1. 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 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, 11740
C.
15100, 15002
D.
15110, 15100
2. The physician is called in to perform repairs for a 17
- year-old girl involved in a motor vehicle accident. She sustained an 8.6 cm
laceration to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm laceration
to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm laceration
to her chest. The wound on her chin required a layered closure. All other
wounds required complex closure.
A.
13132, 13133 x 4, 13101, 12052
B.
13132, 13133 x 13133-52, 13101, 13102, 12052
C.
13132, 13133 x 3, 13101, 13102, 12052
D.
13131, 13132, 13133 x 3x 13101, 13102, 12052
3. A 36-year-old male pr4esents to have multiple lesions
destroyed. Three benign lesions on his face are destroyed and five actinic
keratoses on his left arm are destroyed. Code for the procedures.
A.
17000, 17003
B.
17000, 17003 x 4, 17110
C.
17110
D.
17280 x 5, 17000,17003
4. A 15-year-old boy was burned in a fire and assessed to
have received burns to 75 percent of his total body surface area. He was
transferred to a burn center for definitive treatment. Once stable, he was
brought to the OR. Procedure: Due to extent of the patient’s burns and lack of
sufficient donor sites, his full- thickness burns with be excised and covered
with porcine grafts and a split-thickness skin biopsy will be harvested for
preparation of autologous grafts to be applied in the coming weeks when
available. After induction of anesthesia, extensive debridement of the
full-thickness burns was undertaken. Attention was first directed to the
patient’s face neck, and scalp. A total of 500 sq cm in this area received
full-thickness burns. The eschar involving this area was excised down to viable
tissue. Hemostasis was achieved. Attention was then turned to the trunk. A
total of 950 sq cm in this area received full-thickness burns. The eschar
involving this area was excised down to viable tissue. Hemostasis was achieved.
Attention was then turned to the arms and legs. A total of 725 sq cm received
full-thickness burns, The eschar involving this area was excised down to viable
tissue. Hemostasis was achieved. Attention was then turned to the hands and
feet. A total of 300 sq cm in this area received full-thickness burns. The
eschar involving this area was excised down to viable tissue. All involved
areas were then covered with porcine graft. Finally a split thickness skin
graft of 0.015 inches in depth was harvested using a dermatome from a separate
donor site. A total of 85 sq cm was recovered. What procedures codes would be
reported service?
A.
15200, 15201 x 46, 15220, 15221x 35, 15240, 15241 x 40, 15002, 15003 x 16,
15004, 15005 x7
B.
15273, 15274 x 7, 15277, 15278 x 16, 15004, 15005 x 16, 15002, 15003 x 7
C.
15277, 15278 x 7, 15273, 15274 x16, 15004, 15005x7, 15002, 15003x16, 15040
D.
15275, 15276 x7, 15271, 15272x 16, 15004, 15005 x7, 15002, 15003x16
5. The left breast was prepped and draped in a sterile
fashion. An incision from the 3 around to the 9 o’clock position on the areolar
border on its inferior aspect was made in the skin a extended to the
subcutaneous tissue. The breast mass was excised by sharp dissection. The mass
was found to be approximately 1.5 - 2 cm in maximum dimension. Hemostasis was
made adequate using electrocautery and Argon beam coagulator. After this was accomplished,
the skin margins were reapproximated with running inverted 3-0 Vicryl
subcuticular suture. Select the procedure codes.
A.
19120
B.
19301
C.
19125
D.
19101
6. This 37- year-old paraplegic has developed a sacral
decubitus ulcer. He is brought to the OR today for debridement of the pressure
ulcer with a split-thickness skin graft to cover the defect. The patient was
placed prone on the operative table after induction of adequate endotracheal
anesthesia. The sacral area was prepped and draped sterilely, and the ulcer is
inspected. The area id debrided extensively to healthy tissue. Involved bone,
including part of the coccyx, was also removed. Once the area was clear of
necrotic tissue, the site was prepared for a skin graft. A split-thickness skin
graft was harvested from the thigh with a dermatome. Total graft size was 25
sq. Cm. The graft was sutured in place using 6-0 Vicryl. The harvest site was
closed primarily with skin staples. Dressings were applied. Needle counts were
correct x 2. The patient tolerated the procedure well. Code the procedure(s).
A.
15002, 15100-51
B.
15937, 15100-51
C.
15937
D.
15937, 15100-51, 15002
7. 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
8. A 55-year-old male presents in the office with an
ingrown toenail on the right and left foot. The procedure was discussed in
detail and the patient elected to have it performed. The right foot was prepped
and draped in sterile fashion. The right great toe was anesthetized with 50/50
solution of 2 percent lidocaine and .05 percent Marcaine. A mini-tourniquet was
placed around the toe for hemostasis. The lateral border was incised and
excised in total. Phenol was then applied, the toe was then flushed. Tourniquet
was released and dressing applied. At this time the patient elected to only
have on performed and will return in two weeks for the left foot. Code the
procedure.
A.
11765
B.
11750
C.11755
D.11740
9. Pre-Procedure Diagnosis: Basal cell carcinoma, left
chin. Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell
carcinoma of the left chin with a 4 cm closure. Procedure: The patient’s left
chin was examined. The site of intended excision was marked out. The site was
then prepped. The patient was then prepped and draped in the usual fashion. A
15 blade scalpel was then used to make an incision in the previously marked
site. It was carried down to the subcuticular fat. The lesion was then sharply
dissected off underlying tissue bed using a 15-blasde scalpel. It was tagged
for pathologic orientation. The hyfrecator was used for hemostasis. The wound
edges were then undermined. The would was then closed by advancing the tissue
surrounding the lesion and closing in layers with 3-0 Vicryl for the deep
layer, followed by 5-0 Prolene for the skin. The skin closure was in a running
subcuticular fashion. Steri-Strips were then applied. What are the procedure
and diagnosis codes?
A.
11644, 12052-51, C44.319
B.
11643, 12013-51, C44.319
C.
11444, 12052-51, D49.2
D.
11443, 12013-51, D49.2
10. The physician removes a tumor from the patient’s neck
using the Mohs micrographic surgery technique. During the first stage, the
physician takes four tissue blocks and reviews them under a microscope. The
exam of the tissue blocks reveals a second stage is necessary to remove areas
where the tumor is still present. The physician removes two tissue blocks. What
are the appropriate CPT codes for reporting the procedure?
A.
17311, 17312, 17315
B.
17313, 17315
C.
17313, 17314, 17315
D.
17311, 17312
11. patient is having ongoing back and hip pain. The
physician elects to perform a sacroiliac injection at an ambulatory surgery
center. After sterile prep, the patient is placed prone and under fluoroscopic
guidance; the needle is placed into the SI joint with a mixture of 20 mg of
Celestone and Marcaine for pain relief. Code the procedure(s).
A.
27096, 77003-26
B.
20610
C.
27096, 72200-26
D.
27096
12. Patient is seen in the hospital’s outpatient surgical
area with a diagnosis of a displaced comminuted fracture of the lateral
condyle, right elbow. An ORIF procedure was performed, which included the
following techniques: An incision was made in the area of the lateral
epicondyle. This was carried through subcutaneous tissue, and the fracture site
was easily exposed. Inspection revealed the fragment to be rotated in two
places about 90 degrees. It was possible to manually reduce this quite easily,
and the manipulation resulted in an almost anatomic reduction. This was fixed
with two pins driven across the humerus. The pins were cut off below skin
level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for
the skin. Dressings and a long arm cast were applied. Which are the correct ICD-10-CM
and CPT codes assignment?
A.
24579, 29065-51, S42.431A
B.
24577, S42.451A
C.
24579, S42.451A
D.24575,
S42.431A
13. A 35-year-old female patient presents with acute onset
of severe pain since October. Her workup has revealed evidence of disk
herniation with loss of lordosis at the C5-C6. Intraoperative findings were
consistent with two large fragments of free disk fragments in the foramen at
C5-C6 on the right side. After general anesthesia, the patient was placed on
the operative table in the supine position. All pressure points were cushioned
and transverse skin incision was fashioned under fluoroscopic guidance over the
C5-C6 disc space. Dissection through the platysma eventually allowed for
exposure of the anterior entrance to the vertebral body of C5 and C6 and
retractors were inserted to maintain adequate exposure. The operating
microscope was brought into the field. Caspar posts were placed and slight
distraction allowed exposure. A complete discectomy was performed at C5-C6 by
using endplate curets pituitary rongeurs and Kerrison rongeurs. The posterior
longitudinal ligament was resected and beneath the posterior longitudinal
ligament, two significant sized disc fragments were noted in the foramen at
C5-C6. These were removed using pituitary and Decker instruments. The endplates
were then decorticated so that they were parallel to each other and a midline
keel was performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody
kineflex-C device was placed under fluoroscopic guidance. Satisfied with the
positioning of the device, the decision was made to close. What is the correct
code for this procedure?
