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

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

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

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

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

Residency Training Initiative Should Include Clinical Documentation

American Medical Association (AMA) announced Oct. 30 the Reimagining Residency initiative, a new program aimed at transforming residency training. The $ 15 million grant program will support innovative projects that promote systemic change in the current and future healthcare system. “During this unprecedented time of rapid growth and technological change in the U.S. health care system, […]

The post Residency Training Initiative Should Include Clinical Documentation appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

should i code for ptca also?

Conclusion

This patient with prior treatment for coronary artery disease status post PCI to left circumflex, OM1, OM 2 in 2005, hypertension, dyslipidemia is having symptoms of exertional angina. He also had a abnormal stress test revealing inferolateral ischemia. Left heart catheterization was recommended.
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After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath was inserted in the right radial artery. Radial cocktail consisting of 2.5 mg of verapamil and 200 mcg of nitroglycerin was administered via right radial artery sheath to prevent radial artery spasm. A 6 French Judkins left and right coronary catheters was used for left and right coronary angiography. TR band was placed on right radial artery access site for patent hemostasis.
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I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 11:57 AM and end time was 12:40 PM. There were no complications. See nurse’s sedation sheet, for complete pre-and post service details.
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Hemodynamics:
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The left ventricular end-diastolic pressure was 19 mmHg. The aortic pressure was 114/61 mmHg.
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Coronary Angiography:
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Right coronary artery is a small nondominant artery with severe diffuse disease.
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Left Main coronary artery is patent.
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Left anterior descending is a medium to large caliber vessel with proximal 20-30% tubular disease at the bifurcation of diagonal 1, mild mid to distal luminal irregularities. Diagonal 1 and diagonal 2 are small caliber vessels with luminal irregularities.
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Left circumflex is a large caliber dominant vessel with patent proximal stent with mild to moderate ISR, moderate mid vessel disease and distal luminal irregularities. Obtuse marginal 1 has subtotal occlusion at the ostium with TIMI III flow in the mid to distal vessel. This was likely jailed during OM 2 stent deployment. Obtuse marginal 2 has severe 99% in-stent restenosis extending into the distal vessel. LPDA and LPL have mild luminal irregularities.
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Left ventriculogram: Left ventricular cavity was entered using guide catheter and LVEDP was measured at 19 mmHg.
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The patient was then transferred to the recovery area in stable condition:
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Summary conclusion:
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1. Coronary disease status post PCI in 2005
2. Abnormal nuclear stress test
3. Angina
4. Hypertension
5. Dyslipidemia
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Recommendation:
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Recommend PCI of left circumflex/OM 2 due to evidence of inferolateral ischemia and a dominant circumflex territory.
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6 French XB 3.5 guide was used to engage left coronary system. Run-through wire was advanced into distal OM 2. A second run through wire was used as a buddy wire and advanced into distal left circumflex. Lesion was predilated using a 2.5 x 15 mm noncompliant balloon. Promus 2.5 x 32 mm stent deployed from left circumflex into OM 2 and postdilated up to 3.0 mm with stent balloon. Post stent deployment there was pinching of true circumflex. Run-through wire was withdrawn and readvanced through the stent struts and left circumflex was unrevealed using a 2.0 x 12 mm semi-compliant balloon. Postprocedure angiography revealed TIMI-3 flow without any evidence of dissection or perforation.
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Aspirin and Plavix for at least 12 months. Aggressive lipid control management.

Results

Contrast Administered (mL):
Implants

SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE – S08714729844952 – LOG337003

Inventory item: SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE Serial no.: 08714729844952 Model/Cat no.: H7493952832250
Implant name: SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE – S08714729844952 – LOG337003 Laterality: N/A Area: Coronary
Manufacturer: Boston Scientific Corp Action: Implanted Number used: 1

thank you in advance
my question is 93458-xu, c9600-lc should I also do 92920 lc? physician wants to add for his time
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Medical Billing and Coding Forum

5 Questions Every Radiology Coder Should Ask

The answers to proper medical coding and reimbursement are not always transparent. From the referral to the claim submission, there are many opportunities for errors that result in a claim denial, improper payment, or even an audit. To secure proper payment, here is a checklist of five essential questions to ask yourself as you code […]
AAPC Knowledge Center

CPC-A, Which positions should I be looking into?

