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1. While whittling a piece of wood, the patient sustained an avulsion injury to a portion of his left index
finger and underwent formation of a direct pedicle graft with transfer from his left middle finger.
Immobilization was accomplished with a plaster splint. What CPT® code is reported?
a. 15574 c. 15750
b. 15740 d. 15758
ANS: A
Rationale: In the CPT® Index look for Pedicle Flap/Formation, you are directed to 15570-15576. Code
selection is based on location. Subsection guidelines for Flaps state the codes refer to the recipient site
not the donor site. The term pedicle indicates this is a flap not a direct graft, where skin is removed from
one site and transferred to another. Instead, a flap of skin is raised, leaving it attached to its source
location to maintain blood supply until it is established sufficiently in the new site. Code 15574 describes
a direct pedicle graft of the hands with or without transfer.
2. A 3 year-old is brought to the burn unit after pulling a pot of hot soup off the stove and spilling it on
herself. She sustained 18% second degree burns on her legs and 20% third degree burns on her chest
and arms. Total body surface area burned is 38%. What ICD-10-CM codes are reported for the burns (do
not include external cause codes for the accident)?
a. T21.21XA, T22.20XA, T24.209A, T31.23
b. T21.31, T22.20, T24.209, T31.32
c. T21.31XA, T22.399A, T24.299A, T31.32
d. T21.31XA, T22.20XA, T24.209A, T31.32
ANS: C
Rationale: ICD-10-CM guideline I.C.19.d.1 states to sequence first the code that reflects the highest
degree of burn when more than one burn is present. In this case, the burns on her chest and arms are
third degree and are reported first. In the ICD-10-CM Alphabetic Index look for Burn/chest wall/third
degree, referring you to subcategory T21.31. Because the question indicates arms and legs (plural) we
will code multiple sites of the upper and lower limbs. In the Alphabetic Index look for Burn/upper
limb/multiple sites/third degree directing you to subcategory T22.399, and Burn/lower/limb/multiple
sites/second degree directing you to subcategory T24.299. The Tabular List indicates a 7th character is
needed for all three of these codes; a placeholder X is required for T21.31. The 7th character A is
reported for the initial encounter. Refer to ICD-10-CM guideline I.C.19.d.6 for instructions on assigning a
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code from category T31 to report the extent of body surface involved. The 4th character represents the
total body surface area (TBSA) (all degrees) that was burned. The 5th character represents the
percentage of third degree burns to the body. In the scenario, 38% is documented as the TBSA making 3
the appropriate 4th character; 20% is third degree burns, making 2 the 5th character. In the Alphabetic
Index look for Burn/extent (percentage of body surface)/30-39 percent/with 20-29 percent third degree
burns directing you to code T31.32. The external cause codes would also be reported for the accident.
Verify code selection in the Tabular List.
3. Patient is an 81-year-old male with a biopsy proven basal cell carcinoma of this posterior neck just
near his hairline; additionally the patient had two additional areas of concern on his cheek. Informed
consent was obtained and the areas were prepped and draped in the usual sterile fashion. Attention
was first directed to the basal cell carcinoma of the neck, I excised the lesion measuring 2.6 cm as drawn
down to the subcutaneous fat. With extensive undermining of the wound I closed in layers using 4.0
Monocryl, 5.0 Prolene and 6.0 Prolene; the wound measured 4.5cm. Attention was then directed to the
other two suspicious lesions on his cheek; after administering local anesthesia I proceeded to take a
3mm punch biopsy of each lesion and was able to close with 5.0 Prolene. The patient tolerated the
procedures well. Pathology later showed the basal cell carcinoma was completely removed and the
biopsies indicated actinic keratosis. What CPT® codes should be reported?
a. 13132, 11623-51, 11100-59, 11101 c. 12042, 11623-51, 11100-59, 11101
b. 13131, 11622-51, 11100-59, 11100-59 d. 13132, 11623-51, 11440-51, 11440-51
ANS: A
Rationale: Three lesions were addressed. The first lesion is a malignant neoplasm of the neck (basal cell
carcinoma). Look in the CPT® Index for Skin/Excision/Lesion/Malignant. This refers you to code range
11600-11646. The range is narrowed by the location (neck, 11620-11626). The excision was 2.6 cm
making 11623 the correct code. For this lesion, extensive undermining of the wound and the use of
multiple suture materials support use of a complex closure. Complex repairs are indexed under
Repair/Skin/Wound/Complex referring you from range 13100-13160. The range is narrowed again by
location (neck, 13131-13133). The repair length is 4.5 cm making 13132 the correct code. After the
lesion of the neck is removed the provider took two biopsies on the cheek. Look in the CPT® Index for
Skin/Biopsy which refers you to codes 11100 and 11101. 11100 is used for the first biopsy and add-on
code 11101 for the additional biopsy. Biopsies are typically included in excisions. It is necessary to use
modifier 59 for the first biopsy indicating it was performed at a different location than the excision. A
modifier 59 is not used on the second biopsy code because it is an add-on code.