A.
63075
B.
63081
C.
22856
D.
22554
14. A 17-year-old male presents to the emergency
department after being involved in a car accident. The patient’s primary
physician calls the orthopedic surgeon to the emergency department. The
orthopedist diagnoses a sprained knee ligament. He places a long leg walking
cast and instructs the patient to return to his office for follow-up care. What
are the procedure and diagnosis codes?
A.
29358, S83.8X9A
B.
29355, S83.90XA
C.
27520-54, S83.429A
D.
29345, S83.90XA
15. Patient complains of chronic/acute arm and shoulder
pain following bilateral carpal tunnel surgery. Patient is followed by pain
management for over a year. Physician finally diagnoses patient with reflex
dystrophy syndrome (RSD). Physician performs six trigger point injections into
four muscle groups. Code the procedure(S).
A.
20552
B.
20610 x 6
C.
20552 x 5
D.
20553
16. A Grade I, high velocity open right femur shaft
fracture was incurred when a 15-year-old female pedestrian was hit by a car.
She was taken to the operating room within four hours of her injury for
thorough irrigation and debridement, including excision of devitalized bone.
The patient was then reprepped, redraped, and repositioned. Intramedullary
rodding was then carried out with proximal and distal locking screws. What are
the correct codes for this diagnosis and procedure?
A.
27506, 11044-51, S72.301B
B. 27506, 11012-51, S72.301B
C.
27507, 11012-51, S72.301A
D. 27507, 11044-51, S72.91B
17. This 45-year-old male presents to the operating room
with a painful mas of the right upper arm. General anesthesia was induce. Soft
tissue dissection was carried down thru the proximal aspect of the teres minor
muscle. Upon further dissection a large mass was noted just distal of the
IGHL9inferior glenohumeral ligament), which appeared to be benign in nature.
With blunt dissection and electrocautery, the 4.5 cm mass was removed en bloc
and sent to patholoty. The wound was irrigated, and repair of the teres minor
with subcutaneous tissue was then closed with triple-0 Vicryl. Skin was closed
with double-0 Prolene in a subcuticular fashion. What is the correct CPT code
for this service?
A.
23076
B.23066
C.23075
D.
23030
18. Postoperative Diagnosis: 1. Impingement syndrome left
shoulder. 2. AC synovitis left shoulder Procedure: Arthroscopy with subacromial
decompression and AC resection left shoulder. The patient was placed supine on
the operating table prepped and draped in usual sterile fashion. The scope was
introduced from a posterior portal and the joint was inspected. The rotator
curff looked in good condition. The articual surfaces looked good. The bicep
also was in good condition. We went subacromially and there was a fair amount
of bursal inflammation encountered. We did a thorough bursectomy. A ligament
chisel was used to take down the coracoacromial ligament. A high-speed bur was
used to do a subacromial decompression going from lateral to medial. We took
off about 2 cm of bone anteriorly. Next we opened the AC joint through an
anterosuperior portal. We ground off about 10 mm of distal clavicle because
there was a large subchondral cyst and we wanted to get this totally ground
out, which we did. Then the wounds were irrigated out, Nylon suture was placed
in our portals. The patient was placed in a bulky dressing and an arm sling and
sent to the recovery room in stable condition. Code the procedure.
A.
29824-LT, 29826-LT
B.
29825-RT, 29824-RT
C.
23120-LT, 23130-LT
D.
29826-LT, 29824-LT, 29825-LT
19. The patient presented for medial meniscal tear left
knee. Arthroscopy with partial medial menisectomy left knee and arthroscopic
picking (drilling pick holes) of the lateral femoral condyle left knee was
performed. Code the procedure and diagnosis codes.
A.
29880-LT, 29879-LT, S83.242A
B.
29881-LT, 29879-LT, S83.242A
C.
29882-LT, 29885-LT, S83.282A
D.
29881-RT, 29885-LT, S83.207A
20. A 47-year-old patient was previously treated with
external fixation for a Grade III left tibia fracture. There is now nonunion of
the left proximal tibia and he is admitted for open reduction of tibia with
bone grafting. Approximately 30 grams of cancellous bone was harvested from the
iliac crest. The fracture site was exposed and the area of nonunion was
osteotomized, cleaned, and repositioned. Intrafragmentary compression was
applied and three screws and the harvested bone graft were packed into the
fracture site. What are the correct codes for this diagnosis and procedure?
A.
27724, S82.102M
B.
27722, S82.102K
C.
27722, S82.109M
D.
27724, S82.102A
21. Procedure: Dual chamber pacemaker defibrillator
implantation. Indications: A 67-year-old white gentleman who has significant
underlying ischemic cardiomyopathy with EF of 25 percent, prior infarcts,
remote history of syncope and at high risk for malignant ventricular
arrhythmias. He has had a recent T wave alternans test which was clearly
abnormal,. He has had episodes of resting bradycardia also noted. He also meet
Madit II criteria for ICD impplantation. Description of procedure: After
informed consent had been obtained, the patient was brought to the outpatient
hospital lab in the fasting state. The left anterior chest was prepped and
draped in a sterile fashion. Intravenous sedation and local anesthetic were
given. After local anesthetic, a 5 cm incision was made at the left
deltopectoral groove. With blunt dissection and cautery, this was carried down
through the prepectoralis fascia. The cephalic vein was identified and ligated
distally. Through the venotomy, a subclavian venogram was performed to provide
a roadmap. The atrial andventricual leads were then advanced into the vessel to
the level of the right atrium under fluoroscopic guidance. The ventricual lead
was maneuvered to the right ventricual outflow tract and then through the RV
apex where it was actively fixed. Good sensing and pacing thresholds were
demonstrated. The lead was anchored to the pre-pectoralis fascia with
interrupted 2- Tycron sutures. 10 volt pacing did not result in diaphragmatic
capture. A subcutaneous pocket was created with good hemostasis achieved. The
pocket was subsequently irrigated with solution of Bacitrain. The generator was
connected to the lead and then placed in the pocket with no tension on the
lead. The deep fascial layer was closed with interrupted 2-0 Vicryl suture. The
subcutaneous closure was made with running 3-0 Vicryl suture. Subcuticular
closure was made with running 4-0 Vicryl suture. Steri-strips were applied.
Ventricaular fibrillation was induced with a T wave shock. This was
successfully sensed and terminated with a 15 joule shock to sinus rhythm. High
voltage impedence was 39 ohms. Dry dressing was placed over the wound. The
patient returned to the floor in stable condition without apparent
complications. Which of the following codes accurately describes the basic
procedure summarized in this report?
A.
33207
B.
33208
C.
33240, 33208
D.
33249
22. A patient is brought from an MVA to the ER with
multiple fractured ribs, labored breathing, and complaints of chest pain and
palpitations. In the ER the thoracic surgfeon performs a tube thoracostomy with
some relief of the patient’s most severe symptoms. Several tests are run and
radiographs taken. What is the correct code?
A.
32100
B.
32550
C.
32554
D.
32551
23. A sinus endoscopy with tissue removal from the
sphenoid sinus was performed. The correct CPT code is:
A.
31287
B.
31288
C.
31235
D.
31050
24. This 25-year-old male presents with deviated nasal
septum. After intubation, a left hemitransfixion incision was made with elevation
of the mucopereichondrium. Cartilage from the bony septum was detached and the
nasoseptum was realigned and removed in a piecemeal fashion by removing the
anterior third of the bony turbinate and lateral mucosal followed by bipolar
cauterization of the posterior enlarged tip of the inferior turbinate as well
as outfracturing. A small amount of silver nitrate cautery was used to achieve
hemostasis. A Dressing consisted of a fold of Telfa with a ventilating tube for
nasal airway on each side achieved good hemostasis, patient went to recovery in
good condition. What is the correct code for this procedure?
A.
30520
B.
30420
C.
30620
D.
30450
25. At the patient’s bedside in the hospital, a PICC line
is inserted. Using Xylocaine local anesthesia, aseptic technique and ultrasound
guidance, a 21 gauge needle was used to aspirate the right cephalic vein of a
72-year-old patient. When blood was obtained, a 0.018 inch platinum tip
guidewire was advanced to the central venous circulation. A 6 French dual lumen
PICC was introduced through a 6 French peel-away sheath to the SVA Ra junction
and after removal of the heath, the catheter was attached to the skin with a
STAT-LOCK device and flushed with 500 units of Heparin in each lumen. A sterile
dressing was applied and the patient was discharged in improved condition. Code
the procedure(s).
