AAPC Final Exam Test Questions/Answers, Exams of Nursing

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2023 AAPC Final Exam Test Questions/Answers SUCCESS

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1. In what year was HITECH enacted as part of the American Recovery and Reinvestment Act?
   • 2009
2. What type of insurance is Medicare Part D?
   • Prescription drug coverage available to all Medicare beneficiaries
3. The minimum necessary rule applies to
   • Covered entities taking reasonable steps to limit use or disclosure of PHI
4. EHR stands for
   • Electronic Health Record
5. Many coding professionals go on to find work as
   • Consultants
6. Which cells produce hormones to regulate blood sugar?
   • Pancreatic Islets
7. Which of the following are auditory ossicles?
   • Stapes and incus
8. What is vernix caseosa?
   • A white cheese like substance covering the fetus and newborn
9. A diagnostic tool in sleep medicine is
   • Polysomnography
10. The word describing the presence of blood in the plural cavity
    • Hemothorax
11. In the ICD_10_CM Alphabetic Index what is the code next to the main term called?
    • Default code
12. What is the ICD_10_CM code for eyestrain?
    • H53.
13. What is the code for classical migraine?
    • G43.

14. A patient with a history of bilateral otitis media is not responsive to medical therapy. Given the history and physical examination, the provider felt he was a candidate for bilateral myringotomy and tubes. The patient went to the ASC for the procedure. The provider’s findings were bilateral chronic serous otitis media. What diagnosis code is reported?
    • H65.
15. In the ED, a 50 year-old male complains of severe bloating and stomach cramps, some nausea, vomiting, and diarrhea for the past four months. In the last three weeks, he has had pain in middle right side of his back which radiates around his rib cage as well as stomach gurgling with massive pain. After examination, the provider determines he has irritable bowel syndrome with diarrhea. What diagnosis code(s) is/are reported?
    • K58.
16. Pneumonia due to adenovirus. What ICD_10_CM code is reported?
    • J12.
17. A patient is having surgery to repair a recurrent left inguinal hernia without obstruction. What ICD_10_CM code is reported?
    • K40.
18. A patient is seen in the ED for having unprotected sexual intercourse a few months prior. She recently found out that the individual she was with has HIV. She is only being tested for HIV. What ICD_10_CM code is/are reported?
    • Z11.
19. What ICD_10_CM codes are reported for uncontrolled hypertension with stage 3 chronic kidney disease?
    • I12.9, N18.

20. The patient was given thrombolytic therapy for an acute myocardial infarction (STEMI) of the anterolateral wall which converted to a NSTEMI. What ICD-10-CM code is reported?
    • I21.
21. Which statement is TRUE for reporting burn codes?
    • The highest degree of burn is reported as the primary code
22. What ICD_10_CM codes are reported on the maternal record for a delivery of triplets that are all liveborn at 32 weeks of pregnancy?
    • O30.103, Z37.51, Z3A.
23. The patient has a left ovarian pregnancy without intrauterine pregnancy. What ICD_10_CM codes are reported?
    • O00.202, Z3A.
24. A patient is coming in for follow up of a second-degree burn on the left forearm. The provider notes the burn is healing well. He is to come back in two weeks for continued care to checkup on the healing of the burn. What ICD_10_CM codes are reported?
    • T22.212D
25. A 28-year-old male was rushed to the ED after being found unconscious. Information from family members indicated the patient had left a suicide note and taken a large amount of LSD (a hallucinogenic). What ICD_10_CM codes are reported?
    • T40.8X2A, R40.
26. What is the correct HCPCS Level II code for parenteral nutrition solution amnio acid, 3.5%?
    • B
27. What type of CPT code is “modifier 51 exempt” even though there is no modifier exempt symbol next to it?
    • Add on Codes
28. How are ambulance modifiers use
    • They identify ambulance place of origin and destination
29. What is the correct CPT coding for a cystourethroscopy with brush biopsy of the renal pelvis?
    • 52007
30. What is the correct CPT code for complicated nephrolithotomy on a patient with congenital

kidney abnormality?

• 50070

31. What is the correct diagnosis code to report initial treatment of an infected post procedural stitch abscess of the right leg from a previous excision of a squamous cell carcinoma?

• T81.41XA

32. A patient presents to the ED physician with multiple burns. After examination the physician determines the patient has third-degree burns of the anterior and posterior portion of his left leg, starting at the knee extending above the ankle (12.5%). He also has third-degree burns of the anterior portion of the left side of his chest (4.5%). The patient also has second-degree burns on left upper arm (7%). What ICD- 10-CM codes are reported?

• T24.392A, T21.31XA, T22.232A. T31.

