1.
Code
an amputation of the right leg just above the knee.
a. 27598
b. 27590
c. 27290
d. 28825
2. A patient had a unilateral percutaneous
intradiscal electrothermal annuloplasty on L3-L5 with fluoroscopic guidance for
needle placement. How would you report this professional service procedure?
a. 22526, 22527
b. 22526, 22527, 77002-26
c. 22899, 77002-51
d. 22526, 22527, 77003-26
3. A
42-year-old man has his “total knee” prosthesis removed after he develops an
inflammatory reaction. Choose the best procedure codes for the service
a. 27372
b. 27486
c. 27438
d. 27488
4. 52
year old female has a mass growing on her right flank for several years. It has
finally gotten significantly larger and is beginning to bother her. She is
brought to the Operating Room for definitive excision. An incision was made
directly overlying the mass. The mass was down into the subcutaneous tissue and
the surgeon encountered a well encapsulated lipoma approximately 4 centimeters.
This was excised primarily bluntly with a few attachments divided with
electrocautery. What CPT should be reported?
A. 21932
B. 21935
C. 21931
D. 21925
5. While
playing at home, Riley dislocated his patella, when he fell from a tree. The
surgeon documented an open dislocation. Riley underwent a closed treatment
under anesthesia. How would you report the treatment and diagnoses?
a. 27420, S83.006A
b. 27562, S83.013A
c. 27840, 27562-51, S83.006A
d. 27562, S83.006A
6. How
should you report a deep biopsy of soft tissue of the thigh or knee area?
a. 27323
b. 27324
c. 20206
d. 27328
7. This
is a 32 year old female who presents today with sacroilitis. On the physical
exam there was pain on palpation of the left sacroiliac joint and imaging
confirmation was done for the needle positioning. Then 80 mg of Depo-Medrol and
1 mL of bupivacaine at 0.5% was injected into the left sacroiliac joint with a
22 gauge needle. The patient was able to walk from the exam room without
difficulty. Follow up will be as needed. The correct CPT code is:
A. 20610, 77003-26
B. 20551
C. 27096-LT
D. 20555
8. Code an
arthrocentesis into the acromioclavicular joint of the left shoulder
a. 20550
b. 20610
c. 20605
d. 20600
9. 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, 73542-26
D. 27096
10. 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, S42.451B
B. 24577, S42.451B
C. 24579, S42.451A
D. 24575, S42.451A
11. 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 a 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
12. A
patient suffered a fracture of the femur head. He had an open treatment of the
femoral head with a replacement using a Medicon alloy femoral head and methyl
methacrylate cement. How would you report this procedure?
a. 27236
b. 27235
c. 27238
d. 27275, 27236-59
13.
PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open
reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF
PROCEDURE: The patient was brought to the operating room, anesthesia having
been administered. The right upper extremity was prepped and draped in a
sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm
tourniquet was elevated. An incision was made over the dorsal radial aspect of
the right wrist. Skin flaps were elevated. Cutaneous nerve branches were
identified and very gently retracted. The interval between the second and third
dorsal compartment tendons was identified and entered. The respective tendons
were retracted. A dorsal capsulotomy incision was made, and the fracture was
visualized. There did not appear to be any type of significant defect at the
fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending
from the proximal pole of the scaphoid distalward. The guidewire was positioned
appropriately and then measured. A 25-mm Acutrak drill bit was drilled to 25
mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was
accomplished in this fashion. This was visualized under the OEC imaging device
in multiple projections. The wound was irrigated and closed in layers. Sterile
dressings were then
applied. The
patient tolerated the procedure well and left the operating room in stable
condition. What code should be used for this procedure?
A. 25628-RT
B. 25624-RT
C. 25645-RT
D. 25651-RT
14. An
infant with genu valgum is brought to the operating room to have a bilateral
medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used
to localize the growth plate. With the growth plate localized, an incision was
made medially on both sides. This was taken down to the fascia, which was
opened. The periosteum was not opened. The Orthofix figure-of-eight plate was
placed and checked with x-ray. We then irrigated and closed the medial fascia
with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl.
