SAMPLE CPC MODEL TEST - 001

                                                                       

1.     Code the excision of a benign lesion located on the face having a diameter including margins of 2.5 cmand one neck lesion with 6.75 cm, including margins. First lesion being performed as layered closure

a) 12051, 11426, 11443-59

b) 11426, 11443-51, 12051-51

c) 11621-11643-51

d) 11643, 11621-59

2.     Excision of malignant skin lesions was being performed. The first lesion was located on the trunk and measured 2.1 cm. The second lesion was located on the face and measured 3.0 cm. A third lesion was located in the scalp and measured 3.5 cm. the measurements are based on diameter and include margins.Code these services and diagnoses.

a) 11624, 11643-51, 11603-51

b) 11643, 11642, 11603

c) 11642, 11643-51, 11603-51

d) 11624, 11643, 11603

3.     Patient presents to the emergency department with multiple lacerations due to a knife fight at the local bar. After examination it was determined these lacerations could be closed using local anesthesia. The areas were prepped and draped in the usual sterile fashion. The surgeon documented the following closures: 7.6 cm simple closure of the right forearm; 5.7 cm intermediate closure of the upper right arm; 4.7 cm complex closure of the right neck; 10.3 cm intermediate closure of the upper chest. What CPT® codes are reported?

a)      13132, 12035-59, 12004-59

b)     13152, 12035-59, 12004-59

c)      13132, 12036-59

d)     13132, 12034-59, 12032-59,12004-59

4.     Patient presents with a vertical 4 cm scar on the lateral border of her right elbow. The patient complains that the scar contraction limits their range of flexion and wishes to have it removed and corrected surgically. The surgical site is prepped with Betadine and sterile drapes are applied. Two arms are drawn at each end of the linear scar, inscribing an angle of 60 degrees to the scar. The side arms are exactly equal in length to the central scar and have precisely the same angle. Local anesthesia is administered. The physician then makes two vertical incisions through the skin along the lines, using a no.15 scalpel blade and excises the vertical scar tissue. Full thickness skin flaps are undermined at the level of subcutaneous fat, creating two triangular flaps of equal size and shape (Z-plasty) for 10sq cm. Adequate undermining of surrounding subcutaneous tissue is performed to achieve proper mobilization of the flaps. The two flaps are then transposed around each other changing the direction of the original scar. The flaps are held in place internally with a few anchoring stitches. The skin is closed using interrupted sutures. Topical antibiotics and a pressure dressing are applied and the patient is told to return in two weeks fro suture removal. What is the correct code(s)?

a) 14020

b) 11406, 12032

c) 12032

d) 14020, 12032

5.     Code the CPT and ICD-10Procedural Codes for the Op Report Below

DIAGNOSIS: Macromastia. ANESTHESIA: General OPERATION: McKissock reduction mammoplasty, inferior pedicle only.

PROCEDURE: Under adequate general anesthesia, the breasts were prepped and draped in a routine fashion and injected with 0.5% Xylocaine with 1:200,000 epinephrine to aid in hemostasis. The patient’s breasts had been marked for standard McKissock reduction mammoplasty preoperatively with the patient in the sitting position. The right breast was operated upon first, and a standard McKissock reduction mammoplasty was carried out, creating medial and lateral flaps and excising medial and lateral triangles. The nipple was supported with an inferior pedicle approximately 10 cm. in width. Good viability of the nipple was present at the termination of dissection. Approximately 1,000 grams of breast tissue was removed from the left breast, and 1,000 grams from the right breast. The patient’s wounds were closed with clear and black nylon fine sutures. Sterile dressings were applied, and the patient returned to the recovery room in satisfactory condition with a bra in place. Both breasts were operated upon in equal fashion. No drains were placed.There were no complications.

