CCS-P Sample Multiple-choice Questions and Answer Key

1. A patient, followed for a past myocardial infarction that occurred one year ago,
has chronic cholecystitis (575.11) and is seen in the cardiology clinic for surgical
clearance. The cardiologist indicates the patient is currently at no risk for surgery
and no treatment is necessary. Upon review of the record, the coder notes that
there is a right bundle branch block on the EKG. Which of the following is the
correct coding and sequencing for this case?

411.0 Postmyocardial infarction syndrome

412 Old myocardial infarction
414.8 Chronic stage myocardial infarction
426.4 Right bundle branch block
794.31 Abnormal findings on EKG
V12.50 History of unspecified circulatory disease
V65.8 Other reasons for seeking consultation
V70.0 Routine general medical examination
V71.7 Observation for suspected cardiovascular disease
V72.81 Preoperative cardiovascular examination

A. 575.11; 426.4; V12.50; V71.7

B. V65.8; 794.31; V71.7, consult with cardiologist on definitive diagnosis; 412
C. V72.81; 575.11; 412, ask physician for clarification on bundle branch block
D. V72.81; 426.4; 414.8; 575.11

2. A patient is seen in a physician’s office and the nurse has recorded a blood-
pressure reading of 140/90mm Hg. The physician evaluates the patient and
records a blood pressure of 120/80mm Hg and schedules a follow-up visit in 2
weeks to rule out hypertension. The coder should code:

A. 796.2, Elevated blood pressure

B. 401.9, Hypertension
C. V71.7, Observation for suspected cardiovascular disease
D. V12.59, Personal history of other specified circulatory disorder

3. A patient presents to a physician’s office with a previous lab test that indicates
hyperglycemia. The physician records the final diagnosis as suspected diabetes
mellitus. For this case, the coder would assign the code(s) for:

A. Diabetes mellitus with specified complication

B. Diabetes mellitus with unspecified complication
C. Hyperglycemia
D. Hyperglycemia, diabetes mellitus uncomplicated
4. A patient was seen in the clinic for wheezing and a productive cough. The
physician documented “probable bronchitis--pending CXR results.” Performance
of the chest x-ray revealed bronchitis.
A blood-sugar measurement was also taken to determine the status of the
patient’s diabetes. The patient indicated that previously reported arthritis and
insomnia were not currently troublesome. Which of the following diagnoses
should be reported?

A. Bronchitis; diabetes mellitus

B. Bronchitis; diabetes mellitus; arthritis; insomnia
C. Productive cough
D. Productive cough; arthritis; insomnia

5. A patient returns to the emergency department after a previous visit earlier in the
day for severe epistaxis. The epistaxis arose spontaneously at 7:00 am and was
controlled in the emergency department by Doctor A, using bilateral anterior
nasal packing with satisfactory control of the epistaxis. The patient was
discharged in satisfactory condition at 10:30 am. She returned again at 4:00
p.m. with moderate epistaxis. Doctor A was not available. Doctor B completed
the following procedure: nasal packing, anteriorly, bilaterally. Hemorrhage was
adequately controlled. There were no further complications and the patient was
discharged at 7:00 p.m. Which of the following are the correct modifiers for
Doctor B?

-50 Bilateral procedure

-51 Multiple procedures
-76 Repeat procedure by same physician
-77 Repeat procedure by another physician

A. -50, -76
B. Emergency department physicians do not use modifiers to report their
services
C. -50, -77
D. -51, -77
6. A coding specialist was hired to conduct reviews to assess coding accuracy at a
large primary care clinic. To ensure accurate coding, the following sample of
claims was reviewed. What type of error may be revealed in this review?

Claims Code Interpretation

427.9 Cardiac dysrhythmia
425 Cardiomyopathy
414.0 Coronary artery disease
401 Hypertension
402 Hypertensive heart and renal disease
428.1 Left ventricular failure
424.0 Mitral valve stenosis
428.0 Right ventricular failure
424.90 Valvular heart disease

A. The ICD-9-CM codes are too specific

B. The CPT codes are incomplete
C. The HCPCS codes lack specificity
D. The ICD-9-CM codes are incomplete

7. The physician records the following office visit note:

T. 99.3 P. 70 reg. R. 16 Pt c/o productive cough. Lungs clear. Throat red.

To hospital Outpatient Radiology for chest x-ray. Removal of impacted
cerumen. Dx: acute bronchitis. Which of the following CPT code(s) should
be assigned?

