INTEGUMENTARY SAMPLE QUESTIONS - 001

1. Dr. Jess removed a 4.5 cm (excised diameter) cystic lesion from Amy’s forehead. The ulcerated lesion was anesthetized with 20 mg of 1% Lidocaine and then elliptically excised. The wound was closed with a layered suture technique and a sterile dressing applied. The wound closure, according to Dr. Jess’s documentation, was 5.3 cm. How would you report this procedure?

                            

a. 11446, 12053-51

b. 11646, 12013-51

c. 11446, J2001 x 2, 12013-59

d. 11313, 12053-59

                             

2. James suffered a severe crushing injury to his left upper leg. Two days after surgery, Dr. Barnes completed a dressing change under general anesthesia. How would you report this service?

a. 16020-LT

b. 15852, 01232, J2060

c. 01232-P6

d. 15852-LT

3. A 32-year-old male skidded out of control on a wet road while riding his motorcycle. He sustained an open fracture of the shaft of the tibia. The wound was grossly contaminated with road debris. The wound was debrided down to the level of the exposed bone (no bone was debrided) to remove the foreign material on the first day. A planned additional debridement was performed on the third day, which did include some bone, and planned open reduction was performed on the fourth day (a plate and screws were used). Select the codes for the services on all three days.

a. 11012, 11012-78, 27759

b. 11011-58, 11012-58, 27758

c. 11011, 11012-58, 27758-58

d. 11012, 11011-78, 27752-58

4. Choose the code that describes cryotherapy for acne

a. 10040

b. 17340

c. 15789

d. 17004

5. 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

6. A woman is referred to a plastic surgeon when excessive skin weighs down her eyelids to the point that her sight is impaired. The surgeon performs bilateral blepharoplasty 2 weeks later. Which of the following would be correct for the surgical procedure?

a. 67917-50

b. 15822

c. 15823

d. 15823-50

7. 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

8. Preoperative Diagnosis: Right breast mass Postoperative Diagnosis: Same

Operation: Right subcutaneous mastectomy Indications for Surgery: Operative findings included benign-appearing breast tissue. Frozen section reports as benign breast tissue consistent with gynecomastia. The patient is a 51-year-old male who presented to the clinic complaining of swelling in his right breast under his nipple and areola. He complained that this area was tender and was concerned about possible cancer. The patient was scheduled for outpatient procedure, breast biopsy versus subcutaneous mastectomy.Procedure: After obtaining signed consent, the patient was taken to the operating room and placed in comfortable supine position. After placing all proper anesthesia monitoring devices, EKG, blood pressure and saturation monitors, the patient’s right breast was prepped and draped in the usual sterile fashion. Once this was completed, 1% lidocaine was used to infiltrate the inferior aspect circumareolarly and a #15 blade was then used to make an incision circumareolar from 3 o’clock and 6 o’clock to 9 o’clock on the nipple and small extending incisions were created laterally and medially at 3 o’clock and 5 o’clock. This incision was carried down through the skin and into the subcutaneous tissue. Skin flaps were then created using Metzenbaum scissors. Allis clamps were used to secure the mass and the mass was dissected out using electrocautery Bovie. After excision the mass, the lateral border of the mass was marked with long silk, the superior aspect of the mass was marked with a short stitch. This was then passed off to pathology for frozen section. Inspecting the wound, the wound was dry. It was irrigated copiously with normal saline. A 3-0 Vicryl was used to reapproximate the subcutaneous tissue to obliterate the dead space and a 4-0 Vicryl suture was used to reapproximate the skin edges using a subcuticular stitch. Steri-strips were then applied over the wound. A sterile dressing was placed over the wound. The patient tolerated the procedure well and there were no complications. A total of 7 cc of 1% lidocaine were used during the case. The estimated blood loss was less than 10 cc. There were no drains.

a) 19302

b) 19302-RT

c) 19300

d) 19300-RT

9. This patient returns today for palliative care to her feet. Her toe nails have become elongated and thickened, and she is unable to trim them on her own. She states that she has had no problems and no acute signs of any infection or otherwise to her feet. She returns today strictly for nail debridement to her feet.

