CPC EXAM WITH ANSWERS

CPC EXAM WITH ANSWERS 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 - ANSWER- C. 11626,12044-51 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. 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 - ANSWER- C. 11044 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. 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 - ANSWER- 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). 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 - ANSWER- C. 21931, D17.1 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. 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 - ANSWER- A. 25628-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. 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 - ANSWER- D. 27485-50 Your keywords in the scenario to narrow your choices down to code 27485 are: "distal femur,""genu valgum," and "hemiepiphysiodesis." 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 - ANSWER- C. 36561, 77001-26 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. 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 - ANSWER- A. 32557 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 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 - ANSWER- B. 35301, 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. 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 - ANSWER- B. 47562, 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. 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 - ANSWER- B. 49652 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 The patient is a 50 year-old gentleman who presented to the emergency room with