What procedure code should be used?
A. 27470-50
B. 27475-50
C. 27477-50
D. 27485-50
15. After
adequate anesthesia was obtained the patient was turned prone in a kneeling
position on the spinal table. A lower midline lumbar incision was made and the
soft tissues divided down to the spinous processes. The soft tissues were
stripped way from the lamina down to the facets and discectomies and
laminectomies were then carried out at L3-4, L4-5 and L5-S1. Interbody fusions
were set up for the lower three levels using the Danek allografts and augmented
with structural autogenous bone from the iliac crest. The posterior
instrumentation of a 5.5 mm diameter titanium rod was then cut to the
appropriate length and bent to confirm to the normal lordotic curve. It was
then slid immediately onto the bone screws and at each level compression was
carried out as each of the two bolts were tightened so that the interbody
fusions would be snug and as tight as possible. Select the appropriate CPT
code(s) for this visit?
A. 22612, 22614 x 2, 22842, 20938,
20930
B. 22533, 22534 x 2, 22842
C. 22630, 22632 x 2, 22842, 20938,
20930
D. 22554, 22632 x 2, 22842
16. PREOPERATIVE
DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna.
POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius
and ulna. OPERATIVE PROCEDURE: Reduction with application external fixator,
left wrist fracture FINDINGS: The patient is a 46-year-old right-hand-dominant
female who fell off stairs 4 to 5 days ago sustaining an impacted distal radius
fracture with possible intraarticular component and an associated ulnar styloid
fracture. Today in surgery, fracture was reduced anatomically and an external
fixator was applied. PROCEDURE: Under satisfactory general anesthesia, the
fracture was manipulated and C-arm images were checked. The left upper
extremity was prepped and draped in the usual sterile orthopedic fashion. Two
small incisions were made over the second metacarpal and after removing soft
tissues including tendinous structures out of the way, drawing was carried out
and blunt-tipped pins were placed for the EBI external fixator. The frame was
next placed and the site for the proximal pins was chosen. Small incision was
made. Subcutaneous tissues were carried out of the way. The pin guide was
placed and 2 holes were drilled and blunt-tipped pins placed. Fixator was
assembled. C-arm images were checked. Fracture reduction appeared to be
anatomic. Suturing was carried out where needed with 4-0 Vicryl interrupted
subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings were applied.
Vascular supply was noted to be satisfactory. Final frame tightening was
carried out. What CPT codes should be reported?
A. 25600-LT, 20692-51
B. 25605- LT, 20690-51
C. 25606-LT
D. 25607-LT
17. The
patient is a 66-year-old female who presents with Dupuytren’s disease in the
right palm and ring finger. This results in a contracture of the ring digit MP
joint. She is having a subtotal palmar fasciectomy for Dupuytren’s disease
right ring digit and palm. An extensile Brunner incision was then made
beginning in the proximal palm and extending to the ring finger PIP crease.
This exposed a large pretendinous cord arising from the palmar fascia extending
distally over the flexor tendons of the ring finger. The fascial attachments to
the flexor tendon sheath were released. At the level of the metacarpophalangeal
crease, one band arose from the central pretendinous cord-one coursing toward
the middle finger. The digital nerve was identified, and this diseased fascia
was also excised. What procedure code should be used?
A. 26123-RT, 26125
B. 26121-RT
C. 26035-RT
D. 26040-RT
18. Mike
had a bicycle accident and suffered deep hematomas in both knees. He underwent
a bilateral incision and drainage. How would you report the procedure?
a. 27301-50
b. 10040
c. 27303
d. 27301-59
19. PREOPERATIVE
DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS: Medial
meniscus tear, extensive synovitis with an impingement medial synovial plica,
right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial
meniscectomy and synovectomy, right knee The patent was brought to the
operating room, placed in the supine position after which he underwent general
anesthesia. The right knee was then prepped and draped in the usual sterile
fashion. The arthroscope was introduced through an anterolateral portal,
interim portal created anteromedially. The suprapatellar pouch was inspected.
