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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

Scissor snip biopsy or removal, multiple specimens, path is not skin tag.

Hello,
Our staff comes across this type of note daily, and would like some clarification on what is the proper way to bill this scenario?
Thank you in advance.

Note copied below:
Dx given in note as D49.2 and skin tags.

Scissor Snip biopsy
Left axilla x4, Right axilla x3, Groin IFEP. The area was prepped with an alcohol pad, then 1% Lidocaine with epinephrine was injected around the site(s), Scissors and pickups were used to excise the lesion at the skin surface, Monsel’s solution was applied to obtain hemostasis. The patient is instructed to notify the office if the wound site oozes, becomes painful or red. The biopsy specimen was sent to the laboratory for pathological evaluation. Left axilla x4, Right axilla x3, Groin x1

(Path came back as Groin and Left axilla as warts, and the right axilla skin tag.)

Medical Billing and Coding Forum

Coding path help needed – Z01.89 and Z01.81-

I’m working through the AAPC CPC Medical Coding Training Manual (2018) and have questions about guidance on page 79 and 80.

Page 79:
For encounters for routine laboratory, radiology testing in the absence of any signs, symptoms, or associated diagnosis, assign Z01.89 Encounter for other specified special examinations.

For patients receiving preoperative evaluations only, sequence a code from subcategory Z01.81 Encounter for pre-procedural examinations to describe the pre-operative consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-operative evaluation.

Page 80:
A patient presents for a pre-operative screening chest X-ray prior to surgery for a unilateral inguinal hernia.
Z01.818 Encounter for other preprocedural examination

For the life of me, I cannot find any of these in the Alphabetic index. What is the coding path for each of these?

Medical Billing and Coding Forum

Navigate Your Path to Career Satisfaction

Find your passion and follow it all the way to success. We all deserve to work in a job we love. Preparing yourself for the journey can make all the difference in achieving career success. Find Your Passion Identifying your true passion in the business of healthcare is one of the first steps to realizing […]

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Modifier 90 on Path codes when the treating physician is also the pathologist

One of our providers is a board certified dermatologist AND a board certified dermatopathologist. She sees patients as well as reads all the pathology for our clinics.

We have a Main clinic with a CLIA certified histopathology lab with full Certificate of Compliance and we also have a Satellite clinic with a smaller CLIA certified lab that only has PPMP level of certification.

When a specimen is obtained at the Satellite clinic and sent back to our Main clinic lab to be read and reported on we attach a modifier 90 to the path code to indicate specimen was sent to an outside reference lab- (our Main location lab).

One day a week this physician sees patients at the Satellite clinic. When a specimen is obtained on those days, we have a problem billing our path codes (88304 & 88305) for that provider, as the modifier 90 indicates it is inappropriate usage for the treating or reporting physician to complete the laboratory procedure. If we try to submit the path code without a modifier 90, the scrubber will not allow the claim to release saying the code cannot be billed with the CLIA level of certification for that location…. Anyone else run into this? I’m fairly certain this is not the only dermatologist/dermatopathologist clinic in the U.S! Any advice would really be appreciated!

Medical Billing and Coding Forum

Op report vs path report – dx & cpt?

Hi,

I’ve a case where:

Operative report mentions Wrist volar/antebrachial fascia cyst and H&P report mentions "It was a source of local discomfort left wrist". The patient also has Carpal tunnel syndrome.

The surgeon made an incision for CTR procedure and then extended it proximally to gain access to the cyst (0.5 cm) which was within the antebrachial fascia, removed it and submitted to pathology. Then, he went on and released the carpal tunnel.

Pathology report mentions: benign fibroadipose tissue

Now, since the path report doesn’t mention cyst or any other abnormal finding (let alone tumor) I’m not sure what I should code for Dx and CPT. I’ve narrowed it down to the following:

1. Dx – pain wrist left; CPT – Biopsy, soft tissue of wrist; deep
2. Dx – other disease fascia; CPT – Excision, tumor, soft tissue wrist, subfascial; less than 3 cm

I’m more inclined towards the first option as there is no abnormal pathology.

Could anybody help me on this?

Thanks!

Amber

Medical Billing and Coding Forum

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Using Path report for Dx code

In the inpatient setting – When a patient has an inpatient surgery where a specimen was sent to pathology, Can coders use the path report to assign a diagnosis to the surgical charge?

Example: Colonoscopy for diarrhea. Path comes back as collagenous colitis.

1) Can I use the colitis Dx on the colonoscopy claim?
2) Does the surgical provider need to confirm this path dx in a written form in the medical chart?
3) Does the surgical provider need to addend the OP note with this diagnosis before I can use it?

Medical Billing and Coding Forum

Path states BENIGN LYMPHOID PSEUDOPOLYP – Can’t find a code.

I’ve researched and researched and just get mixed information.

We have to code path results, if positive. How would this be coded – benign lymphoid pseudopolyp of the colon. Also, maybe because it’s so many years later – I can’t find a pseudopolyposis code in ICD-10 2018 (there is an old thread in these forums that says use pseudopolyposis)…there’s a K51.40 inflammatory polyps of the colon, but based on my diagnosis – it doesn’t sound inflammatory so I’m leery of using that. Is it a benign neoplasm of colon?

Thanks.

