ICD 10 CM ED Facility Interview Questions:

1. What is meant by chronic condition?

Ans: conditions which are not curable, but it can be controlled through medications or
injections. Ex: HTN, DM, asthma, copd, emphysema ….
2. Pt is having DM complications?
Ans: we have 2 acute and chronic complications.
Acute complications like: dm with hyperglycaemia, hypoglycaemia, ketoacidosis,
gastroparesis, foot ulcer.
Chronic complications: Dm with ckd, neuropathy, nephropathy, Pad/ Pvd / retinopathy,
glaucoma.
3. Exclude1 and Exclude 2?
Ans: Exclude1- which is not included here.
we should not code 2 conditions together. Ex – wheezing and asthma
Ans: Exclude2- which is included here.
we should code 2 conditions together. Hypertensive urgency, htn
4. NCCI edits usage?
Ans: National corrective coding initiative -promotes corrective coding methodologies and
reduces improper payments. For this we can add anatomical modifiers like – LT, RT, F1-F9…
5. HTN combination codes?
Ans:
Only HTN – I10
HTN + Heart failure = I11* series + I50* series
HTN + CKD = I12* series + N18* series
HTN + HF + CKD = I13* series + I50* series + N18*series
6. Types of external causes?
Ans: For coding external causes injury conditions must and should. We have 4 types of E-
codes.
A. Type of accident
B. Place of occurrence
C. activity
D. Status code - will give “AT WORK “given in chart.

7. Etiology vs manifestation?

Ans: Etiology – it is a cause of disease – an underlying condition we can code it as primary

Diagnosis.

Manifestation - disclosure of characteristic signs or symptoms of an illness of

underlying condition. Ex: anemia and ESRD – code ESRD (Etiology) first next

D63.1 (manifestation).

8. Fracture care Guidelines?

Ans: For coding fx care – we must check 3 things.

1. Rad report confirmation

2. Prescribed medication
3. Follow up
 2 types of fx care: Definitive care and Restorative care

Definitive Care - closed type of fx are treated without manipulation.

Restorative Care- open type of fx with manipulations are treated.

Manipulation techniques : 3 types : traction , flexion , Rotation.

9. Covid Guidelines:

 If covid positive – U07.1

 If covid negative – z20.822
 History of covid – z86.16
 Post covid syndrome – U09.9

10. MI guidelines:

 Death of Heart tissue due to lack of blood supply.

 Below 4 weeks is Acute MI
 After 4 weeks is Old MI

2 types of MI:

STEMI- Complete blockage of blood to heart artery.

NSTEMI- temporary blockage of blood to heart artery.

*** Initial Mi Vs Subsequent MI – refer notes of circulatory system.

11. Sepsis Guidelines:

Sepsis- Blood infection- A41.9

Severe sepsis- sepsis + R65.20 +Any one organ dysfunction

Septic shock- Sepsis+ R65.21 + any 2-organ dysfunction/ any system failure.

12. Adverse Effect vs Poisoning?

Adverse Effect – Take a drug, but it will not harmful to life

Poisoning- Improper use of drug to include overdose, wrong substance will threaten life.

Example: patient taken drug of Zofran and he developed a nausea and vomiting. How we are

going to code sequence?

Answer: Code first Nause and vomiting (R11.2) and adverse effect of drug as secondary

(T-series)

12.A. pt is taken Zofran drug more than the prescribed became it as poisoning and developed

abdominal pain and sweating, how will you assign codes?

Ans: pdx: poisoning code and abdominal pain and sweating as secondary dx.

13. Adverse effect vs Underdosing:

Adverse Effect – Take a drug, but it will not harmful to life.

 Underdosing – taken a drug quantity less than actual quantity prescribed.

 If adverse effect and underdosing code adverse effect as primary, while underdosing
it as secondary code.

14. covid and pneumonia given?

Ans: U07.1 and J12.82.

15. What is meant by parenteral medication?

Ans: The parenteral route of drug delivery includes four types: subcutaneous,

intramuscular, intravenous, and intrathecal administration.

