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CPC Practice Exam and Study Guide Package

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Job Hunting Assistance

Hello! I just finished school and passed my final exam. My CPC is scheduled for October. I am trying to find a job now. I really do not have a choice because we have some pretty important bills that have to be paid which is why I went back to school. I have been job searcing since the end of March and I have not had any luck. I have been looking for anything, although I really want to be in coding or billing. I have tried front desk, receptionist, medical records, authorizations and I have even applied to some coding positions in hopes of getting a start with the stipulation of me taking my CPC which is planned and it is on my resume :D. No luck unfortunately. I have no medical experiece but I do have office, management and data entry as well as collections and computer knowledge. I am really not sure what I can do at this point. I want to stay up on everything and not lose any of the knowledge that I have leaned but I have to get a job. I am even willing to go part-time or full-time. I am just not sure what to do and I am getting discouraged. I am beginning to think I have to have some connections in order to be able to get into anywhere. I just do not want to go do something entirely different and then not pass my CPC. I have a goal and I want to work towards it. If anyone could help me or offer me any suggestions I would greatly appreciate it.

Thank you in advance!
Stephanie

Medical Billing and Coding Forum

Spinal Angio Assistance with CPT codes

We’re having a discussion on the proper way to bill this procedure. Please review the abbreviated note and provide feed back.

PREOPERATIVE DIAGNOSIS: *SPINAL DURAL ARTERIOVENOUS FISTULA STATUS
POST PARTIAL EMBOLIZATION IN THE OUTSIDE HOSPITAL WITH PROGRESSIVE
LOWER EXTREMITIES WEAKNESS AND INCONTINENCE
*
POSTOPERATIVE DIAGNOSIS: RESIDUAL DURAL ARTERIOVENOUS FISTULA WITH
SINGLE INTRA DURAL DRAINING VEIN AT T6 LEVEL. FEEDING ARTERIES ARE
RECONSTITUTED FROM RIGHT T5 AND LEFT T6 INTERCOSTAL ARTERIES.
SIGNIFICANT DILATED VEINS ABOVE T6 VERTEBRAE LEVEL IS VISUALIZED.
ADAMKIEWICZ ARTERY IS POSSIBLY VISUALIZED FROM LEFT T6
*
OPERATION: FEMORAL SPINAL ANGIOGRAM
*
ANESTHESIA: MAC
*
COMPLICATIONS: NONE
*
ESTIMATED BLOOD LOSS: *10 CC
*
STUDIED VESSELS: RIGHT VERTEBRAL ARTERY, RIGHT SUBCLAVIAN ARTERY,
LEFT VERTEBRAL ARTERY, LEFT SUBCLAVIAN ARTERY, RIGHT THYROCERVICAL,
LEFT THYROCERVICAL, RIGHT INTERCOSTAL/RADICULAR ARTERIES (T3/4, T5,
T8, T9, T10, T11, T12, L1, L2, L3), LEFT INTERCOSTAL/RADICULAR
ARTERIES (T4, T5, T6, T7, T8, T9, T10, T11, T12, L2, L3)
*
INDICATIONS: *The patient is an 63 years year old Male with history
of progressive bilateral lower extremity numbness and weakness that
became substantially progressive since May of 2017, which led to an
MRI that raised the concern for a spinal dAVF. He was treated
partially with endovascular embolization in XXXX. He now has a
foley catheter and has severe (2/5 on the right and 3/5 on the left)
weakness in lower extremities.

SUPERVISION AND INTERPRETATION:
1. *Angiographic study demonstrates residual dural arteriovenous
fistula at the level of T6. This is supplied by right T5 and left T6
intercostal arteries. Significant dilated spinal veins are visualized
above T6 level.
2. * The artery of Adamkiewecz is possibly visualized in the Left T6
intercostal artery run.
2. *No immediate complications.
*
VESSELS STUDIED:
1. *Right Vertebral Artery
2. *Right Subclavian Artery
3. *Right T3/4
4. *Right T5
5. *Right T8
6. *Right T9
7. *Right T10
8. *Right T11
9. *Right T12
10. *Right L1
11. *Right L2
12. *Right L3
13. *Left Vertebral Artery
14. *Left Subclavian Artery
15. *Left T4
16. *Left T5
17. *Left T6
18. *Left T7
19. *Left T8
20. *Left T9
21. *Left T10
22. *Left T11
23. *Left T12
24. *Left L2
25. *Left L3
26. *Right common femoral artery.

