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AAPC CPC Exam Chapter 6&7BEST STUDYING MATERIAL WITH VERIFIED ANSWERS LATEST VERSION UPDATE 2024-2025
Typology: Exams
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A patient arrives at the hospital from a nursing home with a stage 3 bed sore on his left hip. List the ICD- 10 - CM code for the bedsore. A) L89. B) L89. C) L97. D) L89. D – ANSWER A provider performs a punch biopsy of two pre-cancerous lesions on the patient's back, which he has determined to be actinic keratosis (AK). List the ICD- 10 - CM code for the AK. A) D49. B) C44. C) D23. D) L57. A – ANSWER Patient presents with a cyst on the arm. Upon examination the physician decides to incise and drain the cyst. The site is prepped and the physician takes a scalpel and cuts into the cyst. Purulent fluid is extracted from the cyst and a sample of the fluid is sent to the laboratory for evaluation. The wound is irrigated with normal saline and is covered with a bandage. The patient is to return in a week to ten days to re-examine the wound. Select the CPT® code for this procedure. A) 10060 B) 11400 C) 11100 D) 10061 A - ANSWER A patient presents for tattooing of the nipple and areola of both breasts after undergoing breast reconstruction. The total area for the right breast is 11.5 cm2 and for the left breast of 10.5 cm2. Select the CPT® code(s) for this procedure. A) 11921, 11922
A patient presents to the primary care physician with multiple skin tags. After a complete examination of the skin, the provider discusses with the patient the removal of 18 skin tags located on the patient's neck and shoulder area. Patient consent is obtained and the provider removes all 18 skin tags by scissoring technique. Select the CPT® code(s) for this procedure. A) 11201 B) 11200, 11201- 51 C) 17000 D) 11200, 11201 C - ANSWER Operative Report: INDICATIONS FOR SURGERY: The patient is a 72-year-old male with a biopsy-proven squamous cell carcinoma of his left forearm. With his permission, I marked my planned excision and my best guess at the resultant scar, which included a rhomboid flap repair. The patient observed these markings in a mirror, so he could understand the surgery, agree on the location and I proceeded. DESCRIPTION OF PROCEDURE: The patient was given 1 g of IV Ancef. The area was infiltrated with local anesthetic. The forearm was prepped and draped in a sterile fashion. I excised this lesion measuring 1.2 cm diameter as drawn into the subcutaneous fat. A suture was used to mark this specimen at its proximal tip and this was labeled at 12 o'clock. Negative margins were then given. Meticulous hemostasis was achieved using a Bovie cautery. I incised my planned rhomboid flap measuring 2cm x 2cm. I elevated the flap with a full-thickness of skin and subcutaneous fat. The total defect size was 5.44 sq cm. The flap was rotated into the defect and the donor site was closed and the flap was inset in layers using 4-0 Monocryl and 5-0 Prolene. Loupe magnification was used throughout the procedure and the patient tolerated the procedure well. What CPT® code(s) should be reported for this example? A) 14040 B) 14020, 11602- 51 C) 14020 D) 14021 B - ANSWER A patient presents to her doctor with three medium sized suspicious lesions on her leg. The physician uses a saw type instrument and slices horizontally to remove the lesions. The lesions are sent for pathology. What CPT® code(s) should be reported for this example? A) 11000, 11101 x 2
B) 11300, 11300-51 x 2 C) 11302 x 3 D) A - ANSWER A patient has a squamous cell carcinoma on the tip of the nose. After prepping the patient and site, the physician removes the tumor (first stage) and divides it into seven blocks for examination. Seeing positive margins, he removes a second stage, which he divides into five blocks. The physician again identifies positive margins. He performs a third stage and divides the specimen into three blocks proving to be clear of the skin cancer. What are the correct CPT® codes to report for this example? A) 17311, 17312, 17312, 17315, 17315 B) 17311, 17312, 17312 C) 11640 x 3 D) 11440 x 3 B – ANSWER Patient presents to the dermatologist for the removal of warts on his hands. Upon evaluation it is noted the patient has nine warts on his right hand and 10 on his left hand, all of which he has indicated he would like removed today. After discussion with the patient regarding the destruction method and aftercare the patient agreed to proceed. Using cryosurgery the physician applied two squirts of liquid nitrogen on each of the warts on his right and left hand. Aftercare instructions were given to the patient's wife. The patient tolerated the procedure well. What CPT® code(s) should be reported for this example? A) 17110, 17111 B) 17111 C) 17004 D) 17111 x 19 A – ANSWER A 32-year-old female is having excision of a mass in her left breast. The physician makes a curved incision along the inferior and medial aspect of the left areola. A breast nodule, measuring approximately 1 cm in diameter, was identified. It appeared to be benign. It was firm, gray, and discrete. It was completely excised. There was no gross evidence of malignancy. The bleeding was controlled with electrocautery. The skin edges were approximated with a continuous subcuticular 4-0 Vicryl suture. Indermil tissue adhesive was applied to the skin as well as a dry gauze dressing. What is the correct CPT® code to report for this example? A) 19120-LT