a) 19318

b) 19318-51

c) 19318-50

d) 19324

6.     The patient is a 32-year-old female who was discovered to have breast cancer on the right side. She was treated with mastectomy followed by chemotherapy and radiation therapy. She now elects to proceed with reconstruction by TRAM flap. Code for the reconstruction.

a)      19364

b)     19361

c)      19316

d)     19367

7.     Operative Report: Excision lesion on right shoulder, 2.5 x 1.0 x .5 cm. The 3 cm defect was closed in layers. Excision, skin of left cheek, 1.0 x 1.0 x .5. 1.5 cm laceration was closed primarily. Pathology report states that the skin lesion on the right shoulder is a lipoma and the lesion on the left cheek is a squamous cell carcinoma.

a)      11641, 11403-51, 12032-51

b)     11403, 11441-51

c)       11603, 11641-51, 12031-51

d)     11643, 12031-51

8.     Patient came with multiple lesions. It was diagnosed as Actinickeratoses. Dr. Jerry performed destruction of 7 lesions in neck, 5 lesions in right hand and 6 lesions in left wrist. What CPT codes will be reported for this service?

a) 17000, 17003 X 17

b) 17004

c) 17004 X 17

d) 17000, 17004 X 17

9.     Indication: Patient has a hypertrophic scar on the posterior side of the left leg at the level of the knee. This has begun to restrict his mobility. Physical therapy trial was unsuccessful. Procedure: After the proper induction of anesthesia, the subcutaneous tissue of the patient’s left leg beneath the scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was then excised down to viable dermis. Hemostasis was obtained with epinephrine soaked pads. Skin was harvested from the patient’s thigh in a split thickness fashion and was used to cover the 90 sq cm defect created by the surgery. The graft was secured with skin staples and then dressed with fine mesh gauze followed by medication-soaked gauze. The donor site was dressed with mesh followed by Adaptic, followed by a dry dressing and an Ace wrap.

a) 15110-52, 15002

b) 15100, 11406

c) 15100, 15002

d) 15110, 15002

10. A male patient presents for bilateral mastectomy with a diagnosis of gynecomastia. Choose the correct procedure and diagnosis codes.

a.19303 x 2, N64.89

b. 19301-50, N64.2

c. 19300-50, N62

d. 19304 x 2, N62

11. 64 year old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with 6-0 Prolene sutures. The arm and leg were repaired by 6-0 Vicryl subcutaneous sutures and prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit.

a) 12014, 12034-51, 12002-51, 11041-51

b) 12053, 12034-51, 12002-51

c) 12014, 12034-51, 11041-51

d) 12053, 12034-51

12. Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area of skin where the excisions of the tumor will be performed using Mohs micrographic surgery technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue blocks which were also cut and stained for microscopic examination. The entire base and margins of the excised pieces of tissue were examined by the surgeon. No tumor was identified after the final stage of the microscopically controlled surgery. What procedure codes should be reported?

a) 17313, 17314 x 2

b) 17313, 17315

c) 17260, 17313, 17314

d) 17313,17314, 17315

13. What code would you use if the physician performs FNA using U/S guidance.

a) 10021

b) 10022

c) 10022, 76942-26

d) 10022, 76942

14. 24 yearsold patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT code is,

a)      56405

b)     10060

c)      11004

d)     11042

15. How should you code an excision of a lesion when completed with an adjacent tissue transfer or

rearrangement?

a)      The excision is always reported in addition to the adjacent tissue transfer or rearrangement.

b)     The excision is not separately reported with adjacent tissue transfer or rearrangement codes.

c)      Code only malignant lesions in addition to the adjacent tissue transfer or rearrangement codes.

d)     Code the lesion with a modifier -51 and code in addition to the adjacent tissue transfer or rearrangement codes

16. Patient presents to the physician for removal of a squamous cell carcinoma of the right cheek. After the area being prepped and draped in a sterile fashion the surgeon measured the lesion, documenting the size of the lesion to be 2.3 cm in its largest diameter. Additionally, the physician took margins of 2 mm on each side of the lesion.  Single layer closure was performed. The patient tolerated the procedure well. What CPT® code(s) is/are reported?

