CPC Practice Exam 1 with complete solutions.

46 year-old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn out and a 15 blade scalpel was used for full excision of an 8 cm lesion. Layered closure was performed after the removal. The specimen was sent for permanent histopathologic examination. What are the CPT® code(s) for this procedure? A. 11626 B. 11626, 12004-51 C. 11626, 12044-51 D. 11626, 13132-51, 13133 According to CPT® guidelines "Repair of an excision of a malignant lesion requiring intermediate or complex closure should be reported separately". The intermediate repair code is reported because it was a layered closure. Answer C 30 year-old female is having 15 sq cm debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT® code should be reported? A. 11043 B. 11012 C. 11044 D. 11042 Debridement is not being performed on an open fracture/open dislocation eliminating multiple choice answer B. The ulcer was debrided all the way to the bone of the foot, making multiple choice answer C, the correct procedure. Answer C 00:42 01:17 64 year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 99283-25, 12014, 12034-59, 12002-59, 11042-51 B. 99283-25, 12053, 12034-59, 12002-59 C. 99283-25, 12014, 12034-59, 11042-51 D. 99283-25, 12053, 12034-59 To start narrowing your choices down, the hand and foot were closed with adhesive strips. The Section Guidelines in the CPT® manual for Repair (Closure) states: "Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code." Eliminating multiple choice answers A and B. The lacerations on the face are intermediate repairs, because debridement and glass debris was removed. The guidelines in the CPT® codebook for Repair (Closure) states: "Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair." Eliminating multiple choice answer C. The intermediate repair of the lacerations to the face totaled 6 cm (12053). The right arm and left leg had cuts measuring 5 cm each which totaled 10 cm requiring intermediate repair (12034). Answer D 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® and ICD-10-CM codes are reported? A. 21932, D17.39 B. 21935, D17.1 C. 21931, D17.1 D. 21925, D17.9 The mass growing turned out to be a lipoma found in the subcutaneous tissue of the flank. In the ICD-10-CM Alphabetic Index, look for Lipoma/subcutaneous/trunk. You are referred to code D17.1, eliminating multiple choice answers A and D. Because the 4 cm tumor was found in the subcutaneous tissue code 21931 is the correct CPT® code to report. Answer C 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 distal ward. 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 CPT® code is reported for this procedure? A. 25628-RT B. 25624-RT C. 25645-RT D. 25651-RT Patient had an open reduction, meaning an incision was made to get to the fracture, eliminating multiple choice answer B. The fracture site was the scaphoid of the wrist (carpal), eliminating multiple choices C and D. Answer A 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 is reported? A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50 Your keywords in the scenario to narrow your choices down to code 27485 are: "distal femur,""genu valgum," and "hemiepiphysiodesis." Answer D The patient is a 67 year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What CPT® code(s) is (are) reported for this procedure? A. 36556, 77001-26 B. 36558 C. 36561, 77001-26 D. 36571 Patient is having an Infuse-A-Port put in his chest to receive chemotherapy. The subclavian vein (central venous) is being tunneled for the access device, eliminating multiple choices A and D. The patient had a subcutaneous pocket created to insert the power port, eliminating multiple choice answer B. Code 77001 reports fluoroscopic guidance for a central venous access device. Modifier 26 denotes the professional service. Answer C A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This was estimated to be 800 cc in size and had an appearance of fluid on the CT Scan. A needle is used to puncture through the chest tissues and enter the pleural cavity to insert a guidewire under ultrasound guidance. A pigtail catheter is then inserted at the length of the guidewire and secured by stitches. The catheter will remain in the chest and is connected to drainage system to drain the accumulated fluid. The CPT® code is: A. 32557 B. 32555 C. 32556 D. 32550 The drainage of fluid from the pleural cavity was performed via needle (percutaneous) with insertion of an indwelling catheter to drain the fluid, eliminating multiple choice answers B and D. The procedure was performed under ultrasound guidance, eliminating multiple choice answer C. Answer A The patient is a 59 year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. He is taken to the operating room for re-do left carotid endarterectomy. The left neck was prepped and the previous incision was carefully reopened. Using sharp dissection, the common carotid artery and its branches were dissected free. The patient was systematically heparinized and after a few minutes, clamps were applied to the common carotid artery and its branches. A longitudinal arteriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastic balloon-tip shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima were removed and the endarterectomized surfaces irrigated with heparinized saline. An oval Dacron patch was then sewn into place with running 6-0 Prolene. Which CPT® code(s) is/are reported? A. 35301 B. 35301, 35390 C. 35302 D. 35311, 35390 The procedure involved removing plaque and the vessel lining from the carotid artery through a neck incision, eliminating multiple choice answers C and D. This was a re-operation (35390), as the original surgery was performed a year ago. Answer B A 52 year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting to the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a scope was placed into the abdomen. Three other ports were inserted under direct vision. The fundus of the gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was carried out to the right of this identifying a small cystic duct and artery, was clipped twice proximally, once distally and transected. The gallbladder was then taken down from the bed using electrocautery, delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port. What CPT® and ICD-10-CM codes are reported? A. 47564, K81.2 B. 47562, K81.1 C. 47610, K81.2 D. 47600, K81.1 One way to narrow down your choices is by the diagnosis. The patient has chronic cholecystitis. In the ICD-10-CM Alphabetic Index, look for Cholecystitis/chronic, referring you to code K81.1. Verify code in the Tabular List for accuracy. This eliminates multiple choice A and C. The patient had a laparoscopic cholecystectomy, eliminating multiple choice answer D. Answer B A 70 year-old female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the area of the hernia where a small defect was clearly visualized. There was some omentum, which was adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect. What procedure code(s) is (are) reported? A. 49560, 49568 B. 49652 C. 49653 D. 49652, 49568 The patient is having a laparoscopic ventral hernia repair, eliminating multiple choice answer A. The hernia is not documented as being incarcerated or strangulated, eliminating multiple choice answer C. A parenthetical note under the code description for 49652 indicates that a mesh insertion (49568) is not reported with this code when performed; eliminating multiple choice answer D. Answer B The patient is a 50 year-old gentleman who presented to the emergency room with signs and symptoms of acute appendicitis with possible rupture. He has been brought to the operating room. An infraumbilical incision was made which a 5-mm VersaStep™ trocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar in the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture noted. The base of the appendix was then divided and placed into an Endo-catch bag and the 12-mm defect was brought out. Select the appropriate code for this procedure: A. 44970 B. 44950 C. 44960 D. 44979 Patient is having the surgery performed by a laparoscope, eliminating multiple choice answers B and C. The surgical procedure performed was an appendectomy, eliminating multiple choice D. Answer A 45 year-old male is going to donate his kidney to his son. Operating ports where placed in standard position and the scope was inserted. Dissection of the renal artery and vein was performed isolating the kidney. The kidney was suspended only by the renal artery and vein as well as the ureter. A stapler was used to divide the vein just above the aorta and three clips across the ureter, extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT® code is: A. 50543 B. 50547 C. 50300 D. 50320 This is a surgical laparoscopic procedure for removing the kidney (nephrectomy), eliminating multiple choice answers C and D. The whole kidney was taken out from a donor and put on ice (cold preservation), eliminating multiple choice answer A. Answer B 67 year-old female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy performed with a placement of a sling. An incision was made over the mid urethra dissected laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What CPT® code(s) is (are) reported? A. 57288 B. 57287 C. 57288, 52000-51 D. 51992, 52000-51 Removal or revision of the sling is not being performed, eliminating multiple choice answer B. The procedure was an open surgery, eliminating multiple choice answer D. Cystoscopy procedure code is a separate procedure. According to CPT® Surgery guidelines, The codes designated as a "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component." Meaning that the cystoscopy is included with the sling operation procedure because it was performed in the same surgical session. Answer A 16 day-old male baby is in the OR for a repeat circumcision due to redundant foreskin that caused circumferential scarring from the original circumcision. Anesthetic was injected and an incision was made at base of the foreskin. Foreskin was pulled back and the excess foreskin was taken off and the two raw skin surfaces were sutured together to create a circumferential anastomosis. Select the appropriate code for this surgery: A. 54150 B. 54160 C. 54163 D. 54164 The physician is not incising