CPC PRACTICE EXAM 3 (A GRADED EXAM) NEW ACTUAL TEST SOLUTION
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 are reported?
A. 17313, 17314, 17314
B. 17313, 17315
C. 17260, 17313, 17314
D. 17313,17314, 17315 - CORRECT ANSWER Patient is having Mohs Micrographic Surgery
being performed only, eliminating multiple choice answer C. Mohs codes are based on the
anatomic grouping by code, the number of stages taken, and number of blocks per stage. The
surgery was on the back reporting code 17313 for stage 1 with three blocks, add-on code 17314
is for stage 2 with five blocks, and add-on code 17315 is for the sixth block in stage 2. Answer
D
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) is (are) reported?
A. 14060
B. 11642, 14060
C. 11642, 15115
D. 15574 - CORRECT ANSWER An adjacent tissue transfer (advancement flap) was used to
repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice
answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or
Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant
lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are
not separately reported. This eliminates multiple choice answer B. Answer A
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 - CORRECT ANSWER The abscess had already burst, with no need to perform an
incision to open it, eliminating multiple choice answers A and B. The difference between
multiple choice answers C and D, is that the patient is having the debridement performed due
to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of
necrotized infected tissue on the external genitalia. Answer C
,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, N63
B. 19285, C50.912
C. 19120, R92.8
D. 19125, D24.2 - CORRECT ANSWER You can narrow your choices down by the diagnosis.
The beginning of the operative note documents that core biopsies showed "papilloma". In the
ICD-10-CM Alphabetic Index, look for Papilloma-see also Neoplasm, benign, by site. Go to the
Table of Neoplasms and look for Neoplasm, neoplastic/breast/Benign (column) refers you to
code D24.-. Turn to the Tabular List to complete the code, D24.2.
Procedure code 19125 is correct because preoperative placement of radiologic marker
(preoperative needle localization with hookwire needle injection with methylene blue) was used
to excise the lesion. Answer D
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(s) is (are) used?
A. 26123-RT, 26125-F7
B. 26121-RT
C. 26035-RT
D. 26040-RT - CORRECT ANSWER The patient is having a fasciectomy, eliminating
multiple choice answers C and D. The fasciectomy was performed on the right hand supported
by the documentation that states: "the fascial attachments to the flexor tendon sheath were
released" and "subtotal palmar fasciectomy." Documentation also indicates the right middle
finger ( modifier F7) had diseased fascia excised.
Answer D
, This is a 32 year-old female who presents today with sacroilitis. On the physical exam there
was pain on palpation of the left and right sacroiliac joint and fluoroscopic guidance 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 and right 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(s) is (are):
A. 20611
B. 27096-50, 77012
C. 27096-50
D. 27096, 27096-51, 77012 - CORRECT ANSWER The injection is being performed in the
sacroiliac joint, eliminating multiple choice answer A. Fluoroscopic guidance is included and
should not be reported separately because the code description for code 27096 includes
imaging, eliminating multiple choice answers B and D. There is parenthetical note under code
27096 that indicates to use modifier 50 for bilateral procedure (left and right). Answer C
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 ICD-10-CM codes should be reported?
A. 29880-RT, M23.203, M65.80, M94.261, M22.41
B. 29881-RT, M23.211, M65.861, M94.261, M22.41
C. 29881-RT, M23.221, M65.861, M94.261, M22.41
D. 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41 - CORRECT ANSWER For
this operative note the anatomic location is the knee, specifically with just the medial meniscus
performed on, eliminating multiple choice answers A and D. A limited synovectomy (29875)
was performed; however, it was performed in the medial compartment of the knee along with
the medial meniscectomy; therefore, is not reported. Also, code 29875 is a separate procedure,
according to CPT® Surgery Guidelines: The codes designated as "separate procedure" should
not be reported in addition to the code for the total procedure or service of which it is
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 are reported?
A. 17313, 17314, 17314
B. 17313, 17315
C. 17260, 17313, 17314
D. 17313,17314, 17315 - CORRECT ANSWER Patient is having Mohs Micrographic Surgery
being performed only, eliminating multiple choice answer C. Mohs codes are based on the
anatomic grouping by code, the number of stages taken, and number of blocks per stage. The
surgery was on the back reporting code 17313 for stage 1 with three blocks, add-on code 17314
is for stage 2 with five blocks, and add-on code 17315 is for the sixth block in stage 2. Answer
D
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) is (are) reported?
A. 14060
B. 11642, 14060
C. 11642, 15115
D. 15574 - CORRECT ANSWER An adjacent tissue transfer (advancement flap) was used to
repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice
answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or
Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant
lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are
not separately reported. This eliminates multiple choice answer B. Answer A
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 - CORRECT ANSWER The abscess had already burst, with no need to perform an
incision to open it, eliminating multiple choice answers A and B. The difference between
multiple choice answers C and D, is that the patient is having the debridement performed due
to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of
necrotized infected tissue on the external genitalia. Answer C
,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, N63
B. 19285, C50.912
C. 19120, R92.8
D. 19125, D24.2 - CORRECT ANSWER You can narrow your choices down by the diagnosis.
The beginning of the operative note documents that core biopsies showed "papilloma". In the
ICD-10-CM Alphabetic Index, look for Papilloma-see also Neoplasm, benign, by site. Go to the
Table of Neoplasms and look for Neoplasm, neoplastic/breast/Benign (column) refers you to
code D24.-. Turn to the Tabular List to complete the code, D24.2.
Procedure code 19125 is correct because preoperative placement of radiologic marker
(preoperative needle localization with hookwire needle injection with methylene blue) was used
to excise the lesion. Answer D
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(s) is (are) used?
A. 26123-RT, 26125-F7
B. 26121-RT
C. 26035-RT
D. 26040-RT - CORRECT ANSWER The patient is having a fasciectomy, eliminating
multiple choice answers C and D. The fasciectomy was performed on the right hand supported
by the documentation that states: "the fascial attachments to the flexor tendon sheath were
released" and "subtotal palmar fasciectomy." Documentation also indicates the right middle
finger ( modifier F7) had diseased fascia excised.
Answer D
, This is a 32 year-old female who presents today with sacroilitis. On the physical exam there
was pain on palpation of the left and right sacroiliac joint and fluoroscopic guidance 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 and right 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(s) is (are):
A. 20611
B. 27096-50, 77012
C. 27096-50
D. 27096, 27096-51, 77012 - CORRECT ANSWER The injection is being performed in the
sacroiliac joint, eliminating multiple choice answer A. Fluoroscopic guidance is included and
should not be reported separately because the code description for code 27096 includes
imaging, eliminating multiple choice answers B and D. There is parenthetical note under code
27096 that indicates to use modifier 50 for bilateral procedure (left and right). Answer C
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 ICD-10-CM codes should be reported?
A. 29880-RT, M23.203, M65.80, M94.261, M22.41
B. 29881-RT, M23.211, M65.861, M94.261, M22.41
C. 29881-RT, M23.221, M65.861, M94.261, M22.41
D. 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41 - CORRECT ANSWER For
this operative note the anatomic location is the knee, specifically with just the medial meniscus
performed on, eliminating multiple choice answers A and D. A limited synovectomy (29875)
was performed; however, it was performed in the medial compartment of the knee along with
the medial meniscectomy; therefore, is not reported. Also, code 29875 is a separate procedure,
according to CPT® Surgery Guidelines: The codes designated as "separate procedure" should
not be reported in addition to the code for the total procedure or service of which it is