A.
36565
B.
36556, 76942-26
C.
36561, 76942-26
D.
36569, 76942-26
26. The patient had been hoarse for a month. His surgeon
scheduled a direct laryngoscopy with injection of his vocal cords. During the
surgery it became necessary to use an operating microscope. How should there
services be reported?
A.
31571
B.
31561
C.
31571, 69990
D.
31545
27. A 62-year old female with three-vessel disease and
supraventricular tachycardia, which has been refractory to other management.
She previously had pacemaker placement and stenting of the coronary artery
stenosis, which has failed to solve the problem. She will undergo CABG with
autologous saphenous vein and a modified MAZE procedure to treat the
tachycardia. The risks and benefits have been discussed and the patient wishes
to proceed. She is brought to the cardiac OR and placed supine on the OR table.
She is prepped and draped and adequate endotracheal anesthesia is assured. A
median sternotomy incision is made and cardiopulmonary bypass is initiated. The
endoscope is used to harvest an adequate length of saphenous vein from her left
leg. This is uneventful and bleeding is easily controlled. The vein graft is
prepared and cut to the appropriate lengths for anatomosis. Three bypasses are
performed, one to the LAD, one to the circumflex and another distally on the
circumflex. A modified maze procedure was then performed and the patient was
weaned from bypass. Once the heart was once again beating on its own again, we
attempted to induce an arrhythmia and this could not be done. At this point,
the sternum was closed with wires and the skin reapproximated with staples. The
patient tolerated the procedure without difficulty and was taken to the PACU.
Choose the procedure code(s) for this service.
A.
33519, 33508, 33254
B.
33512, 33508, 33999-51
C.
33512, 33508, 33257
D.
33512, 33508-51, 33254-51
28. The patient is a
three-year-old boy who attempted to swallow a half-dollar. The boy’s mother
immediately brought the child ED, which was only a short distance from the
house, and the thoracic team was called emergently. The patient was in acute
respiratory distreess when we arrived in the ED. A temporary tracheostomy was
accomplished, allowing oxygen exchange. X-ray revealed the coin to be deeply
wedged in the trachea. Several attempts were made to remove the coin in the ED
with the use of forcepts, without success. The patient was given a mild
sedative and taken to the OR where a scope was used to successfully remove the
coin. The trach was discontinued. The patient was admitted for overnight
observation and discharged the next day in satisfactory condition.
A.
31530, 31603-51, T17.400A
B.
31635, 31603-59, T17..400A
C.
31603, 31530-59, T17.400A
D.
31635, T17.400A
29. The patient had trouble breathing for three days. Her
urgent care physician referred her to an ENT physician. The ENT performed a
diagnostic maxillary sinusoscopy. How should the sinusoscopy be reported?
A.
31237
B.
31256
C.
31233
D.
31256-LT
30. Diagnosis: Right lung mass indications: Patient with a
mass in the right lung mass identifiend on routine X-ray presents for
bronchoscopy and biopsy. Procedure: The patient was brought to the endoscopy
suite and the mouth and throat were anesthetized. The bronchoscope was inserted
and advanced through the larynx to the bronchus. The left side was examined
first and no abnormalities were appreciated. The bronchoscope was then
introduced into the right bronchus. Using fluoroscopic guidance, the tip of the
bronchoscope was maneuvered into the area of the mass. Aclosed biopsy forceps
was passed through the channel in the
bronchoscope and then through the bronchial wall. Atissue sample was obtained.
There were no other abnormalities appreciated in the right side and the
bronchoscope was removed. The specimen was labeled and sent to pathology for
testing. The patient tolerated the procedure well. Pathology indicates that the
mass is cancer. What are the procedure and diagnosis codes?
A.
31628, R91.8
B.
31628, C34.91
C.
31628, 31622-51, C34.90
D.
31625, R91.8
31. A 67-year-old male patient with a history of carcinoma
of the sigmoid colon is referred for a diagnostic colorectal cancer screening.
The patient completed all treatment for his cancer in 2004. The physician
performed a diagnostic flex sigmoidoscopy exam to screen for recurrent colon
cancer and examine the anatomic site. During the exam, the physician found
three polyps in the rectosigmoid junction. They were removed by hot biopsy
forceps. The path report indicated the polyps were benign. Code the encounter.
A.
45333
B.45331
C.
45338
D.
45346
32. Postoperative Diagnosis: Calculi of the gallbladder
procedure: Removal of gallbladder Indications: The patient is a 40-year-old
woman who has a six month history of RUQ pain, which ultrasound revealed to be
multiple gallstones. She presents for removal of her gallbladder. Procedure:
The patient was brought to the OR and prepped and draped in a normal sterile
fashion. After adequate general endotracheal anesthesia was obtained, a trocar
was placed and CO2was insufflated into the abdomen until an adequate
pneumoperitoneum was achieved. A camera was placed at the umbilicus and the
gallbladder and liver bed were visulixed. Te gallbladder was enlarged and thickened,
and there was evidence of chronic inflammatory changes. Two additional ports
were placed and graspers were used to free the gallbladder from the liver bed
with a combination of sharp dissection and electrocautery. Several attempts
were made before it was decided that additional exposure was needed and I
converted to an open approach. The trocars were removed and a midline incision
was made. At this time, it was clear that there were multiple adhesions in the
area, and once these were carefully taken down, we were able to grasp the
gallbladder. The cystic duct was carefully ligated and the gallbladder
carefully removed from the field. The area was copiously irrigated, and a
needle biopsy of the liver was taken. Then the skin was reapproximated in layers.
Sponges and needle counts were correct, and the patient was taken to the
recovery room in good condition.
A.
47600-22
B.
47600-22, 47001
C.
47562, 47600-22, 47001
D.
47562-22, 47000
33. A patient with rectal bleeding undergoes a
proctosigmoidoscopy. During the proctosigmoidoscopy, the physician identifies
internal hemorrhoids. The proctoscope was withdrawn, and the anus was prepped
and draped. A field block with Marcaine 0.25% was then placed. There was a
prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by
applying two bands. In the posterior midline, there was another hemorrhoid that
was banded in the same manner. Code the procedures.
A.
46221, 45300-51, 46600-51
B.
46221, 45300-51
C.
46945, 45300
D.
46934, 45300-51, 46600-51
34. A patient diagnosed with GERD presents to the same day
surgery department for an upper GI endoscopy. The procedure is done in order to
treat the GERD by delivering thermal energy to the muscle of the gastric cardia
and lower esophageal sphincter. Anesthesia was administered and as the
physician begins the procedure, the patient’s blood pressure drops to a
dangerously low level. The physician decides not to finish the procedure due to
the risk it may cause the patient. What are the codes for this procedure and diagnosis?
A.
43257-73, K22.6, I95.89
B.
46499, K21.9, I95.9
C.
43257-74, K21.9, I95.81
D.
43257-53, K21.9, I95.81, Z53.09
35. Preopoerative diagnosis: History of prior colon polyps
Postoperative diagnosis: Colon polyps, diverticulosis, hemorrhoids Procedure: A
rectal exam was performed and revealed small external hemorrhoids. The video
colonoscope was passed without diffisulty from anus to cecum. The colon was
well prepped. The instrument was slowly withdrawn with good views obtained
throughout. There was a 3 mm polyp in the proximal ascending colon. This polyp
was removed with hot biopsy forceps and retrieved. There was a 4 mm rectal
polyp located 10 cm from the anus in the proximal rectum. The polyp was removed
by hot biopsy forceps. There was also moderate diverticulosis extending from
the hepatic flexure to the distal sigmoid colon. Code the CPT procedure(s).
A.
45384
B.
45384, 45384-51
C.45380,
45384
D.
45333
36. A patient with exophageal cancer is brought to the OR
for subtotal esophagectomy. A thoracotomy incision is made and the esophagus is
identified. The tumor is carefully dissected free of the surrounding
structures. No invasion of the aorta or IVC is identified. The cervical
exophagus is controlled with pursestring sutures and then transected above the
sternal notch. The esophagus is then dissected free of the stomach and the
entire specimen is removed from the chest cavity and sent to pathology. The
stomach is then pulled into the chest cavity and anastomosed to the remaining
cervical esophageal stump. The anastomosis is tested for patency and no leaks
are found. Hemostasis is assured. The chest is examined for any signs of
additional disease but is grossly free of cancer. The chest is closed in layers
and a chest tube is place through a separate stab incision. The patient
tolerated the procedure well and was taken to the PACU in stable condition.
A.
43101
B.
