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Procedure: Hepatitis B vaccine administration for a Medicare patient on dialysis.

CPT® and HCPCS Codes:

G0010: Administration of Hepatitis B vaccine.

90740: Hepatitis B vaccine, dialysis or immunosuppressed patient dosage, 3-dose schedule.

ICD-10-CM Codes:

Z23: Encounter for immunization.

N18.6: End-stage renal disease.

Z99.2: Dependence on renal dialysis.

Code Selection Justification: G0010 is used for the administration of the vaccine for Medicare patients, and 90740 captures the specific vaccine for dialysis patients. The ICD-10 codes represent the encounter for vaccination and the patient's dialysis status.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

Procedure: Cardiac stress test performed using hospital's equipment with the cardiologist providing supervision, interpretation, and report.

CPT® Codes:

93016: This code is for supervision only without provision of the equipment.

93018: This code is for interpretation and report only.

Code Selection Justification: Since the cardiologist does not own the equipment, codes 93016 and 93018 correctly represent the supervision, interpretation, and report of the test.

AMA CPT® Professional Edition (current year)

94060 = Spirometry pre- and post-bronchodilator

94010 = Baseline spirometry

J45.21 = Mild intermittent asthma with exacerbation

1. Procedure and CPT® Code Selection:

The physician administered the MMRV (measles, mumps, rubella, and varicella) vaccine subcutaneously and dose 3 of Hepatitis B vaccine intramuscularly. The physician also provided counseling on routine immunizations.

CPT® Code 90460 is used for immunization administration with counseling by the physician for patients 18 years or younger for the first or only component of each vaccine.

CPT® Code 90461 is used for each additional component in a vaccine with counseling.

90710 is the code for the MMRV vaccine.

90744 is the code for the Hepatitis B vaccine (pediatric).

2. Application of 90460 and 90461:

For the MMRV vaccine (which has four components: measles, mumps, rubella, and varicella), 90460 is reported once for the first component, and 90461 is reported three times (once for each additional component).

For the Hepatitis B vaccine, 90460 is reported again since it is a separate vaccine with one component.

3. Rationale for Excluding Other Options:

Option A (90471, 90472 x 4, 90707, 90746) uses codes for vaccine administration without counseling and incorrect vaccine codes (90707 for MMR instead of MMRV and 90746 for adult Hepatitis B instead of pediatric).

Option B and Option D also contain incorrect vaccine codes and do not correctly apply the counseling administration codes.

4. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 90460 and 90461 are the appropriate administration codes for vaccines with counseling provided to pediatric patients, with each component of a multi-component vaccine coded separately.

Therefore, the correct answer is C. 90460 x 2, 90461 x 3, 90710, 90744.

93454 = Coronary angiography

R07.9 = Chest pain, unspecified

CAD code is not reported when ruled out

1. Procedure and CPT® Code Selection:

The provider performed both a bronchoscopy and a microlaryngoscopy to evaluate the patient’s airway due to respiratory distress and stridor.

Code 31622 is used for a diagnostic bronchoscopy, which includes the inspection of the trachea, carina, and bronchial structures. Since the bronchoscopy was diagnostic and no additional therapeutic procedures were performed, this is the appropriate code.

Code 31526 is for direct laryngoscopy with the use of an operating microscope or telescope (microlaryngoscopy). This code is appropriate given the use of a Parson’s laryngoscope and magnifying telescope to inspect the larynx.

2. Modifier 51:

Modifier 51 is added to 31526 to indicate that it was performed in conjunction with another procedure (31622, bronchoscopy). Modifier 51 denotes multiple procedures without the necessity of a separate incision.

3. Exclusion of Code 69990:

Code 69990 is used for the use of an operating microscope in microsurgery but is not coded separately when the procedure (such as microlaryngoscopy) already includes visualization with a microscope or telescope as part of the CPT® descriptor. Thus, 69990 is not separately reported in this scenario, per CPT® guidelines.

4. AAPC and CPT® Coding Guidelines:

The guidelines specify that when visualization or microlaryngoscopy is inherently part of the procedure (as in 31526), 69990 should not be billed separately. Also, the use of Modifier 51 for multiple procedures in the same session is appropriate.

Therefore, the verified answer, following the CPT® and AAPC coding rules, is A. 31622, 31526-51.

In ICD-10-CM coding, an Excludes2 note under a code indicates that the condition listed in the note is not included in the definition of the code, but it does not necessarily mean they cannot coexist. This type of note means that while the conditions are distinct, it may be appropriate to report both codes if a patient has both conditions at the same time.

A. is incorrect because Excludes1, not Excludes2, indicates that certain codes should not be reported together.

C. is a description of an Excludes1 note, which implies that the two conditions should not be coded together because they cannot occur simultaneously.

D. is also a description of an Excludes1 note, which serves as a "NOT CODED HERE!" directive.

Therefore, the correct answer is B. It is acceptable to report both the code and the excluded code together, when applicable.

99213-25 = E/M with separate procedure

87880 = Rapid strep test

J02.0 = Streptococcal pharyngitis

Symptoms are not reported with definitive diagnosis

This is a subsequent nursing facility care visit.

MDM Analysis (2021+ E/M Guidelines):

Problems: Multiple chronic conditions → Moderate

Data: 4 labs + telemetry → Moderate

Risk: Prescription drug management → Moderate

99309 – Subsequent nursing facility care, moderate MDM

Why others are incorrect:

99307 / 99308 – Low complexity

99305 – Initial nursing facility care

The prefix “sub-” means below or under.

Common examples include subcutaneous (below the skin) and sublingual (under the tongue).

This is a core concept tested under medical terminology on the CPC exam.