1. Which of the following is
a feature of benign lesion?
a)
They spread vigorously into other structures
b)
They are confined to their place of origin & encapsulated
c)
They may turn into malignant in later time
d)
All of the above
2. Wound closure utilizing
adhesive strips as the sole repair material should be coded using
a) simple repair codes
b) intermediate repair codes
c) complex repair codes
d) E/M codes
3. Single-layer closure of
heavily contaminated wounds that have required extensive cleaning or removal of
particulate matter constitutes —————— repair
a) simple
b) intermediate
c) complex
d) Z-plasty
4. The frozen section
pathology after 1.5 cm malignant melanoma lesion showed positive margins, so an
additional excision for 2.5 cm was done in the post operative period of the
initial procedure. How will you code the second re-excision procedure?
a)
11602-58
b)
11603
c)
11603-58
d)
11606
5. Which of the following is
not included in excision of lesion codes?
a) local anesthesia
b) simple suture
c) measuring the lesion
d) procedures reported with
12031-12057 / 13100-13153
6. Which of the following is
not adjacent tissue transfer?
a)
Z-plasty
b)
W-plasty
c)
V-Y plasty
d)
punch graft
7. When can we bill
diagnostic skin biopsy along with Moh’s micrographic surgery?
a)
always we should bill
b)
never should we bill
c)
when there is no prior pathology confirmation
d)
when there is prior pathology confirmation
8. How do we bill 88314 with
Moh’s micrographic surgery?
a) for routine frozen section
b) for routine frozen section
with modifier 59
c) for non-routine frozen
section
d) for non-routine frozen section
with modifier 59
9. ———————— is a technique
for the removal of complex or ill-defined skin cancer with histologic
examination of 100% of the surgical margins.
a) Cryoablation
b) Shaving of lesion
c) Z-plasty
d) Moh’s micrographic surgery
10. When an open incision biopsy
is done followed by percutaneous placement of metallic clip under stereotactic
guidance
a) 19081
b) 19101, 19081
c) 19100
d) 19101, 19283
11. If a breast mass is
removed through open incision and specific attention to removal of adequate
surgical margins is given then report,
a)
19120
b)
19125
c)
19301
d)
19110
12. Cryocautery of 17 actinic
keratoses is coded as
a)
17000, 17003
b)
17000, 17003 x 16
c)
17000, 17004
d)
17004
13. In which of the following
areas we should not add the individual measurements?
a)
surgical preparation 15002 – 15005
b)
application of autograft 15100 – 15261
c)
excision of benign / malignant lesion
d)
simple, intermediate and complex repair
14.
A
45 year-old male with a previous biopsy positive for malignant melanoma
presents for definitive excision of the lesion. After induction of general
anesthesia, the patient is placed supine on the OR table, the left knee prepped
and draped in the usual sterile fashion. IV antibiotics are given; patient had
previous MRSA infection. The previous excisional biopsy site on the left knee
measured approximately 4 cm and was widely ellipsed with a 1.5 cm margin. The
excision was taken down to the underlying patellar fascia. Hemostasis was
achieved via electrocautery. The resulting defect was 11cm x 5cm. Wide
advancement flaps were created inferiorly and superiorly using
electrocautery. This allowed skin edges
to come together without tension. The wound was closed using interrupted 2-0
Monocryl and 2 retention sutures were placed using #1 Prolene. Skin was closed
with a stapler. What CPT® code(s) is/are
reported?
a. 14301, 11606-51
b. 15738, 11606-51
c. 15758
d.
14301
15. What CPT® code(s) would best describe treatment of 9
plantar warts removed and 6 flat warts all destroyed with cryosurgery during
the same office visit?
a. 17110, 17003
b.
17110
c.
