Chapter 18 — Exercises

How to use these. This chapter's content is structural rather than encyclopedic, and the exercises reflect that. You are not being asked to know the cardiovascular section. You are being asked to know which rule applies and what the note has to say.

Sections F, G, and H — payment mechanics — are the ones that will change what a claim pays. Do them carefully.

Section A — The endoscopic base-code rule (items 1–6)

A.1 State the endoscopic base-code rule in one sentence.

A.2 Why does it exist? Give the reason, not the rule.

A.3 How does it differ from the ordinary multiple-procedure reduction?

A.4 Is a diagnostic endoscopy reported alongside a surgical endoscopy of the same family? Name the Chapter 17 rule this parallels.

A.5 Two endoscopic procedures are performed, one from the colonoscopy family and one from the sigmoidoscopy family. Does the base-code rule apply between them? Explain.

A.6 Where do you find out which reduction applies to a given code?

Section B — Colonoscopy (items 7–14)

B.7 Four polyps are removed by snare during one colonoscopy. How many codes?

B.8 Two polyps are removed by snare and two by hot biopsy forceps. How many codes?

B.9 A polyp is biopsied and a separate lesion is removed by snare. How many codes?

B.10 The scope is advanced only to the splenic flexure. What determines the reporting, and what must the note say?

B.11 (Account 22-9107.) A screening colonoscopy in an average-risk patient finds a 7 mm sessile polyp in the sigmoid colon, removed by snare. Which diagnosis is sequenced first? Which procedure code is reported?

B.12 In B.11, explain in one sentence why the diagnosis and the procedure appear to disagree, and why both are correct.

B.13 Which two modifiers exist to identify a service that began as preventive?

B.14 The pathology returns benign. What diagnosis does the record now support, and which chapter of this book owns the financial resolution of this account?

Section C — Hernia, conversion, and the digestive section (items 15–20)

C.15 Name the five questions the hernia family asks.

C.16 Which of the five is most often missing from the operative note, and why does the surgeon not think to include it?

C.17 Is mesh implantation separately reportable? State the honest answer.

C.18 A laparoscopic procedure is converted to open. What do you report?

C.19 In C.18, what would justify modifier 22, and what would not?

C.20 (Chapter 17) Compare C.16 with Account 31-2245's missing sentence. What is the same about them, and what is the remedy in both cases?

Section D — Cardiovascular, urinary, nervous system (items 21–28)

D.21 Name the two organizing principles of the cardiovascular section.

D.22 A catheterization scenario lists catheter placement, injection procedures, and imaging supervision and interpretation separately. What do you report, and why does this appear on exams?

D.23 For a pacemaker or defibrillator, which question decides the code?

D.24 Vascular interventions are frequently coded per what? What must the note name?

D.25 Some urinary codes are inherently bilateral. What are the two opposite errors, and how do you avoid both?

D.26 A prostate biopsy is performed with transrectal ultrasound guidance and the specimen is read. How many CPT sections are involved? Name them.

D.27 Name the four variables that structure spine surgery coding.

D.28 Pain management codes frequently include imaging guidance in the descriptor. What does that mean for a coder, and what is the compliance consequence of getting it wrong?

Section E — Maternity (items 29–34)

E.29 What three components does the global obstetric package include?

E.30 Name four things it excludes.

E.31 A patient receives antepartum care from Practice A and delivers with Practice B. What does each report?

E.32 Why is the global package billed at the end of the episode a problem for eligibility?

E.33 A practice may need to report antepartum care by visit count. What must it have been doing for eight months?

E.34 From what date does timely filing run for a global obstetric package? What is the honest answer and where do you find the real one?

Section F — Multiple procedures and line order (items 35–40)

F.35 State the multiple-procedure payment reduction. What percentage should you assume?

F.36 Which codes are not subject to it? Name two categories.

F.37 Where do you find out whether a code is subject to it?

F.38 In what order should claim lines be sequenced, and why?

F.39 Three procedures with allowed amounts of \$1,200, \$800, and \$400, reduced at 50% for the second and subsequent. Compute the total when sequenced highest-first and when sequenced lowest-first. State the difference.

F.40 In F.39, what appears in a work queue when the claim is mis-sequenced?

Section G — Bilateral, split global, and surgical teams (items 41–48)

G.41 Name the three bilateral reporting conventions.

G.42 What does the bilateral surgery indicator tell you, and what question does it answer before the convention question arises?

G.43 State what modifiers 54, 55, and 56 each mean.

G.44 Two physicians split a global package. What code does each report?

G.45 (Chapter 17) Would a 54/55 split have resolved Chapter 17's Case Study 2? Answer carefully.

G.46 What must be true for modifier 62? What document must exist for each surgeon?

G.47 Distinguish modifier 80 from modifier AS. Why does the difference matter?

G.48 What does modifier 66 describe?

Section H — Anesthesia and sedation (items 49–56)

H.49 Write the anesthesia formula.

H.50 When does anesthesia time begin and end? What document is the source?

H.51 Compute: 6 base units, 90 minutes at 15-minute increments, P3 adding 1 unit, conversion factor \$22.00.

H.52 Recompute at 91 minutes. State your answer and then state why you cannot actually answer it.

H.53 Which physical status modifiers generally add units?

H.54 What are qualifying circumstances, and which Chapter 13 rule applies to them?

H.55 Define moderate sedation. Name two things it is not.

H.56 When does intraservice sedation time begin? What else must be present for the service to be documented?

Section I — The Encounter (items 57–60)

I.57 Account 10-4471 carries four lines. Is a multiple-procedure reduction applied? Walk each line.

I.58 Suppose both knees had been injected. Which payment mechanism now applies, and which does not?

I.59 In I.58, what happens to the J1030 line? Is it a second line or something else?

I.60 (Chapter 14) Case Study 2 in Chapter 14 was four years of underpayment from a bilateral convention. Which lookup in this chapter would have prevented it, and which reading would have?