the membrane that attaches the foreskin to the glans and shaft of the penis (frenulum), eliminating multiple choice D. The patient is not having the circumcision for the first time, but needed a repair from a previous circumcision, eliminating multiple choice answers A and B. Answer C 5 year-old female has a history of post void dribbling. She was found to have extensive labial adhesions, which have been unresponsive to topical medical management. She is brought to the operating suite in a supine position. Under general anesthesia the labia majora is retracted and the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent granulation tissue was excised on either side. What code should be used for this procedure? A. 58660 B. 58740 C. 57061 D. 56441 The key term to narrow your choices down is the removal of "labial adhesions". This is found in the code descriptive for multiple choice answer D, 56441. The patient is a 64 year-old female who is undergoing a removal of a previously implanted Medtronic pain pump and catheter due to a possible infection. The back was incised; dissection was carried down to the previously placed catheter. There was evidence of infection with some fat necrosis in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump pocket was incised and the pump was dissected from the anterior fascia. A 7-mm Blake drain was placed in the pump pocket through a stab incision and secured to the skin with interrupted Prolene. The pump pocket was copiously irrigated with saline and closed in two layers. What are the CPT® and ICD-10-CM codes for this procedure? A. 62365, 62350-51, T85.898A, Z46.2 B. 62360, 62355-51, T85.79XA C. 62365, 62355-51, T85.79XA D. 36590, I97.42, T85.898A This was a removal of an intrathecal catheter and pump, eliminating multiple choice answer D. The pump is not being implanted or replaced eliminating multiple choice answer B. Nor is the intrathecal catheter being implanted, revised or repositioned eliminating multiple choice answer A. Answer C The patient is a 73 year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt placement with Codman® programmable valve. What is the correct code for this surgery? A. 62220 B. 62223 C. 62190 D. 62192 This key word to choose the correct shunt being performed is "ventriculo-peritoneal", leading you to multiple choice answer B. Answer B What is the CPT® code for the decompression of the median nerve found in the space in the wrist on the palmar side? A. 64704 B. 64713 C. 64721 D. 64719 The key term to choose the correct answer is "median nerve", found in code 64721. Answer C 2 year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia. With a #11 blade the chalazion was incised and a small curette was then used to retrieve any granulomatous material on both lids. What CPT® code should be used for this procedure? A. 67801 B. 67805 C. 67800 D. 67808 There is more than a single chalazion to be removed, eliminating multiple choice answer C. The chalazion was on the upper and lower lid, eliminating multiple choice answer A. The patient was under general anesthesia, eliminating multiple choice answer B. Answer D 80 year-old patient is returning to the gynecologist's office for pessary cleaning. Patient offers no complaints. The nurse removes and cleans the pessary, vagina is swabbed with betadine, and pessary replaced. For F/U in 4 months. What CPT® and ICD-10-CM codes are reported for this service? A. 99201, Z46.89 B. 99211, Z46.89 C. 99202, Z46.9 D. 99212, Z46.9 Scenario documents patient returning to the gynecologist guiding you to the codes for established patient office visit. This eliminates multiple choices A and C. For this scenario, the patient did not have any complaints that required the presence of a physician. There was no examination or medical making decision performed for the patient guiding you to code 99211. There must be an order for the patient to come in for the office visit. For the diagnosis code, the pessary was removed for cleaning reporting Z46.89 Encounter for fitting and adjustment of other specified devices. (Refer to ICD-10-CM guideline I.A.9) Answer D Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision making of moderate complexity. Which E/M service is reported? A. 99285 B. 99284 C. 99221 D. 99222 According to CPT® guidelines: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (example, hospital emergency department, observation status in a hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date of service. Meaning for this scenario the patient's physician had come to the ER and also admitted the patient on the same date of service, eliminating multiple choices A and B. All three of the key components of an initial hospital care code must be met or exceeded. 