It looks to me after reading recent posts that in this environment I would be wasting time and effort trying to land a coding position right now. I finished a coding/billing course, passed the CPC but have no experience except for Practicode which I am going through now. I am happy to start in a related position, but I am not sure what roles exactly would help me move towards coding/billing. I have mostly been a caregiver in group homes and am interested in the behavioral health field, so maybe something in that direction.

Open to all suggestions, and also hoping to connect with someone with experience. Thank you!

Medical Billing and Coding Forum

Price Transparency Should Be a Healthcare Norm

As consumers, we expect price transparency. That is, we expect to know the price of something, before we commit to buying it. For example, every big-box store clearly lists the prices of every item it sells, from laundry detergent to flat screen TVs. Restaurant menus tell you how much a burger and fries, quinoa salad, […]
AAPC Knowledge Center

10 things you should know to ensure successful discharge planning

10 things you should know to ensure successful discharge planning

Learning objective

At the completion of this educational activity, the learner will be able to:

  • Identify strategies to comply with proposed Medicare changes to the discharge process

 

One of the more challenging aspects of a case manager’s job is helping to ensure a patient successfully transfers from the hospital to the next level of care. Under a set of proposed revisions to Medicare’s Conditions of Participation (CoP) announced in November 2015. This job may get even harder, more specific, and apply to more patients. The changes, among other things, will require hospitals, including critical access hospitals, to create discharge plans for more patients. Case managers will need a more direct plan to include patients and their caregivers in the discharge planning process, in particular taking into account their individual "goals and preferences." This discharge planning process will also need to start sooner?within 24 hours of admission instead.

So what can you do to ensure your organization is up for the challenge? In an April webinar titled "Discharge Planning: Realignment of Standards and Workflow," speaker Jackie Birmingham, RN, BSN, MS, CMAC, vice president emerita of clinical leadership for Curaspan Health Group in Newton, Massachusetts, and Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, the manager of case management at Washington Adventist Hospital in Takoma Park, Maryland, offered up some compliance tips that you can use to ensure your hospital is ready:

1.Assess your current discharge process. Under the proposed changes, the discharge planning process needs to start in the first 24 hours after the patient arrives at the facility. You’ll need to identify how your current processes work in order to make sure they comply with this timeline. Identify your current workflow?specifically, who does what, why they do it, and how it’s done. Ask the following questions:

  • What is your current case management model?
  • Who’s on your team?
  • What’s their role?
  • Who does the screening right now in the current
  • Who does the patient assessment?
  • Who makes referrals when you need to refer patients for services?
  • In your current model, do the nurses perform the assessment for patients who go home while the social workers do the placements? Or do you have nurses and social workers assess everyone? "If you’re having all your patients assessed right now, well, you’re ahead of the game already, because that’s the new proposal," said Blondo.

 

Also think about why your processes were designed the way they are. "If you have it on one unit a certain way and not on another, think about what you need to do to change your practice so that perhaps every unit you can do assessment on every patient," said Blondo. "If your model is something that doesn’t seem to make sense with the proposal, what can you do to change it?"

Changes to bring the model in line could include adding technology (e.g., laptops, tablets) to speed up the process, adding staff members, or reassigning current staff members. "Perhaps some of your social workers can do UR," said Blondo. Alternatively, maybe a staff nurse can do an initial assessment instead of a case manager, or perhaps a nonclinical staff member can take over certain tasks. Taking the time to examine your current processes and think about how they can be switched up to meet the new requirements will give you the foundation for a new plan.

