CPC Practice Exam 2 QUESTIONS WITH COMPLETE SOLUTIONS
PRE OP DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of
Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast FINDINGS: Lesion is located
in the lateral region, just at or below the level of the nipple on the 90 degree lateral view. There
is a subglandular implant in place. I discussed the procedure with the patient today including
risks, benefits and alternatives. Specifically discussed was the fact that the implant would be
displaced out of the way during this biopsy procedure. Possibility of injury to the implant was
discussed with the patient. Patient has signed the consent form and wishes to proceed with the
biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged
from the inferior approach. The lesion of interest is in the anterior portion of the breast away
from the implant which was displaced back toward the chest wall. After imaging was obtained
and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped
with Betadine. 1% lidocaine was injected subcutaneously for local anesthetic. Additional
lidocaine with epinephrine was then injected through the indwelling needle. The SenoRx needle
was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy
samples using vacuum and cutting technique. The specimen radiograph confirmed representative
sample of calcification was removed. The tissue marking clip was deployed into the biopsy
cavity successfully. This was confirmed by final stereotactic digital image and confirmed by post
core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left
breast in satisfactory position. No obvious calcium is visible on the final post core biopsy image
in the area of interest. The patient tolerated the procedure well. There were no apparent
complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack in the usual
manner. The patient did receive written and verbal post-biopsy instructions. The patient left our
department in good condition. IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE
BIOPSY OF LEFT BREAST CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE
TISSUE MARKING CLIP INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR
DEPARTMENT IN GOOD CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4.
PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE
RECEIVE THE PATHOLOGY REPORT.
What is (are) the CPT® code(s)?
A. 19081
B. 19283
C. 19081, 19283
D. 19100, 19283 Correct Answer: To start narrowing your choices was the biopsy performed
percutaneously or by an open incision? The operative note documents that a "SenoRx needle"
was used to obtain the biopsy, which is percutaneous. Because there was a biopsy and a
placement of a localization device (clip), you eliminate multiple choice B. Code 19283 is
reported only for the placement of the localization device. Stereotactic image was used to
perform the needle biopsy and placement of the clip. This eliminates multiple choice D, because
code 19100 is for needle biopsy without imaging guidance. Code 19081 is the only code reported
for the operative note because its code description reports both the biopsy and the placement of
the clip under stereotactic imaging, eliminating multiple choice C. Answer A
Question 2
,53 year-old male is in the dermatologist's office for removal of 2 lesions located on his lower lip
and nose. Lesions were identified and marked. The lower lip lesion of 4mm in size was shaved to
the level of the superficial dermis. Utilizing a 3-mm punch, a biopsy was taken of the left
supratip nasal area. What are the CPT® codes for these procedures?
A. 11100, 11101
B. 11310, 11100-59
C. 17000, 17003
D. 11440, 11100-59 Correct Answer: The first procedure performed was the lesion on the lower
lip removed by the shaving technique. Reported with code 11310. The punch biopsy is
performed on the lesion located on the nose. Reported with code 11100. Modifier 59 indicates
that the biopsy was totally separate performed on another lesion, otherwise it is bundled with
11310. Answer B
76 year-old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be performed
on the eyelids. A lower incision line was marked at approximately 5 mm above the lid margin
along the crease. Then using a pinch test with forceps the amount of skin to be resected was
determined and marked. An elliptical incision was performed on the left eyelid and the skin was
excised. In a similar fashion the same procedure was performed on the right eye. The wounds
were closed with sutures. The correct CPT® code(s) is/are?
A. 15822, 15823-51
B. 15823-50
C. 15822-50
D. 15820-LT, 15820-RT Correct Answer: Patient is having a blepharoplasty done on the upper
eyelids, eliminating multiple choice answer D. There is no indication in the scenario that
excessive skin weighing down the lid had to be excised, eliminating multiple choice answers A
and B. Modifier 50 is appended to indicate the procedure was performed on both eyelids.
Answer C
42 year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in
the glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV
changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus.
The biceps was inflamed, not torn at all. The superior labrum was not torn at all, the labrum was
completely intact. The rotator cuff was completely intact. An anterior portal was established high
in the rotator interval. The rotator interval was very thick and contracted. Adhesions were
destroyed with electrocautery and the Bovie. The superior glenohumeral ligament, the middle
glenohumeral ligament and the tendinous portion of the subscapularis were released. The
arthroscope was placed anteriorly, adhesions were destroyed and the shaver was used to debride
some of the posterior capsule and the posterior capsule was released in its posterosuperior and
then posteroinferior aspect. What CPT® code(s) is (are) reported?
A. 23450-LT
B. 23466-LT
C. 29805-LT, 29806-51-LT
D. 29825-LT Correct Answer: To narrow down your choices decide if the procedure is an open
procedure or performed with an arthroscope? It was performed with an arthroscope, eliminating
multiple choice answers A and B. The diagnostic arthroscopy (29805) is a separate procedure,
and 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
considered an integral component. Meaning code 29806 already includes the diagnostic
arthroscopy code, so you only report code 29806. Code 29806 represents suturing of the capsule
(capsulorrhaphy); however, this was not the procedure performed. The procedure performed was
a lysis of adhesions for a frozen shoulder (29825) noted in multiple choice answer D.
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 away 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® codes 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 Correct Answer: To start narrowing the correct arthrodesis code to
report, you first need to determine the surgical approach. The scenario tells us that the patient
was placed in prone position (lying face down) on the table and a lumbar incision was made
indicating a posterior approach, eliminating multiple choices B and D. The next bit of
information to look for is the technique that was used for the arthrodesis, which was the
interbody fusion technique guiding you to code 22630. Answer C
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 of an external fixation system,
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 fixation system 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® code(s) is/are reported?
