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

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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

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

Cardiovascular Screening: Combating the World’s #1 Killer

Cardiovascular disease is the world’s number one killer today, but it doesn’t need to be this way. September is National Cholesterol Education Month and September 29 is World Heart Day. These observances raise awareness about cardiovascular disease (CVD), cholesterol, and stroke, encouraging individuals, families, communities, and governments to take action now. Join the movement and […]

The post Cardiovascular Screening: Combating the World’s #1 Killer appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Cardiovascular Associates, P.C. Consents to Pay the United States Over $399,000 to Settle False Claims Act Allegations Relating to Improper Billing Practices

Cardiovascular Associates, P.C. has consented to pay $ 399,230.35 to settle asserts that they submitted false cases to the United States for administrations not rendered. Cardiovascular Associates P.C. is a therapeutic practice with workplaces situated in Rockville, Olney, Laurel and Germantown, Maryland.

Read The Full Story Here!

The post Cardiovascular Associates, P.C. Consents to Pay the United States Over $ 399,000 to Settle False Claims Act Allegations Relating to Improper Billing Practices appeared first on The Coding Network.

The Coding Network

Cardiovascular Coding Help needed

If anyone could suggest how I am coding this procedure incorrectly, I would appreciate the guidance. I am pretty new to this specialty and not always sure that I am understanding all that I am reading.

PROCEDURES

1. Aortic arch angiogram

2. Selective left subclavian angiogram with the left arm runoff

3. Percutaneous transluminal angioplasty and balloon expandable bare-metal stent placement to left subclavian artery.

PROCEDURE NOTE

Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in the sterile fashion. Patient was premedicated with 3 mg Versed and 125 mg fentanyl altogether IV. After injecting 2% lidocaine in the right groin, right common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. Using 5 French angled pigtail catheter, ascending aortogram was performed. Patient was proceeded with intervention of left subclavian artery. Patient remained hemodynamically stable and tolerated procedure well.

AORTIC ARCH AORTOGRAM

Mild atherosclerotic disease was noted in the distal aortic arch. Right brachiocephalic trunk was patent with no significant disease. Left common carotid artery was patent with no significant disease. Left subclavian artery had a proximal 90% stenosis.

PERCUTANEOUS INTERVENTION OF LEFT SUBCLAVIAN ARTERY

6 French 90 cm destination sheath was advanced over Magic torque wire without any difficulty. Heparin was used for anticoagulation. 0.035 Magic torque wire was advanced and lesion of proximal left subclavian artery was successfully crossed without difficulty. 6.0 x 20 mm balloon was advanced and proximal subclavian artery stenosis was predilated at 10 atm. 8.0 x 27 mm express LD balloon expandable stent was advanced the stent was deployed covering lesion of proximal left supplement artery at 8 atm. Stent was postdilated using 8.0 x 20 mm balloon at 10 atm couple of times. Subsequent angiogram revealed wide-open supplement artery with 0% residual stenosis and a brisk antegrade flow in the distal subclavian artery. Left arm runoff was performed and found to have occluded distal ulnar artery and forearm which was reconstituted via collaterals at the level of left wrist. Radial artery flow was normal. She had a palpable good radial pulse at the end of the procedure.

IMPRESSION

1. High-grade 90% stenosis of proximal left supplement artery.

2. Successful percutaneous intervention and balloon expandable stent (BMS) placement to left subclavian artery.

3. Occluded distal left ulnar artery with collaterals -likely chronic

RECOMMENDATIONS

Patient is to continue on her Plavix for minimum 4-6 weeks. Continue aspirin 81 mg as before. Patient had CT angiogram of neck which showed possible distal aortic arch mural thrombus versus penetrating ulcer. She has distal embolization of left ulnar artery which appears chronic with collaterals. Will discuss with hematology regarding need for anticoagulation.

I choose 75605 – 26, 75710 – 26 and 37236.

Thank you for any help.

Medical Billing and Coding Forum

Homan’s Sign, Orthopedic or Cardiovascular Exam?

Good afternoon Everyone,

I have a quick question, my provider constantly documents either negative or positive Homan’s sign on his patients and he often bills 99203. On every exam he assesses range of motion (musculoskeletal), tenderness (skin), he documents that the patient is neurovascular intact (neuro) and there are vitals (constitutional); that’s 4 elements which corresponds to an Expanded Problem Focused Exam (99202). He also documents Homan’s sign which according to google it detects DVT and leads me to believe that I should be giving credit towards Cardio under the exam, which is what the provider needs to bill 99203 (detailed exam – 5 exam elements).

Can anyone tell me if I can give credit under Cardiovascular for the Homan’s sign?

Thank you.