33. The patient has a suspicious lesion of the left jaw line. Clinical diagnosis of this lesion is unknown, but due to the appearance, malignancy is a realistic concern. The lesion was excised into the subcutaneous fat measuring 0.8 cm and margins of 0.1 cm on each side. Hemostasis was achieved using light pressure. The wound was closed in layers using 5.0 Monocryl and 6.0 Prolene. Pathology revealed a nevus with clear margins. What CPT and ICD-10-CM codes are reported?

• 12051, 11441-51, D22.

34. Operative Report PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration POSTOPERTIVE DIAGNOSIS: Diabetic foot ulceration OPERATION PERFORMED: Debridement and split thickness autographing of left midfoot ANESTHESIA: General endotracheal INDICATIONS FOR PROCEDURE: This patient with multiple complications from type 2 diabetes developed skin ulcerations which were debrided with homograft last week. The homograft is taking quite nicely; the wounds appear to be fairly clean. He is ready for autografting. DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the operating room and placed in the supine position on the operating table. Anesthetic monitoring was instituted; general anesthesia was induced. The left lower extremity is prepped and draped in a sterile fashion. Staples were removed and the homograft was debrided from the surface of the wounds. One wound appeared to have healed; the remaining two appeared to be relatively clean. We debrided this sharply with good bleeding in all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked sponges. With good hemostasis a donor site was then obtained on the left anterior thigh, measuring less than 100 cm2. The wounds were then grafted with a split-thickness autograft that was harvested with a patch of Brown dermatome set at 12,000 of an inch thick. This was meshed 1.5:1. The donor site was infiltrated with bupivacaine and dressed. The skin graft was then applied over the wound, measured approximately 60 cm2 in dimension on the left midfoot. This was secured into place with skin staples and was then dressed with Acticoat 18's, Kerlix incorporating a catheter, and gel pad. The patient tolerated the procedure well. The right foot was redressed with skin lubricant sterile gauze and Ace wrap. Anesthesia was reversed. The patient was brought back to the ICU in satisfactory condition.
    • 15120-58, 15004-58-51, E11.621, L97.
35. Patient presents to the operative suite with a biopsy-proven squamous cell carcinoma of the left ankle. A decision was made to remove the lesion and apply a split thickness skin graft on the site. The lesion was excised as drawn and documented as measuring 2.4 cm with margins. Using the Padgett dermatome, the surgeon harvested a split-thickness skin graft from the left thigh, which was meshed 1.5 x 1 and then inset into the ankle wound using a skin stapler. Xeroform bolster was then placed on the skin graft using

Xeroform and 4-0 nylon and the lower extremity was wrapped with bulky cast padding and double Ace wrap. The skin graft donor site was dressed with OpSite. The surgeon noted the skin graft measured 9 cm2 in total. What CPT® and ICD-10-CM codes are reported?

• 15100, 11603-51, C44.

36. What is segmental instrumentation

• A spinal fixation device attached at each end of a rod and an additional bony attachment

37. A 66-year-old sustained a left proximal humerus fracture. Standard deltopectoral approach was used and dissection was carried down to the fracture site. The fracture site was identified and fragments were mobilized and the humeral head fragments removed. Once this was done, the stem was prepared up to a size 10. A trial reduction was carried out with the DePuy trial stem and implant head. Sutures were placed in key positions for closure of the tuberosities down to the shaft including sutures through the shaft. The shaft was then prepared and cement was injected into the shaft. The implant was placed. Once the cement was hardened, the head was placed on Morse taper and reduced. A bone graft was placed around the area where the tuberosities were being brought down. The tuberosities were then tied down with a suture previously positioned. This gave excellent closure and coverage of the significant motion at the repair sites. The wound was thoroughly irrigated. The skin was closed with Vicryl over a drain and also staples in the epidermis. A sterile dressing and sling was applied. The patient was taken to recovery in stable condition. No immediate complications. What CPT® code is report