a)      11442

b)     11643

c)      11643, 12013

d)     11642, 12013

17. INDICATIONS FOR SURGERY: The patient is an 82 year-old white male with biopsy-proven basal cell carcinoma of his right lower eyelid extending to the upper part of the cheek. I marked the area for rhomboidal excision and I drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the surgery and agreed on the location and we proceeded.
DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was achieved using Bovie cautery. Modified Mohs analysis showed the margin to be clear. I incised the rhomboid flap as drawn and elevated the flap with a full-thickness of subcutaneous fat. Hemostasis was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap was rotated into the defect. The donor site was closed and flap inset in layers using 5-0 Monocryl and 6-0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm.What CPT® code(s) should be reported?

a)      14060, 11643

b)     14040, 14060

c)      11643

d)     14060

18. Adjacent tissue transfer, trunk, 8 sq.cm. Give the appropriate code.

a) 15002

b) 15101

c) 15220

d) 14000

19. A patient has six wounds repaired. Three wounds 2 cm of the scalp, 3.5 cm on the leg and 1.5 cm on the face require simple repairs. Two more wounds 1 cm on the foot and 3 cm on the hand require layered closures. The final procedure is a complex repair 5 cm on the ear. Code these repairs and list them according to complexity.

a) 13152, 12042-51, 12002-51, 12011-51

b) 12052, 12041-51, 12042-51, 12001-51, 12011-51, 12002-51

c) 12052, 12002-51, 12041-51, 12011-51, 12002-51, 12001-51

d) 12042, 12002-51, 12011-51, 13152-51

20. The frozen section pathology after 1.5 cm malignant melanoma lesion showed positive margins, so an additional excision for 2.5 cm was done in the post operative period of the initial procedure. How will you code the second re-excision procedure

a) 11602-58

b) 11603

c) 11603-58

d) 11606

21. Barry underwent a complex incision and drainage due to a postoperative wound infection, which required an extensive secondary closure of the surgical site. Which codes describe this procedure?

a) 13160, 10081-59

b) 10121, 12020-51

c)13160, 10180-51

d) 10061, 12021-59

22. Two malignant lesions on the scalp measuring 1.1 cm and one malignant lesion on the neck measuring 2.2 cm were destroyed. Electrocautery was used for the first two lesions and laser was used for the third lesion. What procedure code(s) is/ are reported?

a)      17276

b)     17273, 17272-51

c)      17273, 17272-51, 17272-51

d)     17274, 17273-51

23. Dr. Alexis completed Mohs surgery on Ralph’s left arm. She reported routine stains on all slides, mapping, and color coding of specimens. The procedure was accomplished in three stages with a total of seven blocks in the second stage. How would you report Dr. Alexis’ services?

a. 17313, 17314-58, 17315-59, 88314-59

b. 17311, 17312 x 7

c. 17313, 17314 x 2, 17315 x 2

d. 17311, 88302, 17314 x 3, 17312 x 7

24. A patient presents with a recurrent seborrheic keratosis of the left cheek. The area was marked for a shave removal. The area was infiltrated with local anesthetic, prepped and draped in a sterile fashion. The lesion measuring 1.8 cm was shaved using an 11-blade. Meticulous hemostasis was achieved using light pressure. The specimen was sent for permanent pathology. The patient tolerated the procedure well. What CPT® code is reported?

a)      11442

b)     11642

c)      11312

d)     11200

25. The patient has a suspicious lesion of the left jaw line. Clinical diagnosis of this lesion is unknown, but due to the appearance, malignancy is a realistic concern. The lesion was excised into the subcutaneous fat measuring 0.8 cm and margins of 0.1 cm on each side. Hemostasis was achieved using light pressure. The wound was closed in layers using 5.0 Monocryl and 6.0 Prolene. Pathology revealed a nevus with clear margins.  What CPT® and ICD-10-CM codes are reported?