Medical Billing and Coding Forum

AHA Coding Clinic for ICD-10 covers orthopedic, cardiovascular coding

by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS
 
Some interesting tidbits of information can be gleaned from the most recent release of the AHA Coding Clinic for ICD-10-CM/PCS to help coders as they work in the new code set.
 
I never thought I’d be so eager to read a release about coding instead of the newest James Patterson novel, but this newsletter highlighted topics such as orthopedic screw removals, revision of total knee replacements, heart failure with pleural effusions, leadless pacemakers, the Glasgow Coma Scale, and decompression of the spinal cord. 
 
Orthopedics
Typically, when we see that a device is loose or breaking, we automatically think "that shouldn’t happen," so we opt to code a complication of the device. Well, when this occurs in an orthopedic screw as an expected outcome (typically when the patient begins bearing weight during the recovery/healing process), it should not be coded as a complication.
 
The correct diagnosis codes would be assigned for the specified fracture site with a seventh character identifying a subsequent encounter with routine healing, along with the external cause code (if known), also as a subsequent encounter. (Remember that place of occurrence, activity, and status codes should only be used for the initial encounter, per the ICD-10-CM Official Guidelines for Coding and Reporting.)
The ICD-10-PCS root operation would be Removal (third character P) for the removal of the screw from the specified bone.
 
On the other hand, some orthopedic devices can present real complications necessitating removal and replacement. For example, a patient may be admitted for a painful total knee replacement, initial encounter (T84.84xA). In order to remedy this situation, the previously placed components (tibial and femoral) are removed and replaced with new components. This ­scenario leads coders to ponder whether this should be considered a Revision or Replacement, or perhaps something else.
 
ICD-10-PCS defines a Revision as "correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device." In this case, the prosthesis isn’t working exactly the way it should, but the ICD-10-PCS Reference Manual states that "putting in a whole new device or a complete redo is coded to the root operation(s) performed."
 
Therefore, the correct root operations would be Removal (P) for taking out the old components, then a Replacement (third character R) for putting in/on a synthetic material that takes the place of the body part. 
 
Cardiovascular
I am confident many coders noticed that the codes for heart failure (category I50) are mostly identical to their ICD-9-CM counterparts.
 
But one thing that probably raised some eyebrows for coders was the Excludes2 note at category J91 (Pleural effusion in conditions classified elsewhere), which seemed to state that a code from category J91 would be assigned as an additional code when seen "in heart failure."
 
Of course, most coders will recall that in ICD-9-CM we normally could not assign a separate code for this situation, based off information in AHA Coding Clinic for ICD-9-CM, Third Quarter 1991. The new issue provides clarification that the same rules apply in ICD-10-CM for pleural effusions seen in heart failure patients.
 
The pleural effusions would only be reported separately if therapeutic/diagnostic interventions are required. Pleural effusion is commonly seen with congestive heart failure (CHF) with or without pulmonary edema. Usually, the effusion is minimal and resolves with aggressive treatment of the underlying CHF.
 
The issue also addresses the correct coding of a newer procedure performed for heart blocks: the insertion of leadless pacemakers. You may have asked, as I did, how in the world does this device work if there are no leads to provide the electrical impulses?
 
This technology has been explored for many years and is finally here. Current pacemaker devices are susceptible to issues such as lead failure or malpositioning, as well as pulse generator pocket complications, such as scar formation or even just the visible presence of the device. In contrast, these new cylindrical devices fit directly into the right ventricle, accessed via a transcatheter approach and placed into the endocardial tissue of the right ventricular apex to provide pacing capabilities.
 
For coding purposes, the ICD-10-PCS table 02H (Insertion, heart and/or great vessels) does not provide a specific device option for a leadless pacemaker. The correct device character should be D (intraluminal device). The full ICD-10-PCS code to be assigned is 02HK3DZ (Insertion of intraluminal device into right ventricle, percutaneous) to identify a leadless pacemaker. 
 
Neurology
Revisions in ICD-10-CM allow coders not only to report a coma (R40.20-, unspecified coma) but also to report codes that incorporate a common tool to assess the depth and duration of comas or impaired consciousness, known as the Glasgow Coma Scale.
 
Per the Centers for Disease Control and Prevention, this scale helps to gauge the impact of a variety of conditions, such as acute brain damage due to traumatic and vascular injuries or infections and metabolic disorders (e.g., hepatic or renal failure, hypoglycemia, diabetic ketosis).
 
ICD-10-CM contains subcategories to report the three elements that go into calculating the coma scale:
  • R40.21-, coma scale, eyes open
  • R40.22-, coma scale, best verbal response
  • R40.23-, coma scale, best motor response 
If coders opt to use this reporting option, three codes must be assigned to identify each of the three elements.
 