4. Patient is a 53-year-old female who yesterday underwent Mohs surgery with Dr. Smith to remove a
basal cell carcinoma of her scalp. Due to the size of the defect Dr. Smith requested a Plastic Surgeon to
reconstruct the site. Dr. Jones discussed with the patient his planned closure which was a Ying-Yang
type flap. The patient agreed and we proceeded. The area was prepped and draped in a sterile fashion
being careful to keep betadine solution out of the open wound. Wound preparation was done by
excising an additional 1 mm margin to freshen the wound and excising the wound deeper. Starting on
the right, Dr. Jones incised his planned flap, elevating the flap with full-thickness and subcutaneous fat,
staying superior to the galea; then Dr. Jones incised his planned flap on the left elevating the flap with
full-thickness and subcutaneous fat. Both flaps were rotated together and the wound was temporarily
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closed using the skin stapler. Once it was determined there was minimal tension on the wound; the
galea was approximated using 4.0 Monocryl. The wound was then closed in layers using 5-0 Monocryl
and a 35R skin stapler. Meticulous hemostasis was achieved through-out the procedure with the Bovie
cautery. Final measurements of the wound were 36.25 cm squared. What CPT® code(s) is/are
reported?
a. 14021-22 c. 14301
b. 14021, 15004-51 d. 14301, 15004-51
ANS: D
Rationale: A Ying Yang flap is a rotation flap coded using Adjacent Tissue Transfer codes. In the CPT®
Index, look for Skin Graft and Flap/Tissue Transfer and you are directed to codes 14000-14350. When
the defect size is less than 30 sq. cm, it is coded based on location and size. When it is more than 30 sq.
cm, it is coded using 14301 and 14302. In this case, we have a flap 36.25 sq. cm. 14301 is reported for
the first 30 sq. cm – 60.0 sq. cm. Wound preparation was also performed, in the CPT® index look for
Integumentary System/Skin Replacement Surgery and Skin Substitutes/Surgical Preparation referring
you to codes 15002-15005. Code 15004 is reported for the scalp. Modifier 51 is used to indicate
multiple procedures were performed.
5. Patient presents to the emergency department with multiple lacerations due to a knife fight at the
local bar. After examination it was determined these lacerations could be closed using local anesthesia.
The areas were prepped and draped in the usual sterile fashion. The surgeon documented the following
closures: 7.6 cm simple closure of the right forearm; 5.7 cm intermediate closure of the upper right arm;
4.7 cm complex closure of the right neck; 10.3 cm intermediate closure of the upper chest. What CPT®
codes are reported?
a. 13132, 12035-59, 12004-59
b. 13132, 12034-59, 12032-59, 12004-59
c. 13132, 12036-59
d. 13152, 12035-59, 12004-59
ANS: A
Rationale: Four lacerations are repaired. The lacerations are separated first by classification (simple,
intermediate, complex); then by location. There is one simple closure which is 7.6 for the right forearm
(12004). Next the intermediate closures are performed on the arm measuring 5.7 cm and the upper
chest measuring 10.3 cm. Trunk (chest) and extremities (arm) are in the same classification and are
both intermediate, so the lengths are added together to total 16 cm (12035). The last repair is a complex
repair of the neck, 4.7 cm (13132). Subsection guidelines state to append Modifier 59 to indicate that
multiple repair procedures are performed. These codes are indexed in CPT® under Skin/Wound Repair.