43117
C.
43107
D.
43112
37. Patient with RUQ pain and nausea suspected of having a
stone or other obstruction in the biliary tract is brought in for ERCP under
radiologic guidance. Procedure: The patient was brought to the hospital out
patient endoscopy suite and placed supine on the table. The mouth and throat
were anesthetized. Under radiologic guidance, the scope was inserted through
the oropharynx, esophagus, stomach and into the small intestine. The ampulla of
Vater was cannulated and filled with contrast. It was clear that there was an
obstruction in the common bile duct. The endoscope was advance retrograde to
the point of the obstruction, which was found to be a stone that was removed
with a stone basket. The rest of the biliary tract was visualized and no other
obstructions of anomalies were found. The scope was removed without difficulty.
The patient tolerated the procedure well.
A.
43260, 74328-26
B.
43264, 74328-26
C.
43265
D.
43275, 74329
38. Preoperative Diagnosis: Lower left inguinal pain
Postoperative Diagnosis: Inguinal hernia Procedure: This 30-year-old patient
presented with lower left inguinal pain and on examination was found to have a
left inguinal hernia. The decision to perform a left inguinal hernia repair was
made. The procedure was performed in the outpatient hospital surgery center.
Risks and benefits of the surgery were discussed with patient and the patient
decided to proceed with the surgery. A skin incision was placed at the
umbilicus where the left rectus fascia was incised anteriorly. The rectus
muscle was retracted laterally. Balloon dissector was passed below the muscle
and above the peritoneum. Insufflation and deinsufflation were done with the
ballon removed. The structural balloon was placed in the preperitoneal space
and insufflated to 10 mm Hg carbon dioxide. The other trocars were placed in
the lower midline times two. The hernia sac was easily identified and was
well-defined. It was dissected off the cord anteromedially. It was an indirect
sac. It was taken back down and reduced into the peritoneal cavity. Mesh was
then tailored and placed overlying the defect, covering the femoral, indirect,
and direct spaces, tacked into place.
After this was completed, there was good hemostasis. The cord, structures, and
vas were left intact. The trocars were removed. The wounds were closed with 0
Vicryl for the fascia, 4-0 for the skin. Steri-Strips were applied. The patient
was awakened and carried to the recovery room in good condition, having
tolerated the procedure well. What are the correct procedure and diagnostic
codes?
A.
49505-LT, K40.90
B.
49505-LT, 49568, K40.90
C.
49507-LT, K40.20
D.
49501-LT, 49568, K40.20
39. Preoperative Diagnosis:Chronic tonsillitis. Chronic
adenoiditis. Postoperative Diagnosis: Same. Procedure: Tonsillectomy and
adenoidectomy. Patient is a 24-year old male who was taken to the operating
room and put under IV sedation by the anesthesia department. An intial
curettage of adenoids was done and packing was placed. The left tonisil was
then identified and dissected out extracapsular and removed with scissors.
Hemostasis was maintained bypacking the left tonsil. Next, the right tonsil was
identified and incision was made. Dissection was done extracapsular and the
right tonsil was then removed. Both the right and left tonsil were sent as
specimens as well as adenoid tissue. What are the procedure and diagnosis
codes.
A.
42826, 42831-59, J35.02
B.
42826, 42831-51-59, 42809, J35.03
C.
42821-50, 42809-59, J35.01, J35.02
D.
42821, J35.03
40. Diagnostic upper GI endoscopy of the esophagus,
stomach, and duodenum was performed after esophageal balloon dilation (less
then 30 mm diameter) was done at the same operative session. Code the
procedure(s).
A.
43235
B.
43249
C.
43226, 43200
D.
43200, 43235
41. A pregnant patient delivers twins at 30 weeks
gestation. The first baby is delivered vaginally, but during this delivery, the
second baby has turned into the transverse position during labor. The decision
is made to perform a cesarean to deliver the second baby. The OB physician who
performed the delivery also performed the prenatal care. The standard coding
for this is:
A.
59400, 59514-51, O30.003, O30.2XX2
B.
59510, 59409-51, O30.003, O32.2XX2
C.
59510-22, O64.9XX2, O32.2XX2
D.
59510, 59409-51, O30.003, O64.0XX2
42. A 30-year-old disabled Medicare patient is scheduled
for surgery due to the finding of what looks like an ovarian mass on the right
ovary. On entering the abdomen, the surgeon finds an enlarged ovarian cyst on
the right, but the ovary is otherwise normal. The left ovary is necrotic
looking. The decision is made, based on the patient’s age, to remove the cyst
from the right ovary, but performs a left salpingo-oophorectomy. Code this
encounter.
A.
58720-RT, 58925-LT
B.
58925-RT, 58720-59-LT
C.
58925, 58720-50
D.
58720, 58925-51
43. A 35-year-old male patient presented to an urologist
because he was having continuous yeast infections and irritation on his penis.
The physician recommended he have a circumcision. The physician performed the
circumcision using a clamp with regional block. Code this procedure.
A.
54150
B.54160
C.
54161
D.
54150-52
44. A 55-year-old man with complaints of an elevated PSA
of 6.5 presents to the outpatient surgical facility for prostate biopsies. The
patient is placed in the lateral position. Some calcifications were found in
the right to be, with no obvious hypoechogenic abnormality. The base of the
prostate was infiltrated and under ultrasonic guidance random needle diopsies
were performed.
A.
55700, 76872-26
B.
55706
C.
55700, 76942-26
D.
55700
45. A colposcope was introduced into the patient’s vagina
and under direct visualization through a binocular microscope excessive lesions
were revealed in and around the vagina. Electrocautery and laser vaporization
were used to destroy the extensive number of vaginal lesions. What are the
procedure and diagnosis codes?
A.
57061, N 89.8
B.
57065, N89.8
C.
57000, N85.9
D.
57120, N85.9
46. A pregnant patient is diagnosed with an incompetent
cervix. The physician performs a cervical cerclage to prevent a missed
abortion. After inserting a speculum into the vagina to view the cervix, the
physician threads heavy suture material around the cervix using purse-string
sutures. The sutures are pulled tight to make the opening smaller and prevent
spontaneous abortion. What are the procedure and diagnosis codes?
A.
57700, O34.30
B.
59320, O34.30
C.
59325, N88.3
D.
59899, N88.3
47. A patient is diagnosed with a bladder tumor. The
physician performs a cystourethroscopy with fulguration and resects a 7 cm
bladder tumor. Which CPT code(s) would you use for this service?
A.
52000, 52235
B.
52000, 52240
C.
52240
D.
52204, 52240
48. The patient has a positive pregnancy test, but
ultrasound does not confirm a gestational sac in the first trimester. The
physician diagnoses a blighted ovum and performs a suction D&C. What are
the procedure and diagnosis codes?
A.
59870, O02.0
B.
59820, O02.0
C.
58120, O020.0
D.
59840, O02.0
49. The physician performs a cystoscopy, bilateral
retrograde pyelograms and ureteroscopy on the left side at a hospital.
DESCRIPTION: After satifactory genreal anesthesia, and after routine
preparation and draping in the lithotomy position. The urethra seemed to be
free of lesions. There was no prostatic tissue. The bladder had two
diverticula, one right end one left inferolateral wall, no lesions were noted,
and the right was larger. Urine for cytology and FISH was sent. Residual urine
was approximately 100 ML. Ureteral stent was seen in the left ureter. Right
retrograde ureterogram revealed no lesions. The bladder was free of lesions. Ureteroscopy
was carried out into the renal pelvis with no lesions noted. Right retrograde
pyelogram then revealed grade II-III dilatation of the ureter, grade I
dilatation of the calices on the left side, and no other lesions. It was
decided not to replace the double-J stent. The patient tolerated the procedure
well and was sent to the RR in good condition. How would you code the
procedure?
A.
52310
B.
52332, 52000-59
C.
52310, 52000
D.
52351
50. A laparoscopic removal of the patient’s left testicle
was performed on a 34-year-old patient who was diagnosed with testicular
cancer. Code the encounter.
A.
54522, C62.02
B.
58671, E29.8
C.
54640, E29.8
D.
54690, C62.92
51. The patient was taken to the procedure room and placed
prone and the L4-L5 interspace was identified using fluoroscopy to determine
the injection site. The patient was prepped in routine sterile fashion with
Betadine and covered in sterile drape. 1% lidocaine was used to anesthetize the
skin, subcutaneous tissue, and muscle. Once the proper anesthesia was obtained,
a 3 inch, 20 gauge Tuohy needle was inserted and slowly advanced towasrds the
L4-L5 interspace. Using a 6 cc glass syringe and the loss-of-resistance
technique the epidural space was identified. After aspiration revealed no blood
or cerebrospinal fluid return, the syringes were then changed and 80 mg/ml
preservativefree Depo Medrol and 2 cc of 1% methylparaben free lidocaine were
injected in slow incremental fashion. After aspiration, all needles were
removed intat, the skin was cleaned and a Band-Aid was applied. Code this
encounter.