Codes for the individual Glasgow Coma Scale scores from these categories can be assigned if the provider documents the numeric values, as opposed to the physical descriptions associated with those numeric values.
 
The eye opening response is scored as follows:
  • 4, spontaneous eye opening
  • 3, eyes open to speech
  • 2, eyes open to pain
  • 1, no eye opening
 
The verbal response is divided into five categories:
  • 5, alert and oriented
  • 4, confused, yet coherent, speech
  • 3, inappropriate words and jumbled phrases consisting of words
  • 2, incomprehensible sounds
  • 1, no sounds 
The motor response is divided into six different levels:
  • 6, obeys commands fully
  • 5, localizes to noxious stimuli
  • 4, withdraws from noxious stimuli
  • 3, abnormal flexion, i.e., decorticate posturing, an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bent and held on the chest
  • 2, extensor response, i.e., decerebrate posturing, an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, and head and neck arched backwards
  • 1, no response 
For example, the documentation states "Glasgow Coma Scale score was obtained upon arrival at the ED; eyes open = 2, best verbal = 3, and best motor = 5." Coders may assign the following:
  • R40.2122, coma scale, eyes open, to pain, at arrival to ED
  • R40.2232, coma scale, best verbal response, inappropriate words, at arrival to ED
  • R40.2352, coma scale, best motor response, localizes pain, at arrival to ED 
Per the Official Guidelines, the seventh characters must match for all three codes.
Subcategory R40.24- (Glasgow Coma Scale, total score) is an additional option provided that identifies the overall score as opposed to each of the three individual elements.
Those codes are:
  • R40.241, Glasgow Coma Scale score 13-15
  • R40.242, Glasgow Coma Scale score 9-12
  • R40.243, Glasgow Coma Scale score 3-8
  • R40.244, other coma, without documented Glasgow Coma Scale score, or with partial score reported 
Codes from R40.24- would not be assigned if the individual scores are documented.
 
Procedurally, Coding Clinic provided clarification regarding decompressive laminectomies and the assignment of the appropriate body part characters. When assigning an ICD-10-PCS code for a cervical decompressive laminectomy, the body part value states "cervical spinal cord."
 
The cervical spinal cord is considered a single body part value in ICD-10-PCS and would only be assigned one time regardless of the number of cervical levels decompressed to release the spinal cord.
The vertebral level designations of the cervical spinal cord do not constitute separate and distinct body parts anatomically; therefore, ICD-10-PCS Guideline B3.2 does not apply:
 
During the same operative episode, multiple procedures are coded if: The same root operation is repeated at different body sites that are included in the same body part value. 
 
Another note of caution: The ICD-10-PCS Index entry "Laminectomy" instructs coders to see Excision (B), but the objective of a decompressive laminectomy is to release pressure and free up the spinal nerve root. Therefore, the appropriate root operation is Release (N). 

 

Editor’s note: McCall is the director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts. She oversees all of the Certified Coder Boot Camp programs. McCall works with hospitals, medical practices, and other healthcare providers on a wide range of coding-related custom education sessions. For more information, see www.hcprobootcamps.com.This article was originally published in Briefings on Coding Compliance Strategies.

HCPro.com – JustCoding News: Inpatient

Spotlight on Certification: Certified Interventional Radiology Cardiovascular Coder (CIRCC®)

Lately I’ve heard a lot of buzz about the AAPC’s credential, Certified Interventional Radiology Cardiovascular Coder (CIRCC).  Interventional radiology (IR) coders are in demand because of the complexity of the field and the notoriously high error rates seen on audits. It may sound like a great credential to get, but before you make any sudden movements, here’s what you need to know about the CIRCC exam.

Why this credential exists
I’ve been coding now for 22 years and I’ve seen quite a bit.  I helped train the workforce in ICD-10-CM and ICD-10-PCS. I’ve audited ICD-9, ICD-10, CPT and HCPCS codes.  I’ve read the Federal Register on DRGs and APCs.  But the hardest thing I’ve ever had to learn to code is IR and cardiology.  The coding rules are complicated, ever changing, and often inconsistent for different parts of the body.  Learning how to code IR and cardiology procedures by just looking at the CPT book is tough enough, but not all the rules are written there.  There are other societies that develop suggested guidelines and then there are the payer’s rules and interpretations.  In a hospital setting, an understanding of IR and cardiology coding also usually requires an understanding of hospital charging and how departments are credited revenue.  This credential exists to show that you’ve mastered these areas of coding.  In my mind, this is the most difficult area of coding there is.