17110, 17111-52
d. 17111
16. The patient is seen in follow-up for excision of the
basal cell carcinoma of his nose. I
examined his nose noting the wound has healed well. His pathology showed the margins were
clear. He has a mass on his forehead; he
says it is from a piece of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, and
we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local
anesthetic. I had drawn for him how I
would incise over the foreign body. He
observed this in the mirror so he could understand the surgery and agree on the
location. I incised a thin ellipse over
the mass to give better access to it; the mass was removed. There was a capsule around this, containing
what appeared to be a black-colored piece of stained metal; I felt it could
potentially cause a permanent black mark on his forehead. I offered to excise
the metal. He wanted me to, and so I went ahead and removed the capsule with
the stain and removed all the black stain. I consider this to be a complicated
procedure. Hemostasis was achieved with
light pressure. The wound was closed in
layers using 4-0 Monocryl and 6-0 Prolene.
What CPT® and
ICD-10-CM codes are reported?
a.
11010, M79.5,
Z85.828
b. 10121, L92.3, Z18.10, Z85.828
c. 11010, S01.84XA, Z18.10, Z85.828
d.
10121, M79.5,
Z85.828
17. Patient presents with a suspicious lesion on her left
arm. With the patient’s permission the physician marked the area for excision.
The margins and lesion measured a total of 0.9 cm. The wound measuring 1.2 cm
was closed in layers using 4-0 Monocryl and 5-0 Prolene. Pathology later
reported the lesion to be a sebaceous cyst. What codes are reported?
a.
12031, 11401-51,
L72.3
b. 11402, L72.3
c. 13121, 11401-51, D22.62
d.
11401, D22.62
18. Patient presents to the physician for removal of a
squamous cell carcinoma of the right cheek. After the area being prepped and
draped in a sterile fashion the surgeon measured the lesion, documenting the
size of the lesion to be 2.3 cm in its largest diameter. Additionally, the
physician took margins of 2 mm on each side of the lesion. Single layer closure was performed. The
patient tolerated the procedure well. What CPT® code(s) is/are reported?
a.
11442
b. 11643
c. 11643, 12013
d.
11642, 12013
19. A patient presented to the
operating room for a modified radical mastectomy, including axillary lymph
nodes, and saline prosthesis insertion on the right breast, due to primary
breast cancer. Apply all the correct CPT and ICD-10-CM codes.
a)
19307, 19340-51, C50.911
b)
19307, D49.3
c)
19306, 19340-51, C50.811
d)
19305, 19340-51, D49.3
20. An 8-year old child
sustains two percent total body surface area third degree burns from boiling
water she accidentally spills on her hands. The wounds are open and draining.
She is taken to the operating room for surgical excision of the burn wounds to
prepare the recipient site and simultaneous application of a dermal autograft.
Code the procedure.
a)
15004, 15130, 15136
b)
15004, 15005, 15135, 15136
c)
15002, 15130, 15131
d)
15002, 15003, 15135, 15136
21. Forty-two days after an
abdominal aortic aneurysm repair, a 72 year old patient returns to see his
vascular surgeon with the complaint of six fibrocutaneous tags on his neck. The
provider takes a brief history, performs a problem focused exam of the lesion
area and determines electrosurgery of the tags would be the best approach. The
provider performs electrosurgical destruction of the skin tags. What are the
appropriate CPT and ICD-10-CM codes?
a)
11200-79, L91.8
b)
99212-24-25, 11057, D17.39
c)
99213-24, 11057-79, L72.0
d)
11200, D48.5
22. A patient has six wounds
repaired. Three wounds 2 cm of the scalp, 3.5 cm on the leg and 1.5 cm on the
face require simple repairs. Two more wounds 1 cm on the foot and 3 cm on the
hand require layered closures. The final procedure is a complex repair 5 cm on
the ear. Code these repairs and list them according to complexity.
a)
13152, 12042-59, 12002-59, 12011-59
b)
12052, 12041-51, 12042-51, 12001-51, 12011-51, 12002-51
c)
12052, 12002-51, 12041-51, 12011-51, 12002-51, 12001-51
d)
12042, 12002-51, 12011-51, 13152-51
23. Code the surgical
preparation of a 70 sq cm hypertrophic burn scar of the arm and the split
thickness graft required to cover the defect created.