99221 requires: detailed or comprehensive history, detailed or comprehensive examination, and straightforward or low complexity medical decision making. Because the lowest key component in the question is a detailed history, the highest level that can be reached is 99221. To report code 99222 you would need a comprehensive history. Answer C 20 day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct codes for the physician service. A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303-26 C. 99460-25, 31500, 94002, 93303-26 D. 99291-25, 93303-26 According to CPT® subsection guidelines under Inpatient Neonatal and Pediatric Critical Care: If the same physician provides critical care services for a neonatal or pediatric patient in both the outpatient and inpatient setting on the same day, report only the appropriate Neonatal or Pediatric Critical Care codes for all critical care services provided on that day. This eliminates multiple choice answers C and D. The baby is 20 days-old and you cannot bill intubation (31500) and ventilation management with the neonatal and pediatric critical care codes, eliminating multiple choice B. Answer C A 42 year-old with renal pelvis cancer receives general anesthesia for a laparoscopic radical nephrectomy. The patient has controlled type 2 diabetes otherwise no other co-morbidities. What is the correct CPT® and ICD-10-CM code for the anesthesia services? A. 00860-P1, C64.9, E11.9 B. 00840-P3, C65.9, E11.9 C. 00862-P2, C65.9, E11.9 D. 00868-P2, C79.02, E11.9 The patient receives anesthesia for a laparoscopic radical nephrectomy. Look the CPT® Index, for Anesthesia/Nephrectomy. You are referred to 00862. Review the code in the numeric section to verify accuracy. The patient has controlled type 2 diabetes which supports the use of P2. The patient has renal pelvis cancer. The distinction of secondary cancer is not made so the cancer is coded as a primary neoplasm. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/kidney/pelvis/Malignant Primary column. You are referred to C65.-. Complete code in the Tabular List, C65.9. The patient also has controlled type 2 diabetes. Look in the ICD-10-CM Alphabetic Index for Diabetes/type 2 referring you to E11.9. Answer C A healthy 32 year-old with a closed distal radius fracture received monitored anesthesia care for an ORIF of the distal radius. What is the code for the anesthesia service? A. 01830-P1 B. 01860-QS-P1 C. 01830-QS-P1 D. 01860-QS-G9-P1 The patient receives monitored anesthesia care also known as MAC which is reported with HCPCS Level II modifier QS. There is no indication the patient has a history of cardiopulmonary condition so G9 would not be appropriate. Look in the CPT® Index for Anesthesia/Forearm. You are referred to multiple codes (00400, , ). Refer to these codes in the numeric section to determine the correct code using the code descriptions. The procedure was open and performed on the distal radius. The appropriate code is 01830. Answer C A 10 month-old child is taken to the operating room for removal of a laryngeal mass. What is (are) the appropriate anesthesia code(s) to report? A. 00320 B. 00326 C. 00320, 99100 D. 00326, 99100 The patient receives general anesthesia for the removal of a laryngeal mass. Look in the CPT® Index for Anesthesia/Larynx. You are referred to 00320 and 00326. Review the code descriptions in the numeric section. Code 00326 is the correct code to indicate the procedure is performed on a patient younger than one year. 99100 is not reported because the patient's age range is included in the description of the anesthesia code. There is a parenthetical note under 00326 that indicates the code should not be reported with 99100. Answer B A catheter is placed in the left common femoral artery which was directed into the right the external iliac (antegrade). Dye was injected and a right lower extremity angiogram was performed which revealed patency of the common femoral and profunda femoris. The catheter was then manipulated into the superficial femoral artery (retrograde) in which a lower extremity angiogram was performed which revealed occlusion from the popliteal to the tibioperoneal artery. What are the procedure codes that describe this procedure? A. 36217, 75736-26 B. 36247, 75716-26 C. 36217, 75658-26 D. 36247, 75710-26 Selecting the correct answer can be tackled two ways. (1) A third order selective catheter placement in the brachiocephalic system was not performed, eliminating multiple choice answers A and C. Bilateral angiography of the lower extremities was not performed, eliminating multiple choice answer B. Arterial access was the left common femoral artery and the catheter was directed into the right common iliac (36245 - first order) into right external iliac (36246-second order). The catheter was then directed to the common femoral into the superficial femoral artery (36247-third order). Report only the highest level of catheter placement 36247. Angiography for the right extremity is 75710. Modifier 26 denotes the professional service. OR (2) A right lower extremity angiogram was performed. Code 75736 is eliminated because that is for the pelvis. Code 75716 is eliminated because that is if both extremities had an angiogram. Code 75658 is eliminated because that is for the brachial artery. Code 75710 is the correct angiography code. Answer D 56 year-old female is having a bilateral mammogram with computer aid detection conducted as a screening because the patient has had a previous cyst in the right breast. What radiological services are reported? A. 