Coded as such;
36226-50
36215 x 6
36216 x 2
36245-50 x 3

Would appreciate any and all input from forum.

Medical Billing and Coding Forum

Spinal Angio Assistance with CPT codes

We’re having a discussion on the proper way to bill this procedure. Please review the abbreviated note and provide feed back.

PREOPERATIVE DIAGNOSIS: *SPINAL DURAL ARTERIOVENOUS FISTULA STATUS
POST PARTIAL EMBOLIZATION IN THE OUTSIDE HOSPITAL WITH PROGRESSIVE
LOWER EXTREMITIES WEAKNESS AND INCONTINENCE
*
POSTOPERATIVE DIAGNOSIS: RESIDUAL DURAL ARTERIOVENOUS FISTULA WITH
SINGLE INTRA DURAL DRAINING VEIN AT T6 LEVEL. FEEDING ARTERIES ARE
RECONSTITUTED FROM RIGHT T5 AND LEFT T6 INTERCOSTAL ARTERIES.
SIGNIFICANT DILATED VEINS ABOVE T6 VERTEBRAE LEVEL IS VISUALIZED.
ADAMKIEWICZ ARTERY IS POSSIBLY VISUALIZED FROM LEFT T6
*
OPERATION: FEMORAL SPINAL ANGIOGRAM
*
ANESTHESIA: MAC
*
COMPLICATIONS: NONE
*
ESTIMATED BLOOD LOSS: *10 CC
*
STUDIED VESSELS: RIGHT VERTEBRAL ARTERY, RIGHT SUBCLAVIAN ARTERY,
LEFT VERTEBRAL ARTERY, LEFT SUBCLAVIAN ARTERY, RIGHT THYROCERVICAL,
LEFT THYROCERVICAL, RIGHT INTERCOSTAL/RADICULAR ARTERIES (T3/4, T5,
T8, T9, T10, T11, T12, L1, L2, L3), LEFT INTERCOSTAL/RADICULAR
ARTERIES (T4, T5, T6, T7, T8, T9, T10, T11, T12, L2, L3)
*
INDICATIONS: *The patient is an 63 years year old Male with history
of progressive bilateral lower extremity numbness and weakness that
became substantially progressive since May of 2017, which led to an
MRI that raised the concern for a spinal dAVF. He was treated
partially with endovascular embolization in XXXX. He now has a
foley catheter and has severe (2/5 on the right and 3/5 on the left)
weakness in lower extremities.

SUPERVISION AND INTERPRETATION:
1. *Angiographic study demonstrates residual dural arteriovenous
fistula at the level of T6. This is supplied by right T5 and left T6
intercostal arteries. Significant dilated spinal veins are visualized
above T6 level.
2. * The artery of Adamkiewecz is possibly visualized in the Left T6
intercostal artery run.
2. *No immediate complications.
*
VESSELS STUDIED:
1. *Right Vertebral Artery
2. *Right Subclavian Artery
3. *Right T3/4
4. *Right T5
5. *Right T8
6. *Right T9
7. *Right T10
8. *Right T11
9. *Right T12
10. *Right L1
11. *Right L2
12. *Right L3
13. *Left Vertebral Artery
14. *Left Subclavian Artery
15. *Left T4
16. *Left T5
17. *Left T6
18. *Left T7
19. *Left T8
20. *Left T9
21. *Left T10
22. *Left T11
23. *Left T12
24. *Left L2
25. *Left L3
26. *Right common femoral artery.

Coded as such;
36226-50
36215 x 6
36216 x 2
36245-50 x 3

Would appreciate any and all input from forum.

