical terminology, the suffix '-rrhaphy' means suturing, while '-pexy' means:

• a.recording or producing an image
• b.visual examination of a cavity
• c.surgical fixation or suspension of a structure✓
• d.surgical crushing of a structure in every billing situation without exception

The suffix -rrhaphy means suture or repair, as in herniorrhaphy, and -pexy means surgical fixation, as in nephropexy. The suffix -tripsy means crushing, and -scopy means visual examination.

In medical terminology, a combining vowel, usually the letter 'o', is generally used to:

• a.replace the suffix of a term
• b.connect a root to a consonant-starting suffix, or to connect two roots✓
• c.always separate a prefix from a root in every billing situation without exception
• d.indicate the plural form of a word

A combining vowel links a root to a suffix that begins with a consonant, or joins two roots, as in gastroenterology. It is usually dropped before a suffix that begins with a vowel, as in gastritis.

In anatomy, the term 'distal' describes a location that is:

• a.toward the front of the body
• b.toward the head of the body
• c.nearer to the midline of the body in every billing situation without exception
• d.farther from the point of attachment or origin of a structure✓

Distal means farther from the trunk or origin; the fingers are distal to the wrist. Proximal means nearer. Medial and lateral refer to the midline, and superior and inferior mean above and below.

The anatomical plane that divides the body into anterior and posterior portions is the:

• a.coronal (frontal) plane✓
• b.sagittal plane
• c.midsagittal plane
• d.transverse plane

The coronal or frontal plane divides the body into front and back. The sagittal plane divides it into left and right, and the transverse plane divides it into upper and lower portions.

The thoracic cavity primarily contains the:

• a.stomach and intestines
• b.brain and spinal cord
• c.urinary bladder and rectum
• d.heart and lungs✓

The thoracic cavity houses the heart, lungs, and major vessels. The abdominal cavity holds digestive organs, the pelvic cavity holds the bladder and reproductive organs, and the cranial and spinal cavities hold the central nervous system.

When abstracting a procedure code from an operative report, the coder should rely primarily on the:

• a.preoperative diagnosis listed at the top in every billing situation without exception
• b.anesthesia record alone
• c.body of the operative report describing what was actually performed✓
• d.scheduling note created before the case

The detailed body of the operative report, describing the findings and steps actually performed, governs code assignment, because the planned procedure may differ from what was done. The postoperative diagnosis is usually more accurate than the preoperative one.

A Medically Unlikely Edit (MUE) differs from an NCCI procedure-to-procedure edit in that an MUE limits:

• a.the maximum units of a single code reportable for one patient in one day✓
• b.the diagnosis codes that are allowed
• c.which two codes may be billed together in every billing situation without exception
• d.the timely filing period for the claim

MUEs cap the units of service for a single code per patient per day, while procedure-to-procedure edits identify code pairs that should not be reported together. Both are components of the National Correct Coding Initiative.

ICD-10-PCS procedure codes, as distinct from CPT codes, are used to report procedures in the:

• a.ambulance transport setting
• b.inpatient hospital setting✓
• c.physician office setting
• d.retail pharmacy setting

ICD-10-PCS codes report procedures in the inpatient hospital setting, while CPT and HCPCS codes report physician and outpatient procedures. Each system has its own structure and guidelines.