Chapter 19 — Exercises

How to use these. The recurring question in these three sections is not what was done but who did which part, where, and with whose equipment. Most of these items are answered by asking that question and then reading a descriptor.

Section H — the injection and infusion hierarchy — and Section J — the timed-code arithmetic — are the two that require actual work. Do them on paper.

Section A — Components (items 1–8)

For each, state what each party reports.

A.1 A hospital owns the radiography equipment; an independent radiology group interprets.

A.2 A practice owns the equipment and its own physician interprets.

A.3 A practice owns the equipment and sends images out for interpretation.

A.4 A practice owns no equipment and refers the patient elsewhere.

A.5 A physician reviews an image and discusses it with a colleague. No report is written. What professional component exists?

A.6 A mobile imaging unit performs a study in a clinic's parking lot. Who bills the technical component?

A.7 Which file tells you whether a code may be split, and what is that column called?

A.8 A coder appends modifier 26 to a code with no professional component. Describe what the claim now asserts.

Section B — Radiology (items 9–16)

B.9 Name the four variables that select a plain radiography code.

B.10 A CT of the abdomen is performed after the patient drank oral contrast. Nothing intravenous. With or without contrast?

B.11 Define "with contrast."

B.12 A study is performed without contrast and then with contrast in one session. How many codes?

B.13 A report states that three views of the knee were obtained. What does that determine?

B.14 An ultrasound report documents six of the eight elements a complete study requires. What do you report?

B.15 Name the five stages of a radiation oncology episode. Which one is reported per a defined number of fractions?

B.16 In nuclear medicine, what is generally reported separately from the procedure, and which chapter owns those codes?

Section C — Imaging guidance (items 17–20)

C.17 State the three-question decision for whether guidance is separately reportable.

C.18 (Chapter 18) A pain management code names imaging guidance in its descriptor. May guidance be reported separately?

C.19 (Chapter 17) A large joint injection is performed with ultrasound guidance. Which of the three questions applies, and what is the answer?

C.20 What does every guidance code require, and where has this book stated the same principle twice before?

Section D — Panels and pathology (items 21–28)

D.21 State the panel rule in both directions.

D.22 A panel contains fourteen analytes; thirteen were performed. What do you report?

D.23 All fourteen were performed and the coder reports them individually. What is this, and why is it easy for a payer to find?

D.24 More tests were performed than any single panel covers. What is the reporting strategy?

D.25 What is the unit of service in surgical pathology? What do you count?

D.26 Two polyps arrive in one container. Two polyps arrive in two labeled containers. How many specimens in each case?

D.27 A single specimen grows two organisms, each tested against ten antibiotics. Name the three services and the unit of each.

D.28 Distinguish presumptive from definitive drug testing. Name the enforcement pattern and say why it needs no chart to detect.

Section E — Ordering, performing, CLIA (items 29–36)

E.29 Who bills a test? What is the ordering physician's role on the claim?

E.30 A practice collects a specimen and sends it to a reference laboratory. Who bills what?

E.31 What does modifier 90 identify?

E.32 Name the four causes of referring-provider denials in the order they occur. Which one cannot be fixed by the billing office?

E.33 Name the four CLIA certificate types.

E.34 What two constraints define provider-performed microscopy?

E.35 What does modifier QW identify?

E.36 A Certificate of Waiver site's claim for a moderate-complexity test denies for CLIA. What should the billing office do, and what should it not do?

Section F — Repeats and units (items 37–40)

F.37 State what modifier 91 is for. Name three things it is not for.

F.38 A code's descriptor ends "per hour." Does modifier 91 apply to repetition? Explain.

F.39 State the three questions to ask before sending a laboratory line.

F.40 Name the two directions a units error runs and the financial consequence of each.

Section G — The Medicine section (items 41–46)

G.41 Where in CPT are cardiovascular studies? Where is cardiovascular surgery?

G.42 Distinguish 93000 from 93010. What distinction do they encode, and how is the same distinction encoded elsewhere in this chapter?

G.43 What are the eye codes, and what are they an alternative to?

G.44 What makes an eye examination "comprehensive," and how does that standard differ from Chapter 15's?

G.45 An allergy claim carries two lines that look redundant. What are they?

G.46 Pulmonary components bundle into comprehensive studies. Which rule from earlier in this chapter is this the same as?

Section H — Injections and infusions (items 47–52)

H.47 State the hierarchy, both levels of it.

H.48 Does chronology or hierarchy select the initial service?

H.49 A patient receives hydration for one hour, then an antiemetic push, then a two-hour chemotherapy infusion. Classify all three.

H.50 From the medication administration record: hydration 0915–1015, push at 1020, chemotherapy 1030–1235. How many chemotherapy add-on units, and why not more?

H.51 Delete the start and stop times from H.50. What can now be reported?

H.52 Define initial, sequential, and concurrent.

Section I — Immunizations (items 53–56)

I.53 How many codes does an immunization require? Name them.

I.54 Which one is most often missing, and what is the financial consequence?

I.55 A claim carries an administration code and no product code. Is this an error?

I.56 What must be documented to support the counseling-based administration codes, and who must provide the counseling?

Section J — Timed codes (items 57–60)

J.57 Distinguish timed from untimed codes.

J.58 State the substantial-portion methodology. Write out the minute-to-unit bands through 5 units.

J.59 A therapist provides 8 minutes of one timed service and 8 minutes of another. How many units? What is the common wrong answer, and what produces it?

J.60 What does the KX modifier attest to? Explain why appending it automatically at a threshold is the same failure as an auto-appended modifier 59.

Section K — The Encounter (items 61–64)

K.61 Account 10-4471 orders 83036 and 80061 and neither is on the claim. Where are they, and why?

K.62 What is on the claim from this chapter's sections, and what did it charge and collect?

K.63 If Northgate ran both tests in house, name the three new questions that would arise.

K.64 99000 is not on the claim. State the two possible reasons and say how a practice finds out which one it is in.