When coding multiple burns, which is correct? A) Sequence first the code reflecting the largest area in rule of nines with this degree of burn B) Sequence first the circumstance of the burn occurrence C) Sequence first the code reflecting the highest degree of burn D) Sequence first the code identifying burns to the head and neck B – ANSWER A patient presents to the Dermatologist with a suspicious lesion on her left arm and another one on her right arm. After examination the physician feels these lesions present as highly suspicious and obtains consent to perform punch biopsies on both sites. After prepping the area, the physician injects the sites with Lidocaine 1% and .05% Epi. A 3 mm punch biopsy of the lesion of the left arm and a 4mm punch biopsy of the lesion of the right arm is taken. The sites are closed with a simple one-layer closure and the patient is to return in 10 days for suture removal and to discuss the pathology results. The patient tolerated the procedure well. Select the CPT® code(s) for this procedure. A) 10060 B) 11100, 11101 C) 11400, 11400- 59 D) 11600, 11600- 59 D – ANSWER A patient presents to the primary care physician with multiple skin tags. After a complete examination of the skin, the provider discusses with the patient the removal of 18 skin tags located on the patient's neck and shoulder area. Patient consent is obtained and the provider removes all 18 skin tags by scissoring technique. Select the CPT® code(s) for this procedure. A) 11201 B) 11200, 11201- 51 C) 17000 D) 11200, 11201 D - ANSWER
A patient presents to the emergency department with multiple lacerations. After inspection and cleaning of the multiple wounds the physician proceeds to close the wounds. The documentation indicates the following: 2.7 cm complex closure to the right upper abdominal area, a 1.4 cm complex repair to the right buttock, a 7.4 cm intermediate repair to the right arm, a 3.8 cm intermediate repair to the left cheek, an 8.1 cm intermediate repair to the scalp and a 2.3 cm simple repair the right lower lip. What are the correct CPT® codes to report for this example? A) 13101, 13100-59, 12051-59, 12011- 59 B) 13100, 12035-59, 12052-59, 12013- 59 C) 13101, 12034-59, 13100-59, 12052- 59 D) 13101, 12035-59, 12052-59, 12011- 59 B - ANSWER A patient presents for reduction of her left breast due to atrophy of the breast. After being prepped and draped, the surgeon makes a circular incision above the nipple to indicate where the nipple is to be relocated. Another incision is made around the nipple, and then two more incisions are made from the circular cut above the nipple to fold beneath the breast, which creates a keyhole shaped skin and breast incision. Skin wedges and tissue are removed until the surgeon is satisfied with the size. Electrocautery was performed on bleeding vessels and the nipple was elevated to its new position and the nipple pedicle was sutured with layered closure. The last incision was repaired with a layered closure as well. What is the correct CPT code to report for this example? A) 19324-LT B) 19318-LT C) 19350-LT D) 19316-LT ICD- 10 - CM code: L85. CPT® codes: 12051, 11442- 51
margin (0.3 cm margin on both sides - total 0.6cm) designed for total resection of 1. cm (total size of the lesion is 1.7 cm). The area for excision was infiltrated with 1% lidocaine with epinephrine. Careful dissection of the lesion was carried down through the dermis into the subcutaneous tissues. After waiting for hemostasis, it was excised, tagged, and sent for permanent pathology. The wound was irrigated; several bleeders were cauterized. The defect was closed in multiple layers (closure in multiple layers indicates an intermediate repair, which is reported separately) with 3-0 Vicryl, a running subcuticular stitch of 4-0 Vicryl and a few 5-0 chromics. The total length of this closure was 3 cm (repair length is 3 cm). This was covered with Steri-Strips, adaptic gauze, and tape. Patient tolerated this procedure with no complication and was sent home in stable CPT® codes: 17311 ICD- 10 - CM code: C44.
made in the axilla to excise most of the hidradenitis tracts. The incision was carried down through the subcutaneous tissue. The underlying subcutaneous tissue was excised. (The excision went to the subcutaneous tissue.) Bleeding points were controlled by means of electrocautery. The subcutaneous tissues were closed in intermediate layers (The repair was intermediate.) with a suture of 2-0 Vicryl. The skin edges were stapled together and a dry sterile dressing was applied. The patient tolerated the procedure well. What are the CPT® and ICD- 10 - CM codes reported? CPT® code (has modifier): ICD- 10 - CM code: CPT® code: 15879- 50 ICD- 10 - CM code: E66.8 - ANSWER CASE 4 PREOPERATIVE DIAGNOSIS: Segmental obesity of posterior thighs. POSTOPERATIVE DIAGNOSIS: Segmental obesity of posterior thighs. (Postoperative diagnosis to be used for coding) OPERATIVE PROCEDURE: Posterior thigh suction-assisted lipectomy of posterior medial thigh, bilateral (procedure performed). CLINICAL NOTE: This obese patient presents for the above procedure. She understood the potential risks and complications including the risk of anesthesia, bleeding, infection, wound healing problems, unfavorable scarring, and potential need for secondary surgery. She understood and desired to proceed. PROCEDURE: The patient was placed on the operating table in supine position. General anesthesia was induced.(General anesthesia.) Once she was asleep, she was turned and positioned prone. The buttocks and thigh regions were prepped and draped in the usual sterile fashion. She had been marked in the awake, standing position, outlining the incision area, along the gluteal crease that was in continuity with her medial thigh lift scar and extended to the posterior axillary line. The right posterior medial thigh(Location) region was infiltrated with tumescent solution utilizing 750 ml. The liposuction (Liposuction performed.) was then accomplished, removing a total of 200 ml. Then an incision was made along the gluteal crease at the desired site for the final incision. A posterior skin flap was elevated approximately 3 to 4 cm. Hemostasis was assured by electrocautery. There was no residual flap or dead space and the fascia was closed at the deep level with 0 PDS, and then in anatomical layers the closure was completed with 2-0, 3-0, and 4 - 0 PDS. Dermabond and Steri-Strips were then applied. The medial third was also closed with a running 4-0 plain gut. The same was then accomplished on the left side in similar fashion and ste CPT® code: 15830, 15847 ICD- 10 - CM code: E65, M62.08 - ANSWER CASE 5 PREOPERATIVE DIAGNOSIS: Panniculus, Diastasis recti POSTOPERATIVE DIAGNOSIS: Panniculus, diastasis recti (this is the diagnosis used for coding)
