Coding and Billing Practium

Competency Assessment CMS-1500 Claim Form

Patient Information:

William C. Franklin, married 1257 Janes Street Milton, XY 12345 555-752-0978 B.D. 7-3-24 Medicare

Insurance Information:
WPS Medicare Part B, ID# 2385577B
Claims Processing
P.O. Box 555
Marion, IL 62959-0967

Practice Information:
James L. Henry, M.D., P.C.
2865 West Pine Circle
Milton, XY 12345-2222
(555) 799-6457
EIN #27-5257042
CLIA #36D95403186
NPI #3928042759

Case Scenario:

1-22-YY Established patient, William, presents with left hip and knee pain.

He is a known smoker, past history of right knee arthroplasty.
History is expanded problem focused.

Exam is problem focused to musculoskeletal system.

X-rays of the left hip and knee were performed in the office today, two films each. Medical decision making is moderate.

Diagnoses: Degenerative osteoarthritis of hip and knee.

1. What CPT/HCPCS code(s) would be assigned (E/M fee is $100.00, x-rays $33.00 each)?
2. What ICD-10-CM Primary/first-listed diagnosis would be assigned?
3. Are there any secondary diagnoses to assign?