16. Underdose of insulin due to insulin pump failure:

Ans: An underdose of insulin due to an insulin pump failure should be assigned to a code

from subcategory

*T85.6, Mechanical complication of other specified internal and external prosthetic

devices, implants, and grafts, that specifies the type of pump malfunction, as the

principal or first-listed code,

*Followed by code T38.3X6-, Underdosing of insulin and oral hypoglycaemic

[antidiabetic] drugs. *Additional codes for the type of diabetes

17. Neoplasm guidelines:

Ans: if patient getting any therapy for cancer, we will code it as current condition.

If patient is having cancer in past and there is no ongoing therapy will code it as Z-series.

Types : Malignant, Benign, carcinoma in-situ, Uncertain and unspecified cancer.

CPT
1. Joint Injections?
Joint injections are arthrocentesis – aspiring the fluid from join are called arthrocentesis.
Arthrocentesis cpt codes are based on these we have different codes.
Small Joints (toes, fingers),
Intermediate Joints (Wrist, elbow, ankle),
Large Joint- (Shoulder, Hip, Knee)
2. Global Period: Period of time during which all the necessary services normally furnished by
surgeon (before, during, after procedure) are included in the reimbursement for the
procedure performed.
Global surgical packages: minor (0-10 days) , major ( 0-90 days)

3. Trigger Point Injection:

 Trigger point injections are given to muscle to relax muscle and relieve pains.
 Based of number of muscles we have codes.20552- for 1or 2 muscle ,20553 3 or
more muscle.
4. Incision & Drainage:
For coding I&d - Incised with 11 blade scalpel is needed , we have keywords simple vs
complex
 Simple – single incision, cyst found – 10060
 Complex—Multiple incision, complex, Drained Placement, probed broken up
loculations, Extensive packing. – 10061.
5. Laceration repair types: 3 types of laceration
 Simple – keywords like – simple, Dermabond, running sutures, closure layer1,
wound is superficial.
 Intermediate – Keywords like – Extensive cleaning, layered closure, closure layer 2
or3, subcutaneous tissue, foreign body removal found.
 Complex-keywords like -Extensive debridement, closure layer morethan3, Deep
cut, Complex
 Codable sutures – surgiceal, nylon-o, ethylon, Dermabond, skin adhesives
 Non codable sutures --- surgicel, mastisol, sterri-stripes
6. Splint types:
Static splint – non movable splints
dynamic splints – non movable splints
4 splints are – short arm, long arm, short leg, long leg
 Codable sutures – custom
 Non codable suture – non custom
7. Burns cpt coding:
 First degree burn – ointment applied -16000
 Second degree burn – ointment applied + dressing – we have 2 codes based on
TBSA -if 0-5% - 16020
If – 5-10% - 16025
 Third degree burn- Ointment applied + dressing + debridement -16030 if TBSA
greater than 10 %
8. Epistaxis:
 For coding epistaxis will check for packing word
 Simple epistaxis – packings are – rhino hockets, suction, nasal compressions
 Complex epistaxis – packings are – balloon method, , silver nitrides
 We have anterior and posterior – based on document will give appropriate cpt
codes
 Simple – anterior – 30901, posterior – simple -30905
 Complex – anterior -30903, posterior- complex -30906
9. Foley catheter guidelines:
  Foley irrigation – 51700
 Permanent / non indwelling /straight catheter – 51701
 Temporary / indwelling - 51702
 Bladder scan – 51798

10. What is central line placement?
 this is performed in an X-ray room by radiologist to insert a tube into a vein to send
fluids, medications, blood inside the patient to make quick treatment.
 Cpt code – 36556 (less than 5 years)
 Cpt code – 36555 (greater than 5 years)

11. Intraosseous placement:

IO is an injection placed into bone at tibia to send fluids, blood, medication to patient

12. Critical care:

 Critical care is for critically injured cases or life-threatening conditions will treat for
critical care.
 Critical care conditions are – anemia, sepsis, respiratory failures, circulatory failure
cases
 Timings for CC – 99291 – 30 to 74 minutes and 99292 – 75 to 104 minutes.

13. Bundled and non-bundled procedures for critical care:

 Bundled Procedures: we should not these cpt along with critical care - Chest-X-
ray, ventilator management, gastric intubation, vascular procedures.
 Non-Bundled Procedures: we should not these cpt along with critical care -
Cpr, Et intubation, IO, Central line placement, tube thoracostomy.