• 23616-LT

38. This 45 year-old male presents to the operating room with a painful mass of the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient's shoulder was noted. The mass appeared to be benign in nature. With deep blunt dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported?
    • 23075-RT
39. This 45 year-old male presents to the operating room with a painful mass of the right upper arm. General anesthesia was induced. Soft tissue dissection was carried through the proximal aspect of the teres minor muscle. Upon further dissection a large mass was noted just distal of the IGHL (inferior glenohumeral ligament), which appeared to be benign in nature. With blunt dissection and electrocautery, the 4 cm mass was removed en bloc and sent to pathology. The wound was irrigated, and repair of the teres minor with subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. What CPT® code is reported?
    • 23076-RT
40. This 56 year-old female presented with a degenerative posteromedial meniscal flap tear of the right knee. After appropriate preoperative evaluation, the patient was taken to the operating room where general anesthesia was instituted. The patient was placed supine on the operating table. The right lower extremity was sterilely prepped and draped for arthroscopic surgery. The leg was exsanguinated and the tourniquet inflated. The arthroscope was introduced first through the anterolateral portal with medial suprapatellar portal utilized. The lateral compartment looked fairly good. There were some minimal medial degenerative changes. In the medial compartment there was a full-thickness area of osteochondral degeneration with a flap of cartilage noted. It was possible to remove this with a bleeding bony bed with beveled edges of cartilage. The ligament itself was intact. The retropatellar area was normal with Grade I chondromalacia changes noted. The medial joint was inspected and there was a tear at the junction of the middle and posterior portions of the meniscus, a flap tear was based more anteriorly. This was shaved with a combination of small baskets and punches, and the meniscus debrided back to a smooth stable rim. There was additional synovitis in the medial aspect of the intercondylar notch and this was removed with the curved automated meniscal incisor. What CPT® code(s) should be reported?
    • 29881

41. What is the largest single mass of lymphatic tissue?
    • Spleen
42. Which statement is TRUE regarding coding COPD with asthma in ICD_1_CM?
    • The type of asthma is reported along with the COPD
43. An 18-month-old patient is seen in the ED unable to breathe due to a toy he swallowed which had lodged in his throat. Soon brain death will occur if an airway is not established immediately. The ED physician performs an emergency transtracheal tracheostomy. What CPT® and ICD-10-CM codes are reported?
    • 31603, T17.290A
44. The pulmonologist in a multispecialty group refers a patient to the because he thinks that the shortness of breath that the patient is experiencing may be due to sinusitis and laryngopharyngeal reflux (LPR). The otolaryngologist decides to perform a rigid bilateral nasal endoscopy to get a better look at what is going on in the sinuses and a flexible laryngoscopy to determine if (LPR) is contributing to the problems because he could not get adequate visualization on manual exam. First the bilateral nasal endoscopy is performed and the otolaryngologist diagnosis chronic pansinusitis. Next a flexible fiberoptic laryngoscope is introduced nasally and the larynx and trachea are inspected. The diagnosis is chronic laryngitis/tracheitis and LPR. He prescribes Singulair and Nexium and proposes endoscopic surgery will be considered in the future if the current treatment does not fully take care of the problems experienced by the patient. What CPT® and ICD-10-CM codes are reported for the procedure?
    • 31575, 31231-59, J32.4, J37.
45. A patient presents to the emergency department (ED) with a sucking chest wound. The ED provider on duty performs an immediate tube thoracostomy in order to restore normal breathing to the patient before

rushing him to surgery for another provider to address other injuries. What CPT code is reported by the ED provider?

• 32551

46. How many layers of tissue does an artery have?

• Three

47. A physician states he performed comprehensive EP study with induction of arrhythmia in the hospital. The report shows bundle of His recording, pacing, and recording of the right atrium, and induction of arrhythmia by electrical pacing. What CPT coding is reported?

• 93600-26, 93602-26, 93610-26, 93618- 26

48. What information is required to accurately code PVD with diabetes in ICD_10_CM?

• Whether the patient has gangrene

49. Preoperative Diagnosis: Aortic value stenosis with coronary artery disease associated with congestive heart failure Postoperative Diagnosis: Same Anesthesia: General endotracheal Incision: Median sternotomy Description of Procedure The patient was brought to the operating room and placed in supine position. After the patient was prepared, median sternotomy incision was carried out and conduits were taken from the left arm as well as the right thigh. She was cannulated after the aorta and atrium were exposed and after full heparinization. She went on cardiopulmonary bypass, and the aortic cross-clamp was applied. Cardioplegia was delivered through the coronary sinuses in a retrograde manner. The patient was cooled to 32 degrees. Iced slush was applied to the heart. The aortic valve was then exposed through the aortic root by transverse incision. The valve leaflets were removed, and the 23 St Jude mechanical valve was secured into position by circumferential pledgeted sutures. At this point aortotomy was closed. Attention was turned to the coronary arteries. The first obtuse marginal artery was a very large target and the vein graft to the target indeed produced an excellent amount of flow. Proximal anastomosis was then carried out to the foot of the aorta. The radial artery was anastomosed to the left anterior descending

artery target in an end-to-side manner. The proximal anastomosis was then carried out to the root of the aorta. The patient came off cardiopulmonary bypass after aortic cross-clamp was released. She was adequately warmed. Protamine was given without adverse effect. Sternal closure was then done using wires. The subcutaneous layers were closed using Vicryl suture. The skin was approximated using staples. What CPT codes are reported?