The findings on the patella and the femoral groove were as noted above. An
intra-articular shaver was introduced to debride the loose fibrillated
articular cartilage from the medial patellar facet. The hypertrophic synovial
scarring between the patella and the femoral groove was debrided. The
hypertrophic impinging medial synovial plica was resected. The hypertrophic
synovial scarring overlying the intercondylar notch and lateral compartment was
debrided. The medial compartment was inspected. An upbiting basket was introduced to transect
the base of the degenerative posterior horn flap tear. This was removed with a
grasper. The meniscus was then further contoured and balanced with an
intra-articular shaver, reprobed and found to be stable. The cruciate ligaments
were probed, palpated and found to be intact. The lateral compartment was then
inspected. The lateral meniscus was probed and found to be intact. The loose
fibrillated articular cartilage along the lateral tibial plateau was debrided
with the intra-articular shaver. The knee joint was then thoroughly irrigated
with the arthroscope. The arthroscope was then removed. Skin portals were
closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was
then awakened and sent to the recovery room in stable condition. What CPT and should be reported?
A. 29880-RT
B. 29881-RT
C. 29881-RT, 29822-59-RT
D. 29880-RT, 29822-59-RT
20. Re-reduction
of fracture during the postoperative period by the same physician is identified
usingModifier
a) 58
b) 78
c) 76
d) 79
21. A
16-year-old patient undergoes excision of an aneurismal bone cyst of the
proximal right humeruswith allograft.
a) 23155-22
b) 23156
c) 23146
d) 23220-63
22. Codes
20100 – 20103 do not include which of the following procedures?
a) exploration and enlargement of the
wound
b) extension of dissection
c) debridement, removal of foreign
body
d) thoracotomy / laparotomy
23. Patient
underwent replantation of thumb after complete amputation from the distal tip
to the MP joint
a) 20822
b) 20824
c) 20827
d) 20816
24. This 45
year-old male presents to the operating room with a painful mass of the right
upper arm. Upon deep dissection a large
mass in the soft tissue of the patient's shoulder was noted. The mass appeared
to be benign in nature. With deep blunt
dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported?
a. 23076-RT
b. 23066-RT
c. 23030-RT
d. 23075-RT
25. Surgeon
performed open repair of femoral neck fracture with internal fixation.
a) 27230
b) 27235
c) 27236
d) 27244
26. patient
fell and fractured his left femoral shaft in three places. The fracture is
treated with an ORIF of the left femur with an intramedullary nail and
interlocking screws (peritrochanterically). The orthopedist also places the leg
in a plaster splint prior to leaving the OR. What CPT® code(s) is/are reported?
a. 27245
b. 27507, 29505
c. 27506
d. 27513, 29505
27. A
patient with compartment syndrome undergoes decompression fasciotomy of his
right leg posterior compartment. The physician debrided all the nonviable
tissue and nerve in that compartment. Code the procedure.
a) 27601
b) 27601, 10040
c) 27893
d) 27892, 27893
28. A 50 year-old
male had surgery on his upper leg one day ago to remove an intramuscular tumor
and presents with serous drainage from the wound. He was taken back to the
operating room for evaluation of a hematoma. His wound was explored down to the
rectus femoris muscle, and there was a hematoma which was very carefully
evacuated. The wound was irrigated with antibacterial solution, and the wound
was closed in multiple layers. What CPT® and ICD-10-CM codes are reported?
a. 10140-79, M96.810
b. 27603-78, T81.4XXA
c. 10140-76, T81.9XXA
d. 27301-78, M96.840
29. The
type of fracture determines the type of treatment
a) True
b) False
30. Patient
underwent reconstruction of the mandibular rami due to blunt trauma, undergoing
C osteotomy with bone graft.