6. Patient presents to the operative suite with a biopsy proven squamous cell carcinoma of the left
ankle. A decision was made to remove the lesion and apply a split thickness skin graft on the site. The
lesion was excised as drawn and documented as measuring 2.4 cm with margins. Using the Padgett
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dermatome the surgeon harvested a split-thickness skin graft from the left thigh, which was meshed 1.5
x 1 and then inset into the ankle wound using a skin stapler. Xeroform bolster was then placed on the
skin graft using Xeroform and 4-0 nylon and the lower extremity was wrapped with bulky cast padding
and double Ace wrap. The skin graft donor site was dressed with OpSite. The surgeon noted the skin
graft measured 9cm² in total. What CPT ® and ICD-10-CM codes are reported?
a. 15100, 11603-51, C44.729 c. 15120, 13100-51, D22.72
b. 15100, C44.729 d. 15240, 11603-51, C44.729
ANS: A
Rationale: The excision of the lesion is found by looking in the CPT® Index for
Skin/Excision/Lesion/Malignant, you are referred to code range 11600-11646. The lesion is on the ankle
(leg) narrowing the code range to 11600-11606. The lesion is 2.4 cm making the correct code 11603.
The guidelines for Excision – Malignant Lesions tell us to report reconstructive closure (15002-15261,
15570-15770) separately. In this case a split thickness skin graft was used. Look in the CPT® Index for
Skin Graft and Flap/Split Graft which refers us to code range 15100-15101, 15120-15121. 15100 is the
correct code choice. The diagnosis is squamous cell carcinoma. In the Alphabetic Index look for
Carcinoma – see also Neoplasm, by site, malignant. Look in the Table of Neoplasms for Neoplasm,
neoplastic/skin NOS/ankle and you are referred to see also Neoplasm, skin, limb, lower. Skin/limb
NEC/lower/squamous cell carcinoma refers you to C44.72-. In the Tabular List a sixth character is
reported for laterality. The code is specific to the left extremity (C44.729).
7. Patient presents with a suspicious lesion on her left arm. With the patient’s permission the physician
marked the area for excision. The lesion measured 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. 11401, D22.62 c. 13121, 11401-51, D22.62
b. 12031, 11401-51, L72.3 d. 11402, L72.3
ANS: B
Rationale: Understanding a sebaceous cyst is benign, look in the CPT® Index for
Skin/Excision/Lesion/Benign referring you to code range 11400-11446. The lesion is coded based on size
and location for 11401. The note also indicates the wound was closed in layers allowing for
intermediate closure, also coded based on location and size, 12031. In the ICD-10-CM Alphabetic Index,
look for Cyst/sebaceous directs you to L72.3. Verify in the Tabular List.
10000 SERIES
1. While whittling a piece of wood, the patient sustained an avulsion injury to a portion of his left index
finger and underwent formation of a direct pedicle graft with transfer from his left middle finger.
Immobilization was accomplished with a plaster splint. What CPT® code is reported?
a. 15574 c. 15750
b. 15740 d. 15758
ANS: A
Rationale: In the CPT® Index look for Pedicle Flap/Formation, you are directed to 15570-15576. Code
selection is based on location. Subsection guidelines for Flaps state the codes refer to the recipient site
not the donor site. The term pedicle indicates this is a flap not a direct graft, where skin is removed from
one site and transferred to another. Instead, a flap of skin is raised, leaving it attached to its source
location to maintain blood supply until it is established sufficiently in the new site. Code 15574 describes
a direct pedicle graft of the hands with or without transfer.
2. A 3 year-old is brought to the burn unit after pulling a pot of hot soup off the stove and spilling it on
herself. She sustained 18% second degree burns on her legs and 20% third degree burns on her chest
and arms. Total body surface area burned is 38%. What ICD-10-CM codes are reported for the burns (do
not include external cause codes for the accident)?
a. T21.21XA, T22.20XA, T24.209A, T31.23
b. T21.31, T22.20, T24.209, T31.32
c. T21.31XA, T22.399A, T24.299A, T31.32
d. T21.31XA, T22.20XA, T24.209A, T31.32
ANS: C
Rationale: ICD-10-CM guideline I.C.19.d.1 states to sequence first the code that reflects the highest
degree of burn when more than one burn is present. In this case, the burns on her chest and arms are
third degree and are reported first. In the ICD-10-CM Alphabetic Index look for Burn/chest wall/third
degree, referring you to subcategory T21.31. Because the question indicates arms and legs (plural) we
will code multiple sites of the upper and lower limbs. In the Alphabetic Index look for Burn/upper
limb/multiple sites/third degree directing you to subcategory T22.399, and Burn/lower/limb/multiple
sites/second degree directing you to subcategory T24.299. The Tabular List indicates a 7th character is
needed for all three of these codes; a placeholder X is required for T21.31. The 7th character A is
reported for the initial encounter. Refer to ICD-10-CM guideline I.C.19.d.6 for instructions on assigning a
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code from category T31 to report the extent of body surface involved. The 4th character represents the
total body surface area (TBSA) (all degrees) that was burned. The 5th character represents the
percentage of third degree burns to the body. In the scenario, 38% is documented as the TBSA making 3
the appropriate 4th character; 20% is third degree burns, making 2 the 5th character. In the Alphabetic
Index look for Burn/extent (percentage of body surface)/30-39 percent/with 20-29 percent third degree
burns directing you to code T31.32. The external cause codes would also be reported for the accident.