• 33405, 33533-51, 33517, 35600

50. What is the CPT code for removal of a foreign body from the esophagus via the thoracic area?

• 43045

51. A patient is seen in the gastroenterologist's clinic for a diagnostic colonoscopy. When performing the service, the physician notes suspicious looking polyps and removes three using a snare technique to send to pathology for further testing. What is/are the correct CPT® code(s) to report?

• 45385

52. What is the correct ICD_10_CM code for a patient with IBS?

• K58.

53. An 11 year-old patient is seen in the OR for a secondary palatoplasty for complete unilateral cleft palate. Shortly after general anesthesia is administered, the patient begins to seize. The surgeon quickly terminates the surgery in order to stabilize the patient. What CPT® and ICD-10-CM codes are reported for the surgeon?

• 42220-53, Q35.9, R56.

54. Transurethral resection of a medium-size (3.0 cm) bladder tumor was performed in an outpatient setting. What CPT® code is reported for this service?

• 52235

55. A clamp circumcision is performed without dorsal block on a newborn. What CPT code is reported for this service?
    • 54150- 52
56. Which statement is TRUE reporting calculi in both the kidney and ureter?
    • One code identifies both the calculi in the kidney and the ureter
57. Cystoscopy, left ureteroscopy, holmium laser lithotripsy, stone manipulation, stent removal and replacement are performed. The holmium laser was used to break up a cluster of stones at the ureteropelvic (UP) junction which were removed with a basket and a Gibbons stent was exchanged. Previous CT scan showed stones in the lower right pole. It was decided to proceed with ureteroscopy. Ureteroscope was inserted in the right ureter, confirming multiple stones within the proximal ureter. These were basketed and removed. What CPT® codes are reported for this service?
    • 52356-LT, 52352-59-LT
58. What is the root word for vagina?
    • Colp/o
59. What ICD_10_CM code is reported for VIN III?
    • D07.
60. A patient with previous tubal ligation decides that she would like to have another child and requests reversal of the previous procedure. Re-anastomosis of the ligated tubes is performed successfully by low transverse incision. It is found that the fimbriated end of the right tube has adhesions to the ovary and fimbrioplasty is also performed. What is/are the CPT code(s) reported for this procedure?
    • 58750-50, 58760-51-RT
61. A 37 year-old woman presents with abdominal pain, bleeding unrelated to menses and an abnormal pap showing LGSIL (low grade squamous intraepithelial lesion). Treatment is hysteroscopy with thermoablation of the endometrium and cryocautery of the cervix. This is performed without difficulty. What are the CPT® and ICD-10-CM codes reported for this procedure?
    • 58563, 57511-51, R87.
62. What is the term for uncontrolled muscle movements?

• Dyskinesia

63. The provider removes the thymus gland in a 27-year-old female with myasthenia gravis. Using a transcervical approach the blood supply to the thymus is dissected free from the pericardium and the thymus is removed. What CPT code is reported for this procedure?

• 60520

64. Under general anesthesia the provider excises the lower 1/3 portion of the right lobe of the thyroid as well as the lower 1/3 of the left lobe. The isthmus is also removed. What CPT code(s) is/are reported?

• 60212

65. A patient receives a paravertebral facet join injection at three levels on both sides of the lumbar spine using fluoroscopic guidance for lumbalgia. What CPT and ICD_10_CM codes are reported?

• 64493-50, 64494 x 2, 64495 x 2, M54.

66. Which option best describes what is being done during strabismus surgery?

• Corrects the muscle misalignment

67. What ICD_10_CM code is reported for an encounter for cataract screening?

• Z13.

68. What CPT code is reported for a tympanoplasty with mastoidotomy and with ossicular chain reconstruction in the right ear?
    • 69636-RT
69. A provider extracts a tumor, using a frontal approach, from the lacrimal gland of a 14-year-old patient. What CPT and ICD-10-CN codes are reported?
    • 68540, D49.
70. What modifier is used for medically-directed CRNA services?
    • QX
71. Using your ICD_10_CM codebook look for the diagnosis code for a patient with preoperative diagnosis of abdominal pain, right lower quadrant, and a postoperative diagnosis of acute appendicitis with peritoneal abscess. What ICD_10_CM code is reported?
    • K35.
72. The patient had surgery to remove and replace an existing Hickman catheter. The anesthesiologist reported a postoperative diagnosis of a catheter related bloodstream infection (CRBSI). What ICD_10_CM code(s) is/are reported?
    • T80.211A
73. Mrs. Jones is a 90-year-old female having laparoscopic surgery on her gallbladder. Dr. Lot, the anesthesiologist for this case, documents she is a normal healthy person and begins to prepare the patient for surgery at 07:30 am. Surgery begins at 08:00 am. The surgery is concluded at 09:30 am. The anesthesiologist releases the patient to the PACU nurses at 09:45 am. How many minutes of anesthesia time transpired and what is the appropriate anesthesia code?
    • 2 hrs. 15 minutes, 00790-AA-P1, 99100
74. A 72-year-old patient is undergoing a corneal transplant. An anesthesiologist is personally performing monitored anesthesia care. What CPT code and modifier(s) are reported for anesthesia?
    • 00144-AA-QS, 99100
75. A patient arrives at the hospital unable to stand on his leg after a collision in a soccer game. The patient's shin is sore to the touch. Two view X-rays of the tibia and fibula are taken. What is the CPT® code reported by the radiologist for the X-rays?
    • 73590- 26