a)      12051, 11641-51, D22.39

b)     12051, 11441-51, D22.39

c)      13131, 11441-51, C44.309

d)     13131, 11441-51, D49.2

26. The provider trims non-dystrophic nails on the right hand (five fingers) and the left hand (two fingers), with debridement of the same fingers. Proper coding is:

a)      11719, 11721

b)     11719, 11721-59

c)      11719, 11721-51

d)     11721

27. Meredith has breast cancer on the left side, diagnosed by an excisional biopsy performed last week. Today she is having a radical mastectomy, Urban type, and concurrently a single pedicle TRAM flap reconstruction with supercharging. What CPT® codes are reported?

a. 19367-LT, 19302-51-LT

b. 19368-LT, 19305-51-LT

c. 19368-LT, 19306-51-LT

d. 19367-LT, 19307-51-LT

28. Patient is an 81 year-old male with a biopsy-proven basal cell carcinoma of the posterior neck just near his hairline; additionally, the patient had two other areas of concern on his cheek. Informed consent was obtained and the areas were prepped and draped in the usual sterile fashion. Attention was first directed to the basal cell carcinoma of the neck. I excised the lesion measuring 2.6 cm as drawn down to the subcutaneous fat. With extensive undermining of the wound I closed it in layers using 4.0 Monocryl, 5.0 Prolene and 6.0 Prolene; the wound measured 4.5cm. Attention was then directed to the other two suspicious lesions on his cheek. After administering local anesthesia, I proceeded to take a 3mm punch biopsy of each lesion and was able to close with 5.0 Prolene. The patient tolerated the procedures well. Pathology later showed the basal cell carcinoma was completely removed and the biopsies indicated actinic keratosis. What CPT® codes should be reported?

a. 13131, 11622-51, 11100-59, 11100-59

b. 12042, 11623-51, 11100-59, 11101

c. 13132, 11623-51, 11100-59, 11101

d. 13132, 11623-51, 11440-51, 11440-51

29. The MRI shows full- thickness tear of the right rotator cuff consistent with Mr. John’s acute symptoms. The symptoms began when he slipped and fell on the ice Thursday?

a)      S46.001A, W00.0XXA

b)     M66.20, W00.0XXA

c)      M75.121, W00.0XXA

d)     S46.011A, W00.0XXA

30. The patient’s dense breast tissue made the mammogram unreadable and she is here today for a breast ultrasound. Her mother and sister both have a history of breast cancer. What codes are reported for the diagnosis?

A.     N60.89, Z80.3

B.      N12.39, N64.59, Z80.3

C.      Z12.39, R92.2, Z80.3

D.     Z12.31, R92.2, Z83.3

31. A 30-year-old is brought into the burn unit with burns covering 30 % of his total body. He has third degree burns to his chest wall (10%). Second degree burns on his arm and both legs (15%), and first degree burns on his face (5%) What ICD 10 CM codes are reported for the burn?

a)      T21.30XA, T22.239A, T24.231A, T24.232A, T20.10XA

b)     T30.0, T21.60XA, T30.4

c)      T21.31XA, T22.20XA, T24.201A, T24.202A, T20.10XA, T31.31

d)     T20.10XA, T22.20XA, T21.31XA, T24.201A, T23.202A, T31.31

32. SIRS with acute respiratory failure due to bacterial meningitis. ____

a) G00.9, J96.00

b) R65.11, G00.8

c) G00.9, R65.11, J96.00

d) G00.9, R65.20, J96.00

33.  Tina was treated at her doctor’s office for warts on her hands. _____

a) B07.9

b) B07.8

c) B07.0

d) L82.1

34. A 35-year-old female returns to her primary care provider for follow up of an upper respiratory infection diagnosed the previous week. Her condition has not improved and her cough has increased. She has a long history of smoking and currently smokes one pack a day. She uses a bronchodilator for her simple chronic bronchitis which is caused by her smoking history. The physician changes her antibiotics to treat both her simple chronic and acute bronchitis. Provide the diagnosis code(s) for this visit.