a) 21195
b) 21188
c) 21193
d) 21194
31. Codes
for external fixation
a) can be used
always when it is mentioned
b) should not
be billed separately
c) can be
billed if it is part of the basic procedure
d) can be
billed if it is not part of the basic procedure
32. Surgeon
performs removal of Harrington rod in a patient suffering from chronic
irritation in the region of insertion.
a) 22850
b) 22850, 22851-59
c) 22850-62, 22851-59
d) 22852, 22849-59
33. Ultrasound
guided trigger point injection in the deltoid, biceps and trapezius.
a) 20553
b) 20552
c) 20553, 76942
d) 20552, 76942
34. A patient was seen in the office for
trigger point injection involving the trapezius and lattismus muscle groups.
a) 20551
b) 20552
c) 64614
d) 64613
35. A 42
year-old with chronic right trochanteric bursitis is scheduled to receive an
injection at the Pain Clinic. A 22-gauge spinal needle is introduced into the
trochanteric bursa, and a total volume of 8 cc of normal saline and 40 mg of
Kenalog is injected. What are the CPT® codes?
a. 20550-RT
b. 20610-RT
c. 20611-RT
d. 27093-RT
36. A doctor
performs an open procedure of ankle arthrodesis for a patient with ankle
arthritis. After arthrodesis, the doctor fits a small bone graft obtained from
the fibula into the ankle. Code this procedure.
a) 27870, 20900
b) 27870, 20900-51
c) 27860
d) 27860, 20900
37. A 22 year-old female has a retained Kirschner wire in
the left little finger. Using local anesthesia, the left upper extremity was
thoroughly cleansed with Betadine. The end portion of the little finger was
opened with a transverse incision through the subcutaneous tissue to the bone.
The retained Kirschner wire was located within the distal phalanx. It was
removed and the skin was closed with sutures.
What CPT® code is reported?
a. 20670-F4
b. 20680-F4
c. 10121-F4
d. 10120-F4
38. A 31 year-old secretary returns to the office with
continued complaints of numbness involving three radial digits of the upper
left extremity. Upon examination, she has a positive Tinel’s test of the median
nerve in the left wrist. Anti-inflammatory medication has not relieved her
pain. Previous electrodiagnostic studies show sensory mononeuropathy. She has
clinical findings of carpal tunnel syndrome. She has failed physical therapy
and presents for injection of the left carpal canal. The left carpal area is
prepped sterilely. A 1.5 inch 25-gauge needle is inserted radial to the
palmaris longus or ulnar to the carpi radialis tendon at an oblique angle of
approximately 30 degrees. The needle is advanced a short distance about 1 or 2
cm observing for any complaints of paresthesia or pain in a median nerve
distribution. The mixture of 1 cc of 1% lidocaine and 40 mg of Kenalog-10 is
injected slowly along the median nerve. The injection area is cleansed and a
bandage is applied to the site. What codes are reported?
a. 20526
b. 20550
c. 20551
d. 20605
39. A 22 year-old female sustained a dislocation of the
right elbow with a medial epicondyle fracture while on vacation. The patient
was given general anesthesia and the elbow was reduced and was stable. The
medial epicondyle was held in the appropriate position and was reduced in
acceptable position and elevated. A long arm splint was applied. The patient is
referred to an orthopedist when she returns to her home state in a few days.
What CPT® code(s) are reported?
a. 24565-54-RT, 24605-54-51-RT
b. 24577-54-RT, 24600-54-51-RT
c. 24575-54-RT, 24615-54-51-RT
d. 24576-54-RT, 24620-54-51-RT
40. A young
man with left tibial shaft fracture is provided open treatment without
intramedullary implant.After the procedure the leg was placed in a short leg
cast. Give the appropriate CPT codes.
a) 27758
b) 27758, 29425
c) 27758, 29405
d) 27759, 29425
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