Medical Billing and Coding Forum

L Code Assistance Please

Working in Florida, non-Medicare/Medicaid, Accounts Receivable Multiproduct Lines TPA with vendor network- In order to confirm that billing was accurate and that shortpayments and denials should be appealed by collectors, I need to confirm my understanding of these features of non prosthetic L codes. Also need to confirm need for Department of HEalth professional license inclusion in billing. All help will be very much appreciated.
1. Prefabricated are the only codes for which OTS or custom fitted must be determined for appropriate coding? Codes clearly defined as OTS or Custom fabricated are self defined in the long description.
2. Codes with includes fitting and adjustment are classified as ORTHOSES: PREFABRICATED (CUSTOM FITTED) by PDAC. All of these codes require the services of a orthotist or equivalent training?
3. Addition to codes L1010 for example that do not reference custom fitting or fabrication are classified by PDAC as custom fabricated. Do these codes require the services of orthotist or person with equivalent training?
4. Code L2999 Lower extremity orthosis not otherwise specified is classified by PDAC as custom fabricated. This follows because the product and service are unusual enough to not be represented by a code. A professional is required to be associated with this code?
5. Can custom fabricated products be constructed in a geographically different location using mold, measurements, xrays, CAD\CAM and drop shipped to a patient?
Must these have final fitting by a professional?
Are custom fabricated products always built by an orthotist or someone with equivalent training?

I need to be 100% confident of my understanding of these questions in this product group. Thank you for sharing your expertise.

Medical Billing and Coding Forum

Drug Assay Coding – Your assistance please

Hello all,

I have a new client who has been billing the following for Presumptive Drug Class Screening (urine). The Laboratory Requisition indicates Drug Screen and Full Confirmation for a Comprehensive Test Panel.

80307 – Drug tests, presumptive, any number of drug classes…by instrument chemistry analyzers, includes sample validation when performed per date of service
G0483 – Drug test(s) definitive, utilizing drug identification methods able to identify individual drugs ….including metabolite(s) if performed
82542 – Column chromatography, includes mass spectrometry if performed, non drug analyte(s) not elsewhere classified, qualitative or quantitative, each specimen.
82570 – Creatinine – other source
83986 – ph, Body fluid
83789 X2 – Mass spec and tandem mass spect…non-drug analyte(s), not elsewhere specified, qualitative or quantitative, each specimen
84311 X2 – Spectrophotometry, analyte, not elsewhere specified.

Research to date shows proper billing for what is documented on the report as 80307 and G0483. Codes 82570 and 83986 would appear to be included under the "sample validation" umbrella and not separately billable.
The questions I have are:

1. Is a specific order required to bill 83789, 84311 and 82542?
2. What additional documentation would need to be demonstrated to consider these codes billable? What they are telling me is that they use this when testing for non-drug analytes such as bath salts or glue, for example. However, on their current reporting form, none of these appear as detected or not detected, just the overall drug classifications.

All assistance is greatly appreciated.

Susan Miedzianowski, CPC

Medical Billing and Coding Forum

Peripheral Assistance

I still struggle with these and appreciate any assistance with this. Any suggestions for resources to better educate myself on these would be great too.

Here is what I came up with:
75630-26
37224-RT
37228-RT
99152

I73.9

Thank you in advance!

PROCEDURES:
1. Distal aortogram.
2. Distal runoff bilaterally.
3. CSI, right SFA and posterior tibial artery.
4. PTCA, popliteal and posterior tibial artery.
5. Drug-coated balloon angioplasty, distal SFA/popliteal artery.

INDICATIONS:
Claudication.

DESCRIPTION OF PROCEDURE:
The risks and benefits of lower extremity angiography and PCI were discussed
with the patient. He is agreeable to procedure. Consent was obtained.

Time-out was performed. The patient, physician, and procedure to be
performed were identified.

The patient was given Versed 1 mg and fentanyl 50 mcg intermittently
during the procedure for conscious sedation.

The patient was prepped and draped in the normal fashion. A 1% lidocaine
was generously infiltrated into the left groin region. The common femoral
artery was accessed with ultrasound guidance. A 6-French sheath was
introduced without difficulty. Distal aortogram was performed using
a Contra catheter. Distal aortogram showed ectatic abdominal aorta.
The renal arteries are patent bilaterally.