Verify code selection in the Tabular List.
3. Patient is an 81-year-old male with a biopsy proven basal cell carcinoma of this posterior neck just
near his hairline; additionally the patient had two additional areas of concern on his cheek. Informed
consent was obtained and the areas were prepped and draped in the usual sterile fashion. Attention
was first directed to the basal cell carcinoma of the neck, I excised the lesion measuring 2.6 cm as drawn
down to the subcutaneous fat. With extensive undermining of the wound I closed in layers using 4.0
Monocryl, 5.0 Prolene and 6.0 Prolene; the wound measured 4.5cm. Attention was then directed to the
other two suspicious lesions on his cheek; after administering local anesthesia I proceeded to take a
3mm punch biopsy of each lesion and was able to close with 5.0 Prolene. The patient tolerated the
procedures well. Pathology later showed the basal cell carcinoma was completely removed and the
biopsies indicated actinic keratosis. What CPT® codes should be reported?
a. 13132, 11623-51, 11100-59, 11101 c. 12042, 11623-51, 11100-59, 11101
b. 13131, 11622-51, 11100-59, 11100-59 d. 13132, 11623-51, 11440-51, 11440-51
ANS: A
Rationale: Three lesions were addressed. The first lesion is a malignant neoplasm of the neck (basal cell
carcinoma). Look in the CPT® Index for Skin/Excision/Lesion/Malignant. This refers you to code range
11600-11646. The range is narrowed by the location (neck, 11620-11626). The excision was 2.6 cm
making 11623 the correct code. For this lesion, extensive undermining of the wound and the use of
multiple suture materials support use of a complex closure. Complex repairs are indexed under
Repair/Skin/Wound/Complex referring you from range 13100-13160. The range is narrowed again by
location (neck, 13131-13133). The repair length is 4.5 cm making 13132 the correct code. After the
lesion of the neck is removed the provider took two biopsies on the cheek. Look in the CPT® Index for
Skin/Biopsy which refers you to codes 11100 and 11101. 11100 is used for the first biopsy and add-on
code 11101 for the additional biopsy. Biopsies are typically included in excisions. It is necessary to use
modifier 59 for the first biopsy indicating it was performed at a different location than the excision. A
modifier 59 is not used on the second biopsy code because it is an add-on code.
4. Patient is a 53-year-old female who yesterday underwent Mohs surgery with Dr. Smith to remove a
basal cell carcinoma of her scalp. Due to the size of the defect Dr. Smith requested a Plastic Surgeon to
reconstruct the site. Dr. Jones discussed with the patient his planned closure which was a Ying-Yang
type flap. The patient agreed and we proceeded. The area was prepped and draped in a sterile fashion
being careful to keep betadine solution out of the open wound. Wound preparation was done by
excising an additional 1 mm margin to freshen the wound and excising the wound deeper. Starting on
the right, Dr. Jones incised his planned flap, elevating the flap with full-thickness and subcutaneous fat,
staying superior to the galea; then Dr. Jones incised his planned flap on the left elevating the flap with
full-thickness and subcutaneous fat. Both flaps were rotated together and the wound was temporarily
,CPC FINAL WITH ANSWERS
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closed using the skin stapler. Once it was determined there was minimal tension on the wound; the
galea was approximated using 4.0 Monocryl. The wound was then closed in layers using 5-0 Monocryl
and a 35R skin stapler. Meticulous hemostasis was achieved through-out the procedure with the Bovie
cautery. Final measurements of the wound were 36.25 cm squared. What CPT® code(s) is/are
reported?
a. 14021-22 c. 14301
b. 14021, 15004-51 d. 14301, 15004-51
ANS: D
Rationale: A Ying Yang flap is a rotation flap coded using Adjacent Tissue Transfer codes. In the CPT®
Index, look for Skin Graft and Flap/Tissue Transfer and you are directed to codes 14000-14350. When
the defect size is less than 30 sq. cm, it is coded based on location and size. When it is more than 30 sq.
cm, it is coded using 14301 and 14302. In this case, we have a flap 36.25 sq. cm. 14301 is reported for
the first 30 sq. cm – 60.0 sq. cm. Wound preparation was also performed, in the CPT® index look for
Integumentary System/Skin Replacement Surgery and Skin Substitutes/Surgical Preparation referring
you to codes 15002-15005. Code 15004 is reported for the scalp. Modifier 51 is used to indicate
multiple procedures were performed.
