CPC Exam Dumps : Certified Professional Coder (CPC) Exam

The patient is undergoing a cardiac catheterization with a CRNA providing monitored anesthesia care (MAC). Code 00520 is for anesthesia for heart catheterization procedures. Modifier QX indicates CRNA service with medical direction by a physician, QS indicates MAC, and P5 indicates a patient with a severe systemic disease that is a constant threat to life. Thus, the correct code and modifier combination is 00520-QX-QS-P5.

1. Procedure and CPT® Code Selection:

The patient requires a surgical nasal sinus endoscopy to repair a cerebrospinal fluid (CSF) leak caused by a skull fracture that resulted in CSF draining into the nasal passage.

Code 31291 is the correct CPT® code for an endoscopic repair of a cerebrospinal fluid leak in the sphenoid sinus. This procedure code is appropriate because it specifically addresses surgical endoscopy for CSF leak repair in the sinus region.

Other codes provided, such as 31287 (nasal/sinus endoscopy with balloon dilation) and 31235 (nasal endoscopy with biopsy), do not match the description for surgical repair of a CSF leak and are therefore inappropriate for this case.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code S02.19XA is used to describe a fracture of the anterior cranial base, which fits the described injury of the skull with cerebrospinal fluid leakage.

External cause code V47.5XXA is used for motor vehicle accidents involving a car hitting a stationary object.

Y92.411 is the appropriate code to describe the location of the accident as a highway.

3. Exclusion of Additional Procedure Codes:

There is no need for a second endoscopy code or a modifier, as 31291 fully describes the endoscopic repair procedure for the CSF leak.

4. AAPC and CPT® Coding Guidelines:

Per AAPC guidelines, procedure codes for sinus endoscopy are chosen based on the specific type of intervention (e.g., CSF leak repair). The guidelines for ICD-10-CM stress including external cause codes and location codes for trauma cases related to motor vehicle accidents.

Thus, the correct answer based on CPT® and ICD-10-CM coding standards is B. 31291, S02.19XA, V47.5XXA, Y92.411.

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.