This is not an entry-level credential
I took the CIRCC exam four years ago with about 10 years of experience under my belt.  It was a tough exam.  As a matter of fact, it was the hardest multiple choice exam I’ve ever taken and I would put it up there with the Certified Coding Specialist (CCS) test as one of the toughest.  If you are thinking you will get the CIRCC and then land a job as an IR coder without any experience, think again.  This is the test you take after you’ve been coding those types of cases for a long time and feel confident in your abilities.  AAPC recommends, but does not require, at least two years of coding experience before taking the CIRCC exam.

What’s on the test
The CIRCC exam is spotlighted for its focus on IR coding, but it also includes cardiology procedures.  The procedures we’re talking about are surgical-type procedures done in a radiology suite or cardiac cath lab using radiological (fluoroscopic) guidance.  For IR, this can be vascular studies (angiograms) and interventions (e.g., angioplasty, stenting, thrombectomy) or nonvascular procedures (e.g., placement of biliary stents, nephrostomies, and fluoroscopically-guided biopsies).  For cardiology, this can be diagnostic cardiac catheterization, angioplasty and stenting, and cardiac electrophysiology studies and arrhythmia ablations.   If you don’t know what any of that means, I don’t recommend taking the test until you learn more!

What it costs
At the time of this writing, the cost to sit for the CIRCC exam is $ 400.  But the cost of taking the CIRCC doesn’t end when you register and pass the exam.  Like other credentials, you need continuing education units (CEUs) to maintain the certification.  But unlike most other AAPC credentials, there are limited vendors from which you can get those CEUs.  Before you decide to take the test, look at the CEU requirements and visit the vendor websites (the AAPC has links) to see how much your CEUs will cost you and be very realistic about what you can afford.  If your primary job is coding these types of cases, check with your employer to see if they will reimburse you for any of the costs.  This is an expensive credential to maintain, but if it’s valued by your employer, they may cover the costs.

Read all about it
I could regurgitate the contents of the AAPC’s website about the CIRCC exam, but instead of doing that, I will direct you to their website with this simple instruction: Do your homework!  There is a plethora of information on the AAPC’s website for this exam and it will tell you everything you need to know from the breakdown of the exam questions, approved manuals and materials (yes, you can bring anatomy cards showing selective vascular ordering), certification requirements, history of the exam, and FAQs.  If you were going to spend $ 400 on a new smartphone, you would probably read up on the different models before making a final decision.  Why wouldn’t you also do this for a credential?  Don’t take this exam until you’ve read all the fine print.

Preparing for the exam
Once you decide that you’re ready to pull the plug and take the test, it’s time to prepare.  Even if you’ve coded these cases for a long time, there is still preparation to be done.  Here is my list of recommendations:

  • Get the right CPT book.  The AAPC’s website is very clear that they will only allow you to use the American Medical Association’s (AMA) version of CPT.  If you have a CPT book from any other publisher, you cannot use it.  I recommend the AMA’s Professional Edition of CPT for its color coding and pictures.  It’s more expensive than the standard edition, but I think it’s worth the money.
  • Mark your CPT book.  Don’t waste time writing in the things you already know, but I do recommend making cross-reference notes for any codes that have a one-to-one relationship.  For example, I wrote all of the C codes for drug-eluting stent placements next to their CPT counterparts so I didn’t have to open another book during the test.  Sometimes CPT includes instructional notes in the Surgical section directing you to the Radiology component code.  And sometimes it doesn’t, so I wrote those in too.  Especially if you are used to using an encoder, make sure you have your book set up so you can flip to different code sections fast.
  • Get the exam prep book.  Yes, it costs more money and no, I am not being paid by the AAPC to push their products!  The exam prep book will go over what’s on the test.  It will give you practice questions and show you the type of questions that will be on the exam.  The one thing I remember from the exam prep book is it said in several places that none of the questions are meant to be trick questions.  That might sound like a no-brainer, but when you really get into IR coding, you’ll see why that’s an important thing to remember.
  • Spend your study time on your weak areas.  Don’t waste your time studying things you already know.  If there is an area that is not your strongest, make notes on those CPT sections and find tricks to help you remember.  When I took the test, I was strong in vascular IR and cardiology, but not so much on nonvascular IR, so those sections of my book had the most notes.  Remember: you can write notes in your CPT book, you just can’t put any loose pieces of paper in them.  
  • Take a prep class.  If you can find a class that will cover part or all of the exam content, enroll now.  I am teaching a vascular interventional radiology class in October 2017 in Denver, which covers some of the trickiest IR coding.  I would love to see you there and chat about your CIRCC aspirations!
If you’ve ever considered taking the CIRCC exam, I hope you found this post useful.  Want to learn more about IR coding?  Stay tuned – more posts to come!

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