2.Drill documentation. Hold physicians accountable for following through and documenting discharge plans and dates. "If they’re documenting in the chart the discharge date and plan, that makes your job a little easier, because you have that in the chart already and can discuss that with the patient and their family," said Blondo. Take advantage of pre-procedure assessments by ensuring they are included in the chart, then making sure staff members follow through on that plan. "You don’t want Joint Commission or the state coming to do their survey and then you find out the assessment is not getting done because your staff has decided they want to do something different. So make sure everyone is doing the same," said Blondo.

3.Focus on delays. Use these potential discharge changes in the CoPs as an opportunity for process improvement. Look at what’s causing delays in your current process?use this information to improve systems and boost patient satisfaction. "You’re going to improve, perhaps, length of stay with this increased attention with discharge planning," said Blondo.

4.Make rounds count. If you are currently using rounds, examine what they’re being used for and how they’re working. Blondo says it’s important to ask:

  • Are rounds being used for discharge planning?
  • Are they used for the patient experience to improve your scores?
  • Are they used for throughput or for some other reason?

 

After thinking about the current purpose your rounds serve, consider how they can be modified to fit your new objectives. "Many people just do one type of rounds per day, but you could actually be creative with these. There are some hospitals that I know of that divide rounds into different parts of the day," said Blondo. "For instance, you might want to think about doing rounds early in the morning for those patients that will be discharged [later] that day." The discussion could center on determining whether those patients are prepared to leave and have the right resources. Another idea is to add rounds to the short-stay area or outpatient area for procedures done late in the day. "And if you have case managers in the emergency room, you could ask them to round for those areas, catching any patients that might need something late in the day after your regular case management staff have left," said Blondo.

5.Understand patient options. This topic includes both big-picture and smaller issues. Case managers should focus on patient-based issues, which relate to talking to the patient, as well as on setting the patient’s broader goals and preferences. The organization’s systems must be set up to give patients a choice of postacute options. But keep in mind, when working with patients, you’ll always come across those who don’t like what you’re doing or who don’t agree with you and want to go another direction. "You need to have something standardized and something that you can fall back on when you’re presented with a patient and family who, in their eyes, have a reasonable goal and clinically or medically or psychosocially, they don’t," said Birmingham. Staff members must understand the concept of patient choice. "The staff must be comfortable that they are doing the right thing for the patient and the right thing for networks and the right thing for the organization."

It’s also important for staff to understand that the patient has the right to refuse the plan. "[The patient] may be in denial. They may be suffering grief," said Birmingham. The hospital should have a policy for patients leaving against medical advice (AMA), but case management must have its own discharge planning policy for those leaving AMA. In these instances, it’s not just enough to have the patient sign a paper, but rather actively assist the patient with the transition by ensuring that he or she has transportation and needed prescriptions. Even though there is an exemption for patients who signed out AMA and are readmitted the hospital, the hospital should have a plan for how to work with these patients, said Birmingham., said Birmingham.

You should also consider planning for a patient’s deficits related to loss of functioning, whether it be ADLs or IADLs. Birmingham recommended asking the following questions:

  • Is the patient medicated and therefore unable to participate in planning?
  • Does the patient need to have a conservatorship?
  • Is there conflict among the patient’s children or the patient’s siblings?
  • Does the patient have a family or responsible person?
  • Is the patient appealing the discharge?

 

A plan should be in place to address the answers to these questions.

6.Help patients achieve their goals. This is something that organizations should have been doing all along, but there is much more emphasis on it now. A problem arises when the patient’s goals and preferences don’t align with what is medically necessary or what is reasonable and necessary. In these instances, it may be wise to involve social workers. "Look at some of the things that patients might be going through?denial, grief that might affect their decision-making at the time," said Birmingham. "With the family dynamics, there might be family members trying to convince the patient to make a decision that isn’t really what the patient wants." Ultimately, the goal is to help the patient make the decision that is best for him or her, but also to think about what is medically the best option.