76. A patient with hydronephrosis has a left nephrostomy and he has agreed to a pyelography (IVP) to rule out a right renal obstruction.
    • 74400- 26
77. A patient is seen in the clinic with sharp abdominal pain, vomiting and nausea and a history of cholelithiasis. An ultrasound of the gallbladder is performed revealing she has stones in the gallbladder. What CPT code is reported?
    • 76705
78. A 41-year-old male is in his doctor’s office for a follow up of an abnormality which was noted on an abdominal CT scan. He also had a chest X-ray (PA and lateral views) performed in the office due to chest tightness. He states he otherwise feels well and is here to go over the results of his chest X-ray performed in the office, and the CT scan performed at the diagnostic center. The results of the chest X- ray were normal. CT scan was sent to the office, and the physician interpreted and documented that the CT scan of the abdomen showed a small mass in his right upper quadrant. What CPT® codes are reported for the doctor's office radiological services?
    • 71046, 74150- 26
79. What doe the services in the Reproductive Medicine Procedures section of the Pathology and Laboratory chapter of CPT report?
    • Services related to in vitro fertilization

80. A patient has a fine needle aspiration with the specimen sent to cytopathology for examination. Once the specimen is reviewed, it is found to be inadequate to perform the test. A new specimen must be obtained which is then examined and a diagnosis is confirmed. What modifier is appropriate to indicate that two specimens were examined?
    • No modifier
81. A patient presents with right upper quadrant pain, nausea, and other symptoms of liver disease as well as complaints of decreased urination. Her physician orders an albumin; bilirubin, both total and direct; alkaline phosphatase; total protein; alanine amino transferase; aspartate amino transferase, and creatinine. What CPT® code(s) is/are reported?
    • 80076, 82565
82. A patient’s mother and sister have been treated for breast cancer. She has blood drawn for cancer gene analysis with molecular pathology testing. he has previously received genetic counseling. Blood will be tested for full sequence analysis and common duplication or deletion variants (mutations) in BRCA1, BRCA2 (breast cancer 1 and 2). What CPT® code(s) is (are) reported for this molecular pathology procedure?
    • 81162
83. According to CPT guidelines what is the first step in selecting an evaluation and management code?
    • Determine the category or subcategory
84. A patient is diagnosed as having both acute and chronic tonsilitis. How is this reported in ICD_10_CM?
    • The acute tonsilitis is reported first, the chronic tonsilitis is reported second
85. Mr. Flintstone is seen by his oncologist just two days after undergoing extensive testing for a sudden onset of petechiae, night sweats, swollen glands, and weakness. After a brief review of history, Dr. B. Marrow re- examines Mr. Flintstone. The exam is documented as expanded problem focused and the medical decision making of moderate complexity. The oncologist spends an additional 45 minutes discussing Mr. Flintstone's new diagnosis of Hodgkin's lymphoma, treatment options and prognosis. What is/are the appropriate procedure code(s) for this visit?
    • 99215, 99417
86. Subjective: 6 year-old girl twisted her arm on the playground. She is seen in the ED complaining of pain in her wrist. Objective: Vital Signs: stable. Wrist: Significant tenderness laterally. X-ray is normal

Assessment: Wrist sprain Plan: Over the counter Anaprox. Give twice daily with hot packs. Recheck if no improvement. What is the E/M code for this visit?

• 99281

87. A 5-year-old fell on broken glass and required suturing of a laceration. Due to the age and combative behavior of the patient, the provider utilized moderate sedation while repairing the laceration. The provider gave the child 50 mg of Ketamine IM. A nurse monitored the patient during the procedure which took 30 minutes. What CPT® code is reported for moderate sedation?

• 99152, 99153

88. A 49-year-old female was brought to the emergency department. She was lethargic, but awake. She is four years post liver transplant. Neurology was consulted who determined the patient was encephalopathic with altered mental status. There was some question whether she had a seizure. An EEG and WADA test were performed. What CPT® and ICD-10-CM codes are reported?