a)
15120, 15002
b)
15100
c)
15100, 15002
d)
15220, 15221×3
24. A physician removes 17
fibrocutaneous tags by electrosurgical destruction. Code the services performed
to destroy these lesions.
a)
11057
b)
11200, 11201
c)
11200, 11201-52
d)
11055, 11056, 11057
25. Code the excision of a
benign lesion located on the face having a diameter including margins of 2.5 cm
and one neck lesion with 0.75 cm, including margins
a) 11443, 11421-59
b) 11421, 11443
c) 11621-11643-51
d) 11643, 11621-59
26. Excision of malignant skin
lesions was being performed. The first lesion was located on the trunk and
measured 2.1 cm. The second lesion was located on the face and measured 3.0 cm.
A third lesion was located in the scalp and measured 3.5 cm. the measurements
are based on diameter and include margins. Code these services and diagnoses.
a)
11624, 11643-59, 11603-59
b)
11643, 11642, 11603
c)
11642, 11643-51, 11603-51
d)
11624, 11643, 11603
27. During a riot on the
street in front of a federal building, an 18-year old female is hit in the face
and left foot with flying glass and sustains a complicated wound (4 cm in
length) to the right cheek that requires a complex repair. She requests a
plastic surgeon (Surgeon A) repair the wound to her cheek while a general
surgeon (surgeon B) repairs a wound on her left foot (7.7 cm) with a layered
closure. Code both surgeon’s procedures and diagnoses.
a) A- 13132-62, S01.401A, B-
12004-62, S91.329A
b) A-13152-62, S01.409A, B-
12004-59, S91.302A
c) A-13152, S09.93XA, B-
12054, S91.302A
d) A-13132, S01.401A, B-
12044, S91.302A
28. Patient presents with a
vertical 4 cm scar on the lateral border of her right elbow. The patient complains
that the scar contraction limits their range of flexion and wishes to have it
removed and corrected surgically. The surgical site is prepped with Betadine
and sterile drapes are applied. Two arms are drawn at each end of the linear
scar, inscribing an angle of 60 degrees to the scar. The side arms are exactly
equal in length to the central scar and have precisely the same angle. Local
anesthesia is administered. The physician then makes two vertical incisions
through the skin along the lines, using a no.15 scalpel blade and excises the
vertical scar tissue. Full thickness skin flaps are undermined at the level of
subcutaneous fat, creating two triangular flaps of equal size and shape
(Z-plasty) for 10sq cm. Adequate undermining of surrounding subcutaneous tissue
is performed to achieve proper mobilization of the flaps. The two flaps are
then transposed around each 11406, 12032other changing the direction of the
original scar. The flaps are held in place internally with a few anchoring
stitches. The skin is closed using interrupted sutures. Topical antibiotics and
a pressure dressing are applied and the patient is told to return in two weeks
fro suture removal. What is the correct code(s)?
a) 14020
b) 11406, 12032
c) 12032
d) 14020, 12032
29. A 45-year old was shooting
hoops with his neighbors in the drive way. He lost his balance and hit his head
on a wool retaining wall along the driveway. He presents to the emergency room
with a 8 cm laceration of his forehead. On examination the laceration involves
only the subcutaneous tissues. The wound is quite dirty with what appears to be
mud and cut grass. After copious washing small splinters of wood can be seen
and are removed before the wound is closed with one layer closure.
a) 12014
b) 13131
c)
12053
d)
12054
30. A patient requires
extensive skin grafts following burns of the lower left leg. The physician
harvests skin for the graft. Late she applies the STSG graft to a 200 square cm
area.
a.
15040, 15100, 15101
b.
15100, 15101
c.
15040, 15002, 15100
d.