EXAMINATION: Her pedal pulses are palpable bilaterally. The nails are mycotic, 1 through 4 on the left ,and 1 through 3 on the right.

ASSESSMENT: Onychomycosis, 1 through 4 on the left and 1 through 3 on the right.

Follow - up palliative care.

a) 11721 x 7, B49

b) 99212, 11721, B35.1

c) 11719, B35.1

d) 11721, B35.1

10. Bobbie “bumpy” Fimple decides to quit the circus and have 151 skin tags removed. How is this reported?

a) 11200, 11201×13

b) 11200 x 16

c) 11200, 11201 x 15

d) 11200, 11201 x 14

11. Debridement of the skin of the abdominal wall due to necrotizing soft tissue infection, the wound was closed with insertion of mesh.

a) 11005, 11008

b) 11042, 11008

c) 11005, 49568

d) 11000, 11008

12. Following excision of a malignant lesion of the nose, the subsequent pathology report shows that an additional excision is necessary to remove the entire lesion. The patient is schedules for a second visit during the postoperative period of the primary excision and the remainder of the lesion is removed. The original lesion measures 1.2 cm with skin margins of 0.6 cm. the second encounter involved excising an additional area having a diameter of 1.2 cm along one of the original margins. Select the CPT code for the second encounter.

a. 11641-76

b) 11642-58

c) 11643

d) 11641-58

13. Code selection when reporting a lesion excision is determined by which of the following?

a) Measuring the greatest clinical diameter of the lesion only

b) Measuring the greatest clinical diameter of the lesion plus the narrowest margin required for complete excision

c) Judgement of the provider

d) Measuring the greatest clinical diameter of the lesion plus the widest margin required for complete excision

14. Hair transplant, 21 punch grafts. Give the appropriate CPT code.

a) 15050

b) 14300

c) 15775

d) 15776

15. Surgical treatment of burn with escharotomy, 4%, 11-year-old female. Give the appropriate CPT code.

a) 16000

b) 16035

c) 16010

d) 16030

16. The measurement of 100 sq.cm in codes 15100 – 15136  is applicable to which of the following subgroups?

a. Infants and children under age of 10, not dependent on setting

b. Adults and children age of 10 and older, inpatient only

c. Infants and children under age of 10, Inpatient only

d. Adults and children age 10 and older, not dependent on setting

17. According to CPT, the surgical package includes all of the following

a. Anesthesia, the operation per se, postoperative complications

b. Whatever Medicare says it is

c. Digital blocks, operation per se, typical postoperative care

d. Operation per se, inpatient services, care of underlying diseases for 90 days

18. 24 year old 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. 10061

C. 11004

D. 11042

19. 45 year old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the

nasolabial fold and was advanced into the primary defect. Which CPT code(s) should be used?

A. 14060

B. 11642, 14060

C. 11642, 15115

D. 15574

20. 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

21. 76-year-old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be performed on the eyelids. A lower incision line was marked at approximately 5 mm above the lid margin along the crease.Then using a pinch test with forceps the amount of skin to be resected was determined and marked. An elliptical incision was performed on the left eyelid and the skin was excised. In a similar fashion the same procedure was performed on the right eye. The wounds were closed with sutures. The correct CPT codes are?

A. 15822, 15823-51

B. 15823-50

C. 15822-50

D. 15820-LT, 15820-RT

22. 53-year-old male for removal of 2 lesions located on his nose and lower lip. Lesions were identified and marked. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area. The lower lip lesion of 4mm in size was shaved to the level of the superficial dermis. What are the codes for these procedures?