• 98958, G93.40, R41.82, Z94.

89. A patient diagnosed with amyotrophic lateral sclerosis has increasing muscle weakness in the upper extremities. The provider orders needle electromyography (EMG) to record electrical activity of the muscles. What CPT® and ICD-10-CM codes are reported?

• 95861, G12.

90. A 54 year-old female with uncontrolled type 1 insulin dependent diabetes and related peripheral vascular disease presents with a deep diabetic ulceration on the bottom of her right foot. The wound reaches into the fascia and appears to be draining. She acknowledges going barefoot frequently and is not certain how

or when the wound occurred. After the provider discusses the seriousness of her condition, he debrides the wound, using a water jet and surgical scissors. Size of wound is 70 sq. cm. He applied topical ointment and a sterile dressing. He counseled the patient about the need to wear shoes at all times and inspect her feet daily. He advised the patient to wear a water protective covering on her lower leg when taking a shower and to change the dressing daily, using ointment provided. A surgical shoe was provided. Patient is to return weekly until the wound heals and continue her insulin regime. If satisfactory progress does not occur, a graft may be considered. What codes are reported?

• 97597, 97598 x3, L3260, E10.621, E10.51, L97.

91. Myocardial Perfusion Imaging (MPI)—Office Based Test Indications: Chest pain. Procedure: Resting tomographic myocardial perfusion images were obtained following injection of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress gated images of the left ventricle were also acquired. Myocardial perfusion images were compared in the standard fashion. Findings: This is a technically fair study. There were no stress induced electrocardiographic changes noted. There were no significant reversible or fixed perfusion defects noted. Gated images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an estimated left ventricular ejection fraction of 50%. Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection fraction. What CPT® code(s) is/are reported?

• 78452

92. PREOPERATIVE DIAGNOSIS: Heart Block POSTOPERATIVE DIAGNOSIS: Heart Block ANESTHESIA: Local anesthesia NAME OF PROCEDURE: Reimplantation of dual chamber pacemaker DESCRIPTION: The chest was prepped with Betadine and draped in the usual sterile fashion. Local anesthesia was obtained by infiltration of 1% Xylocaine. A subfascial incision was made about 2.5 cm below the clavicle, and the old pulse generator was removed. Using the Seldinger technique, the subclavian vein was cannulated and through this, the old atrial lead was removed, and a new atrial lead (serial # 6662458) was placed in the right atrium and to the atrial septum. Thresholds were obtained as

follows: The P-wave was 1.4 millivolts, atrial threshold was 1.6 millivolts with a resultant current of 3.5 mA and resistance of 467 ohms. Using a second subclavian stick in the Seldinger technique, the old ventricular lead was removed and a new ventricular lead (serial # 52236984) was inserted and placed into the right ventricular apex. The thresholds were obtained and were as follows: R-wave was 23.5 millivolts. The patient was pacing at 100% at 0.5 volts, with resultant current of 0.8 mA and resistance of 480 ohms. When we were satisfied with the thresholds, the leads were connected to the pacemaker generator (serial # 22561587), which was inserted into the previously created pocket. The wound was thoroughly irrigated with antibiotic solution and hemostasis was obtained. The incision was closed in layered fashion with 2-0 Dexon. A compressive dressing was applied, and the patient tolerated the procedure very well. He was taken to the recovery room in satisfactory condition.

• 33235, 33208-51, 33233- 51

93. Procedure: Colectomy with a take-down of splenic flexure. The patient was taken to the operating room, placed in the dorsal lithotomy position, and then prepped and draped in the usual sterile fashion. A vertical paramedian incision was made along the left side of the umbilicus from the symphysis and taken up to above the umbilicus. This incision was carried down to the rectus muscles, which were separated in the midline. The peritoneal cavity was entered with findings as described. The ascitic fluid was removed and hand-held retractors were used to assist in surgical exposure. The malignant intra-abdominal tumor was resected from the hepatic flexure into the mid transverse colon. The resection was extended into the left upper quadrant and the attachments were also clamped, cut and suture ligated with 2-0 silk sutures in a stepwise fashion until mobilization of the tumor mass could be brought medial and hemostasis was obtained. Attempts to find a dissection plane between the malignant tumor mass and the transverse colon were unsuccessful as it appeared the tumor mass was invading into