A.
62322
B.
62323
C.
62326
D.
62327
52. A 65-year-old patient presented with ectropion of the
right lower eyelid. Repair with tarsal wedge excision is performed for
correction. Attention was then directed to the left eye. The patient also had
an ectropion of the left lower lid which was repaired by suture repair. Code
this procedure.
A.
67916-50
B.
67916-E4, 67914-E2
C.
67914-50
D.
67923-E4, 67921-E2
53. A 42-year-old patient returns to the hospital
neurology clinic for follw-up. He was checked three days prior to this visit
where a lumbar puncture was done to find the etoloty of the patient’s
headaches. The headaches have increased in intensity over the past three days.
The neurologist examines the patient and finds a CSF leak from the lumbar
puncture. A blood patch by epidural injection is performed to repair the leak.
Code the services for today’s visit.
A.
62272
B.
62273
C.
62270, 62273
D.
62270, 62287
54. A 63-year-old woman presented to the eye clinic as a
new patient with symptoms of floaters in the right eye for two days duration.
The ophthalmologist does a general evaluation of the complete visual system,
including dilating her eyes and checking her with the indirect ophthalmoscope,
revealing peripheral retinal tear. The physician explains to the patient that
if left untreated, there is a high likelihood of retinal detachment. The
patient agrees to the procedure. The physician lasers the retinal tear and
tells the patient to come back in 24 hours for follow-up. Code this visit.
A.
67210, 92004-25
B.
67145, 92004-25
C.
66821
D.
67145
55. Postoperative Diagnosis: Carpal tunnel syndrome right
wrist. The patient was brought to the operating room and sedated by anesthesia.
After sterile prepping and draping of the right had, wrist and arm the
patient’s area of incision was infiltrated with Xylocaine/Marcaine
infiltration. After Satisfactory anesthesia an Esmarch bandage was used to
exsanguinate the right hand and wrist and used about the distal forearm as a
touniquet. A curvilinear incision was made on the palmar aspects of the right
wrist.Dissection was carried out through the skin and subcutaneous tissue.
Bleeding was controlled. The median nerve and it branches were identified, retracted,
and protected at all times. The ligament was incised from proximal to distal. A
thorough decompression was carried out. A neurolysis was carried out. The nerve
was found to be flattened and ischemic underneath the transverse carpal
ligament. The fascia was closed, the tourniquet was released. A dressing was
applied and patient was transferred to recovery room. Code this procedure.
A.
64721-RT
B.
64450-RT
C.
64642-RT
D.
29878-RT
56. A 35-year-old man presents to the urgent care center
with severe neck pain. The physician examines the patient and makes the
diagnosis of cervical nerve impingement and injects an anesthetic agent into
the cervical plexus using three injections. Select the procedure and diagnosis
codes.
A.
64400 x 3
B.
64405
C.
64413
D.
64413 x 3
57. A four-year-old with chronic otitis media and fluid
buildup in both ears was admitted by her otolaryngologist for a bilateral
tympanostomy. The procedure was performed with placement of ventilating tubes.
The procedure required general anesthetic due to the patient’s age. Select the
procedure code for this procedure.
A.
69420-50
B.
69421-50
C.
69433-50
D.
69436-50
58. A patient presents to the emergency department with
complaint of painful eye. The patient states that her right eye is constantly
tearing and is sensitive to light. The physician performs an exam and
identifies a corneal foreign body in the right eye. Utilizing a slit lamp, the
foreign body is removed. Code the encounter.
A.
65205-RT
B.
65220-RT
C.
65222-RT
D.
65435-RT
59. The physician performs a right thyroid lobectomy. The
patient was prepped and draped. After adequate general anesthesia, the neck was
incised on the right side and sharp dissection was then used to cut down onto
the strap muscles and sternodcleidomastoid muscles. The strap muscles were
separated and transected on the right side. A small thyroid libe was visualized
and dissected free. There was no evidence of a tumor. The wound was closed with
3-0 interrupted Vicryl for the platysma, 4-0 Vicryl for the deep tissues and
6-0 fast absorbing gut for the skin. Code the encounter.
A.
60252-RT
B.
60210-RT
C.
60220-RT
D.
60260-RT
60. PROCEDURE: Bilateral lumbar medial branch block under
fluoroscopy for the L3, L4, L5 medial branches for the L4-L5, L5-S/1 facets for
diagnostic and therapeutic purposes. PROCEDUR: The patient was placed in the
prone position on the fluoroscopy table and automated blood pressre cuff and
pulse oximeter applied. The skin entry points for approaching the anatomic
target points of the bilateral segmental medial branches or dorsal ramus of L3,
L4, L5 were identified with a 22.5 degree from perpendicular lateral oblique
fluoroscopy view and marked. Following thorough Chloraprep preparation of the
skin and draping and 1% lidocaine infiltration of the skin entry points and
subcutaneous tissues, a 22 gauge 6” spinal needle was placed under fluoroscopic
guidance down on the target point for each respective segmental medial branch
or dorsal ramus. At each point 1 ML consisting of 0.5% bupivacaine and Depo
Medrol was injected. A total of 80 mg of Depo-Medrol was divided between all
six sports. Code the procedure(s).
A.
64483, 64484, 77003-26
B.
64493-50, 64494-50, 64495-50
C.
64493, 64494, 77003-26
D.
64493-50, 64494-50
SECTION B
61. Physician performs a medical review and documentation
on an 83-year-old patient still hospitalized for confusion for the last two
days. She is alert and oriented x 3 today. Reviewing her labs from yesterday,
her BNP was elevated suspecting her confusion is due to congestive heart
failure. An echocardiogram is ordered and treatment will be for congestive
heart failure. Patient is not safe to return home. What CPT code should be
reported?
A.
99231
B.
99221
C.
99218
D.
99232
62. 42-year-old woman is
being discharged today, 2/5/XX. She was admitted to the hospital 2/2/XX for
acute diverticulitis. Refer to dictated notes for a detailed description of the
history, exam, and assessment and treatment protocol. Patient was also seen in
consultation by Dr Z. She was placed on intravenous antibiotics and has made
slow steady progress. Today has no abdominal pain. Labs are normal and CT of
the abdomen and pelvis showed changes consistent with diverticulitis in the
left side of colon. She was given follow up instructions, of her medications,
what diet to have and to follow up with PCP in 10 to 14 days or return if pain
resumes. Total time spent with patient 40 minutes. What CPT code(s) should be
reported?
A.
99233, 99239
B.
99217
C.
99252, 99238
D.
99239
63. 63 year-old man is coming
in for a second opinion for his sleep apnea. He has had it for the past five
months. Sleep is disrupted by frequent awakenings and getting worse due to
anxiety and snoring. He feels tired all the time, has some joint stiffness and
night sweats; all other systems were negative. He is going through a divorce
with is causing him anxiety and had a hernia repair two month ago. Doctor
performs a comprehensive exam and orders labs and a sleep study test.
Prescription was given to help with the anxiety. What CPT code would be
reported?
A.
99203
B.
99204
C.
99244
D.
99214
64. A 55-year-old established patient is coming in for a
pre-op visit; he is getting a liver transplant due to cirrhosis. The physician
performs an expanded problem focused history, detailed examination, and
moderate MDM. Patient agrees with his physician’s recommendations and the
transplantation with take place as scheduled. After the evaluation, the patient
expresses a number of concerns and questions for the prospective liver
transplant. Physician spends an additional 30 minutes, excluding the time spent
in doing the E/M service, in counseling and answering questions regarding the
surgery and discussing possible outcomes. What CPT codes should be reported?
A.
99213, 99354
B.
99214, 99358
C.
99213, 99358
D.
99214, 99354
65. A plastic surgeon is called to the ED at the request
of the emergency department physician to evaluate a patient that arrived with
multiple facial fractures after being in an automobile accident for her opinion
on the need for reconstructive surgery. The plastic surgeon arrives at the ED,
obtains a history of present illness including an extended history of present
illness; a system review, including constitutional, musculoskeletal,
integumentary, neurologic, and EENMT; and the patient’s social history and past
medical history. The plastic surgeon then performs a physical exam including
respiratory, cardiovascular, and an extended examination of the skin and bony
structures of the patient’s face. The plastic surgeon performs moderate medical
decision making, including deciding the patient needs major surgery to repair
the injuries. The plastic surgeon schedules the patient for surgery the next day
and documents her full note with findings in the ED chart.
