2019 Medical Coding Training: CPC® Practical Application Workbook—Answer Key Disclaimer This course was current when it was published. Every reasonable effort has been made to assure the accuracy of the information within these pages. The ultimate responsibility lies with readers to ensure they are using the codes, and following applicable guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient healthcare organizations. US Government Rights This product includes CPT®, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/ or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/ or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. AMA Disclaimer CPT® copyright 2018 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association. Regarding HCPCS Level II HCPCS Level II codes and guidelines discussed in this book are current as of press time. The 2017 code set for HCPCS Level II were unavailable when published. Clinical Examples Used in this Book AAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees. All examples and case studies used in our study guides, exams, and workbooks are actual, redacted office visit and procedure notes donated by AAPC members. To preserve the real-world quality of these notes for educational purposes, we have not re-written or edited the notes to the stringent grammatical or stylistic standards found in the text of our products. Some minor changes have been made for clarity or to correct spelling errors originally in the notes, but essentially, they are as one would find them in a coding setting. © 2018 AAPC 2233 South Presidents Dr. Suites F-C, Salt Lake City, UT 84120 800-626-2633, Fax 801-236-2258, www.aapc.com Updated 10102018. All rights reserved. ISBN 978-1-626886-667 CPC®, CIC™, COC™, CPC-P®, CPMA®, CPCO™, and CPPM® are trademarks of AAPC. ii 2019 Medical Coding Training: CPC Practical Application Workbook—Answer Key CPT® copyright 2018 American Medical Association. All rights reserved. Contents Chapter 1 The Business of Medicine . 1 Chapter 2 Medical Terminology and Anatomy Review . 5 Chapter 3 Introduction to ICD-10-CM . 7 Chapter 4 ICD-10-CM Coding Chapters 1–11 . 11. Chapter 5 ICD-10-CM Coding Chapters 12–21 . 19 Chapter 6 Introduction to CPT®, Surgery Guidelines, HCPCS Level II, and Modifiers . 29 Chapter 7 Integumentary System . 33 Chapter 8 Musculoskeletal System . 45 Chapter 9 Respiratory, Hemic, Lymphatic, Mediastinum, and Diaphragm . 57 Chapter 10 Cardiovascular System . 67 Chapter 11 Digestive System . 81 Chapter 12 Urinary System and Male Genital System . 93 Chapter 13 Female Reproductive System . 105 CPT® copyright 2018 American Medical Association. All rights reserved. www.aapc.com iii Chapter 14 Endocrine and Nervous System . 117 Chapter 15 Eye and Ocular Adnexa, Auditory Systems . 131 Chapter 16 Anesthesia . 143 Chapter 17 Radiology . 155 Chapter 18 Pathology and Laboratory . .169 . Chapter 19 Evaluation and Management . 181 Chapter 20 Medicine . 201 iv 2019 Medical Coding Training: CPC Practical Application Workbook—Answer Key CPT® copyright 2018 American Medical Association. All rights reserved. Chapter 1 The Business of Medicine Exercise 1 1. What type of profession, other than coding, might a skilled coder enter? Answer: Consultants, educators, medical auditors 2. What is the difference between outpatient and inpatient coding? Answer: Outpatient coders focus on assigning CPT®, HCPCS Level II, and ICD-10-CM codes. They work in provider offices, outpatient clinics and facility outpatient departments. Outpatient facility coders also work with ambulatory payment classifications (APCs). Inpatient hospital coding focuses on a different subset of skills, where coders work with ICD-10-CM and ICD-10-PCS. These coders also assign Medicare severity-diagnosis related groups (MS-DRGs) for reimbursement. Outpatient coders usually have more interaction throughout the day and must communicate well with providers; inpatient coders tend to have less interaction throughout the day. 3. What is a mid-level provider? Answer: Mid-level providers include physician assistants (PA) and nurse practitioners (NP). Mid-level providers are known also as physician extenders because they extend the work of a physician. 4. Discuss the different parts of Medicare and what each program covers. Answer: l Medicare Part A helps to cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare. l Medicare Part B covers two types of services: 1) Medically necessary provider services that are needed to diagnose or treat a medical condition and that meet accepted standards of medical practice; and 2) preventive services to prevent illness or detect it at an early stage. Medicare Part B is an optional benefit for which the patient pays a premium, an annual deductible and generally has a 20% co-insurance except for preventive services covered under healthcare law. Coders working in provider offices code mainly Medicare Part B claims. l Medicare Part C, also called Medicare Advantage, combines the benefits of Medicare Part A, Part B and sometimes Part D. The plans are managed by private insurers approved by Medicare and may include preferred provider organizations, health maintenance organizations, etc. l Medicare Part D is a prescription drug coverage program available to all Medicare beneficiaries for a fee. Private companies approved by Medicare provide the coverage. CPT® copyright 2018 American Medical Association. All rights reserved. www.aapc.com 1 The Business of Medicine Chapter 1 5. Evaluation and management (E/M) services are often provided in a standard format. One such format is SOAP notes. What does SOAP represent? Answer: S—Subjective — The patient’s statement about his or her health, including symptoms. O— Objective — The provider assesses and documents the patient’s illness using observation, palpation, auscultation, and percussion. Tests and other performed services may be documented here as well. A— Assessment — Evaluation and conclusion made by the provider. This is usually where the diagnosis(es) for the services are found. P— Plan — Course of action. Here, the provider will list the next steps for the patient, whether ordering additional tests, taking over the counter medications, etc. 6. What are five tips for coding operative (OP) reports? Answer: 1. Diagnosis code reporting — Use the post-operative diagnosis for coding unless there are further defined diagnoses or additional diagnoses found in the body or op report findings. If a pathology report is available, use the findings from the pathology report for the diagnosis. 2. Start with the procedures listed — One way to start the research process quickly is by focusing on the procedures listed in the header. Read the note in its entirety to verify the procedures performed. Procedures listed in the header may not be listed correctly and procedures documented within the body of the report may not be listed in the header at all; however, it is a place to start. 3. Look for key words — Key words may include locations and involved anatomical structures, surgical approach, procedure method (debridement, drainage, incision, repair, etc.), procedure type (open, closed, simple, intermediate, etc.), size and number, and the surgical instruments used during the procedure. 4. Highlight unfamiliar words — Research for understanding. 5. Read the body — All reported procedures should be documented within the body of the report. The report’s body may indicate a procedure was abandoned or complicated, possibly indicating the need for a different procedure code or reporting of a modifier. 7. What is medical necessity and what tool can you refer to for the medical necessity of a service? Answer: The term medical necessity relates to whether a procedure or service is considered appropriate in a given circum- stance. Tools to determine medical necessity include national coverage determinations (NCDs), local coverage determina- tions (LCDs), and commercial payer policies. 8. What are common