the wall of the bowel with extrinsic compression and distortion of the bowel lumen. Given the mass could not be resected without removal of bowel, attention was directed to mobilization of the splenic flexure. Retroperitoneal dissection was started in the pelvis and continued along the left paracolic gutter. The ligamentous and peritoneal attachments were taken down with Bovie cautery in a stepwise fashion around the splenic flexure of the colon until the entire left colon was mobilized medially. Similar steps were then carried on the right side as the right colon and hepatic flexure were mobilized. The peritoneal and ligamentous attachments were taken down with Bovie cautery. Vascular attachments were clamped, cut, and suture ligated with 2-0 silk until the right colon was mobilized satisfactorily. The GIA stapler was introduced and fired at both ends to dissect the tumorous bowel free. The bowel was delivered off the operative field. Attention was then directed towards re-anastomosis of the colon. Linen-shod clamps were used to gently clamp the proximal and distal segments of the large bowel. The staple line was removed with Metzenbaum scissors and the colon lumen was irrigated. The silk sutures were used to divide the circumference of the bowel into equal thirds, and the proximal and distal edges of the bowel were reapproximated with silk sutures. The posterior segment of the bowel was then retracted and secured with a TA stapler, ensuring a full thickness bowel wall insertion into the staple line. The additional two- thirds were also isolated and, with the TA stapler, clamped, ensuring that all layers of the bowel wall were incorporated into the anastomosis. A third staple line was fired and the integrity of the anastomosis was checked. First, complete hemostasis was noted. There was well beyond a finger width lumen within the large bowel. The linen-shod clamps were released and gas and bowel fluid were moved through the anastomosis aggressively with intact staple line, no leakage of gas or fluid. The abdomen was then irrigated and water was left over the anastomosis. The anastomosis was manipulated with no extravasation of air. The abdomen and pelvis were then irrigated aggressively. The Mesenteric trap was then re-approximated with interrupted 3-0 silk suture ligatures. All sites were inspected and noted to be hemostatic. Attention was directed towards closing. Pathology report showed intra-abdominal cancer. Transverse colon and hepatic flexure cancer were also indicated. The origin of the cancer could not be determined from the specimen given.

• 44140,44139,C76.2,C18.

94. A 68 year-old female with long-standing degenerative arthritis in her right knee presented. Risks and benefits were discussed. She was agreeable to surgery. After adequate anesthesia, the patient was

prepped and draped in usual sterile fashion with DuraPrep1 and Betadine scrub. The leg was exsanguinated and tourniquet inflated. An anterior incision was made and carried through the skin and bursa, cauterizing all bleeders. The bursa was elevated medially and a medial parapatellar incision was made. The proximal tibia was cleaned. The knee had an 18-degree flexion contracture. The cruciate ligaments were debrided along with the menisci. The proximal tibial cutting guide was placed and the proximal tibial cut made. The femoral canal was entered and a 6 degree cut was made for the anterior jig. The distal cut was made at 6 degrees. The femur measured a size 2. The 2 cutting block was placed and the anterior, posterior and chamfer cuts were made. The notch cut was made and the trial component was placed with a size 2 tibia and 12 mm spacer and was found to fit beautifully and it tracked well. The patella was cut and measured to be a 32. The holes were drilled and the proximal tibial cuts were made. All the excess meniscal tissue and hypertrophic synovium were debrided. The wound was thoroughly irrigated and the bone dried. The cement was mixed; the size 2 tibia with a 12 mm tibial tray, size 2 femur and a size 32 patella were all cemented in place removing all excess cement. After the cement was hard, the tourniquet was released. The knee was placed through a range of motion and was found to track beautifully. The knee was thoroughly irrigated. The retinaculum was closed with interrupted figure- of- eight 1 Vicryl. The bursa was closed with 1 and 0. The subcutaneous layers were closed with 0 and 2- and the skin with staples. Sterile dressing was applied. The patient was taken to the recovery room in stable condition. What CPT® code is reported?

• 27447-RT

95. Operative Report PROCEDURE: Left L3-L4 peri-articular paravertebral facet joint injection. PATIENT HISTORY: The patient is a 67 year-old woman referred by Dr. X for repeat diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral facet joint injection. She had no relief

of symptoms from that injection. TECHNIQUE: The patient was positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically, despite trying numerous angles. This was explained to the patient who wished to proceed with the injection. A 22-gauge 6-inch spinal needle was advanced toward the region of the left L3-L4 paravertebral facet joint under fluoroscopic guidance. Injection of 0.5 cc of Isovue 200 contrast showed the needle was not in an intravascular location. Intra-articular placement could not be confirmed and the injection was presumed to be peri-articular. 2 cc containing equal parts preservative free 2% Lidocaine plus Depo-Medrol (80 mg per ml) was injected. The patient reported injection of medication produced discomfort in the region of her usual left low back pain. Immediately following the procedure, upon standing up from the procedure table, she reported her pain was a little bit better. What CPT® code(s) is/are reported for this procedure?