PROCEDURE PERFORMED: Abdominoplasty (procedure performed) ANESTHESIA: General CLINICAL NOTE: The patient has had multiple pregnancies, with diastasis recti occurring with the last pregnancy. She has had long term problems with low back pain and constipation as a result of the diastasis recti to the point where child care and every day activities are limited. Since having her last child she has also developed a pannus causing significant chaffing and irritation, which at times results in bleeding and infection. She is here today for the above procedure. She understood the potential risks and complications including the risks of anesthesia, bleeding, infection, wound healing problems, unfavorable scaring, and potential need for secondary surgery. She wanted to proceed. She also understood the possibility of impaired circulation to the flaps and hematoma/seroma formation. PROCEDURE IN DETAIL: The patient was placed on the operating table in supine position. General anesthesia was induced (general anesthesia was used). The abdomen was prepped and draped in the usual sterile fashion and marked for abdominoplasty along the suprapubic natural skin crease. This coursed 36 cm in total. The umbilicus was also marked, and the area was infiltrated with 100 cc of 0.5% Xylocaine with 1:200,000 epinephrine. After adrenaline effect, the incision was made. The flap was elevated to the umbilicus. The umbilicus was circumscribed and dissected free, with care taken to maintain a generous vascular stalk. Dissection was then taken to the subcostal margin as it tapered superiorly and narrowed the exposure. Hemostasis was obtained by electrocautery. There was still a lot of skin laxity, and it CPT® code: 19325- 50 ICD- 10 - CM: N64.82 - ANSWER CASE 6 PREOPERATIVE DIAGNOSIS: Hypoplasia of the breast. POSTOPERATIVE DIAGNOSIS: Hypoplasia of the breast. OPERATIVE PROCEDURE: Bilateral augmentation mammoplasty. ANESTHESIA: General. OPERATIVE SUMMARY: The patient was brought to the operating room awake and placed in a supine position, where general anesthesia was induced without any complications. The patient's chest was prepped and draped in the usual sterile fashion. The patient had previous inframammary crease incisions on both the left and right sides. The extent of the dissection would be to the sternal border within two fingerbreadths of the clavicle and slightly beyond the anterior axillary line. The left breast was operated upon first. An incision was made in the inframammary crease going through skin, subcutaneous tissue, down to the muscle fascia. Dissection at the subglandular level was then performed until an adequate pocket was made according to the previous limits. After irrigation with normal saline and careful hemostasis, a Mentor and Allergan silicone filled, high profile, textured implant was used and placed into the pocket. It was 300 cc. The skin was closed using 4-0 vicryl in an interrupted fashion for the deep subcutaneous tissue 4-0 Monocryl in an interrupted fashion was used for the superficial subcutancous tissue and the skin was closed using 4-0 Monocryl in a subcuticular fashion. Antibiotic ointment and Tegaderm were applied. The right breast was operated on in a very similar fashion. The implant was a 340 cc silicone gel, high profile, textured implant from Allergan. Skin closure was the same. Both left and right
breasts were very similar in size and shape. The patient had a bra applied. The patient tolerated this procedure well and left the operating room in stable condition. What are the CPT® and ICD- 10 - CM codes reported? CPT® code (ha CPT® codes: 13101, 11403- 51 ICD- 10 - CM code: D23.5 - ANSWER CASE 7 PREOPERATIVE DIAGNOSES: Large Dysplastic nevus, right chest. POSTOPERATIVE DIAGNOSES: Large Dysplastic nevus, right chest. PROCEDURES PERFORMED: Excision, dysplastic nevus, right chest with diameter of 1.2 cm and 0.5 cm margins on each side, and complex repair of 4.0 cm wound. ANESTHESIA: Local using 20 cc of 1% lidocaine with epinephrine. COMPLICATIONS: None. ESTIMATED BLOOD LOSS: Less than 2 cc. SPECIMENS: Dysplastic nevus, right chest with suture at superior tip, 12 o'clock for permanent pathology. INDICATIONS FOR SURGERY: The patient is a 49-year-old white woman with a dysplastic nevus of her right chest, which I marked for elliptical excision in the relaxed skin tension lines of her chest with gross normal margins of around 0.5 cm. I drew my best guess at the resultant scar, and she observed these markings well and we proceeded. DESCRIPTION OF PROCEDURE: We started with the patient prone. The area has been infiltrated with local anesthetic. The chest prepped and draped in sterile fashion. I excised the dysplastic nevus as drawn into the subcutaneous fat. Hemostasis was achieved using the Bovie cautery. To optimize the primary repair extensive undermining was done to pull wound edges together and retention sutures were used to keep it closed. This constituted a very a complex repair technique due to skin tension. The wound was closed in layers using 4-0 Monocryl and 5-0 Prolene. A loupe magnification was used. The patient tolerated the procedure well. ADDENDUM: Pathology report confirms it is benign. What are the CPT® and ICD- 10 - CM codes reported? CPT® codes #1, #2 (second code has modifier): ICD- 10 - CM code: CPT® codes: 15240, 14040-51, 11643- 59 ICD- 10 - CM codes: C44.319, C44.629 - ANSWER CASE 8 PREOPERATIVE DIAGNOSES:
ANESTHESIA: Local using 8 cc of 1% lidocaine with epinephrine to the right temple and 3 cc of 1% plain lidocaine to the left hand. INDICATIONS FOR SURGERY: The patient is a 77-year-old white woman with a biopsy-proven basal cell carcinoma of right temple that appeared to be recurrent and a biopsy-proven squamous cell carcinoma of her left hand. I marked the lesion of her temple for elliptical excision in the relaxed skin tension lines of her face with gross normal margins of around 2-3 mm. I also marked my planned rhomboidal excision of the squamous cell carcinoma of her left hand with gross normal margins of around 3 mm, and I drew my planned rhomboid flap. She observed all these markings with a mirror so she could understand the surgery and agree on the locations, and we proceeded. DESCRIPTION OF PROCEDURE: All areas were infiltrated with local anesthetic (the anesthetic with epinephrine). The face and left upper extremity were prepped and draped in normal sterile fashion. I excised the lesion of her right temple and left hand as drawn to the subcutaneous fat. Hemostasis was achieved with Bovie cautery. It took a few more passes to get the margins clear from the basal cell carcinoma on the right temple. The wound had become very large by that time, around quarter sized, and I attempted to close the wound. I began with a 3-0 Monocryl. It was simply too tight and was deforming her eyelid. I felt that we would have to close with a skin graft. I marked the area of CPT® code: 19301-RT ICD- 10 - CM code: N63 - ANSWER CASE 9 PREOPERATIVE DIAGNOSIS: Right breast mass, lower outer quadrant. POSTOPERATIVE DIAGNOSIS: Right breast mass. PROCEDURE: Right breast lumpectomy. ANESTHESIA: A 1% lidocaine with epinephrine mixed 1:1 with 0.5% Marcaine along with IV sedation. INDICATIONS: The patient is a 23 year-old female who recently noted a right breast mass (lower outer quadrant). This has grown somewhat in size and we decided it should be excised. FINDINGS AT THE TIME OF OPERATION: This appeared to be a fibroadenoma. OPERATIVE PROCEDURE: The patient was first identified in the holding area and the surgical site was reconfirmed and marked. Informed consent was obtained. She was then brought back to the operating room where she was placed on the operating room table in supine position. Both arms were placed comfortably out at approximately 85 degrees. All pressure points were well padded. A time-out was performed. The right breast was prepped and draped in the usual fashion. I anesthetized the area in question with the mixture noted above. This mass was at the areolar border at approximately the outer central to lower outer quadrant. I made a circumareolar incision on the outer aspect of the areola. This was carried down through skin, subcutaneous tissue, and a small amount of breast tissue. I was able to easily dissect down to the mass itself. Once I was there, I placed a figure-of-eight 2-0 silk suture for traction. I carefully dissected this mass out from the surrounding tissue along with a margin of healthy breast tissue. Once it was removed from the field, the traction suture was removed and the mass was sent in formalin to pathology. The wound was then inspected for hemostasis, which was achieved with electrocautery. I then re-
approximated the deep breast tissue with interrupted 3-0 vicryl suture and another 3- 0 vicryl suture in the sup CPT® codes: 15002-58, 15271- 58 - 51 ICD- 10 - CM code: M72.6 - ANSWER CASE 10 PREOPERATIVE DIAGNOSIS: Necrotizing fasciitis. POSTOPERATIVE DIAGNOSIS: Necrotizing fasciitis. PROCEDURE: Planned return to the OR to assess wound closure options. Wound excision and homograft placement with surgical preparation, exploration of distal extremity. FINDINGS AND INDICATIONS: This very unfortunate gentleman with liver failure, renal failure, pulmonary failure, and overwhelming sepsis was found to have necrotizing fasciitis last week. At that time we excised the necrotizing wound. The wound appears to have stabilized; however, the patient continues to be very sick. On return to the operating room, he appears to have no evidence of significant healing of any areas with extensively exposed tibia, fibula, Achilles tendon, and other tendons in the foot as well as the tibial plateau and fibular head without any hope of reconstruction of the lower extremity or coverage thereof. There is an area on the lateral thigh that we may be able to be closed with a skin graft for a viable above-the-knee amputation. PROCEDURE IN DETAIL: After informed consent, the patient was brought to the operating room and placed in supine position on the operating table. The above findings were noted. Sharp debridement with the curved Mayo scissors and the scalpel were helpful in demonstrating the findings noted above. Because of the unviability of this area, it was felt that we would not perform a homografting to this area; however, the lateral thigh appeared to be viable and this was excised further with curved Mayo scissors. Hemostasis was achieved without significant difficulty. The homograft was meshed 1.5:1 and then placed over the hemostatic wound on the lateral thigh. This was secured in place with skin staples. Upon completion of the homografting, photos were taken to demonstrate the rather desperate nature of this wound A - ANSWER Melanin is found in what layer of the epidermis? A) Basal B) Epithelium C) Dermal D) Squamous D - ANSWER Which statement is TRUE regarding the Table of Neoplasms in ICD- 10 - CM? A) The Table of Neoplasms is found in the Tabular List. B) There is not a Table of Neoplasms in ICD- 10 - CM. C) The Table of Neoplasms is found by looking for Neoplasm in the ICD- 10 - CM Alphabetic Index. D) There are six columns in the Table of Neoplasms; Malignant Primary, Malignant Secondary, Ca in situ, Benign, Uncertain Behavior and Unspecified Behavior.