15002, 15100, 15101
31. A patient presents with
flash burns for the entire face, second degree, 25 percent of the neck, second
degree and the left forearm and hand, third degree. The dermatologist debrides
the face and neck and then performs an escharotomy using 2 incisions to the
left forearm and hand, all under general anesthesia. Code the treatment.
a)
16000, 16020
b)
16035, 16036, 16025
c)
16035, 16036
d)
16025, 16035
32. DIAGNOSIS: Lesion of the
left mandibular line times two. HISTORY: This patient has two lesion on her
left jaw line with “dog-ears” on either end, and she desires revision of these
areas for more normal anatomic reconstruction site. She, therefore, presents
today for definitive removal of these lesions. PROCEDURE: With the patient in
the supine position under intravenous sedation, 1% lidocaine with 1:100,000
epinephrine buffered with sodium bicarbonate was injected into the two lesions
in question along the left jaw line. Each lesion measured approximately 1.5 cm
in length. Having waited 10 minutes for vasoconstriction to occur, each lesion
was excised under loupe magnification with a #15 Bard-Parker. Hemostasis was
obtained with the Bovie. The closure was performed with two layers of 5-0
Vicryl, followed by running, fine, 6-0 black nylon, again under loupe
magnification. The patient tolerated the procedure well. Sponge and needle
counts were reported as correct.
a)
11442
b)
11442 x 2
c)
12031-51
d)
12031, 11000-51
33. Code the CPT and
ICD-10Procedural Codes for the Op Report Below
DIAGNOSIS: Macromastia.
ANESTHESIA: General OPERATION: McKissock reduction mammoplasty, inferior
pedicle only.
PROCEDURE: Under adequate
general anesthesia, the breasts were prepped and draped in a routine fashion
and injected with 0.5% Xylocaine with 1:200,000 epinephrine to aid in
hemostasis. The patient’s breasts had been marked for standard McKissock
reduction mammoplasty preoperatively with the patient in the sitting position.
The right breast was operated upon first, and a standard McKissock reduction
mammoplasty was carried out, creating medial and lateral flaps and excising
medial and lateral triangles. The nipple was supported with an inferior pedicle
approximately 10 cm. in width. Good viability of the nipple was present at the
termination of dissection. Approximately 1,000 grams of breast tissue was removed
from the left breast, and 1,000 grams from the right breast. The patient’s
wounds were closed with clear and black nylon fine sutures. Sterile dressings
were applied, and the patient returned to the recovery room in satisfactory
condition with a bra in place. Both breasts were operated upon in equal
fashion. No drains were placed.There were no complications.
a)
19318
b)
19318-51
c)
19318-50
d)
19324
34. A squamous cell carcinoma
(diameter 0.8 cm) of the right palm was excised with margins. The remaining
defect measured 0.8 cm by 0.9 cm and was repaired by using split skin graft
reconstruction.Give the appropriate CPT code.
a)
15120, 11621-59
b)
15120, 15121, 11640
c)
15120, 11621-51
d)
15100
35. Adjacent tissue transfer,
trunk, 8 sq.cm. Give the appropriate code.
a)
15000
b)
15101
c)
15220
d)
14000
36. An 57-year-old man, status
post ventral hernia repair, has incision and drainage of an infected
postoperative abscess in the doctor’s office. The wound is closed after
placement of a latex drain. The patient is placed on p.o. antibiotics. The
culture grows staph aureus. Give the appropriate CPT code.
a)
10180, 12034-51
b)
10180
c)
10140
d)
10060
37. Mr. Philips met with an
accident. He presented to his primary care doctor. The doctor has to do complex
repair of a 5.5 cm cut on his left flank and intermediate repair of a 20 cm cut
on his left hand. What CPT codes the doctor should bill for?
a)
13101, 12045-59
b)
13101-58, 12045-51
c)
13101, 12045-51
d)
13101, 12035-51
38. Xenograft, left thigh, 4×8
sqcm
a) 15271
b) 15273
c) 15275
d) 15277
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