Module 10 - Quality Review of Coded Data Fill in the blank: 1. What is the government’s audit plan called? ______________________________ Instructions: Following are excerpts from three CMS-1500 billing forms. In each problem, compare the visit note to the CMS-1500 to detect the CPT coding error(s) and supply the correct coding assignment. (The ICD-9-CM codes are provided for reference only.) 2. CMS-1500 Question #1—Visit Note CC—Eye pain S—This new patient comes in with his right eye red and mattering for the last day. He wears contacts and has them in at this time. He has no sore throat, no stuffy nose, and no temperature, earaches, or coughing. He is currently on no medication and is not allergic to any medication. He also is concerned about a wart on his hand. O—He is in no acute distress. Vital signs are normal. TMs look okay. Pharynx was good. Pupils equal, round, react to light and accommodation. No evidence of any iritis. Bulbar conjunctivae of the right eye is red. Some mattering is noted on the right side; left eye looks okay. Right hand shows a wart at the base of thumb. A—Right eye conjunctivitis, wart on right hand P—Liquid nitrogen was applied to the wart. Retreat in about seven to ten days, if necessary. Will treat the conjunctivitis by removing contacts and wearing only regular eyeglasses for at least one week. Started on Gentamycin Ophthalmic, one to two drops in the eye, four times a day, warm compresses to the eye. Be careful not to infect the left eye. Sterilize the contacts before putting them back into the eyes. He will return for retreatment of the wart or sooner if he has any further problem with his eye. He will schedule a baseline physical exam within the next month. CMS-1500 #1: 21. Diagnosis or nature of illness or injury 1. 372.30 (Conjunctivitis) 3. ______ 2. 078.10 (Wart) 4. ______ 24 CPT/HCPCS Dx 99202 17340–25 1 2 Correct codes: _____________________ 3. CMS-1500 Question #2—Visit Note CC—Sore throat S—This 15-year-old male is brought in with a sore throat and sinus congestion. He has been running a slight fever since yesterday and has had severe ear pain since last night. He has had a nonproductive cough for three days, and today he woke up feeling nauseous and then he vomited. He vomited here at the office today. O—He is alert, in no acute distress. Temperature is 97.2, pulse is 74, respirations are 18, blood pressure is 102/72. His right ear is clear. Left ear has loss of light reflex, and is erythematous and bulging. Both TMs show evidence of otosclerosis, which is old. Nose is congested. Pharynx shows some erythema on the left side. Neck is supple. Lungs are clear. Heart regular rate and rhythm. Abdomen is soft, nontender. Rapid strep test is negative, but a throat culture was obtained for verification. A—Otitis media and pharyngitis P—Patient was put on Septra DS one, po b.i.d. He is to use Tylenol as needed for pain and fever. He is to .

1. Module 10 - Quality Review of Coded Data
Fill in the blank:
1. What is the government’s audit plan called?
______________________________
Instructions: Following are excerpts from three CMS-1500
billing forms. In each problem, compare the visit note to the
CMS-1500 to detect the CPT coding error(s) and supply the
correct coding assignment. (The ICD-9-CM codes are provided
for reference only.)
2. CMS-1500 Question #1—Visit Note
CC—Eye pain
S—This new patient comes in with his right eye red and
mattering for the last day. He wears contacts and has them in at
this time. He has no sore throat, no stuffy nose, and no
temperature, earaches, or coughing. He is currently on no
medication and is not allergic to any medication. He also is
concerned about a wart on his hand.

2. O—He is in no acute distress. Vital signs are normal. TMs look
okay. Pharynx was good. Pupils equal, round, react to light and
accommodation. No evidence of any iritis. Bulbar conjunctivae
of the right eye is red. Some mattering is noted on the right
side; left eye looks okay. Right hand shows a wart at the base of
thumb.
A—Right eye conjunctivitis, wart on right hand
P—Liquid nitrogen was applied to the wart. Retreat in about
seven to ten days, if necessary. Will treat the conjunctivitis by
removing contacts and wearing only regular eyeglasses for at
least one week. Started on Gentamycin Ophthalmic, one to two
drops in the eye, four times a day, warm compresses to the eye.
Be careful not to infect the left eye. Sterilize the contacts before
putting them back into the eyes. He will return for retreatment
of the wart or sooner if he has any further problem with his eye.
He will schedule a baseline physical exam within the next
month.
CMS-1500 #1:
21. Diagnosis or nature of illness or injury
1. 372.30 (Conjunctivitis)
3. ______
2. 078.10 (Wart)
4. ______
24

3. CPT/HCPCS
Dx
99202
17340–25
1
2
Correct codes:
_____________________
3. CMS-1500 Question #2—Visit Note
CC—Sore throat
S—This 15-year-old male is brought in with a sore throat and
sinus congestion. He has been running a slight fever since
yesterday and has had severe ear pain since last night. He has
had a nonproductive cough for three days, and today he woke up
feeling nauseous and then he vomited. He vomited here at the
office today.
O—He is alert, in no acute distress. Temperature is 97.2, pulse
is 74, respirations are 18, blood pressure is 102/72. His right ear
is clear. Left ear has loss of light reflex, and is erythematous

4. and bulging. Both TMs show evidence of otosclerosis, which is
old. Nose is congested. Pharynx shows some erythema on the
left side. Neck is supple. Lungs are clear. Heart regular rate and
rhythm. Abdomen is soft, nontender. Rapid strep test is
negative, but a throat culture was obtained for verification.
A—Otitis media and pharyngitis
P—Patient was put on Septra DS one, po b.i.d. He is to use
Tylenol as needed for pain and fever. He is to follow up if he
does not have complete resolution but should be followed up in
any case for reevaluation of the ear after completion of the
medication. Otherwise, he will be seen as needed.
CMS-1500 #2:
21. Diagnosis or nature of illness or injury
1. 382.9 (Otitis media)
3. ______
2. 462 (Pharyngitis)
4. ______
24
CPT/HCPCS
Dx

5. 99213
87880
87040
2
2
2
Correct codes:
_____________________
4. CMS-1500 Question #3—Outpatient Procedure
Note
CC—Sebaceous cyst
Indication:
The patient has had a few infectious processes of cysts on the
neck. He is a patient of Dr. Johnson, who sends him for excision
of the most recent cyst today.
Pleasant male in no distress. A 0.5 cm sebaceous cyst is evident
on the neck. No drainage. No inflammation at this time. The
area is washed with iodine and alcohol. Injected with 2%
Lidocaine plain. An ellipse of skin was taken overlying the area
of the cyst. The cyst was taken intact. Good hemostasis was
provided with electrocautery. The skin was then approximated

6. with 3-0 Vicryl in a vertical mattress form. Three stitches were
placed. The area was washed with peroxide and water, dried,
dressed with Telfa and Tegaderm, and a 2
×
2 gauze was added for pressure effect.
Procedure Performed:
Excision of sebaceous cyst from the neck
The patient was given written and verbal wound instructions.
Treat with ice and pressure at home today. Call with any
difficulties with bleeding. Otherwise, follow back in two weeks
for suture removal.
CMS-1500 #3:
21. Diagnosis or nature of illness or injury
1. __706.2__ (Cyst)
3. _____
2. ________
4. ______
24
CPT/HCPCS
Dx

7. 99212–25
11420
1
1
Correct codes:
_____________________