77065 x 2 B. 77065, 77066 C. 77067 D. 77066 The radiological service is a screening mammogram of both breasts eliminating multiple choices A, B and D. Note: If this was a bilateral diagnostic mammogram you only report code 77066 because the code is specifically for both breasts. You will not report 77065 and 77066, or report 77065 twice or with a modifier 50. Code 77066 also does not have modifier 50 appended because the code description already indicates that it is a bilateral code. Answer C 63 year-old patient with bilateral ureteral obstruction presents to an outpatient facility for placement of a right and left ureteral stent along with an interpretation of a retrograde pyelogram. What codes should be reported? A. 52332, 74000 B. 52332-50, 74420-26 C. 52005, 74420 D. 52005-50, 74425-26 The radiological service is a screening mammogram of both breasts eliminating multiple choices A, B and D. Note: If this was a bilateral diagnostic mammogram you only report code 77066 because the code is specifically for both breasts. You will not report 77065 and 77066, or report 77065 twice or with a modifier 50. Code 77066 also does not have modifier 50 appended because the code description already indicates that it is a bilateral code. Patient is coming in for a pathological examination for ischemia in the left leg. The first specimen is 1.5 cm of a single portion of arterial plaque taken from the left common femoral artery. The second specimen is 8.5 x 2.7 cm across x 1.5 cm in thickness of a cutaneous ulceration with fibropurulent material on the left leg. What surgical pathology codes should be reported for the pathologist? A. 88304-26, 88302-26 B. 88305-26, 88304-26 C. 88307-26, 88305-26 D. 88309-26, 88307-26 Code 88305 - Skin, other than cyst/tag/debridement/plastic repair is for the cutaneous ulceration on the left leg. Code 88304 - Artery, atheromatous plaque is for the arterial plaque taken from the femoral artery. Modifier 26 is appended to show the pathologist's service. Answer B During a craniectomy the surgeon asked for a consult and sent a frozen section of a large piece of tumor and sent it to pathology. The pathologist received a rubbery pinkish tan tissue measuring in aggregate 3 x 0.8 x 0.8 cm. The entire specimen is submitted in one block and also a gross and microscopic examination was performed on the tissue. The frozen section and the pathology report are sent back to the surgeon indicating that the tumor was a medulloblastoma. What CPT® code(s) will the pathologist report? A. 80500 B. 88331-26, 88307-26 C. 80502 D. 88331-26, 88332-26, 88304-26 The pathology consultation of the tumor is performed during a surgery guiding you to code 88331. Code 88331 is only reported once because one block is submitted. Codes 80500 and 80502 are reported according to CPT® guidelines when the pathologist gives a response to a request from an attending physician in relation to a test result(s) requiring additional medical interpretive judgment. A gross and microscopic examination was also performed reporting code 88307. Answer B Physician orders a basic (80047) and comprehensive metabolic (80053) panels. Select the code(s) on how this is reported. A. 80053, 80047 B. 80053 C. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 D. 80053, 82330 Subsection guidelines in the CPT® codebook under Organ or Disease-Oriented Panels state: "Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes." The comprehensive metabolic panel has the greater number of tests than the basic metabolic panel, eliminating multiple choice answers A and C. Code 82330 (Calcium, ionized) is not listed under panel code 80053, and because that is the remaining test in the basic metabolic panel that is not included in the comprehensive metabolic panel it is also reported, eliminating multiple choice answer B. Answer D A 4 year-old is getting over his cold and will be getting three immunizations in the pediatrician's office by the nurse. The first vaccination administered is the Polio vaccine intramuscularly. The next vaccination is the live influenza (LAIV3) administered in the nose. The last vaccination is the Varicella (live) by subcutaneous route. What CPT® codes are reported for the administration and vaccines? A. 90713, 90658, 90716, 90460, 90461 x 2 B. 90713, 90660, 90716, 90460, 90461 x 1 C. 90713, 90660, 90716, 90471, 90472, 90474 D. 90713, 90658, 90716, 90471, 90472, 90473 The young child was administered the Poliovirus vaccine by intramuscular route guiding you to code 90713. The influenza vaccine was for intranasal route is code 90660 eliminating multiple choices A and D. For the administration codes the vaccines were administered without face-to-face counseling eliminating multiple choice answer B. The first vaccination was administered by the intramuscular route guiding you to code 90471. The second vaccine (additional vaccine) was administered by the intranasal route guiding you to code 90474. The third vaccine (additional vaccine) is given by the subcutaneous route guiding you to code 90472. Answer C A patient with chronic renal failure is in the hospital being evaluated by his endocrinologist