A. Evaluation and management office visit code

B. Evaluation and management office visit code; removal impacted cerumen
C. Removal of impacted cerumen
D. Evaluation and management office visit code; chest x-ray

8. The following CPT codes appear:

93000 Electrocardiogram, routine ECG with at least 12 leads; with

interpretation and report
99201 Office or other outpatient visit with problem focused history
and examination, straightforward medical decision making,
new patient
99241 Office consultation with problem-focused
history and examination, straightforward
medical decision making, new or established patient
99271 Confirmatory consultation with problem-
focused history and examination, straight
forward medical decision making, new or
established patient

A patient, without a history of cardiac problems, was referred to a cardiologist for

surgical clearance at the request of a general surgeon. A problem-focused
history and examination was performed and medical decision-making was
straightforward. A routine EKG was performed and interpreted. Findings were
 sent to the surgeon. Which of the following is the appropriate coding by the
cardiologist?

A. 99241; 93000
B. 93000
C. 99201; 93000
D. 99271; 93000

9. The physician performed a diagnostic colonoscopy with hot biopsy forceps

removal of one polyp and removal of a second polyp by snare technique. The
following is an excerpt from CPT codes/modifiers:

45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic,

with or without collection of specimen(s) by brushing or
washing, with or without colon decompression
(separate procedure)
45379 with removal of foreign body
45380 with biopsy, single or multiple
45382 with control of bleeding, any method
45383 with ablation of tumor(s), polyp(s), or
other lesion(s) not amenable to
removal by hot biopsy forceps, bipolar
cautery, or the snare technique
45384 with removal of tumor(s), polyp(s), or
other lesion(s) by hot biopsy forceps or
bipolar cautery
45385 with removal of tumor(s), polyp(s), or
other lesion(s) by the snare technique
Modifiers:
-22 Unusual procedural service
-51 Multiple procedures

Which of the following is the correct coding assignment?

A. 45384-22
B. 45384; 45385-51
C. 45380-51; 45384-51; 45385-51
D. 45378; 45384-22

10. Which of the following series of Evaluation and Management codes should be
used to report an admission of a patient to a partial hospitalization program
according to CPT guidelines?

A. 90804-90809, Individual psychotherapy based on time

B. 99217-99220, Initial observation care
C. 99221-99223, Hospital inpatient services
D. 99321-99323, Domiciliary, rest home, or custodial care services
11. Which of the following statements describes a poisoning that should be coded in
ICD-9-CM?

A. Interaction between two prescribed medications

B. Side effect of a medication taken according to instructions
C. Medication taken by the wrong person
D. Drug intoxication from a medication taken as prescribed by the physician

12. A Medicare patient has a surgical procedure performed in the office. Which of
the following services is most likely to result in additional reimbursement,
depending on coverage policy?

A. A4550, Surgical trays

B. A4554, Disposable underpads for the surgical table
C. D9215, Local anesthesia
D. D9241, Intravenous sedation/analgesia – first 30 minutes

13. Modifier -51 (multiple procedures) is assigned to a CPT code. What will happen
to the payment for that code?

A. Reimbursement will generally be reduced according to the terms of the

health plan
B. Payment will be doubled because the insurance company will recognize
that the procedure is bilateral
C. Payment will be increased due to an unusual procedure requiring more
physician work
D. Reimbursement will not be affected

14. In which situation is it appropriate to use modifier –59?

A. Distinct and different operative session or patient encounter.

B. Multiple procedures performed at the same session by same provider
C. A combination of medical and operative procedures performed at the
same session
D. Any CPT procedure considered a “Separate Procedure”

15. The physician documents that a cannula was inserted into the subclavian vein
and the tip was threaded through the vein. The tip rested within the right atrium of
the heart. The above description explains which of the following insertions?