• 64493

96. Operative Report Diagnosis: Basal Cell Carcinoma Procedure: Mohs micrographic excision of skin cancer Site: Face Lateral upper canthus eyelid Pre-operative size: 0.8 cm Indications for surgery: Area of high recurrence, area of functional and/or cosmetic importance. Discussed procedure including alternative therapy, expectations, complications, and the possibility of a larger or deeper defect than expected requiring significant reconstruction. Patient's questions were answered. Local anesthesia 1:1 Marcaine and 1% Lidocaine with Epinephrine. Sterile prep and drape. Stage 1: The clinically apparent lesion was marked out with a small rim of normal appearing tissue and excised down to subcutaneous fat level with a defect size of 1.2 cm. Hemostasis was obtained and a pressure bandage placed. The tissue was sent for slide preparation. Review of the slides show clear margins for the site. Repair: Complex repair. Repair of Mohs micrographic surgical defect. Wound margins were extensively undermined in order to mobilize tissue for closure. Hemostasis was achieved. Repair length 3.4 cm. A layered closure was

performed. Multiple buried absorbable sutures were placed to re-oppose deep fat. The epidermis and dermis were re-opposed using monofilament sutures. There were no complications; the patient tolerated the procedure well. Post-procedure expectations (including discomfort management), wound care and activity restrictions were reviewed. Written Instructions with urgent contact numbers given, follow-up visit and suture removal in 3-5 days. What CPT® and ICD-10-CM codes are reported?\

• 17311, 13152-51, C44.119

97. A patient with chronic pneumothoraces presents for chemopleurodesis. Under local anesthesia a small incision is made between the ribs. A catheter is inserted into the pleural space between the parietal and pleural viscera. Subsequently, 5g of sterile asbestos free talc was introduced into the pleural space via the catheter. What CPT® and ICD-10-CM codes are reported?

• 32560, J93.81

98. A woman presents for hysterectomy after ECC (endocervical curettage) and EMB (endometrial biopsy) indicates endometrial cancer. Transabdominal approach (incision) is chosen for exposure of all structures possibly affected. The abdomen is thoroughly inspected with no gross disease outside the enlarged uterus but several lymph nodes are enlarged and the decision is made to perform a hysterectomy with bilateral removal of tubes and ovaries and bilateral pelvic lymphadenectomy with periaortic lymph node sampling. Specimens sent to pathology confirm endometrial cancer but find normal tissue in the lymph nodes. What are the CPT® and ICD-10-CM codes reported for this service?

• 58210, C54.1

99. Preoperative diagnosis: Cytologic atypia and gross hematuria Postoperative diagnosis: Cytologic atypia and gross hematuria Procedure performed: Cystoscopy and random bladder biopsies and GreenLight laser ablation of the prostate. Description: Bladder biopsies were taken of the dome, posterior bladder wall and lateral side walls. Bugbee was used to fulgurate the biopsy sites to diminish bleeding. Cystoscope was replaced with the cystoscope designed for the GreenLight laser. We introduced this into the patient's urethra and performed GreenLight laser ablation of the prostate down to the level of verumontanum on, the prostatic crest near the wall of the urethra. There were some calcifications at the left apex of the prostate, causing damage to the laser but adequate vaporization was achieved. What CPT® code(s) is/are reported for this service?
    • 52648, 52224- 59 100.Operative Report PREOPERATIVE DIAGNOSIS: Prolapsed vitreous anterior chamber with corneal edema POSTOPERATIVE DIAGNOSIS: Same OPERATION PERFORMED Anterior vitrectomy The patient is a 72 year-old woman who approximately 10 months ago underwent cataract surgery with a YAG laser capsulotomy, developed corneal edema and required a corneal transplant. The patient has done well. Over the last few weeks, she developed posterior vitreous detachment with vitreous prolapse to the opening in the posterior capsule with vitreous into the anterior chamber with corneal touch and adhesion to the graft host junction and early corneal edema. The patient is admitted for anterior vitrectomy. PROCEDURE: The patient was prepped and draped in the usual manner after first undergoing retrobulbar anesthetic. A lid speculum was inserted. An incision was made at approximately the 10 o'clock meridian 3 mm in length, 2 mm posterior to the limbus, and grooved forward into clear cornea with a 3.2 mm anterior chamber. An anterior vitrectomy was carried out, placing a visco-elastic substance in the anterior chamber to maintain it. A Sinskey hook was used to sweep vitreous away from the corneal wound and this was removed with the disposable vitrectomy instrument. The patient's pupil is noted to be round.

There was no vitreous to the wound. The wound self-sealed without aqueous leak. Cautery was used to close the conjunctiva. Subconjunctival Decadron and Gentamicin was given. The patient tolerated the procedure well and was discharged to the recovery room in good condition. What CPT® code(s) is/are reported?

• 67010