after just placing a catheter into the peritoneal cavity for dialysis. The physician is evaluating the dwell time and running fluid out of the cavity to make sure the volume of dialysate and the concentration of electrolytes and glucose are correctly prescribed for this patient. What code should be reported for this service? A. 90935 B. 90937 C. 90947 D. 90945 Patient is having an evaluation for peritoneal dialysis eliminating multiple choices A and B. There is no documentation in the scenario where the physician repeated the dialysis evaluation of the patient due to a complication, eliminating multiple choice C. Answer D An established patient had a comprehensive exam in which she has been diagnosed with dry eye syndrome in both eyes. The ophthalmologist measures the cornea for placement of the soft contact lens for treatment of this syndrome. What codes are reported by the ophthalmologist? A. 92014-25, 92071-50 B. 99214-25, 92072-50 C. 92014-25, 92325-50 D. 92014-25, 92310-50 Patient is having an ophthalmological evaluation service provided, eliminating multiple choice B. The contact lens is being fitted for a therapeutic use, eliminating multiple choice answers C and D. Answer A A patient who is a singer has been hoarse for a few months following an upper respiratory infection. She is in a voice laboratory to have a laryngeal function study performed by an otolaryngologist. She starts off with the acoustic testing first. Before she moves on to the aerodynamic testing she complains of throat pain and is rescheduled to come back to have the other test performed. What CPT® code is reported? A. 92520 B. 92700 C. 92520-52 D. 92614-52 The patient is having a laryngeal function study in which an acoustic test was performed, eliminating multiple choice answer B. The test is not performed with an endoscope, eliminating multiple choice D. The aerodynamic testing was not performed on this visit so modifier 52 is appended due to a parenthetical note that indicates: For performance of a single test, use modifier 52. Answer C What is the difference between entropion and ectropion? A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. B. Entropion is facial droop and ectropion is a facial spasm. C. Entropion is the outward turning of the hands and ectropion is the inward turning of the hands. D. Entropion inward turning of the feet and ectropion is the outward turning of the feet due to muscle disorder. Multiple choice A is the correct answer. In the ICD-10-CM Alphabetic Index look for Entropion (eyelid), H02.009. Ectropion is H02.109. In the Tabular List category H02 is for Other disorders of the eyelid. Answer A What is the full CPT® code description for 00846? A. Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy B. Radical hysterectomy C. Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified radical hysterectomy D. Radical hysterectomy not otherwise specified Code 00846 is an indented code, which means the description from code 00840 up to the semicolon is the beginning of the full description for code 00846. Multiple choice A is the correct answer for the full code description. Answer A Ventral, umbilical, spigelian and incisional are types of: A. Surgical approaches B. Hernias C. Organs found in the digestive system D. Cardiac catheterizations These are types of hernias. CPT® codes are categorized by the type of hernias to be repaired. Answer B Fracturing the acetabulum involves what area? A. Skull B. Shoulder C. Pelvis D. Leg The acetabulum is the cup-shaped socket of the hip joint which is part of the pelvis. You can locate this answer in the ICD-10-CM codebook. In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/pelvis and you will see acetabulum listed under pelvis. Answer C When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located? A. Foot B. Upper Arm C. Upper Leg D. Hand The abductor hallucis is a muscle of the foot that abducts the big toe. In the CPT® Index look for Tenotomy. There are many anatomical areas to choose from, but you will find this muscle located in the description of code 28240. All the codes in that section deal with the foot. Answer A 44 year-old had a history of adenocarcinoma of the cervix on a conization in March 20XX who has been followed with twice-yearly endocervical curettages and Pap smears that were all negative for two years, per the recommendation of a GYN oncologist. Her Pap smear results from the last visit noted atypical glandular cells. In light of this, she underwent a colposcopy and the biopsy of the normal-appearing cervix on colposcopy was benign. The endocervical curettage was benign endocervical glands, and the endometrial sampling was benign endometrium. In light of the fact that she had had previous atypical glandular cells that led to diagnosis of adenocarcinoma and the concerns that this may have recurred, she had been recommended for a cone biopsy and fractional dilatation and curettage, which she is undergoing today. What ICD-10-CM code(s) should be reported? A. R87.619, C53.9 B. C55 C. R87.619, Z85.41 D. Z12.4, Z85.41 According to ICD-10-CM guidelines (Section I.C.2.d): When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. The