1. A small
incision was made over the left proximal tibia, and a traction pin was inserted
through the bone to the opposite side. Weights were then affixed to the pins to
stabilize the tibial fracture repair could be performed.
a) 20650-L T
b) 20663-LT
c) 20690-LT
d)
20692-LT
2. Hemiarthoplasty
of the femoral head for a complete femoral neck fracture in a 75-year-old
female patient.
a) 27125
b) 27130
c) 27236
d) 27137
3. Replantation
of foot that was amputated incompletely.
a) 20838
b) 20838-52
c) 20838-53
d) 20802
4. A surgeon
performs a midfoot capsulotomy, medial tendon release and tendon lengthening,
Select the appropriate code.
a) 28250
b) 28260
c) 28261
d) 28262
5. What is the
appropriate CPT code to report replacement of a forearm cast on a date other
than the initial application?
a) 29085
b) None, as
the cast application is part of the global fracture care code
c) 29805×2
d) 99024
6. The
physician performs a surgical procedure for the release of a trigger finger
condition on the right middle finger. At the same operative session, the
surgeon excises a bone cyst on the left fourth metacarpal of the hand (no graft
necessary). Select the correct codes,
a) 26210-F6,
26070-F8
b) 26200-F2,
26210-F3
c) 26200-F3,
26055-F7
d) 26210-F3,
26055-F8
7. Libby was
thrown from a horse while riding in the ditch; a truck that honked the horn as
it passed her startled her horse. The horse reared up, and Libby was thrown to
the ground. Her left tibia was fractured and required insertion of multiple
pins to stabilize the defect area. A unilateral multiplane external fixation
system was then attached to the pins.
a) 20661-LT,
S82.202B
b) 20692-LT,
S82.202A
c) 20692-LT,
S82.202B
d) 20690-LT,
S82.202A
8. A patient
presents to an internal medicine provider complaining of wrist pain due to an
imbedded foreign body (thorn entered while trimming outside bushes). The
internist requests an orthopedist to evaluate the patient’s injury. The
orthopedist performs a detailed history and exam and discusses the treatment
option & performed low complexity MDM.The patient opts for surgical
intervention. The orthopedist relays his findings to the internist and proceeds
to explore the wrist area. The thorn is located deep in the tissues of the
wrist which the orthopedic surgeon removes without complications. Select the
appropriate CPT codes.
a) 25250,
25246-51, 99242-57
b) 25040,
25248, 99241-57
c) 25248,
99243-57
d) 25040,
99242-57
9. A patient
is admitted to the hospital outpatient department where an excision of a tumor
(2.5 cm) located on the lower back (subcutaneous tissue) is performed.
Pathology report comes back verifying a diagnosis of lipoma. Select the
appropriate CPT and ICD-10-CM codes.
a) 21930,
D17.79
b) 22100,
21930-51, D17.39
c) 21935,
D17.79
d) 21930,
D17.39
10. Total hip
replacement is performed for aseptic necrosis of the head and neck of the
femur. What arethe correct CPT and ICD-10-CM codes for this procedure?
a) 27130,
M87.059
b) 26392,
M89.159
c) 28238,
M87.059
d) 29901,
M84.459A
11. Carl Ostrick,
a 21-year-old male, slipped on a patch of ice on his sidewalk while shoveling
snow. When he fell, his left hand was wedged under his body and his index
finger was dislocated. After manipulating the joint back into normal alignment,
the surgeon fixed the dislocation by placing a wire percutaneously through the
carpometacarpal joint to maintain alignment.
a) 26608-F1
b) 26650-FA
c) 26706-LT
d) 26676-F1
12. Code the CPT
for the following procedure(s):
DIAGNOSIS:
Dorsal ganglion cyst, left wrist
NAME OF
OPERATION: Excision of dorsal ganglion cyst
FINDINGS AT
OPERATION: This patient had one of these thick, very firm cysts in the classic
location beneath the extensor tendon
PROCEDURE: The
patient was given a general anesthetic, and the arm was prepped and draped in a
sterile fashion, with a well-padded tourniquet around the arm. The tourniquet
was inflated to 250 mmHg after exsanguination with an Esmarch. A transverse
incision was made over the cyst, carried down through subcutaneous tissue. The
extensor retinaculum was incised, and tendons were protected with retractors.
The cyst was
then surrounded and lifted up off the carpus, taking a portion of the dorsal
ligament.Irrigation was then carried out. The incision was closed with nylon
and Steri-Strips. A sterile dressing was applied. The patient appeared to
tolerate the procedure well.
a) 25111
b) 25112
c) 25116
d) None of the
above
13. Maryann
received a blow to her right tibial shaft while moving a large stuffed chair up
a flight of stairs when the person in front of the chair slipped and released
his hold on the chair.