A.
99284-57
B.
99244
C.
99243-57
D.
99221
66. At the request of the mother’s obstetrician, the
physician was called to attend the birth of an infant being delivered at 29
weeks gestation. During delivery, the neonate was pale and bradycardic.
Suctioning and bag ventilation on this 1000 gram neonate was performed with 100
percent oxygen. Brachycardia worsened; endotracheal intubation was performed
and insertion of an umbilical line for fluid resuscitation. Later this
critically ill neonate was moved from the delivery room and admitted to the
NCCU with severe repiratory distress and continued hypotension. What are the
appropriate procedure codes?
A.99465,
99468
B.99465,
99464, 99468-25, 31500, 36510-51
C.
99468, 99464
D.
99465, 99468-25, 31500-59, 36510-59
67. 38-year-old female
initial visit , just moved from out of state, has neck and back pain for the
last year and is getting worse. Pain is exacerbated when she drives, bends, or
changes positions, and moderately alleviated with ibuprofen. Positive for aches
and weakness in her muscles and tingling and tingling and numbness of the arms
and hands, as well as headaches. All other systems are reviewed and are
negative. She has had a partial hysterectomy and is divorced. Her mother has a
history of breast cancer. The physician performs an exam on the following
systems: constitutional, eyes, ENT, respiratory, cardiovascular,
gastrointestinal, musculoskeletal, and neurologic. X-rays of the cervical and
lumbar spine were taken. Will be sending her to get a MRI and to start physical
therapy. Prescription was given for muscle relaxer. Select the appropriate CPT
code for this visit?
A.
99203
B.
99204
C.
99214
D.
99244
68 A four- year-old patient
presents with pain in the left forearm following a fall form a chair. The
injury occurred one hour ago. Her mom applied ice to the injury but it does not
appear to help. The ED physician performs a detiled history, expanded problem
focused examination medical decision making of moderate complexity. An XX-ray
is ordered, orthopedic surgeon. The ED physician performs moderate conscious
sedation with Ketamine for 30 minutes. The fracture is reduced and cast applied
by an orthopedic surgeon. The child was monitored with pulse oximetry, cardiac
monitor and blood pressure by the Ed physician frequently. The patient was
discharged with a sling and requested to follow up with the orthopedic surgeon.
Code the services performed by the ED physician.
A.
99284, 99151, 99153
B.
99283-25, 99155, 99157
C.
99238-25, 99151, 99153
D.
99283
69. Dr. X performs a follow-up consultation on certain
tests that were not available in a nursing facility for a 75-year-old-male that
was having chest pain. Today the patient is feeling better after a GI cocktail
with Maalox and Xylocaine. The EKG showed an arrhythmia and the chest X-ray
came back normal. Dr. X performs a problem focused history. He listens to the
patient’s heart and lungs. Dr. X makes the recommendation of repeat cardiac
enzymes and EKG and to have a GI evaluation. The PCP accepts the
recommendations and implements the plan
of care. What CPT code should be reported or Dr. X?
A.
99241
B.
99232
C.
99308
D.
99251
70. Physician was called to the floor to evaluate a
94-year-old that had sudden weakness, hypotension, and diaphoresis. Physician
found the patient in mild distress and dyspenic. Her BP 101/60, pulse 85. Her
heart was positive for a systollic murmur. EKG came back with ST elevation
V2-V6. Labs were still pending. She was admitted to CCU for Acute
Antero-lateral MI and hypotension. Physician spent total critical care time of
48 minutes. Select the appropriate CPT code for this visit:
A.
99253
B.
99233
C.
99291
D.
99236
71. A 56-year-old receives general anesthesia for an open
pleura biopsy. An anesthesiologist medically directing two other cases, and
medically directs a CRNA on this case. What are the appropriate codes for both
providers?
A.
00540-AA, 00540-QZ
B.
00540-QK, 00540-QX
C.
00541-AA, 00540-QZ
D.
00541-QK, 00541-QX
72. The anesthesiologist performs an axillary block for
postoperative pain management. The patient receives general anesthesia for a
carpal tunnel release. What are the appropriate codes?
A.
01810
B.
01810, 64417
C.
01810, 64417-59
D.
01830, 64417-59
73. A healthy 45-year-old is having a needle thyoid
biopsy. The anesthesiologist begins to prepare the patient for surgery at 0900.
The surgery begins at 0915 and ends at 0945. The anesthesiologist turns over
the care of the patient to the recovery room nurse at 10000. What is the
appropriate anesthesia code and what is the anesthesia time?
A.
00320, one hour
B.
00320, 45 minutes
C.
00322, 45 minutes
D.
00322, one hour
74. Patient is admitted in labor for delivery. She
received a labor neuraxial epidural for a vaginal delivery. The baby goes into
fetal distress and a cesarean section is performed. Following delivery the
patient starts to hemorrhage. The physician decides, with family approval, to
perform a hysterectomy. Code the anesthesia services.
A.
01967, 00840
B.
01962
C.
01968
D.
01967, 01969
75. Angiograms reveal three artery blockages. The patient
has COPD, which is a severe systemic disease. The patient undergoes a CABG X 3
venous grafts on cardiopulmonary bypass and cell saver. Code the anesthesia
service.
A.
00562-P3
B.
00560-P4
C.
00567-P3
D.
00566-P4
76. A healthy 11-month-old-patient with bilateral cleft
lip and palate undergoes surgery. The surgeon performs a bilateral cleft lip
repair, single stage. Code the anesthesia service.
A.
00170-P1, 99100
B.
00102-P1
C.
00102-P1, 99100
D.
00170-P1
77. The anesthesiologist performed MAC (monitored
anesthesia care) for a patient undergoing an arthroscopy of the right knee.
Code the anesthesia service.
A.
01382-AA
B.
01382-AA-QS
C.
01400-AA
D.
01400-AA-QS
78. General anesthesia is administered to a 9-month-old
undergoing a tracheostomy. Code the anesthesia service.
A.
00320, 99100
B.
00320
C.
00326
D.
00326, 99100
79. The physician requests a dual energy absorptiometry of
the foot. Which code should be reported for this diagnostic test?
A.
77080
B.
77081
C.
77075
D.
77077
80. The physician performs bilateral extremity
angiography, the physician only performed the radiological supervision and
interpretation.
A.
75710
B.
75716-50
C.
75710-50
D.
75716
81. A patient with colon cancer receives seven radiation
treatments. During the course of the treatments, the physician views the port
films, reviews the treatment parameters, and assesses the patient’s response to
the treatment. Code for the radiation treatment management.
A.
77427
B.
77431 x 4
C.
77427 x 2
D.
77427, 77431
82. A 78-year-old with lower back pain and leg pain is
scheduled for an MRI of lumbar spine without contrast. Following the MRI, the
patient is diagnosed with spinal stenosis of the lumbar region. What are the
procedure and diagnosis codes?
A.
72020, M54.5, M48.00
B.
72149, M54.89
C.
72148, M48.06
D.
72158, M54.5
83. A 46-year-old female with history of cervical
carcinoma. She underwent placement of an ileal conduit, with subsequent
development of left hydronephrosis. A retrograde ureteral catheter was recently
placed. She returns today for catheter exchange. Patient was placed in the
supine position. The ileal conduit was accessed. The existing catheter was
removed over a guidewire and replaced with a similar 10 French 50 cm long
locking pigrtail catheter. Contrast was injected, confirming good position.
IMPRESSION: Left retrograde ureteral catheter exchange via the ileal conduit.
A.
50432
B.
50693
C.
50385
D.
50688, 75984
84. The physician orders an ultrasound on a patient 25
weeks pregnant with twins to access fetal heart rate and fetal position. Select
the code(s).
A.
76805, 76810
B.
76811, 76812
C.
76816 x 2
D.
76815
85. The physician performed a percutaneous needle core
biopsy on a suspicious lump on the patient’s right breast. This procedure was
performed in the physician’s office. Code this encounter.
A.
19100-RT
B.
19100-RT, 76942
C.
19083-RT
D.
19083-RT, 76942
86. Due to an
elevated CEA level two years following a colon resection, the patient’s
oncologist ordered a diagnostic liver ultrasound. Code this encounter.
A.
76700
B.
78201
C.
76705
D.
76970
87. The physician orders a heart CT without contrast. The
tests will evaluate the amount of coronary calcium. What is the correct code?
A.
75571
B.
75572
C.
75574
D.