The right and left common iliac, internal and external iliac arteries
were without significant disease.

The right and left common femoral artery are also without significant disease.

On the right side, the superficial femoral artery has mild plaquing in
the mid and distal segment. The popliteal artery had diffuse 70% to
80% stenosis. The anterior tibial artery was totally occluded in the
proximal segment. The posterior tibial artery was also occluded in
the proximal segment. The peroneal artery had 90% proximal stenosis.

On the left side, there was mild popliteal disease, 40% to 50%. The
distal posterior tibial trunk had 90% stenosis. The peroneal artery
is totally occluded. The posterior tibial artery had ostial 90% stenosis.
The anterior tibial artery was totally occluded at the ostial/proximal
segment.

Our attention was directed to the right popliteal and peroneal artery.
A 6-French Terumo 45 cm catheter was used to go up and over from the
left to the right external iliac artery. The FiberWire was advanced
to the popliteal artery. We were able to cross the stenosis with backup
with a Quick-Cross support. The wire was exchanged for a ViperWire.
We did multiple runs with a CSI 1.5 bur. This was followed by PTCA
with a NanoCross 3.0/115 mm balloon. The distal SFA/proximal popliteal
artery was post dilated with a TrailBlazer drug-coated balloon 3.5/120
mm.

Final angiography showed the previous 80% to 90% stenosis to have 0% stenosis.

At the end of procedure, the sheath was removed and a 6-French Angio-Seal
collagen sponge was successfully deployed. Good hemostasis was obtained.
The patient tolerated the procedure well and was transferred back to
the floor in stable condition. While in the cath lab here, he received
Plavix 300 mg and aspirin 325 mg x1.

DEVICE USED: CCL Dev Vasc Clos Angioseal BCE

Medical Billing and Coding Forum

Medical Malpractice New York – Find out Right Legal Assistance!

In general term medical malpractice mean misuse or inappropriate use of the medical facilities. In most of the case, medical malpractice can be quite fatal or even life threatening. Medical malpractice generally occurs due to negligence of medical staff or the paramedics; inability to act on certain critical situation or due to sheer medical staff can often lead to this situation. Most of the people, who suffer in hand of these perpetrators usually, do not complaint against them; mostly because of the fact that they remain unaware of the situation or ignorant of the fact that a legal assistance can be taken.

We have well placed laws in New York to act against such situation and the people can slot action against the perpetrators with the help of a lawyer generally called a Medical Malpractice Lawyer. The Medical Malpractice New York Lawyers are highly specialist in the field of Medical Malpractice. If you are a victim of medical malpractice then you may take help from these lawyers who are well versed with their profile.

Medical Malpractice New York attorneys are easily available these days. With the advent of the new malpractice laws, people have become more intellectual in dealing with the malpractice situation. One can now easily search for a malpractice lawyer with the help of Internet however; help from local expertise can also be taken. We should always try to hire a lawyer who is highly specializes in his field and should have a hand on experience of handling cases in the past. Please note that a medical malpractice lawyer is like a general lawyer, hence it is highly recommended to hire a highly experience lawyer to in such cases.

Some of the most commonly occurring accidents that can be seen presently include miscarriage, wrong diagnostic, incorrect medical prescriptions. The most importance things that one should keep in mind before filling a case are the prescriptions and reports. These should be readily available with the victim before filing a legal case. These are highly sensitive sets of evidence that may turn the case around.

The people of New York City are protected by well governed laws that protect them from any malpractice situation. Apart from monetary benefit to the victim the law also penalizes the wrongdoer. This not only helps the people from becoming victim but also stops such activity from happening in future. Medical malpractice can be of different category such as surgical errors, incorrect prescriptions infant mortality etc. Depending on these factors monetary benefit is provided to the victims and a fine on the medical officials is imposed.

Some of the medical malpractice can affect the patient in the long term. One good example is that of incorrect or in appropriate prescription. In such case the symptom of the actually illness may be seen in the latter life. A medical malpractice New York lawyer should always emphasis on the effect of malpractice on the victims and its associates. The lawyer can also help the victim to project the claim amount based on history of the case. The prospect affect of the malpractice usually decides the compensation amount.