5. Patient presents to the emergency department with multiple lacerations due to a knife fight at the
local bar. After examination it was determined these lacerations could be closed using local anesthesia.
The areas were prepped and draped in the usual sterile fashion. The surgeon documented the following
closures: 7.6 cm simple closure of the right forearm; 5.7 cm intermediate closure of the upper right arm;
4.7 cm complex closure of the right neck; 10.3 cm intermediate closure of the upper chest. What CPT®
codes are reported?
a. 13132, 12035-59, 12004-59
b. 13132, 12034-59, 12032-59, 12004-59
c. 13132, 12036-59
d. 13152, 12035-59, 12004-59
ANS: A
Rationale: Four lacerations are repaired. The lacerations are separated first by classification (simple,
intermediate, complex); then by location. There is one simple closure which is 7.6 for the right forearm
(12004). Next the intermediate closures are performed on the arm measuring 5.7 cm and the upper
chest measuring 10.3 cm. Trunk (chest) and extremities (arm) are in the same classification and are
both intermediate, so the lengths are added together to total 16 cm (12035). The last repair is a complex
repair of the neck, 4.7 cm (13132). Subsection guidelines state to append Modifier 59 to indicate that
multiple repair procedures are performed. These codes are indexed in CPT® under Skin/Wound Repair.
6. Patient presents to the operative suite with a biopsy proven squamous cell carcinoma of the left
ankle. A decision was made to remove the lesion and apply a split thickness skin graft on the site. The
lesion was excised as drawn and documented as measuring 2.4 cm with margins. Using the Padgett
, CPC FINAL WITH ANSWERS
10000 SERIES
dermatome the surgeon harvested a split-thickness skin graft from the left thigh, which was meshed 1.5
x 1 and then inset into the ankle wound using a skin stapler. Xeroform bolster was then placed on the
skin graft using Xeroform and 4-0 nylon and the lower extremity was wrapped with bulky cast padding
and double Ace wrap. The skin graft donor site was dressed with OpSite. The surgeon noted the skin
graft measured 9cm² in total. What CPT ® and ICD-10-CM codes are reported?
a. 15100, 11603-51, C44.729 c. 15120, 13100-51, D22.72
b. 15100, C44.729 d. 15240, 11603-51, C44.729
ANS: A
Rationale: The excision of the lesion is found by looking in the CPT® Index for
Skin/Excision/Lesion/Malignant, you are referred to code range 11600-11646. The lesion is on the ankle
(leg) narrowing the code range to 11600-11606. The lesion is 2.4 cm making the correct code 11603.
The guidelines for Excision – Malignant Lesions tell us to report reconstructive closure (15002-15261,
15570-15770) separately. In this case a split thickness skin graft was used. Look in the CPT® Index for
Skin Graft and Flap/Split Graft which refers us to code range 15100-15101, 15120-15121. 15100 is the
correct code choice. The diagnosis is squamous cell carcinoma. In the Alphabetic Index look for
Carcinoma – see also Neoplasm, by site, malignant. Look in the Table of Neoplasms for Neoplasm,
neoplastic/skin NOS/ankle and you are referred to see also Neoplasm, skin, limb, lower. Skin/limb
NEC/lower/squamous cell carcinoma refers you to C44.72-. In the Tabular List a sixth character is
reported for laterality. The code is specific to the left extremity (C44.729).
7. Patient presents with a suspicious lesion on her left arm. With the patient’s permission the physician
marked the area for excision. The lesion measured 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. 11401, D22.62 c. 13121, 11401-51, D22.62
b. 12031, 11401-51, L72.3 d. 11402, L72.3
ANS: B
Rationale: Understanding a sebaceous cyst is benign, look in the CPT® Index for
Skin/Excision/Lesion/Benign referring you to code range 11400-11446. The lesion is coded based on size
and location for 11401. The note also indicates the wound was closed in layers allowing for
intermediate closure, also coded based on location and size, 12031. In the ICD-10-CM Alphabetic Index,
look for Cyst/sebaceous directs you to L72.3. Verify in the Tabular List.