75557
88. A 42-year-old has a lesion on his pancreas. The
physician passes the biopsy needle through the skin and removes tissue to be
sent to pathology. Fluoroscopic guidance is used to obtain the biopsy. Code
this encounter.
A.
48100, 77002
B.
48102, 77002
C.
48120, 76942
D.
48102, 76942
89. A surgical specimen was removed from the proximal
jejunum during a resection for adenocarcinoma and was submitted to surgical
pathology for gross and microscopic examination. The correct code for this
service is:
A.
88300
B.
88309
C.
88304
D.
88305
90. The physician performs the following tests on her
automated equipment: HDL, total serum cholesterol, triglycerides and a
quantitative glucose. The correct codes for these procedures are:
A.
83718, 82465, 84478, 82947
B.
83721, 82465, 82951
C.
80061, 82947
D.
80061, 82950
91. A patient with rheumatoid arthritis is being treated
with gold. The physician orders a therapeutic drug test to measure the level of
gold. What is the correct code?
A.
80375
B.
80171
C.
80305
D.80299
92. A patient presents to the ED with crushing chest pain
radiating down the left arm and up under the chin. There are elevated S-T
segments on EKS. The cardiologist sees and admits the patient to CCU. He orders
three serial CPK enzymes levels with instructions that the tests are also to be
done with iso-enzymes if the initial tests are elevated for that date of
service. The CPK enzme levels were elevated, the lab codes would be:
A.
82550, 82552, 82550-76 x 2, 82552-76 x 2
B.
82550, 82552, 82552-91 x 2
C.
82550, 82550-91 x 2, 82552, 82552-91 x 2
D.
82550 x 3, 82554 x 3
93. Which of the following panels does NOT include
chloride?
A.
80061
B.
80050
C.
80053
D.
80047
94. The patient presents with burning urination and
frequency. The physician performs a UA dipstick, which shows elevated WBC. He
orders a urine culture with identification for each isolate to determine which
antibiotic to give to the patient for the infection. What are the appropriate
lab codes?
A.
81000, 81007
B.
81002, 87088
C.
81001, 87086
D.
87086, 87088
95. Which of the following coding combinations is an
example of unbundling?
A.
80048, 80061
B.
80076, 80305
C.
80061, 83718, 84478
D.
82310, 82355, 82374
96. Patient is undergoing in vitro fertilization to get
pregnant. Following the retrieval of follicular fluid from the patient, the
physician uses a microscope to examine the fluid to identify the ooctyes. What
is the code for the laboratory service?
A.
89250
B.
89254
C.
89255
D.
89258
97. A patient has an iliac crest bone marrow biopsy. The
physician suspects the patient has myelofibrosis. The bone marrow specimen is
sent to pathology for gross and microsopic exam. What is the appropriate code
for the pathhologist’s service?
A.
99304
B.
88305
C.
88309
D.
88307
98. A. pathologist performs a comprehensive consultation
and report after reviewing a patient’s records. Specimens and official findings
from other sources. What is the correct code?
A.
88325
B.
99244
C.
80502
D.
88329
99. A patient presents to her oncologist’s office for
schedule chemotherapy. The patient is severely dehydrated. The physician
decides to schedule the chemotherapy for another day and orders hydration
therapy to be performed today instead of the chemotherapy. The therapy is
ordered and administered for one hour and 10 minutes. Select the code(s).
A.
96413-53, 96360
B.
96360
C.
96360, 96361
D.
96413, 96361
100. Left heart catheterization retrograde from the femoral
artery with injection procedures for selective coronary angiography and
selective left ventriculography, including imaging supervision and
interpretation with report, are performed. The cardiologist performed all of
the services at the hospital. The CPT codes are:
A.
93458
B.
93452, 93545
C.
93452, 93563
D.
93458, 93565
101. The correct code for OMT performed on the cervical,
thoracic and sacral regions would be:
A.
97110
B.
98941
C.
98926
D.
97124
102. The patient is admitted to the hospital for an eight
channel EEG to determine the focus of her cerebral seizures. The EEG is
performed for 24 hours. Select the appropriate code.
A.
95813
B.
95824
C.
95827
D.
95950
103. A pediatrician is managing the care of a patient who
is at home on a ventilator under the care of a home health agency. The patient
has cystic fibrosis and is suffering from recurrent pneumonia. The MD did the
initial plan of care for the home health agency and now is following this
monitor vent management oversight on day 20. The provider has a total 45
minutes for this month how should he code?
A.94002
B.
94003
C.
94005
D.
94004
104. A two-month-old comes in for a well check up and
several shots (Rota, DTap, PCV) with her pediatrician. He offers suggestions to
the mom, completes the exam, and counsels her on the vaccinations. How should
this be coded?
A.
99391-25, 90471, 90472 x 2, 90680, 90700, 90670
B.
99381-25, 90460, 90461 x 2, 90680, 90700, 90648, 90670
C.
99381-25, 90471, 90472 x 3, 90680, 90700, 90648, 90670
D.
99391-25, 90460x3, 90461 x 2, 90680, 90700, 90670
105. Mary, who has food allergies, came to her physician
for her weekly allergen immune therapy that consists of two injections prepared and provided by the physician. The
correct code is:
A.
95125
B.
95117
C.
95131
D.
95146
106. Photodynamic therapy involving application of light
externally to destroy premalignant lesions on the lower lip was provided to a
63-year-old patient. Code the encounter.
A.
96570
B.
96999
C.
96567
D.
96913
107. The patient presents to see the nurse for his
scheduled vitamin B12 injection. The physician ordered the injection at the
patient’s last visit. The phyusician is in the office seeing other patients.
The nurse administers the 1000 mcg of vitamin B12 intramuscularly. She
schedules the patient for his next appointment.
A.
99211-25, 96372, J3240
B.
99211-25, J3420
C.
96372, J3420
D.
96401, J3420
108. In the inpatient setting, the psychiatrist provides
psychotherapy for 30 minutes to affect a change in the patient’s maladaptive
behavior. What is the procedure code?
A.
90834
B.
90832
C.
90791
D.
90839
109. What is orchitis?
A. Inner ear imbalance
B.
Lacrimal infection
C.
Inflammation of testis
D.
Inflammation of an iloinguinal hernia
110. The wound was debrided. What was done to the wound?
A. It was closed with layered sutures and dressed
B.
It was medicated and left open to heal.
C.
It was cleansed of foreign materials or dead tissue
D.
It was examined radiographically for defects
111. Which of the following patients might be documented as
having meconium staining?
A. Woman with renal failure
B. Teenage boy with sickle cell anemia
C.
Newborn with pneumonia
D.
Man with alcoholic cirrhosis of liver
112. Which of the following anatomical sites have septums?
A. Nose, heart
B.
Kidney, lung
C.
Sternum, coccyx
D.
Orbit, ovary
113. Lordosis is a disorder of which anatomical site?
A. Spine
B.
Integument
C.
Male genitalia
D.
Nasal sinus
114. What occurs in angiography?
A. The veins or arteries are viewed by X-ray
B.
The patient is checked for angina
C.
The heart is viewed using ultrasonography
D.
The electrical current of the heart is mapped
115. Meatus describes:
A. Septum
B. Muscle
C. Passageway
D. Nutrient
116. Which of the following is not like the other three?
A. Radius
B. Femur
C. Tibia
D. Calcaneus
117. What is the function of the esophagus?
A. To carry air from the pharynx into the lungs
B.
To carry nutrients from the pharynx into the larynx
C.
To carry air from the nose into the larynx
D.
To carry nutrients from the pharynx into the stomach
118. What is the approach in PTCA?
A. The pancreatic and common bile ducts are accessed via
the stomach and duodenum.
B. A catheter is threaded through an extremity vein and
into the heart.
C. A bronchoscope is threaded down the throat and into
the alveoli of the lung.
D. Through a wide, open incision, the ankle fracture is
reduced and internal fixation placed.
119. A patient with a contralateral fracture has what?
A. A second fracture on the same side
B. Multiple and complete bone fractures
C.
A fracture of only the surface of the bone
D.
A fracture on the opposite side
120. What is ascites?
A. Fluid in the abdomen
B. Enlarged liver and spleen
C.
Abdominal malignancy
D.
Abdominal tenderness
121. Which of the following is a disorder of the facial
nerve?
A. Exotropia
B. Enlarged liver and spleen
C.
Brachial plexis lesions
D.
Bell’s palsy
122. Which of the following describes functions of the
lymphatic system?
A. Remove excess fluid from tissue and transports and
protect the body against disease
B. Maintain blood pressure and circulate hormones
throughout the body
C. Return carbon dioxide to the lungs and protect the
body against disease
D. Circulate hormones throughout body and return carbon
dioxide to the lungs
123. Islets of Langerhans are found in which organ?
A. Kidney
B. Parathyroid gland
C. Pancreas
D. Liver
124. Which of the following conditions would most likely be
attributed to hyperlipidemia?