A. 11104, 11105

B. 11310, 11104-59

C. 17000, 17003

D. 11310, 11105-59

23. PRE OP DIAGNOSIS: Left Breast Abnormal MMX or Palpable Mass; Other Disorders Of Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast FINDINGS: Lesion is located in the lateral region, just at or below the level of the nipple on the 90 degree lateral view. There is a subglandular implant in place. I discussed the procedure with the patient today including risks, benefits and alternatives. Specifically discussed was the fact that the implant would be displaced out of the way during this biopsy procedure. Possibility of injury to the implant was discussed with the patient. Patient has signed the consent form and wishes to proceed with the biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged from the inferior approach. The lesion of interest is in the anterior portion of the breast away from the implant which was displaced back toward the chest wall. After imaging was obtained and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped with Betadine. 1% lidocaine was injected subcutaneously for local anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling needle. The SenoRx needle was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy samples using vacuum and cutting technique. The specimen radiograph confirmed representative sample of calcification was removed. The tissue marking clip was deployed into the biopsy cavity successfully. This was confirmed by final stereotactic digital image and confirmed by post core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left breast in satisfactory position. No obvious calcium is visible on the final post core biopsy image in the area of interest. The patient tolerated the procedure well. There were no apparent complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack in the usual manner. The patient did receive written and verbal post-biopsy instructions. The patient left our department in good condition. IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT BREAST CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE RECEIVE THE PATHOLOGY REPORT. What are the codes for the procedures?

A. 19081

B. 19283

C. 19101, 19283

D. 19100, 19283

24. 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

25. 30 year old female is having debridement performed on an infected ulcer with eschar on the right foot.Using sharp dissection, the ulcer and eschar infection was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT code should be reported?

A. 11000

B. 11011

C. 11044

D. 15004

26. 46 year old female had a previous biopsy that indicated positive margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn out and a 15 blade scalpel was used for full excision of an 8cm lesion. Light undermining of all margins was performed along with layered closure. The specimen was sent for permanent histopathologic examination. What are the code(s) for this procedure?

A. 11426

B. 11626

C. 11626, 12044-51

D. 11426, 13132, 13133

27. A 36-year-old male presents 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

28. 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 3, 13133-52, 13101, 13102, 12052

C. 13132, 13133 x 3, 13101, 13102, 12052

D. 13131, 13132, 13133 x 3, 13101, 13102, 12052

29. 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

30. James had a malignant lesion removed from his right arm (excised diameter 4.6 cm). During the same visit the dermatologist noticed a new growth on James’ left arm. Dr. Terry took a punch biopsy of the new lesion and sent it in for pathology. The biopsy site required a simple closure. Report the Dr. Terry’s biopsy procedure?

                                                             

a. The biopsy is included in the primary procedure and not reported

b. 11104

c. 11406, 11104-59                 

d. 11106, 12001, 11406-51

31. Tina fell from a step ladder while clearing drain gutters at her home. She suffered contusions and multiple lacerations. At the emergency room she received sutures for lacerations to her arm, hand, and foot. The doctor completed the following repairs: superficial repair to the arm of 12.8 cm, a single-layered closure of 7.9 cm that required extensive cleaning and removal of glass from the hand, and a simple repair to the foot of 9.6 cm How would you report the wound repairs?

a. 12034, 12036, 12046, 12007

b. 12006, 12034-59

c. 12044, 12006-51

d. 12005, 12004 x 2

32. 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

33. A patient had a chest wall tumor excised. The procedure involved the ribs with plastic reconstruction, and mediastinal lymphadenectomy. How would you report this procedure?

a. 19272, 32503-59

b. 19272

c. 32503, 19271-59, 21632-59

d. 32422, 19260-51

34. 76-year-old female had a recent mammographic and ultrasound abnormality in the 6 o’clock position of the left breast. She underwent core biopsies which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hookwire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o’clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, we performed a generous excisional biopsy around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology. Once hemostasis was assured, digital palpation of the depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound was closed in 2 layers with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local anesthetic was infiltrated for postoperative analgesia. What CPT and ICD-10-CM codes describe this procedure?

A. 19100, D24.2

B. 19105, C50.919

C. 19120, R92.8

D. 19125, D24.2

35. Martha has a non-healing wound on the tip of her nose. After an evaluation by Dr. Martino, a dermatologist, Martha is scheduled for a procedure the following week. Dr. Martino documented an autologous split thickness skin graft to the tip of Martha’s nose. A simple debridement of granulated tissues is completed prior to the placement. Using a dermatome, a split thickness skin graft was harvested from the left thigh. The graft is placed onto the nose defect and secured with sutures. The donor site is examined, which confirms good hemostasis. How would you report this procedure?

a. 99213-25, 15050

b. 15050, 15004, 15005-59

c. 15273, 11041-59

d. 15120