A. Implantable venous access port

B. Balloon-tipped flotation catheter
C. Implantable infusion pump
D. Central venous catheter

CCS-P Multiple-choice Answer Key

1. C 2. A 3. C 4. A 5. C 6. D 7. B 8. A 9. B 10. C 11. C 12. A 13. A 14. A 15. D
 PROCEDURES FOR CODING PART II OF THE CCS-P EXAMINATION
1. Apply ICD-9-CM instructional notations and conventions and current approved
"Basic Coding Guidelines for Outpatient Services" and "Diagnostic Coding and
Reporting Requirements for Physician Billing" (Coding Clinic for ICD-9-CM, Fourth
Quarter, 1995), to select diagnoses, conditions, problems, or other reasons for care
that require ICD-9-CM coding in a physician-based encounter/visit either in a
physician's office, clinic, outpatient area, emergency room, ambulatory surgery, or
other ambulatory care setting. Code for professional services only.

2. Sequencing is not required for the diagnoses or procedures.

3. Modifiers are not required.

4. Apply the following directions to assign codes to secondary diagnoses:

A. Chronic diseases treated on an ongoing basis may be coded and reported as

many times as the patient is receiving treatment and care for the condition(s).

B. Code all documented conditions that coexist at the time of the encounter/visit
and that require or affect patient care, treatment, or management.

C. Conditions previously treated and no longer existing are not coded.

5. Code for the professional services only and only for the physician designated on the
cover sheet for each individual case.

6. Assign CPT and/or HCPCS Level II codes for all appropriate procedures.

7. Assign CPT codes for anesthetic procedures listed in the anesthesia section only if
indicated on the case cover sheet.

8. Assign CPT codes for medical procedures based on current CPT guidelines.

9. Confirm Evaluation and Management (E/M) codes based on the information

provided in the box for each case.

For the purposes of this examination do not challenge the level of key components
chosen. You will not be expected to assign the level of history, examinations, and
medical decision-making.

10. Assign CPT codes for radiologic and laboratory procedures listed in the radiology
and laboratory sections only when applicable.

11. Assign HCPCS Level II National (alphanumeric) codes, as appropriate.

12. Do not assign HCPCS Level III Local (alphanumeric) codes.

13. Do not assign ICD-9-CM E-codes.

14. Do not assign ICD-9-CM Morphology codes (M-codes).

15. Do not assign ICD-9-CM, Volume 3, procedure codes.
CCS-P Sample Medical Record Coding Cases and Answer Sheets

Case No. 1

Code the procedure(s) performed at the ambulatory surgery center for the
gastroenterologist only.

AMBULATORY SURGERY CENTER CHART

Admit Date/Time: 3/14 10:00 am Discharge Date/Time: 3/14 12:45 pm

Sex: M Age: 59 Disposition: Home Height: 5’6” Weight: 160

Admitting Diagnosis:
1. Abdominal Pain
2. R/O Ulcer

Discharge Diagnosis:
1. Hiatal hernia 3. Healing prepyloric gastric ulcer
2. Moderate reflux esophagitis 4. Normal flexible sigmoidoscopy

Procedures:
1. EGD and sigmoidoscopy
GASTROENTEROLOGY NOTE

Date: 3/14

Height: 5’6”

Vital Signs: T 99, P 80, R 20, BP 122/74, stable

Mental Status: Alert and oriented

Allergies: NKA

NPO: Yes, since midnight

Current Meds: Stomach pills, Tagamet

History and Physical

Date: 3/10 (performed in office)

History of Present Illness: 59-year-old male with abdominal pain, unresponsive to H2

blockers

Past Medical History: Periodic high blood-pressure readings

Medications: Tagamet, Dicyclomine

Allergies: NKA

Examination:

General: Well-developed, well-nourished male in minor distress.

HEENT:
No gross lesions noted. Pupils round and equal. No icterus. Neck supple, trachea
midline. Negative soft tissue swelling. Oropharynx negative. Soft tissues within normal
limits.