A. 25600-LT, 20692-51
B. 25605- LT, 20690-51
PRE OP DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of
Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast FINDINGS: Lesion is located
in the lateral region, just at or below the level of the nipple on the 90 degree lateral view. There
is a subglandular implant in place. I discussed the procedure with the patient today including
risks, benefits and alternatives. Specifically discussed was the fact that the implant would be
displaced out of the way during this biopsy procedure. Possibility of injury to the implant was
discussed with the patient. Patient has signed the consent form and wishes to proceed with the
biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged
from the inferior approach. The lesion of interest is in the anterior portion of the breast away
from the implant which was displaced back toward the chest wall. After imaging was obtained
and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped
with Betadine. 1% lidocaine was injected subcutaneously for local anesthetic. Additional
lidocaine with epinephrine was then injected through the indwelling needle. The SenoRx needle
was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy
samples using vacuum and cutting technique. The specimen radiograph confirmed representative
sample of calcification was removed. The tissue marking clip was deployed into the biopsy
cavity successfully. This was confirmed by final stereotactic digital image and confirmed by post
core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left
breast in satisfactory position. No obvious calcium is visible on the final post core biopsy image
in the area of interest. The patient tolerated the procedure well. There were no apparent
complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack in the usual
manner. The patient did receive written and verbal post-biopsy instructions. The patient left our
department in good condition. IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE
BIOPSY OF LEFT BREAST CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE
TISSUE MARKING CLIP INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR
DEPARTMENT IN GOOD CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4.
PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE
RECEIVE THE PATHOLOGY REPORT.
What is (are) the CPT® code(s)?
A. 19081
B. 19283
C. 19081, 19283
D. 19100, 19283 Correct Answer: To start narrowing your choices was the biopsy performed
percutaneously or by an open incision? The operative note documents that a "SenoRx needle"
was used to obtain the biopsy, which is percutaneous. Because there was a biopsy and a
placement of a localization device (clip), you eliminate multiple choice B. Code 19283 is
reported only for the placement of the localization device. Stereotactic image was used to
perform the needle biopsy and placement of the clip. This eliminates multiple choice D, because
code 19100 is for needle biopsy without imaging guidance. Code 19081 is the only code reported
for the operative note because its code description reports both the biopsy and the placement of
the clip under stereotactic imaging, eliminating multiple choice C. Answer A
Question 2
,53 year-old male is in the dermatologist's office for removal of 2 lesions located on his lower lip
and nose. Lesions were identified and marked. The lower lip lesion of 4mm in size was shaved to
the level of the superficial dermis. Utilizing a 3-mm punch, a biopsy was taken of the left
supratip nasal area. What are the CPT® codes for these procedures?
A. 11100, 11101
B. 11310, 11100-59
C. 17000, 17003
D. 11440, 11100-59 Correct Answer: The first procedure performed was the lesion on the lower
lip removed by the shaving technique. Reported with code 11310. The punch biopsy is
performed on the lesion located on the nose. Reported with code 11100. Modifier 59 indicates
that the biopsy was totally separate performed on another lesion, otherwise it is bundled with
11310. Answer B
76 year-old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be performed
on the eyelids. A lower incision line was marked at approximately 5 mm above the lid margin
along the crease. Then using a pinch test with forceps the amount of skin to be resected was
determined and marked. An elliptical incision was performed on the left eyelid and the skin was
excised. In a similar fashion the same procedure was performed on the right eye. The wounds
were closed with sutures. The correct CPT® code(s) is/are?
A. 15822, 15823-51
B. 15823-50
C. 15822-50
D. 15820-LT, 15820-RT Correct Answer: Patient is having a blepharoplasty done on the upper
eyelids, eliminating multiple choice answer D. There is no indication in the scenario that
excessive skin weighing down the lid had to be excised, eliminating multiple choice answers A
and B. Modifier 50 is appended to indicate the procedure was performed on both eyelids.
Answer C
42 year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in
the glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV
changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus.
The biceps was inflamed, not torn at all. The superior labrum was not torn at all, the labrum was
completely intact. The rotator cuff was completely intact. An anterior portal was established high
in the rotator interval. The rotator interval was very thick and contracted. Adhesions were
destroyed with electrocautery and the Bovie. The superior glenohumeral ligament, the middle
glenohumeral ligament and the tendinous portion of the subscapularis were released. The
arthroscope was placed anteriorly, adhesions were destroyed and the shaver was used to debride
some of the posterior capsule and the posterior capsule was released in its posterosuperior and
then posteroinferior aspect. What CPT® code(s) is (are) reported?
A. 23450-LT
B. 23466-LT
C. 29805-LT, 29806-51-LT
D. 29825-LT Correct Answer: To narrow down your choices decide if the procedure is an open
procedure or performed with an arthroscope? It was performed with an arthroscope, eliminating
multiple choice answers A and B. The diagnostic arthroscopy (29805) is a separate procedure,
and 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
considered an integral component. Meaning code 29806 already includes the diagnostic
arthroscopy code, so you only report code 29806. Code 29806 represents suturing of the capsule
(capsulorrhaphy); however, this was not the procedure performed. The procedure performed was
a lysis of adhesions for a frozen shoulder (29825) noted in multiple choice answer D.
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 away 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® codes 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 Correct Answer: To start narrowing the correct arthrodesis code to
report, you first need to determine the surgical approach. The scenario tells us that the patient
was placed in prone position (lying face down) on the table and a lumbar incision was made
indicating a posterior approach, eliminating multiple choices B and D. The next bit of
information to look for is the technique that was used for the arthrodesis, which was the
interbody fusion technique guiding you to code 22630. Answer C
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 of an external fixation system,
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 fixation system 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® code(s) is/are reported?
A. 25600-LT, 20692-51
B. 25605- LT, 20690-51
