Competency Quiz

This quiz has been designed to be general in nature, so it is a viable test for almost any sort of practice. The questions below are not specific to any specialty. They are designed to show a general understanding of the basics of procedural coding for medical services. We have avoided cases that would require a high level of understanding for any specific area of medicine. The test is meant to be open book and open computer. Should you need a quiz specific to your specialty, please contact us via the e-mail link on any page, and we'll be happy to customize one especially for you.

Procedural Coding

PLEASE NOTE: All questions should be answered using current Medicare guidelines and appropriate procedure codes.

1.   An established patient visits office for routine follow-up ten days after Physician removed a 2cm benign lesion from her forearm. Physician examines the site and removes the stitches.

Patient asks Physician to check her cholesterol 'just to be sure it's ok'. Physician orders a cholesterol test. A specimen is obtained which will be tested by your in-house lab later in the day.

Patient also complains that she just cannot hear as well as she once could. Physician asks patient about her personal and family history concerning hearing loss. He also asks about other possible symptoms such sinus drainage, sore throat and dizziness. He examines her ears, listens to her chest and checks her eyes and throat. Both of her ears are blocked with impacted cerumen - which he removes.

Test results reveal Jane Smith does have dangerously elevated cholesterol. Patient is called and a follow-up is scheduled.

What procedure codes may be billed for these services? Should anything else be done to get this claim paid?

2.   Patient suffers from multiple medical problems. Among the problems is widespread arthritis. Physician performs a thorough evaluation and management service. Because of a confirmed bacterial infection, you give the patient a 250mg injection of Rocephin. In addition, Physician injects each of patient's painful knees with 40mg of Depomedrol per knee. What, if any, procedure codes should be used for the injections? Assume that the evaluation and management code is 99213.

3.   A long term patient is no longer able to care for his medical needs without assistance. Physician orders home health services and reviews and signs the certification form for home health care. During the second month of home health care, the home health nurse calls the Physician three times about abnormal labs and adjustments to medications. Physician spends and appropriately documents thirty minutes of time in reviewing the patient's medical data and modifying orders. What, if anything, may be billed for these services?

4.   Patient presents at office with severe shortness of breath and nausea. Patient complains of pressure in his chest radiating into his shoulders and arms. Physician does a brief assessment in the office and immediately calls for a wheelchair to take the patient to the emergency room at the adjoining hospital. With the assistance of the emergency room physician, patient is stabilized. Physician does a comprehensive history and physical and admits the patient to the hospital. Physician documents in his notes that he spent two hours in stabilizing and treating the patient. What should be billed?

5.   Patient was terminal. Nothing more could be reasonably done except make the patient comfortable. After discussing his condition with patient and family, patient requested to go home. Physician prepared all discharge papers and made the original contact with a hospice agency to arrange for in home care. Sadly, patient quietly dies in his hospital bed prior to leaving for home. Physician then pronounces the patient. Physician is excellent with documentation. All notes and orders are appropriately headed with date and time. Can anything be billed?

6.   Patient is in a Nursing Facility. Nurse calls Physician and says Patient is extremely agitated and that the PEG tube continually comes out. Physician visits the patient and replaces the PEG tube. He also reviews the medical records and does a history and physical that qualify as expanded problem focused. He changes the orders to different medications and includes an order to keep him informed as to any changes in patient's behavior with the new medications. How would these services be coded?

7.   Patient has a long history of hypertension and cholesterolemia. Her cholesterolemia has been managed successfully for several years with Lipitor. Patient has read recent articles in the press concerning an elevated risk of kidney failure associated with Lipitor, and seen late night commercials from lawyers urging Lipitor patients to call them if they have certain side effects. Even though her visit was meant to be a brief, routine visit to ensure the treatment plan was still having its desired effect, Physician spends thirty-five minutes talking to the patient. During most of the visit they discussed the serious side effects of elevated cholesterol vs. the slight possibility of life-threatening complications. Physician discusses alternate drugs that are available and counsels her on things she can do to decrease her statin dosage including taking her medication with Maalox TC. He explains to her that since the body makes its own cholesterol, diet alone may not be enough to control her cholesterol. He suggests she supplement daily with CoQ10 since Lipitor is known to reduce the levels of this naturally occurring coenzyme. After the discussion, patient decides to remain on her current regimen. You briefly summarize the discussion and the amount of time you spent explaining to the patient in patient's medical records. What level evaluation and management service was performed?

8.   Forty-two year old new patient presents asking for a complete physical. Physician performs a comprehensive history and physical and runs appropriate diagnostic and laboratory tests. The tests show that the patient's blood sugar and cholesterol levels are both at the high end of normal. Patient is also thirty pounds overweight. Physician spends twenty minutes discussing the results of the tests, educating the patient and recommending a nutritionist and several good books to help. How would you bill for the evaluation and management components of this visit only?

9.   Patient had visited the office three days earlier complaining of a 5cm 'knot' on his leg. After an appropriate assessment, physician determined that the knot was a fibrous lesion inflamed by a localized infection, prescribed antibiotics and scheduled a return visit for removing lesion. Prior to the procedure, physician did a cursory exam of the site. Physician removed lesion including margins, did extensive cleaning of the site which included both foreign matter and devitalized tissue and closed the site. The excised diameter was 6cm. How would you code the visit during which the lesion was removed?

10.   Two patients received colo-rectal screening tests. Both patients are in their 60s. Patient One had been previously tested, ten months earlier, using the immunoassay test. Physician elects to test with the fecal occult blood method this time. Patient Two, who had not been previously tested, was tested with the fecal occult blood method. In both cases, three simultaneous samples were tested. What needs to be done to ensure payment?

For more quizzes visit the Upstate Medicare site who received an 'exemplary' recognition from CMS for their quiz site!

Please click here for Answers to Quiz