14. Hierarchy of Infusions and injections:

 Chemotherapy, Infusion, Injection, Hydration, Intramuscular,
Vaccination
15. HII Timings:
Infusion – time gap min 16 minutes to code

96365- Initial code

96366 – Same drug
96367- different drug
96368 – concurrent infusion -2 different drugs infused same time same site

iv push/ Injection – less than or equal 15 minutes

96374 – initial drug

96375 – different drug
96376 – same drug

Hydration – time gap of 31 minutes

 96360 – initial
96361 – add on hour

Intramuscular – 96372
Vaccination – 90471

16. Nail procedures:

11730 – avulsion of nail plate / removal of nail bed

11740 – subungual hematoma

11750 – excision of nail matrix partial/complete.

11765 – ingrown toe nail

11760 – repair of nail bed

17. Cardioversion:
 It is medical procedure used for restore regular heart rhythms.
 Chemical cardioversion – uses medications that can relax an overactive heart
 Electrical cardioversion – uses one or more electric shocks to heart.
 We code electrical cardioversion Only – cpt code -92960 (External),
92961(Internal).

Drugs to use cardioversions: Adenosine, metoprolol, Quinidine, sotalol

18. Moderate Sedation:

 It is drug given to a patient during surgery time to make patient asleep and
relief from pain.
 Time to code moderate sedation is minimum 15 minutes

Moderate sedation performed by same physician following codes

 99151 – for initial 15 minutes – age less than 5 years

 99152 – for initial 15 minutes – age greater than 5 years
 99153 – add on code for every 15 minutes

Moderate sedation performed by different physician following codes

 99155 – for initial 15 minutes – age less than 5 years

 99156 – for initial 15 minutes – age greater than 5 years
 99157 – add on code for every 15 minutes

Ex: same physician means: if reduction procedure and moderate sedation given during
procedure by same physician.

Different physician means: if reduction procedure done one physician and moderate
sedation given by different physician code it as different physician.

19. Do you code nebulizers?

 Ans: NO, we are not coding nebulizers.

LEVELS
1. Contrast: a substance taken by mouth or injected into an intravenous (IV) line
that causes the Particular organ or tissue under study to be seen more clearly
Ahima Guidelines: in most of the interviews they are asking these questions.

1. CT with contrast - 99285

2. Ct without contrast – 99284
3. 1 Lab + x-ray + EKG – 99283
4. 2 Lab + X-ray + EKG – 99284
5. 3 Lab + X-ray + EKG – 99285
6. 2 X-ray (multiple body area) - 99284
7. 3 X-ray – 99285
8. Parenteral medication – 99284
9. CT combined with Parenteral medication – 99285
10. Discharge disposition: simple-99282
11. Simple fractures: 99282
12. Discharge disposition: Moderate(complexity) – 99283
13. Discharge disposition: complex -99284

Modifiers

What are ED facility Modifiers your codes?

Ans: 50,52,59,76,77, LT, RT, finger modifiers, toes modifiers.

 50 – Bilateral
 52 – Reduced services: if any procedure is unsuccessful, we will add 52 modifiers to
cpt code.
 59 – distinct procedures.
Ex: laceration repair and incision and drainage. Append 59 to I&D
 Ex: bed side ultrasound and Ekg done.59 modifier to EKG
Ex: 99285 level and intramuscular96372.will give 59 to intramuscular.

 76- repeated EKG done by same physician done on same day, we will assign 76
modifiers to second EKG. Ex: 93010, 93010-76
 77- repeated EKG done by different physician done on same day, we will assign 77
modifiers to second EKG. Ex: 93010, 93010-77.
** linking diagnosis for EKG are Abnormal Ekg , Htn, Old MI

What is E&M modifiers? 24, 25, 57

 24 – unrelated E&M services done by same physician during post operative period.
Ex: Laceration repair done 5 days ago, now patient came for otitis media- which unrelated to
previous surgery we will assign 24 modifier to E&M service.
 25 -- Both E&M (99281-99285) and Non E&M (1 to 6 series) services done by same physician
on same day we will assign 25 modifier to E&M services.
Ex: level – 99285 and splint application done. We will assign 25 modifier to 99285
 57 – decision for major type of surgery -within24 hrs surgery has to do
Ex: pt visited hospital for abdominal pain, physician decided to do appendectomy surgery.