Tuesday, September 25, 2012

Pain Management Questions

Sample/Practice/Free Pain Management Coding Questions

1. Which of the following prefixes has the meaning “on, upon, over, near, on top of”?

a. Intrab.
b .Epic.
c. Extrod.
d. Para

This scenario is applicable to question 2:

Location: Physician’s office treatment room

Diagnosis: chronic failed back syndrome

Procedure: Physician refill of implanted intrathecal pump with analysis and reprogramming to higher infusion rate

2. What CPT code would be reported for the pump refill?

a. 95990
b. 95991
c. 96522
d. 99213

3. Select the correct primary ICD9CM code for a pain management evaluation for chronic pain due to metastatic cancer :

a. 338.29
b. 199.1
c. 338.3
d. 780.96

4. An interventional pain management provider performs injections in his office treatment room. He uses his own fluoroscopy machine and his office staff assists him with the procedures performed. What modifier, if any, would be applied to the provider’s radiologic imaging services?

a. 26 modifier
b. –TC modifier
c. – 59 modifier
d. No modifier

5. What HCPCS code and billing units of service would be coded for an injection of 20
milligrams of DepoMedrol?

a. J1020, 1 unit
b. J1020, 2 units
c. J1030, 1 unit
d. J3301, 2 units

6.       When a CPT code description includes the term “separate procedure”, which of the following circumstances applies?

a.      The code designated as “separate procedure” is always reported separately in addition to any other procedure performed.

b.       The code designated as “separate procedure” may never be reported separately    if any other service is performed at the same session.

c.      The code designated as “separate procedure” may only be reported if performed at the same session as the code for the total procedure or service of which it is considered an integral part.

d.      The code designated as “separate procedure” may be reported if no other related procedures were performed in the same session.

7.      Per CPT Instructions and CPT Assistant guidelines, what is the CPT code is used to report a pulsed radiofrequency destruction of greater occipital nerve?

a. 64640
b. 64405
c. 64999
d. 64626

The following scenario is applicable to questions 3-6:


Pre & Postprocedure

Diagnosis: Lumbar facet joint syndrome with low back pain and spondylosis

Procedure Performed: Radiofrequency destruction of L2, L3 and L4 paravertebral facet joint nerves

Previous positive diagnostic blocks were performed of the L2, L3 and L4 medial branches with 80% relief of symptoms for the duration of local anesthetic. Fluoroscopic imaging was utilized to identify the corresponding lumbar vertebrae. 1 ml of 1% Lidocaine was injected in the skin and subcutaneous tissues over the target vertebrae. Next, a 20gauge RF needle with a 5 mm curved active tip was advanced and the lateral projection revealed the needle tip to be in an appropriate position. Sensory and motor stimulation trials were performed and revealed appropriate needle placement for RF lesioning of L2 facet joint nerve. 1 ml of 2% Lidocaine was injected and five minutes were allowed to pass. A lesion was instituted at 80°C for 60 seconds. The needle was then rotated 180 degrees and a second lesion was performed at 80°C for 60 seconds. 0.5 ml of Triamcinolone was injected and the needle was removed. Repeat lesions were performed at 80°C for 60 seconds at the L3 and L4 paravertebral facet joint nerves utilizing the same technique.

The following four questions below refer to the previous vignette. Assign the codes below as you would report the items and services. If a question asks about a code, such as a modifier, secondary CPT code, etc., but you do not believe a code is necessary / compliant to report, put N/A in the blank:

8.      What is the CPT code for the primary medial branch surgical procedure? _________

9.      What is the CPT code for the additional medial branch surgical procedures? _______

10.What is the number of billing service units for the code in above question for the additional medial branch surgical procedures?
a. 1
b. 2
c. 3
d. 4

11.      What CPT code would be reported for the injection of the paravertebral facet joint nerve steroid injections? _______

1. b
2. b
3. c
4. d
5. a
6. d
7. c
8. 64622
9. 64623
10. b
11. N/A

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