C - ANSWER What term relates to connection of skin to underlying muscles? A) Dermis B) Sebaceous C) Hypodermis D) Epidermis C - ANSWER Most categories in ICD- 10 - CM chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes have three main 7th character extenders (with the exception of fractures). What does 7th character D indicate? A) Sequela B) Initial encounter C) Subsequent encounter D) 7th character extenders are not applicable for injury and poisoning. D - ANSWER What is the correct diagnosis code to report treatment of a melanoma in- situ of the left upper arm? A) C44. B) C43. C) D04. D) D03. A - ANSWER What CPT® codes are reported for the destruction of 16 premalignant lesions and 10 benign lesions using cryosurgery? A) 17004, 17110 B) 17000, 17003, 17004, 17110 C) 17000, 17003 x 2, 17110 D) 17110, 17003 B - ANSWER A 63 year-old patient arrives for skin tag removal. As previously noted at her last visit, she has 3 located on her face, 4 on her shoulder and 15 on her back. The physician removes all the skin tags with no complications. What CPT® code(s) is/are reported for this encounter? A) 11200, 11201- 52 B) 11200, 11201 C) 11201, 11201- 51 D) 11201 C - ANSWER Patient presents to the physician for removal of a squamous cell carcinoma of the right cheek. After the area is prepped and draped in a sterile fashion the surgeon measured the lesion, and documented the size of the lesion as 2.3 cm at its largest diameter. Additionally, the physician took margins of 2 mm on each side of the lesion. Single layer closure was performed. The patient tolerated the procedure well. What CPT® code(s) is/are reported? A) 11643, 12013 B) 11642, 12013
A - ANSWER The patient is here to follow-up for a keloid excised from his neck in November of last year. He believes it is coming back. He does have a recurrence of the keloid on the superior portion of the scar. Because the keloid is still small, options of an injection or radiation to the area were discussed. It was agreed our next course should be a Kenalog injection. Risks associated with the procedure were discussed with the patient. Informed consent was obtained. The area was infiltrated with 1.5 cc of medication. This was a mixture of 1 cc of Kenalog-10 and 0.5 cc of 1% lidocaine with epinephrine. He tolerated the procedure well. What codes are reported? A) 11900, J3301, L91. B) 11950, J3301, L90. C) 11951, J3300, L91. D) 11900, J3300, L90. C - ANSWER A 45 year-old male with a previous biopsy positive for malignant melanoma presents for definitive excision of the lesion. After induction of general anesthesia, the patient is placed supine on the OR table, the left knee prepped and draped in the usual sterile fashion. IV antibiotics are given as the patient had previous MRSA infection. The previous excisional biopsy site on the left knee measured approximately 4 cm and was widely ellipsed with a 1.5 cm margin. The excision was taken down to the underlying patellar fascia. Hemostasis was achieved via electrocautery. The resulting defect was 11cm x 5cm. Wide advancement flaps were created inferiorly and superiorly using electrocautery. This allowed skin edges to come together without tension. The wound was closed using interrupted 2-0 Monocryl and 2 retention sutures were placed using #1 Prolene. Skin was closed with a stapler. What CPT® code(s) is/are reported? A) 15758 B) 14301, 11606- 51 C) 14301 D) 15738, 11606- 51 D - ANSWER The patient is here to see us about some skin tags on her neck and both underarms. She has had these lesions for some time; they are irritated by her clothing, itch, and at times have a burning sensation. We discussed treatment options along with risks. Informed consent was obtained and we proceeded. We removed 16 skin tags from the right axilla, 16 skin tags from the left axilla, 10 from the right side of the neck and 17 from the left side of the neck. What CPT® and ICD- 10 - CM codes are reported? A) 11057, D23.5, D23. B) 11200, 11201-51 x 5, D23.5, D23. C) 11200, 11201 x 4, 11201-52, L91. D) 11200, 11201 x 5, L91. A - ANSWER A patient is diagnosed with actinic keratosis of the chest and arms. She presents to her physician's office for destruction of these lesions. Using cryosurgery, the
physician destroys 4 lesions on the right arm, 4 lesions on the left forearm and 4 lesions on the chest. What CPT® and ICD- 10 - CM codes are reported? A) 17000, 17003 x 11, L57. B) 17000, 17003, D49. C) 17000, 17003, 17004, L57. D) 17003 x 19, D48. B - ANSWER A 14 year-old boy was thrown against the window of the car on impact. The resulting injury was a star-shaped pattern cut to the top of his head. In the ED, the MD on call for plastic surgery was asked to evaluate the injury and repair it. The total length of the intermediate repair was 5+4+4+5 cm (18 cm total). The star-like shape allowed the surgeon to pull the wound edges together nicely in a natural Y-plasty in two spots. What CPT® code is reported for the repair? A) 13121 B) 12035 C) 14041 D) 14040 C - ANSWER What CPT® code(s) would best describe treatment of 9 plantar warts removed and 6 flat warts all destroyed with cryosurgery during the same office visit? A) 17110, 17003 B) 17110, 17111- 52 C) 17111 D) 17110 C - ANSWER INDICATIONS FOR SURGERY: The patient is an 82 year-old male with biopsy-proven basal cell carcinoma of his right lower eyelid extending to the upper part of the cheek. I marked the area for rhomboidal excision and I drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the surgery and agreed on the location and we proceeded. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was achieved using Bovie cautery. Modified Mohs analysis showed the margin to be clear. I incised the rhomboid flap as drawn and elevated the flap with a full-thickness of subcutaneous fat. Hemostasis was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap was rotated into the defect. The donor site was closed and flap inset in layers using 5- 0 Monocryl and 6-0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm. What CPT® code(s) should be reported? A) 14060, 11643 B) 11643 C) 14060 D) 14040, 14060
D - ANSWER The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a fragment of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, and we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it; the mass was removed. There was a capsule around this, containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal. He wanted me to, and so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene. What CPT® and ICD- 10 - CM codes are reported? A) 10121, L92.3, Z18.10, Z85. B) 11010, S01.84XA, Z18.10, Z85. C) 11010, M79.5, Z85. D) 10121, M79.5, Z85. D - ANSWER The patient is seen for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest area and was continued on the right and the lateral trochanteric and posterior aspect of the medial thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a compression garment was applied. What CPT® codes are reported? A) 15830, 15832- 50 - 51 B) 15877, 15878- 50 - 51 C) 15830, 15839- 50 - 51, 15847 D) 15877, 15879- 50 - 51 D - ANSWER A localization wire placement in the lower outer aspect of the right breast was performed by a radiologist the day prior to this procedure. During this operative session, the surgeon created an incision through the wire track and the wire track was followed down to its entrance into breast tissue. A nodule of breast tissue was noted immediately adjacent to the wire. This entire area was excised by sharp dissection, sent to pathology and returned as a benign lesion. Bleeders were cauterized, and subcutaneous tissue was closed with 3-0 Vicryl. Skin edges were approximated with 4- 0 subcuticular sutures and adhesive strips were applied. The patient left the operating room in satisfactory condition. What is/are the correct code(s) for the surgeon's service? A) 19120-RT B) 11400-RT C) 19125-RT, 19285 D) 19125-RT
A - ANSWER Patient has returned to the operating room for aspiration of a seroma that developed from a genitourinary surgical procedure performed two days ago. A 16- gauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported? A) 10160-78, N99. B) 10140-78, S20.20XS C) 10180-58, N99. D) 10140-58, N99. C - ANSWER Patient is an 81 year-old male with a biopsy-proven basal cell carcinoma of the posterior neck just near his hairline; additionally, the patient had two other areas of concern on his cheek. Informed consent was obtained and the areas were prepped and draped in the usual sterile fashion. Attention was first directed to the basal cell carcinoma of the neck. I excised the lesion measuring 2.6 cm as drawn down to the subcutaneous fat. With extensive undermining of the wound I closed it in layers using 4.0 Monocryl, 5.0 Prolene and 6.0 Prolene; the wound measured 4.5cm. Attention was then directed to the other two suspicious lesions on his cheek. After administering local anesthesia, I proceeded to take a 3mm punch biopsy of each lesion and was able to close with 5.0 Prolene. The patient tolerated the procedures well. Pathology later showed the basal cell carcinoma was completely removed and the biopsies indicated actinic keratosis. What CPT® codes should be reported? A) 12042, 11623-51, 11100-59, 11101 B) 13132, 11623-51, 11440-51, 11440- 51 C) 13132, 11623-51, 11100-59, 11101 D) 13131, 11622-51, 11100-59, 11100- 59 D - ANSWER Operative Report: Pre-Operative Diagnoses: Basal Cell Carcinoma, forehead Basal Cell Carcinoma, right cheek Suspicious lesion, left nose Suspicious lesion, left forehead Post-Operative Diagnoses: Basal Cell Carcinoma, forehead with clear margins Basal Cell Carcinoma, right cheek with clear margins Compound nevus, left nose with clear margins Epidermal nevus, left forehead with clear margins INDICATIONS FOR SURGERY: The patient is a 47 year-old white man with a biopsy- proven basal cell carcinoma of his forehead and a biopsy-proven basal cell carcinoma of his right cheek. We were not quite sure of the patient's location of the basal cell carcinoma of the forehead whether it was a midline lesion or lesion to the left. We felt stronger about the midline lesion, so we marked the area for elliptical excision in relaxed skin tension lines of his forehead with gross normal margins of 1-2 mm and I marked the lesion of the left forehead for biopsy. He also had a lesion of his left alar crease we marked for biopsy and a large basal cell carcinoma of his right cheek, which was more