George Turner gives advice to clients who are looking for attorneys to handle injury related cases. To know more about the services of medical malpractice, medical malpractice lawyer new york, medical malpractice lawyers new york, medical malpractice law firm, personal injury New York, medical malpractice New York visit www.nbrlawfirm.com

Incomplete Procedure Code Assistance

Hi All…could someone let me know what they are thinking for codes/mods for this since it the procedure wasn’t completed? Thank you!

Emergency left heart catheterization with measurement of left ventricular end-diastolic
pressure, selective right and left coronary angiography, PTCA of mid-vessel RCA lesion,
unable to open or cross the mid-vessel lesion to reach the culprit lesion, although we did
re-establish TIMI-3 flow with a guidewire.
CLINICAL DATA:
Patient is a 75-year-old female with known coronary artery disease. She had an
anterior wall infarct in 2011. She underwent PCI and placement of 2 stents in her LAD
with good results. She is noncompliant, stopped all her medications, has not followed up.
At the time of her original cardiac catheterization her ejection fraction was estimated
in the 35% range with anterior wall motion abnormality and she was felt to have a 90%
residual lesion, which was apparently scheduled to be treated as a staged procedure.
However, the patient never followed up. She began having chest pain and nausea today
approximately 9 hours prior to presentation to emergency room where an EKG demonstrated
subtle ST-segment elevation in lead 3 and AVF with reciprocal depression in V2 and lateral
leads. The patient is taken urgently to the cardiac catheterization laboratory. The
diagnostic procedure is performed from the right groin using modified Seldinger technique
and a 6-French multipurpose catheter.
HEMODYNAMIC DATA:
1. Arterial pressure 200/70, mean 125.
2. LV pressure 200 with an LVEDP of 32.
3. Left ventricular angiography is not performed because of elevated left ventricular
end-diastolic pressure.
CORONARY ANGIOGRAPHY:
Coronary angiography is performed in multiple projections:
A. The left main coronary artery is a moderate-sized vessel. There is mild
nonobstructive plaquing in the distal aspect of the left main coronary artery, but no
significant disease is noted. The left main ends in a bifurcation and arises from the
left cusp.
B. The circumflex is a moderate size nondominant vessel. There is mild nonobstructive
plaquing noted in the proximal circumflex. No significant disease is noted.
C. The left anterior descending artery is patient’s previous culprit vessel. There are 2
patent stents in the proximal portion of left anterior descending artery with minimal
in-stent restenosis. In the distal aspect of the left anterior descending artery there is
an eccentric plaque of approximately 50%.
D. The right coronary artery is the patient’s current culprit vessel. The right coronary
artery is severely and diffusely diseased. There appears to be mild amount of calcium.
The origin of the right coronary artery is patent immediately supplies a very large right
ventricular branch, which also gives rise to the SA nodal branch. As the right coronary
artery continues it is very small, there is a lesion in the proximal portion of at least
80% to 90%. At the acute margin the right coronary artery is totally occluded. The RV
branch is also severely diseased in its mid-segment.
IMPRESSIONS:
1. Acute inferior wall myocardial infarction.
2. Elevated left ventricular end-diastolic pressure.
3. Normal sinus rhythm.
4. Totally occluded native right coronary artery, which appears to be dominant vessel.
There are some intercoronary collaterals from the septal arcade of the LAD to the right
coronary artery and posterolateral ventricular branch.
COMMENTS:
Plans for ad hoc angioplasty had been made. We selected a JR4 guiding catheter. We
placed 0. 014 wire and a 2 x 20 Emerge balloon. The patient had been given 10000 units of
heparin IV push in the emergency room, was given an additional 5000 units of heparin at
the start of the PCI. We were able to wire the vessel and penetrate the thrombus in the
distal right coronary artery with the use of 2-0 balloon. I then attempted to advance the
2-0 balloon, however we could not advance the balloon past the mid-portion of the right
coronary artery and certainly it did not reach the area of total occlusion. We were able
to take subsequent angiograms and there was concentric 99% diameter stenosis in the distal
right coronary artery proximal to the origin of the posterior descending artery. We did
establish TIMI-3 flow in this vessel. We attempted multiple times to cross the lesion
giving intracoronary nitroglycerin. We downsized to a 1.2 x 20 balloon. We did several
inflations in the mid-right coronary artery proximal to the lesion. However, we were
still unable to advance the balloon catheter past the mid-vessel. It was clear we would
never be able to stent the culprit lesion. After trying multiple guiding catheters
including JR4, JR4 with side holes, AL2, and an AL2 with side holes. We abandoned the
procedure. Repeat angiograms demonstrated TIMI-3 flow into the distal right coronary
artery. There was some spasm in the right ventricular branch, which was gradually
relieved by the time the patient left the laboratory. At this point in time, I felt that
surgery may be an option for the patient. We took a diagnostic JR4 catheter, and we did a
selective left internal mammary angiogram. The vessel appears to be adequate for use as
in situ graft however, there was 75% diameter stenosis involving the left subclavian
artery proximal to the origin of the LIMA. The patient’s left vertebral artery also
arises from the very proximal portion of the left subclavian artery near the transverse
aortic arch origin of the left subclavian vessel. At this point in time, the procedure
was terminated. We started the patient on heparin drip. We secured the sheath. We will
consult cardiovascular surgery. Graftable vessels included the distal right coronary
artery, the right ventricular branch which has severe disease in its mid-portion and
possibly the
left anterior descending artery. An echocardiogram will be ordered to evaluate the
patient’s left ventricular ejection fraction.