scenario indicates the patient had a history of cervical cancer, and for two years had Pap smears performed to check for the cancer not returning meaning the patient does not have current adenocarcinoma of the cervix. This eliminates multiple choice answers A and B. The reason she is going into surgery is due to a last cervix Pap smear coming back with abnormal results, eliminating multiple choice answer D. Answer C Patient comes into see her primary care physician for a productive cough and shortness of breath. The physician takes a chest X-ray which indicates the patient has double pneumonia. Select the ICD-10-CM code(s) for this visit. A. J18.9, R05, R06.2 B. R05, R06.2, J18.9 C. J18.9 D. J15.9 According to ICD-10-CM guidelines (Section I.B.4): Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. For this scenario a definitive diagnosis was confirmed by the physician with the patient having pneumonia, eliminating multiple choice answers A and B. The diagnosis is double pneumonia. Look in the ICD-10-CM Alphabetic Index for Pneumonia. The term "double" is found in parenthesis next to the main term Pneumonia. According to ICD-10-CM Coding Guidelines, I.A.7.: ( ) Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. That means because the word double is in parentheses next to Pneumonia it is a supplementary word used for diagnosing the disease and if it is documented with pneumonia you report code J18.9 for that diagnosis, eliminating multiple choice D. Answer C What is the correct way to code a patient having bradycardia due to Demerol that was correctly prescribed and properly administered? A. T40.2X1A, R00.1 B. T40.2X3A, R00.1 C. R00.1, T40.2X5A D. R00.1, T40.2X2A ... Which statement is TRUE when reporting pregnancy codes (O00-O90A): A. These codes can be used on the maternal and baby records. B. These codes have sequencing priority over codes from other chapters. C. Code Z33.1 should always be reported with these codes. D. The seventh character assigned to these codes only indicate a complication during the pregnancy. According to ICD-10-CM guidelines (Section I.C.15.a.1): Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 15 codes to further specify conditions. Answer B 66 year-old Medicare patient, who has a history of ulcerative colitis, presents for a colorectal cancer screening. The screening is performed via barium enema. What HCPCS Level II code is reported for this procedure? A. G0104 B. G0105 C. G0120 D. G0121 Patient is not having a flexible sigmoidoscopy performed for the colorectcal cancer screening, eliminating multiple choice A. The screening for the cancer is being performed via barium enema instead of a colonoscopy. This eliminates multiple choices B and D. This patient is qualified by Medicare to be a high risk by having a history of ulcerative colitis. An individual with ulcerative enteritis or a history of a malignant neoplasm of the lower gastrointestinal tract is considered at high-risk for colorectal cancer, as defined by CMS. Answer C What is PHI? A. Physician-health care interchange B. Private health insurance C. Protected health information D. Provider identified incident-to ... What is NOT included in CPT® surgical package? A. Typical postoperative follow-up care B. One related Evaluation and Management service on the same date of the procedure C. Returning to the operating room the next day for a complication resulting from the initial procedure D. Evaluating the patient in the post-anesthesia recovery area Patient is not having a flexible sigmoidoscopy performed for the colorectcal cancer screening, eliminating multiple choice A. The screening for the cancer is being performed via barium enema instead of a colonoscopy. This eliminates multiple choices B and D. This patient is qualified by Medicare to be a high risk by having a history of ulcerative colitis. An individual with ulcerative enteritis or a history of a malignant neoplasm of the lower gastrointestinal tract is considered at high-risk for colorectal cancer, as defined by CMS. Answer C Which of the following is TRUE about reporting codes for diabetes mellitus? A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus. B. When a patient uses insulin, Type 1 is always reported. C. The age of the patient is a sole determining factor to report Type 1. D. When assigning codes for diabetes and its associated condition(s), the code(s) from category E08-E13 are not reported as a primary code. The ICD-10-CM coding guidelines for diabetes mellitus are found in Section I.C.4. Multiple choice A is the correct answer, this guideline is in Section I.C.4.a.2. Answer A Which statement is TRUE for reporting external cause codes of morbidity (V00-Y99)? A. All external cause codes do not require a seventh character. B. Only report one external cause code to fully explain each cause. C. Report code Y92.9 if the place of occurrence is not stated. D. External cause codes should never be sequenced as a first-listed or primary code Multiple choice D is the correct answer. The ICD-10-CM guidelines for the External Causes Of Morbidity (V00-Y99) is in Section I.C.20. Answer D