7.Involve the physician. Physicians are an integral part of discharge planning, so it’s important to make sure they are actively involved in the process. This communication between the patient and the physician needs to be sensitive to generational and cultural differences. "To involve perhaps some of the older patients, just have the doctor come in and say, ‘We want you to do this,’ " said Blondo. "That might not work for younger generation or baby boomers who are used to rebelling, but if you have the doctor come in and say, ‘This is what we’re recommending and this is why’ and help the patient to understand why it is recommended."

While it may be easier to foster good communication if you’re working with a hospitalist, it can be more of a challenge if the physician is community based. "How will you manage when the patient is transferred to another facility? It’s not been a problem if you’re transferring the patient to another hospital, but if that patient is being transferred to a SNF, there haven’t been that many times when the doctors have called to the doctor in that SNF to give them an update," said Blondo. Have a plan in place to ensure the communication lines are always open.

8.Work to decrease unplanned readmissions and improve patient outcomes. "Readmissions are an old problem with new incentives," said Birmingham. Readmissions can be strongly linked to location and patient access to resources, which shows that they often depend on factors other than the medical treatment the patient received. This underscores the importance of ensuring your patients have access to things like food and transportation when they leave the facility. "Is your [patient’s] area in a food desert? No car, no supermarket store within a mile?and that makes a huge difference," said Birmingham. If this is the case, your organization might want to develop or contact an existing program that delivers food to the homes of qualifying individuals. "Home health agencies could do that too for some programs to be able to provide some fresh groceries to some patients," she said.

Also find out if your patient has been readmitted in the past, a risk factor for readmissions. "You can look to see if a patient is readmitted from an acute level of care, but you’ll need to ask the patient if they’ve been in the emergency room in the past 30 days, if they were admitted from a facility SNF," said Blondo. "Often, that information is sent with them to the hospital, but you can ask them." Ask if the patient was receiving home health services prior to admission. Encourage physicians to include this type of information in the history and physical to ensure it won’t be missed.

"We’re never going to be perfect and have no readmissions, because some patients have a legitimate need to come back to the hospital within those 30 days, but look at your readmissions. Learn from who is coming back and think about what strategies you can put in place for that," said Blondo.

9.Keep the focus where it belongs. "Discharge planning is a patient-centered function," said Birmingham. "You can do utilization review without talking to the patient. You can do quality improvement without talking to the patient and family, but you can’t do discharge planning." For this reason, discharge planning can be very rewarding to clinicians who want to be involved in the patient’s care, and to be there for them when they’re at their most vulnerable.

10.Take your cues from the experts. While Medicare’s CoPs aren’t a cookbook on how to run your organization, they are a good place to start because they’re based on years of evidence. "Many of the changes in the original CoPs happen because commenters send in a comment to CMS and CMS responded and actually changed the proposed rule," said Birmingham. "Now, will they change these proposed [discharge planning] rules? I don’t think so, and I think that’s because they’ve been published as interpretive guidelines for over two years." That means these discharge changes are likely here to stay. Like all other CoPs, they should be blended into your workflow and your strategies and partnerships with other departments, said Birmingham.

HCPro.com – Case Management Monthly

Modifier 58 Versus 78; Which Should You Use?

Sometimes coders are confused when they should apply modifier 58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period and modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure […]
AAPC Knowledge Center

WHO SHOULD GET THE REFUND? Both Medicare and Aetna paid as primary

We have a patient in which both Medicare and Aetna paid for multiple dates of service as primary payers. Our office contacted both insurance companies who assured our office that they were in fact the primary payer.

In turn, we contacted the patient to ask that they contact Medicare and Aetna to update their coordination of benefits. The patient has since expired and we even called the patient’s spouse to ask them to contact the insurance companies regarding COB as well, with no success.

We are left with the question of who or how we should refund the overpayment(s) received. Any advice or input would be much appreciated.

Medical Billing and Coding Forum