A. Atherosclerosis
B. Multiple myeloma
C. Kwashiorkor
D. Pernicious anemia
125. The newborn has been placed in NICU to treat herpetic
vesicles on her torso and lower extremities. Tests have been ordered to rule
out herpetic encephalitis, chorioretinitis, and sepsis, and prophylactic
protocols will be put in place to prevent spread of the infection from
rupturing lesions. Code the patient’s diagnosis.
A. B00.9
B. P35.2
C. O98.83
D. B00.0
126. Following the MUGA scan, the physician documents that
the patient has developed congestive heart failure associated with the
trastuzumab she received as a treatment for her breast cancer. The trastuzumab
antineoplastic therapy is being discontinued while he attempts to manage the
heart failure pharmaceutically. Code the diagnosis.
A. I50.9, T45.1x1A, Z85.3
B. I50.9, T45. 1X1A, C50.919
C.
I50.9, T45.1X5A, C50.919
D.
I50.9, C50.919, Z85.3
127. The patient has a history of symptomatic HIV.
A. Z21
B. B20
C. Z86.19
D. R75
128. Which statement is true regarding the perinatal
period?
A. It begins at 6 weeks
B. It ends at 90 days
C.
It ends at 28 days
D.
It begins at 29 days
129. Which of the following Z codes can be reported as a
first listed code?
A. Z37.0
B.
Z79.890
C.
Z87.710
D.
Z00.129
130. Preschool vision testing discovered that Matt has
congenital tritanopia, just like his mother.
A. Q14.8
B. H53.53
C. H53.55
D. Q15.8
131. Mr. Jones is here today to receive an intercostal
nerve block to mitigate the debilitating pain of his malignancy. His cancer has
metastatized to his lungs.
A. G89.3, C78.00
B. G89.3, C34.90
C. G89.12, C34.90
D. G89.12, C78.00
132. The patient came today to discuss Lapband surgery. He
is engaged to be married next spring, and is ready to change his life. He is
morbidly obese and his BMI calculates to 41. His diabetes is controlled with
preprandial tablets of 120 mg Starlix. He has bilateral primary osteoarthritic
changes in his knees. Overall, he is a good candidate for the procedure, and I
have referred him to Dr. Mast, general surgeon.
A. E11.9, E66.9, M17.0, Z15.89
B. E66.01, E11.9, M17.0, Z68.41
C.
E11.69, M17.4, E66.9, Z68.41
D.
E66.01, E11.69, M17.0, Z68.41
133. Patient presents with sternal chest pain, possible
angina. Physician rules out angina and documents probable costochondritis. Code
the diagnosis.
A. R07.9
B. M94.0
C. R07.2
D. I20.9
134. The patient is seen today for radiation therapy for
treatment of breast cancer following a lumpectomy that removed a lesion on the
central portion of the right breast. Which of the following diagnosis codes
would be listed first for this encounter?
A. C50.119
B. Z85.3
C. D05.90
D. Z51.0
135. The patient is a 75-year-old woman who is here for
follow-up after an incident last week in which she had an FB lodged in her
throat due to a narrowing in her esophagus. An emergency esophagoscopy was
performed and the piece of hamburger meat removed and biopsy performed. She is
positive for Barrett’s esophagus. She has a history of GERD and is here today
to be evaluated for photodynamic therapy. Code all the current diagnosis /
symptoms.
A. K21.9, K22.70, R13.10
B. T18.128A, K22.2, R13.10
C.
T18.128A, K22.2, K21.9
D.
K22.2, K22.70, K21.9
136. The physician performed a medial meniscectomy and
removal of loose bodies from the lateral compartment. Select the appropriate
codes for a Medicare patient.
A.29881
B.
29881, G0289
C.
29880, 29874
D.
G0289
137. What is the HCPCS Level II code for wound closure
using tissue adhesive(s) only?
A. A6250
B. G0168
C. A4452
D. A4450
138. A patient has an insulin pump of 100 units. The pump
is filled. Which code reports the supply?
A. J1817
B. J1815 x20
C. J1817 x 2
D. J1835
139. A 78-year-old patient, with known arrhythmia,
presented to an outpatient clinic for the insertion of a cardiac event
recorder. What is the proper HCPCS Level II code for this device?
A. C1767
B. C1764
C. C1777
D. C1785
140. The physician performed manipulation of a closed
fracture of the distal radius on a 12-year-old male. He placed a short arm
fiberglass cast. What is the HCPCs Level II code for the supply?
A. Q4012
B. Q4011
C. Q4010
D. Q4009
141. What is the full CPT code description for 61535?
A. Craniotomy with elevation of bone flap; for subdural
implantation of an electrode array, for long-term seizure monitoring; for
removal of epidural or subdural electrode array, without excision of cerebral
tissur (separate procedure)
B. Craniotomy with elevation of bone flap;for removal of
epidural or subdural electrode array, without excision of cerebral tissue (separate
procedure)
C. For removal of epidural or dubdural electrode array,
without excision of cerebral tissue (separate procedure)
D. For excision of epileptogenic focus without
electrocorticography during surgery; for removal of epidural of subdural
electrode array, without excision of cerebral tissue (separate procedure)
142. Which of the following place of service codes is
reported for fracture care performed by an orthopedic physician in the
emergency department?
A.
11
B.
20
C.
22
D.
23
143. When coding for a patient who has had a primary
malignancy of the thyroid cartilage that was completely excides a year ago,
which of the following statements it TRUE?
A. When no further treatment is provided and there is no
evidence of any existing primary malignancy, code Z85.850.
B. When further treatment is provided and there is
evidence of an existing metastasis, code first Z85.850 and then C32.3.
C. Any mention of
extension, invasion, or metastasis to another site is coded as a D49.1.
D.
When further treatment is provided and there is evidence of an existing
metastasis, code first C78.39.
144. In order to use the critical care codes, which of the
following statments is TRUE?
A. Critical care services can be provided in an
internist’s office.
B. Critical care services provided for more than 15
minutes but less then 30 minutes should be billed with 99291 and modifier 52.
C. Time spent
reviewing laboratory test results or discussing the critically ill patient’s
care with other medical staff in the unit or at the nursing station on the
floor cannot be included in the determination of critical care time.
D. Critical care services can only be billed if the patient is ina licensed emergency room
or internsive care type unit (I.e., cardiac, surgical, respiratory).
145. Which of the following
statement regarding the ICD-10-CM coding conventions is TRUE?
A.
If the same condition is described as both acute and chronic and separate
subentries exist in the Alphabetic Index at the same indentation level, code
only the acute condition.
B.
Only assign a combination code when the Alphabetic Index explanation directs
the coder to use it.
C.
An ICD-10-CM code is stillvalid even if it has not been coded to the full
number of digits required for that code.
D.
Signs and symptoms that are integral to the disease process should not be
assigned as additional codes, unless otherwise instructed.
146. Which modifier should be append to a CPT, for which
the provider had a patient sign an ABN from because there is a possibility the
service may be denied because the patient’s diagnosis might not meet medical
necessity for the covered service?
A. GJ
B.
GA
C.
GB
D.
GY
147. Which of the following is an example of fraud?
A. Reporting the code for ultrasound guidance when used
to perform a liver biopsy.
B. Reporting a biopsy and excision performed on the same
skin lesion during the same encounter.
C. Failing to append modifier 26 on an X-ray that is
performed in the physician’s office.
D. Failure to append modifier 57 on the EM service
performed the day prior to a minor procedure.
148. Which of the
following statements regarding advanced beneficiary notices (ABN) is TRUE?
A. ABN must specify only the CPT code that medicare is
expected to deny.
B. Generic ABN which states that a medicare denial of
payment is possible or the internist is unaware whether Medicare will deny
payment or not is acceptable.
C. An ABN must be completed before delivery of items or
services are provided.
D. An ABN must be obtained from a patient even in a
medical emergency when the services to be provided are not covered.
149. Which of the following services are covered by
Medicare Part B?
A. Inpatient chemotherapy
B. Minor surgery performed in a physician’s office
C. Routine dental care
D. Assisted living facility
150. What is the patient’s right when it involves making
changes in the personal medical record?
A. Patient must work through an attorney to revise any
portion of the personal medical information.
B. They should be able to obtain copies of the medical
record and request corrections of errors and mistakes.
C. It is a violation of federal health care law to revise
a patient medical record.
D. Revision of the patient medical record depends solely
on the facility’s compliance program policy.
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