The full
weight of the chair was pushed against her; when she was unable to hold the
chair in place, both she and the chair fell to the landing a dozen steps below.
The chair tipped on its side and landed on her tibia. On x-ray, the right tibia
shaft was fractured in 3 places. Percutaneous screws and pins were placed to
secure the fracture sites.
a) 27750-RT,
S82.201B
b) 27756-RT,
S82.201B
c) 27756-RT,
S82.201A
d) 27750-RT,
S82.201A
14. Darin was a
passenger in an automobile rollover accident and was not wearing a seat belt at
the time.He was thrown from the automobile and was pinned under the rear of the
overturned vehicle. He sustained craniofacial separation that required
complicated internal and external fixation using an open approach to repair the
extensive damage. A halo device was used to hold the head immobile.
a) 21435,
20661
b) 21435
c) 21432
d) 21436,
20661
15. A surgeon
performs a diagnostic knee arthroscopy without synovial biopsy that revealed
tears of the medial and lateral menisci. He proceeded with menisectomies of
both medial and lateral menisci along with shaving of the surrounding
tissue/bone. Select the correct code(s).
a) 29880-RT
b) 29880,
29870-51
c) 29881-RT,
29871-51
d) 29870-51,
29871-51
16. Ultrasound
guided arthrocentesis of the acromioclavicular joint with permanent record.
a) 20604
b)
20606
c) 20606,
76942
d) 20611,
76942
17. Mary tells
her physician that she has been having pain in her left wrist for several
weeks. The physician examines the area and palpates a ganglion cyst of the
tendon sheath. He marks the injection sites, sterilizes the area, and injects
corticosteroid into two areas.
a) 20550-LT x
2, M67.432
b) 20551-LT,
M67.40
c) 20551-LT x
2, M67.432
d) 20612-LT,
20612-59-LT, M67.432
18. The physician
applies a Minerva-type fiber glass body cast from the hips to the shoulders and
to the head. Before application, a stockinette is stretched over the patient’s
torso, and further padding of the bony areas with felt padding was done.
a) 29040
b) 29550
c) 29035
d) 29000
19. Operative
report:
Preoperative
diagnosis: Open fracture, left humerus, with possible loss of left radial
pulse.Procedure performed: Open reduction internal fixation, left open humerus
fracture.Procedure: While under general anesthetic, the patient’s left arm was
prepped with Betadine and draped in sterile fashion. We then created a
longitudinal incision over the anterolateral aspect of his left arm and carried
the dissection through the subcutaneous tissue. We attempted to identify the
lateral intermuscular septum and progressed to the fracture site, which was
actually fairly easily to do because there was some significant tearing and
rupturing of the biceps and brachialis muscles. These were partial ruptures,
but the bone was relatively easy to expose through this. We then identified the
fracture site and thoroughly irrigated ut with several liters of saline. We
also noted that the radial nerve was easily visible, crossing along the
posterolateral aspect of the fracture site. It was intact. We carefully
detected it throughout the remainder of the procedure. We then were able to
strip the periosteum away from the lateral side of the shaft of the humerus
both proximally and distally from the fracture site. We did this just enough to
apply a 6-hole plate, which we eventually held in place with six cortical
screws. We did attempt to compress the fracture site. Due to some communition,
the fracture was not quite anatomically aligned, but certainly it was felt to
be very acceptable. Once we had applied the plate, we then checked the radial
pulse with a Doppler. We found that the radial pulse was present using the
Doppler, but not with palpation. We then applied Xeroform dressings to the
wounds and the incision. After padding the arm thoroughly, we applied a long-
arm splint with the elbow flexed about 75 degrees. He tolerated the procedure
well, and the radial pulse was again present on the Doppler examination at the
end of the procedure.
a) 24515-RT,
S42.302B
b) 24500-LT,
S42.402A
c) 24515-LT,
S42.302B
d) 24505-LT,
S42.402B
20. Dexamethasone
acetate, 16 mg was injected into the left shoulder joint for a frozen shoulder
syndrome of an established patient in the provider’s office. Before the
injection, on the same visit, AP and lateral shoulder x-rays were performed in
the provider’s office and interpreted by the provider. Apply all the correct
CPT and HCPCS codes.
a. 20605-LT,
77057-26, J1094 X 3
b. 20610-LT,
73030-LT, J1094 x 16
c.