Heart: Regular rate and rhythm. EKG showed normal sinus rhythm

Lungs: Clear to auscultation

Abdomen: Soft, tender to touch

Extremities: No clubbing, cyanosis, or edema

Rectal: Deferred

Impression: Abdominal pain, possible ulcer

Pre-procedure Diagnosis: Abdominal pain, rule out ulcer

Orders:
1. Set up EGD and possible flexible sigmoidoscopy at ambulatory surgery
center
2. NPO after midnight day of procedure

OPERATIVE REPORT

Date of Procedure: 3/14

Procedure: Esophagogastroduodenoscopy and flexible sigmoidoscopy

Preoperative Medication: Preop Demerol 50 mg, Vistaril 50 mg, Atropine .4 mg, Versed
4 mg given by the anesthesiologist

Preoperative Diagnosis:
Abdominal pain, possible peptic ulcer disease. Patient has upper abdominal pain,
unresponsive to H2 blockers.

Postoperative Diagnosis:
1. Hiatal Hernia
2. Moderate reflux esophagitis
3. Healing prepyloric gastric ulcer
4. Normal sigmoidoscopy

Findings:
Endoscopy was performed with the Olympus video panendoscope, which was easily
introduced into the esophagus. This was normal to the proximal midportion of the
esophagus, but at the GE junction, there was evidence of a moderate degree of reflux
esophagitis with several small superficial erosions at the location and also isolated
erosions several centimeters above. The endoscope was advanced into the stomach
and turned in a retrograde direction. The cardiac and fundic areas were examined and
found to be otherwise normal. The antrum showed normal peristalsis and mucosa. In
the immediate prepyloric area, there was a small defect that was thought to represent
scarring from previous ulcer, which was still healing. Biopsies were obtained. The
duodenum, including the second portion, was normal. Subsequently, the endoscope
was withdrawn. The patient turned on his left side. Flexible sigmoidoscopy was then
carried out to the lower descending colon. A biopsy of the sigmoid was obtained. Patient
tolerated the procedure well.
ENDOSCOPY ORDERS

3/14:
Admit to ambulatory surgery, endoscopy area
Obtain consent for procedure, sign, and witness
Start IV of 55 cc D5W or NS TO KVO or heparin lock.
Preoperative Medications: Vistaril 50 mg IM, Demerol 50 mg IM, atropine .4 mg IM

3/14:
To Recovery
Give soft diet
Discharge at 12:30 p.m.
CCS-P EXAMINATION ANSWER SHEET

DIAGNOSES ICD-9-CM CODES

DX1 5 3 1 • 9 0
DX2 5 5 3 • 3
DX3 5 3 0 • 1 1
DX4 •

PROCEDURES CPT CODES

PR1 4 3 2 3 9
PR2 4 5 3 3 1
PR3
PR4
PR5
PR6
Case No. 2

Code the professional service(s) and procedure(s) performed at the physician office visit
only.

PHYSICIAN OFFICE RECORD

S: This is a 17-year-old established patient, with a problem hearing out of his right
ear. The problem began two weeks ago
and hearing slowly deteriorated. Chief Complaint: He currently describes his
hearing as “muffling sounds” in the right ear. There is some ear discomfort in
both ears. Brief History: This has been an ongoing problem for this patient. He
has been seen seven times in the past two years for cerumen impaction and
otitis. No other complaints at this time.

O: Examined HEENT including external and internal inspection of ears and nose,
and otoscopic examination of auditory
canals and tympanic membranes. Found a wax plug in right ear and
inflammation of both ear canals.

A: 1. Cerumen plug impaction, right

2. Externa otitis, both ears

P: Removed impacted ear wax successfully. Due to history of cerumen impaction, I

counseled the patient on daily ear maintenance and demonstrated the
appropriate wax removal techniques.
Placed patient on Cortisporin Otic suspension for the next three days as directed.
Should use the drops if this problem recurs before next visit.
Follow-up for ear check in two weeks if no additional problems.

Evaluation and Management Data:

History: Problem focused

Examination: Problem focused
Medical Decision Making: Straightforward
CCS-P EXAMINATION ANSWER SHEET

DIAGNOSES ICD-9-CM CODES

DX1 3 8 0 • 4
DX2 3 8 0 • 1 0
DX3 •
DX4 •

PROCEDURES CPT CODES

PR1 9 9 2 1 2
PR2 6 9 2 1 0
PR3
PR4
PR5
PR6