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

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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

Practice Exam

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

RSV as the cause of diseases classified elsewhere B97.4

I am getting a lot of denials this time of year for services provided to children for diagnosis B97.4, RSV as the cause of diseases classified elsewhere. I did some research on this code and found in Encoder Pro that "This code is reported only when the disease caused by RSV is in an organ or site beyond the respiratory tract.". So I have been having to send these back to the providers to determine if this is appropriate code or if it should be another RSV code. There are three other RSV codes, J12.1 (RSV pneumonia), J20.5 (Acute bronchitis due to respiratory syncytial virus) and J21.0 (Acute bronchiolitis due to respiratory syncytial virus). So my question is, for what ‘diseases’ would the B97.4 be appropriate? Just trying to find some type of examples of when a provider would use B97.4 and in what circumstances.

Thanks in advance!

Samantha

Medical Billing and Coding Forum

Good cause for extension of the time limit for filing appeals


The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file appeal requests on a timely basis. A request from the provider, physician, or other supplier to extend the period for filing the request for redetermination would not be routinely granted.

Note: A finding by the contractor that good cause exists for late filing for the redetermination does not mean that the party is then excused from the timely filing rules for the reconsideration.

Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:

• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;

• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (the Centers for Medicare & Medicaid (CMS), the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);

Note: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.

• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;

• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);

• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;

• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;

• A death or serious illness in his or her immediate family; or

• A request was sent to a government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired.

Note: Failure of a billing company or other consultant (that the provider, physician, or other supplier has retained) to timely submit appeals or other information is not grounds for finding good cause for late filing. Also, good cause does not exist where the provider, physician, or other supplier claims that lack of business office management skills or expertise caused the late filing.

See also: Time Limits for Each Level of Appeal


Coding Ahead

Medical Cause Of A Aggressive Dog Behavior

There are some reasons in which different breed shows aggressive dog behavior. This aggressive dog behavior may be the cause of some environmental problem, sometimes the genetic problem might be the reason. Another main cause of aggressive dog behavior is mainly due to some medical illness. In this article the main focus is on medical cause of aggressive dog behavior and there proper treatment.

If a dog has any physical injury, disease or a genetic abnormality defect and if these problems swing the mood of the dog towards aggression, then no training process will be effective to minimize or overcome this problem. There are many problems under medical case which can cause aggressive dog behavior, like the problems with eyesight or teeth. If the aggressive dog behavior or his temperament problem is congenital, then the cure of the aggression can be minimal by the likelihood of the dog. The physical injury of the dog may occur due to some accident and it can be treated by proper medical care or exercise. The disease which can cause aggressive dog behavior may occur due to change in atmosphere or consuming any contaminated food. In this case exercise is strictly prohibited but proper medical checkup is required with treatment.

The genetic abnormality may include hypothyroidism, which means the deficiency of thyroid hormones in vertebrates, which can also cause aggressive dog behavior. However this is very difficult to overcome or minimize but there are some medication for this disease. There are certain conditions which cause inflammation of the brain of the dog resulting neurological problem which also include aggression thus developing aggressive dog behavior. Sometime a chemical imbalance can make the behavior of the dog unstable and proper medication is required for this treatment to remove aggression. The reason why these problem cause aggression is that it develops a rage syndrome which are actually partial seizures and occurs in the region of the brain which is very helpful in controlling aggression, and can cause sudden aggression. These are some common medical problems which normally cause aggression in dog’s behavior and can be treated if above mentioned precautionary measures are properly taken.

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External cause codes for professional reporting

Hi,
I’m in a situation where I need to advise an billing company that does professional claims only whether they need to report external cause codes for Emergency Department claims. It’s my understanding that e-code reporting requirements differ by state and/or by payer., but I’m having difficulties finding this information.

Could someone point me in a good direction to find more information about professional coding of external cause codes? :confused: I’d really appreciate this.

Thanks!

Medical Billing and Coding Forum

Clarification of injury code 7th character and external cause codes

I am coding an inpatient consult for infectious disease MD. The pt has a nonunion of a subtrachanteric fracture (RT femur) following an ORIF done 6 months prior to the consult. Infectious disease process was ruled out. There is no documentation in the entire inpt chart to determine if the fracture was traumatic or related to osteoporosis nor is there documentation to support an external cause code. The code M96.89 (other intraoperative and postsurgical complications and disorders of the musculoskeletal system) has been suggested. I think S72.21XK (diplaced subtrochanteric fx rt femur, nonunion) is the most accurate code however I cannot provide an ext cause code associated with the fx. Though I can’t find a specific statement, the guidelines for Chp 19 seem to indicate an ext cause code should be associated with codes from that chapter. Is it necessary to provide an external cause code for every Chapter 19 code? How would you code this?

Medical Billing and Coding Forum

Am I getting this External Cause, Place, Activity, Status

Can someone tell me what I’m missing here, I have read and read the guidlines but I’m just knocking my head on the wall with this right now for some reason, am I on the right track?

Patient involved in an automobile accident where he was the unrestrained driver of a vehicle hit by a minivan on a business street.

I have V43.64XA, S01.82XA, Y92.414

The S code is for the other things but in terms of the external cause and all that, what am I missing here.

Thanks anyone….

Medical Billing and Coding Forum

ICD10 coding for woman when male infertility is the cause of treatment

Hi all,

I’m hoping for some input on coding ICD10 for a woman receiving fertility treatment – IUI – when the male is infertile. Our providers keep using N46.9 – Male infertility for the woman, but, of course, it rejects as gender mismatch. Would Z31.81 (Encounter for male factor infertility in female patient) be an appropriate billable code for this situation? Any other input?

Medical Billing and Coding Forum

Coding question- infection as a cause of the disease classified elsewhere

What is the correct codes for the following infectious disease;

Septicemia due to Pseudomonas with septic shock

1. A48.8, R65.21
2. B96.5, R65.21

It seems that the correct answer should be the second one because here Pseudomonas is the CAUSE OF DISEASE CLASSIFIED ELSEWHERE which in this case is septicemia, but in a prominent coding book they chose the first one as the correct answer. Any idea what the rational is in this case?
Thanks

Medical Billing and Coding Forum

Missing documentation for external cause injury codes

Patient comes in for a hospital f/u diagnosed with a concussion. There is no documentation in the visit note as to how it happened but it is very clear in the hospital notes. I have always been taught that a note must stand alone for coding so I queried my provider and asked her to please review as external causes were not documented. She does not feel she has to document this. Does anyone have any documentation they can share regarding this or am I incorrect to query my physicians when this happens?

Medical Billing and Coding Forum