obvious. This was marked for elliptical excision with gross normal margins of 2-3 mm in the relaxed skin tension lines of his face. I also drew a possible rhomboid flap that we would use if the wound became larger. He observed all these margins in the mirror, so he could understand the surgery and agree on the locations, and we proceeded. DESCRIPTION OF PROCEDURE: All four areas were infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion of the forehead measuring 6 mm and right cheek measuring 1.3 cm as I had drawn them and sent in for frozen section. The biopsies were taken of the left forehead and left nose using a 2-mm punch, and these wounds were closed with 6-0 Prolene. Meticulous hemostasis w A - ANSWER Operative Report PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration. POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration. OPERATION PERFORMED: Debridement and split thickness autografting 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 pati D - ANSWER Operative Report PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp. POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp. PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin- Yang flap repair
ANESTHESIA: Local, using 4 cc of 1% lidocaine with epinephrine. COMPLICATIONS: None. ESTIMATED BLOOD LOSS: Less than 5 cc. SPECIMENS: Squamous cell carcinoma, scalp sutured at 12 o'clock, anterior tip INDICATIONS FOR SURGERY: The patient is a 43 year-old male patient with a biopsy- proven squamous cell carcinoma of his scalp measuring 2.1 cm. I marked the area for excision with gross normal margins of 4 mm and I drew my planned Yin-Yang flap closure. The patient observed these markings in two mirrors to understand the surgery and he agreed on the location. We proceeded with the procedure. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The patient was placed prone, his scalp and face were prepped and draped in sterile fashion. I excised the lesion as drawn to include the galea. Hemostasis was achieved with the Bovie cautery. Pathologic analysis showed the margins to be clear. I incised the Yin-Yang flaps and elevated them with the underlying galea. Hemostasis was achieved in the donor site using Bovie cautery. The flap rotated into the defect with total measurements of 2.9 cm x 3.2 cm. The donor sites were closed and the flaps inset in layers using 4-0 Monocryl and the skin stapler. Loupe magnification was used. The patient tolerated the procedure well. What CPT® and ICD- 10 - CM codes are reported? A) 14041, C44. B) 14060, C43. C) 14040, C44. D) 14020, C44. B - ANSWER Operative Report Diagnosis: Basal Cell Carcinoma Procedure: Mohs micrographic excision of skin cancer. Site: Face left lateral 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. 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? A) 13152, 11442-51, C44. B) 17311, 13152-51, C44. C) 17313, 13152-51, C44. D) 13152, 11642-51, C44. A - ANSWER What is the correct CPT® code for the excision of a benign lesion on the scalp with an excised diameter of 2.3 cm? A) 11423 B) 11623 C) 11403 D) 11603 D - ANSWER What is the full description for CPT® code 43622? A) With formation of intestinal pouch, any type B) Gastrectomy, total; with Roux-en-Y reconstruction and formation of intestinal pouch, any type C) Gastrectomy, total; with esophagoenterostomy with formation of intestinal pouch, any type D) Gastrectomy, total; with formation of intestinal pouch, any type C - ANSWER Select the TRUE statement regarding modifier 51 in the CPT® code book. A) Modifier 51 can be replaced by using the RT and LT modifiers. B) Add-on codes should always have modifier 51 appended to them. C) Codes exempt from modifier 51 are identified with the universal forbidden symbol. D) A list of modifier 51 exempt codes can be found in Appendix A of the CPT® code book. B - ANSWER What are three methods used to list main terms in the CPT® manual alphabetical index? A) Condition, brand names, procedure B) Condition, synonyms, abbreviations C) Anatomic site, surgical specialty, eponyms D) Eponyms, procedure, instruments B - ANSWER Which CPT® Appendix lists clinical examples for E/M coding?
A) Appendix B B) Appendix C C) Appendix D D) Appendix P A - ANSWER What is the CMS global period status indicator for endoscopies? A) 000 B) 010 C) 030 D) None of the above C - ANSWER What is the postoperative period included in the surgical global package for major surgery? A) 0-10 days B) 60 days C) 90 days D) 120 days D - ANSWER Which set of HCPCS Level II codes are used to report injected drugs? A) A codes B) C codes C) H codes D) J codes C - ANSWER What are three types of codes printed in the HCPCS Level II codebook? A) Level II codes, Modifiers, DME codes B) Level II codes, G codes, Miscellaneous C) Miscellaneous codes, Permanent National codes, Temporary National codes D) Dental codes, Permanent National codes, Unlisted Codes D - ANSWER Which HCPCS Level II modifier should you append for a new wheelchair purchase? A) GM B) HC C) NR D) NU B - ANSWER Which CPT® modifier should you append to a procedure code for a bilateral procedure? A) 22 B) 50 C) 51 D) 59 D - ANSWER Which one of the CPT® codes listed below would modifier 50 be appended to for a bilateral procedure?