Kimberlee

Medical Billing and Coding Forum

Medical Terminology – First Step on a New Career Path

In these days of economic uncertainty, career change is a hot button issue. As baby boomers retire and leave the work force, employers are concerned about the shortage of skilled workers. In addition, corporate cost cutting, off-shoring, layoffs, and forced career changes leave many workers with difficult choices. Gone are the days of one job and one employer for life. Following a career path today can mean maneuvering many twists and turns, setbacks, side roads, and blind alleys. Where is the roadmap to a new career that provides enrichment, stability and growth potential?

One of the best ways to ease some of the uncertainty and increase your marketability quotient is to broaden your skill set. Since continuing education is often required to maintain licenses and certifications, make those education hours do double duty. The right training can mean more opportunities in your current field, and serve as a stepping stone to a new career. But which industries offer the best chance for job stability and advancement?

It is predicted that expanding healthcare and healthcare-related industries will require many additional skilled workers in the coming decade. According to Forbes Magazine, “As well-heeled baby boomers age, look to the health care industry… (B)etween 2004 and 2014, seven of the 10 fastest-growing jobs in the U.S. will be in health care.” In addition to careers directly involved in patient care, demand for support professionals such as medical records and health information technicians, therapists, counselors, and medical transcriptionists will increase.

A basic requirement for entry into almost any healthcare-related career is a command of medical terminology. The ability to recognize, understand, spell, and pronounce basic medical terms, identify medical abbreviations, and decipher unfamiliar words using roots, suffixes and prefixes is a necessary tool to perform well in any medical setting. Medical terminology courses are widely available in online, home study and instructor-led formats. Because medical technology advances rapidly, medical terminology evolves to keep pace. To stay on top of new terminology, consider taking the course again if you’ve taken it in the past.

The Department of Labor database lists seven nontraditional careers that require medical terminology:

Medical Transcriptionists – To understand and accurately transcribe dictated reports, medical transcriptionists must understand medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms.

Medical Records and Health Information Technicians – In addition to general education, coursework requirements for medical records and health information technicians includes medical terminology, anatomy and physiology, legal aspects of health information, health data standards, coding and abstraction of data, statistics, database management, quality improvement methods, and computer science.

Surgical Technologists – Surgical technologists receive their training in formal programs offered by community and junior colleges, vocational schools, universities, hospitals, and the military. In 2006, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) recognized more than 400 accredited training programs. Programs last from 9 to 24 months and lead to a certificate, diploma, or associate degree. Programs provide classroom education and supervised clinical experience. Students take courses in anatomy, physiology, microbiology, pharmacology, professional ethics, and medical terminology. Other topics covered include the care and safety of patients during surgery, sterile techniques, and surgical procedures. Students also learn to sterilize instruments; prevent and control infection; and handle special drugs, solutions, supplies, and equipment. Most employers prefer to hire certified technologists.

Occupational Therapist Assistants and Aides – There were 126 accredited occupational therapist assistant programs in 2007. The first year of study typically involves an introduction to health care, basic medical terminology, anatomy, and physiology. In the second year, courses are more rigorous and usually include occupational therapist courses in areas such as mental health, adult physical disabilities, gerontology, and pediatrics. Students also must complete 16 weeks of supervised fieldwork in a clinic or community setting.

Radiologic Technologists and Technicians – The Joint Review Committee on Education in Radiologic Technology accredits most formal training programs for the field. The committee accredited more than 600 radiography programs in 2007. The programs provide both classroom and clinical instruction in anatomy and physiology, patient care procedures, radiation physics, radiation protection, principles of imaging, medical terminology, positioning of patients, medical ethics, radiobiology, and pathology.

Medical Assistants – Postsecondary medical assisting programs are offered in vocational-technical high schools, postsecondary vocational schools, and community and junior colleges. Programs usually last either 1 year and result in a certificate or diploma, or 2 years and result in an associate degree. Courses cover anatomy, physiology, and medical terminology, as well as typing, transcription, recordkeeping, accounting, and insurance processing. Students learn laboratory techniques, clinical and diagnostic procedures, pharmaceutical principles, the administration of medications, and first aid. They also study office practices, patient relations, medical law, and ethics. There are various organizations that accredit medical assisting programs, and accredited programs often include an internship that provides practical experience in physicians’ offices, hospitals, or other health care facilities.

Court Reporters – Candidates for first level court reporting certification – the CVR – must pass a written test of spelling, punctuation, vocabulary, legal and medical terminology and three 5-minute dictation and transcription examinations that test for speed, accuracy, and silence.

In addition to these fields, many other professionals can benefit from an understanding of medical terminology. Lawyers, paralegals, legal secretaries and other legal professionals handling cases involving medical-related issues are better able to litigate these cases when they understand the terminology involved. Health insurance professionals, as well as those working in medical billing and coding positions also benefit from a working knowledge of medical terminology.

Many agencies require certification in medical terminology for pharmacy technicians. Professionals and technicians of biology, dentistry, hospital administration and many others must properly utilize medical terminology to communicate with patients, staff, customers and colleagues. Therapists, technicians, counselors and home health care providers can improve communication, increase the quality of care to patients, and reduce oversights and liability issues with a clear understanding of medical terminology.

A course in medical terminology is a widely accessible means to broaden your skill set, boost your marketability, and increase opportunities for advancement in your current career while helping you map a route to exciting work in the healthcare industry. Doubling the value of your time and education leads to better employment that will enrich your life.

This article was authored by Donna Swanson. Donna is a Registered Nurse and the CE Program Developer for Corexcel, a company specializing in online continuing education and workplace training. For more information about Corexcel and the training materials they offer, visit http://www.corexcel.com

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