Medical Billing and Coding Forum

Medical Assistance Services Bunch of Benefits

Medical assistants are the healthcare individuals that are supporting or aiding the medical doctors and other health professionals in their work. Clinical and administrative support is provided by them to the doctors and other health professionals. Several kinds of tasks are performed by medical assistant performs. He or she is responsible for measuring the patient’s vital signs, recording information in the medical records system, doing routine tasks, and helping with medication processes and injections and also carries the task to prepare and handle medical supplies and instruments, and collects and prepares body fluids that are needed for laboratory testing.

Medical assistants play an imperative role in the medical office where they work, whether it’s at a hospital, large healthcare facility, private medical clinic, or medical insurance company. They can go by many names, including billing specialist, insurance biller, claims analyst, patient account representative, claims processor, billing coordinator, or reimbursement specialist.

The doctors and the medical crew are required to be cautious for calls round the clock, in view of the fact that the emergency concerning any health aspect may occur at any instant of the day. Generally, the doctors are accessible only in the regular nine to eight hours. Although, in case the patients meet with some emergency situations after evening hours or in the middle of the night, then the medical assistance is required at that very moment. Usually, in these situations, the suffering individual cannot get in touch with the doctor for medical help and life threatening situations may also arise.

The medical assistance services provide assurance to medical professionals with the aim of ensuring their patients to make contact with the medical office at any time of the day or night. This is also a technique to treat the patients who gets exasperated or irritated when there is no one available to answer their desperate calls. Medical doctors and the professionals have so many issues to look into, that they would find it difficult to answer every call. If left unanswered then they might lose their customers who regularly visit their hospital. In recent times, there are so many outsourcing companies available which specializes in attending the medical calls and providing medical assistance.

Travel Medical assistance services have the added benefit of giving you access to great medical benefits. If you are hurt or injured badly and are far from hospital, it could mean an emergency transport with a large price tag would be required, which you may, or may not, be able to cover expenses. With travel medical assistance, you can put your worries aside because if something happens, your personal assistant will get you the help you need without asking for a big fee. Just knowing that you are covered under almost any circumstance can make your vacation worry free and much more relaxing.

Hence, if any unforeseen medical emergency or requirement arises, medical assistance services companies can help in many ways, in any part of the world. They provide access to medical opinion from world-class doctors at leading hospitals. In addition, they also arrange for emergency medical evacuation by air or surface transport in case a person needs more appropriate medical care. All in all, one can say that these companies provide any possible medical assistance one can think of.

Author of this article is a leading provider of medical assistance services and is serving the health care industry since past many years.

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