Part 1

1. List the four types of medical decision-making, and explain how the complexity of medical decision-making is
2. What are the three types of wound repair, and what must be documented to code them?
3. Review the stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the guidelines of the ICD-10-CM Explain the stages of CKD and when a code for ESRD may be assigned.
4. Explain the use of Anesthesia Qualifying Modifiers, and list and explain what add on codes are reported for qualifying
5. A 10-year-old patient is admitted for multiple injuries after being hit by a car while riding his bike. Discuss the coding guidelines for reporting

 

Part 2

Evaluate the following chart information.

 

Patient presents for pilonidal cyst and skin tag removal. Patient has a history of hypertension and diabetes. Patient is taking lisinopril and metformin, and their chronic conditions are well managed.

PFSH

Occupation: Truck driver

Tobacco use: Stopped smoking in 2016 Alcohol: N/A

Seatbelt use: Yes Marital status: Married

Physical exam and procedure:

Patient is well developed, well-nourished, and in no acute distress. Patient was informed of the surgical risk factors, including postoperative bleeding, infection, and pain, and consented to the procedures. Patient has approximately 15 acrochordons to be removed from the abdomen and neck areas. Patient also has a pilonidal cyst approximately 4 cm in size. Due to the nature of the operation, the skin tags will be removed first. Patient was draped and the skin prepped in the usual fashion. Patient’s preference is electrocautery for the skin tags. Patient has 10 lesions for removal on the abdomen and 5 on the neck. Topical anesthesia was applied followed by lidocaine injections into each lesion. I gripped each lesion with forceps and then used the Bovie to cauterize the area. Patient tolerated the procedure well, and all lesions were successfully removed. Bacitracin and a sterile adhesive bandage were applied.

Next, I moved to the pilonidal cyst. Patient was rotated into a prone position and was draped and prepped in the usual fashion. 2% lidocaine was injected into the area around the cyst after local anesthetic. I used a #10 scalpel to incise the cyst. A large amount of white cystic matter was removed. I irrigated the wound copiously with saline solution. I then used the Bovie to remove the ventral margins around the cyst. The resulting wound was packed with Bacitracin and a sterile adhesive bandage was applied. Patient tolerated the procedure well, and blood loss was minimal.

1. What diagnoses should be listed on the patient’s claim?
2. What procedures should be listed on the patient’s claim?
3. Would a modifier be needed?

 

Answer questions 4–7 by referring to the CMS-1500 claim form in the figure below.

 

Click to enlarge image. (https://lessons.pennfoster.edu/pdf/42735202.pdf)

4. How many diagnosis codes can be reported on this claim?
5. In which box would the UCR for a procedure be listed?
6. After the claim is submitted electronically, what file format is used, and where does the claim go first?
7. In which box would you write the internal control number (ICN) when submitting a corrected claim?
8. What’s the difference between a claim rejection and a claim denial?

 

For questions 9–11, evaluate the electronic remittance advice in the figure below.

 

Click to enlarge image. (https://lessons.pennfoster.edu/pdf/42735203.pdf)

9. How much total payment will the provider receive for this claim?
10. How much is the patient responsible for? How much would the patient pay with 10% coinsurance?
11. Within the patient’s account, what will be the contractual adjustment?

 

For questions 12–15, evaluate the following ERA and the associated remark codes.

Click to enlarge image. (https://lessons.pennfoster.edu/pdf/42735204.pdf)