20610-50, 73020-50, J1094
d. 20605,
73030, J1070
21. Code for
trigger finger release
a) 20551
b) 26055
c) 26060
d) 26037
22. What is
(are) the correct CPT code(s) for an arthrodesis, anterior interbody technique
involving T2-T4?
a) 22556,
22585
b) 22612,
22830-51
c) 27130
d) 28755
23. A patient
presents to the operating room with contracture and tenosynovitis of the left long
finger after sustaining the injury in an accident several months ago. The
physician performs a tenolysis and capsulotomy on the flexor tendon in the
interphalangeal joint. Provide the most appropriate CPT coding for the
scenario.
a) 26440-F2
b) 26525-LT,
26445
c) 26525-LT,
26440-51
d) 26445-F2
24. A 78-year-old
patient suffering from pain related to osteoporosis and subsequent vertebral
compression fractures presents to an ASC for percutaneous vertebroplasty under
CT guidance at the L1 level. Provide the appropriate procedure coding for the
osteoplasty.
a) 22515
b) 22510
c) 22511
d) 22325,
22612
25. Select the
appropriate code(s) for a patient undergoing a hammertoe operation that
includes an interphalangeal fusion on the right great toe.
a) 28285-TA,
28755-RT-51
b) 28285-T5
c) 28286
d) 28286-RT-51
26. DIAGNOSIS:
Foreign body, ball of left foot.
NAME OF
OPERATION: Excision of foreign body, ball of left foot.
ANESTHESIA:
General, tube balanced.
PROCEDURE:
This 24-year-old lady was taken to surgery with the finding of a very tender
isolated spot at the ball of the left foot between the first and second toes.
By history, she felt like she stepped onsomething with pain, and over the
ensuing week-and-a-half to two weeks the pain has gotten unbearable when she
walks. X-rays did not show evidence of a foreign body. However, there is
definitely a callous,granulous formation here that could possibly be a plantar
wart.In the operating room in the supine position after induction of adequate
per Anesthesia, the left foot was prepped with Hibiclens and alcohol for full
three-minute prep. Drapes were applied exposing the ball of the footonly. Local
infiltration of 0.5 cc of 2% Xylocaine
was carried out. The area was elliptically excised, noting a very thick
granular reaction beneaththis. This was sent for pathology review which gave
the final interpretation as a superficial foreign body embedded in the
subcutaneous area of the foot. Total excision area was approximately 8 mm x 3
mm. There was no reaction deep to this.With
this, the wound was closed with two interrupted 5-0 Monocryl stitches giving
complete closure. The area was cleansed with peroxide. A dressing was applied,
and the patient was sent to the recovery room in satisfactory condition. Sponge
count, needle count, and
instrument
counts were correct times three.
a) 10120
b) 11420
c) 28090
d) 28190
27. John, an
84-year-old male, tripped while on his morning walk. He stated he was thinking
about something else when he inadvertently tripped over the sidewalk curb and
fell to his knees. X-ray indicated a fracture of his right patella. With the
patient under general anesthesia, the area was opened and extensively
irrigated. The left aspect of the patella was severely fragmented, and a
portion of the patella was subsequently removed. The remaining patella was
wired. The surrounding tissue was repaired, thoroughly irrigated and closed in
the usual manner.
a) 27524-RT,
S82.001A
b) 27520-RT,
S82.001A
c) 27524-RT,
S82.001B
d) 27530-RT,
S82.001A
28. Code the CPT
for the Op Report Below:
DIAGNOSIS:
Recurrent dislocation, right shoulder
FINDINGS AT
OPERATION: Preoperatively, the patient had instability of the shoulder
anteriorly. He did not have any posterior or inferior instability. At surgery,
he was found to have a large Hill-Sach lesion, as well as very thorough Bankart
lesion (link). The inferior part of the labrum was calcified, and this could be
seen on preoperative x-rays. The glenohumeral surface was relatively clean.
There was no rotator cuff tear or biceps tendon damage.
PROCEDURE: He
was given a general anesthetic and put in the beach-chair position, and prepped
and draped in a sterile fashion. The shoulder was instilled with fluid,
followed by diagnostic arthroscopy with the arthroscope in the posterior
portal, with findings as noted above. The bursal area was examined, also, and
no abnormalities were found. The scope was then removed, and the patient was
put back in the semireclining position. A deltopectoral incision was made,
carried down through the subcutaneous tissue, and the vein was retracted
laterally. The deep structures were approached, and clavipectoral fascia
incised. The arm was externally rotated, and the subscapularis reflected off
the capsule. The capsule was entered, and debridement of the calcified inferior
labrum was carried out. The labral tissue was in relatively good condition, and
it was freed up by using a knife to allow it to come up over the edge of the
glenoid better,and then the edge of the glenoid was roughened.Three Mitek
sutures were then placed right at the edge of the glenoid, and these were used
to repair the labrum. Copious irrigation was carried out. The arm was then
reduced into position, and the lateral capsule tightened down to the labrum,
allowing about 15 degrees of external rotation. These sutures were tied and
were felt to be quite satisfactory. Again,irrigation was performed. The
subscapularis was anatomically closed. The subcutaneous tissue and skin were
closed in layers, and a sterile dressing was applied. All the capsular
redundancy seemed to be negated by the procedure, and he seemed to be quite
stable. Sponge and needle counts were correct. The patient tolerated the
procedure well.
a) 23450
b) 23450,
29807
c) 23455
d) 23455,
29807
29. DIAGNOSIS: Left knee medial meniscus tear.
NAME OF
OPERATION: Partial medial menisectomy with limited debridement.