A. J44.9, Z72.0

B. J20.9, J41.0, Z72.0

C. J20.9, Z72.0

D. J20.9, J42, Z72.0

35. Mr. Jones is here today to receive an intercostal nerve block to mitigate the debilitating pain of his malignancy. His treatment is for the cancer that has metastasized to his right lung. Select the appropriate ICD-10-CM codes.

A. G89.3, C78.01

B. C34.91, G89.3

C. G89.3, C34.91

D. C78.01, G89.3

36. 32-year-old delivered a baby girl one week ago via cesarean section. She is in the obstetrician’s office with complaint of her cesarean wound bleeding. The wound is cleaned and a small hematoma removed. The edges are pulled with steri-strips, and a clean dressing is applied. What ICD-10-CM code should be reported?

A. L76.02

B. O90.1

C. O90.2

D. O82

37. 55-year-old female presents to the office with ongoing history of diabetes which has been controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetes on her left great toe. Patient is recommended to see a general surgeon for treatment of the gangrene on her left great toe. Select the diagnosis codes to report.

a)      E10.610, Z79.4 

b)     E11.52, Z79.4

c)      E10.52, Z79.2

d)     E11.610, Z79.2

38. A 44-year-old male was spraying weeds in his backyard. He accidentally got some of the weed killer in his ice tea. After drinking the ice tea and working for several hours, he told his wife he felt “funny” and started to vomit. She drove him to the emergency room for treatment. How would you report this scenario?  

a. T60.8x1A, R11.2, T60.1x1A

b. T60.8x1A, R11.10, T60.3x1A

c. R11.2, T60.3x2A, T60.2x4A

d. T60.8x1A, R11.10  

39. A 25 year-old is brought to the burn unit being rescued from a burning house. She sustained 25% second degree burns on her anterior trunk and back and 20% third degree burns on her legs and arms. Total body surface area burned is 45%. What ICD-10-CM code is reported for the burns classified according to the extent of body surface involved?

A. T31.22                        B. T32.42                    C. T31.24                    D. T31.42

40. This 5 year-old child is seen by her peditrician for cough, sore throat, chills and fever.  The patient tested positive for H1N1 virus. What code(s) would be used to report this encounter?

a)      J10.1

b)     J11.1

c)      J10.1, R05, J02.9, R50.9

d)     J11.1, R05, J02.9, R50.9

41. Sarcoidosis with cardiomyopathy.

a) D86.9,J99

b) D86.9, I43

c) I43, D86.9

d) D86.9, I43, V71.7

42. An unlisted CPT code may be reported when no other code accurately describes the procedure or service. The AMA however, instructs coders to report another type of code in the place of the unlisted code when appropriate. What is the other type of code?

                A.     category II code

                B.      category III code

                C.      ICD-10-CM Volume III code

                D.     category I code and modifier 59

43. When using the CPT index to locate procedures, which of the following are considered primary classes for main entries?

                  A.     Procedure or service; organ or other anatomic site; condition; synonyms,                                   eponyms, and abbreviations

                  B.      Abbreviations; signs and symptoms, anatomic site; and code assignment

                  C.      Conventions; code ranges; modifying terms

                  D.     Procedure or service; modifiers; clinical examples; and definitions

44. Definition for supervision and interpretation is included in

                    A.     Surgery guidelines

                    B.      Radiology guidelines

                    C.      E/M guidelines

                    D.     Anesthesia guidelines

45. ——————– is utilized to allow placement of related concepts in appropriate locations within the families of codes regardless of the availability of numbers for sequential numerical placement.

A.     Recycling

B.      Resequencing

C.      Deleting

D.     Unlisted codes