Mod3ApplyCPTCodingGuidelinesModifiers_101023

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Rasmussen College, Minneapolis *

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HIM1103

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Mechanical Engineering

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Feb 20, 2024

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Module 03 Assignment - Apply CPT Coding Guidelines and Modifiers Instructions: Read each scenario and answer the associated questions. Refer to Appendix A and Section coding guidelines in the CPT code book. Be sure to write your answer beneath each question, using complete sentences, reflecting proper spelling and grammar. Scenario 1 A patient presents to the Emergency Room following an incident in her home where she fell and hit her head on the edge of a table. She indicated she felt dizzy prior to the fall. The fall resulted in a 1.5 cm laceration to her forehead and another 0.75 cm laceration to her neck. In addition, she was experiencing a headache and some blurred vision. Note: In this scenario, the provider would need to evaluate the source of the dizziness and performed a simple repair the lacerations. Questions: 1. Indicate the modifier that would be appended to the E/M code. Modifier 25 2. Indicate the coding guideline applied to a simple repair of two lacerations, same site. For multiple simple lacerations in different locations report each location and its code. 3. Indicate the code for a Simple Repair of two lacerations to the forehead (scalp) and neck. 12001-12007 Scenario 2 A patient is scheduled for an inpatient (hospital) surgical procedure. The patient was intubated, and anesthesia administered. The surgeon made the initial incision to access the operative site when the patient’s blood pressure dropped, and the patient became hypotensive. The procedure was aborted. Questions: 1. Indicate the modifier that the surgeon would append to the surgical CPT code? Modifier 53 2. Indicate the modifier that would be appended to the surgical CPT code if this was an Outpatient Procedure? Modifier 59 3. Under which circumstances would a “Discontinued Service” modifier not be allowable based on the definition? It is not used to report the elective cancellation of a procedure. Scenario 3 A patient is admitted for an emergency appendectomy due to a ruptured appendix with abscess. The patient is morbidly obese which presents difficulty in removing the appendix and managing the operative site to avoid infection. Due to the obesity and complicated nature of the procedure, the procedure took 30 minutes longer than usual to perform the procedure and close the operative site.

Questions: 1. Which modifier would be appended to the appendectomy CPT code due to the increase in operative time? Modifier 22 2. Which CPT format (punctuation) guides the coding pathway for determining the appropriate code for Ruptured Appendix? Semi-colon 3. What is the code for Appendectomy for a ruptured appendix with abscess? 44960 Scenario 4 A patient is recovering from a recent surgical procedure and is presenting to the physician’s office for routine postoperative follow-up care. The postoperative follow-up care is included in the charges for the surgical procedure. Question: 1. Which “Surgery Guideline” states that typical postoperative follow-up care is not to be billed separately? Modifier 55

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