ANESTHESIA:
General
PROCEDURE: In
the preoperative holding area the site and side and the procedure were
confirmed with the patient. The risks, benefits, and alternatives were
discussed. He voiced understanding regarding the limitations of arthroscopic treatment,
particularly if there is arthritis involved.The patient was taken to the
operating room, and after adequate general anesthesia the left leg was
carefully fitted with a tourniquet over a snugly-fitted Webril and placed in
the left leg holder. The leg was prepped and draped in sterile fashion. Portals
were carefully established using landmarks as a guide. The anterior-medial
portal was established using a spinal needle as a guide. Sequential examination
of the joint was performed. Generalized
arthritis was noted throughout except no full-thickness cartilaginous tears
were noted. There was an unstable medial meniscus tear which was carefully
debrided. The anterior cruciate ligament was a little bit incompetent with some
fraying fibers, but no evidence of gross instability detected as pivot shift
was equivocal. Hence this was left intact. The posterior cruciate ligament was
normal. The patellofemoral joint tracked well. There were grade III articular
changes throughout the knee. A few loose bodies were removed from some of the
cartilaginous surfaces. The worst areas were smoothed, but otherwise it was
left intact. Final inspection was made for loose bodies. These were removed.
The last inspection found none. The joint was irrigated and back-bled. The knee
was injected with Xylocaine and Marcaine for preand postoperative pain. A
sterile dressing was applied. The patient was aroused from anesthesia and taken
to the recovery room in
stable condition having tolerated the procedure well.
a) 27409
b) 29880-LT
c) 29881-LT
d) 29877,
29881-LT
30. Code the closed treatment of a carpal bone
fracture (not scaphoid) with manipulation.
a. 25635
b. 25624
c. 25645
d. 25628
31. The patient fell while at home tow and a half
weeks ago. She had sudden onset of severe left hip pain.She has been ambulatory
with a cane, however, movement is slow and increasingly painful. The patient
was noted to have a nondisplaced proximal neck fracture of the left femur. The
patient elected to undergo stabilization with percutaneous pinning. The patient
was taken to the operating room where spinal anesthetic was administered. The patient was placed on
a fracture table in the supine position. Under fluoroscopic visualization, the
direction for placement of the pins were noted and the skin was marked. A 1 cm
stab incision was made over the the lateral aspect of the left hip at the level
of the lesser trochanter. A self-tapping and self drilling Biomer 6.0
cannulated screw system was used. A guide pin was placed through the incision
and through the lateral aspect of the proximal femur. It was drilled through
the cortex across the fracture site then the femoral neck and femoral head.
This portion of the procedure was accomplished under fluoroscopic guidance. It
was measured to 85 mm and an 85 mm cannulated screw was placed over the
guidewire. It was threaded into the femoral head. The identical procedure was
performed with two more screws, one placed posteriorly in an anterior and
posterior fashion and the other screw placed in the middle anterior position. The guide pins
were removed. A fluoroscopy in AP and lateral projection showed that the screws
were within the femoral head. The femoral head was put through a range of
motion under fluoroscopy to confirm that there was no penetration of the screws
out of the femoral head. The incisions were irrigated with normal saline and
closed with 2-0 Vicryl subcutaneous sutures. The wounds were dressed with
Adaptic, 4 x 4 gauze and an ABD pad held in place with tape. All sponge,
needle, and instrument counts were correct. The patient left the operating room
in good condition and there were no complications. Estimated blood loss was
less than 20 cc. What are the correct codes to report this service?
a) 27235,
S72.002A
b) 27238,
S72.102A
c) 27244,
S72.102A
d) 27235,
S72.146B
32. A 37 year old was admitted to the surgery unit
for surgical repair of the left elbow. The surgeon performed a left elbow
membrane arthroplasty for the patient’s system sclerosis. What are the correct
procedure and diagnosis codes for this encounter?
a) 24330,
M34.0
b) 24360,
M34.9
c) 24343,
M34.9
d) 24356,
M34.0
33. Code a repeat closed treatment of a femoral
shaft fracture with manipulation by the same physician who performed the
initial treatment.
a. 27502-77
b. 27506-76
c. 27507-77
d. 27502-76
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