B - ANSWER Which CPT® code set is used voluntarily by physicians to report quality patient performance measurements? A) Category I codes B) Category II codes C) Category III codes D) CPT® unlisted codes D - ANSWER What services are included in the surgical global package? A) Preoperative Visits, Intraoperative Services, Initial consultation B) Intraoperative Services, Diagnostic tests, Experimental procedures C) Bilateral procedures, Documentation, Diagnostic tests D) Preoperative visits, Intraoperative services, Postsurgical pain management C - ANSWER Which set of HCPCS Level II codes are considered temporary codes assigned by CMS and reviewed by AMA for inclusion in the CPT®? A) A codes B) C codes C) G codes D) T codes B - ANSWER In which option below is it appropriate to append HCPCS Level II modifiers to CPT® procedure codes? A) Never, HCPCS Level II modifiers are only appended to HCPCS Level II codes B) When specificity is required for eyelids, fingers, toes, and coronary arteries C) When CPT® and HCPCS Level II codes are reported together D) Always B - ANSWER What types of modifiers are listed in the Appendix A of the CPT® codebook? A) CPT®, Anesthesia Physical Status Modifiers, Surgical B) CPT®, ASC, HCPCS, Anesthesia Physical Status Modifiers C) HCPCS, CPT®, Surgical D) CPT®, HCPCS, Category I 43800 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Pyloroplasty 27614 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Deep biopsy of soft tissue of the ankle
24400 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Osteotomy, humerus, with internal fixation 50200 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Renal biopsy, percutaneous, needle 17282 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Destruction of a malignant lesion on the face with a lesion diameter of 1.2 cm 31500 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Emergency endotracheal intubation 94012 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age 80051 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): An electrolyte panel is performed on an 86 year-old for dizziness 71046 - ANSWER Look up the procedures in the CPT® codebook and list the CPT® code. (No modifiers are necessary for this exercise): A frontal and lateral chest X-ray is performed in the office for a patient with chest pain 1050F - ANSWER The performance measure code for history obtained regarding new or changing moles 57 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Decision for surgery 22 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Increased procedural service P3 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Physical status modifier for a patient with a severe systemic disease F5 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Right hand, thumb
24 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Unrelated evaluation and management services by the same physician or other qualified health care professional during a postoperative period 58 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period 25 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service TA - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Left foot, great toe GA (Waiver of liability statement issued as required by payer policy, individual case), GU (Waiver of liability statement issued as required by payer policy, routine notice) - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Waiver of liability statement on file (goes with ABN) 52 - ANSWER List the CPT® or HCPCS Level II modifier(s) for the definition given (Do not type the word "Modifier" for your answer.): Reduced services B - ANSWER What modifier is used to report the termination of a surgery following induction of anesthesia due to extenuating circumstances or those that threaten the well-being of the patient? A) Modifier 22 B) Modifier 53 C) Modifier 52 D) Modifier 54 C - ANSWER What is the correct code for a radical maxillary sinusotomy? A) 31050 B) 31020 C) 31030 D) 31032 A - ANSWER How are new additions and revisions indicated in the CPT® codebook each year? A) Green print B) Bold print C) Italic print
D) Red print C - ANSWER What is the correct HCPCS Level II code for a removable metatarsal foot arch support that is pre-molded? A) L3090 B) L3080 C) L3050 D) L3060 B - ANSWER What is the correct CPT® code for a MRI performed on the brain first without contrast and then with contrast? A) 70554 B) 70553 C) 70552 D) 70551 D - ANSWER CPT® Category III codes reimburse at what level? A) 85 percent B) 10 percent C) 100 percent D) Reimbursement, if any, is determined by the payer A - ANSWER What is the correct CPT® coding for a cystourethroscopy with brush biopsy of the renal pelvis? A) 52007 B) 52000, 52007 C) 52005, 52007 D) 52005 A - ANSWER What temporary HCPCS Level II codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals? A) C codes B) G codes C) Q codes D) H codes A - ANSWER What publications does the AMA copyright and maintain? A) CPT® codebook and CPT® Assistant B) CPT® codebook, HCPCS Level II codebook, ICD- 10 - CM codebook C) CPT® codebook and HCPCS Level II codebook D) AHA Coding Clinic and CPT® Assistant C - ANSWER What hernia repair codes can be reported with add-on code 49568? A) 49654- 49659 B) 49570- 49572 C) 49560- 49566
B - ANSWER What is the correct code for the application of a short arm cast? A) 29280 B) 29075 C) 29065 D) 29125 D - ANSWER How often are HCPCS Level II permanent national codes updated? A) Three times a year B) Bi-annually C) Quarterly D) Annually D - ANSWER A patient is seen in the physician's office for a 2,400,000 U injection of Bicillin L-A. What code represents this drug and the units given? A) J2540 x 4 B) J0558 x 24 C) J2510 x 4 D) J0561 x 24 D - ANSWER What is the correct CPT® code to report a microscopic urinalysis? A) 81001 B) 81000 C) 81003 D) 81015 B - ANSWER Which statement is TRUE regarding the instruction for use of the CPT® codebook? A) Use an unlisted code when modifying a procedure. B) Select the name of the procedure or service that accurately identifies the service performed. C) Select the name of the procedure or service that most closely approximates the procedure or service performed. D) Parenthetical instructions define each code listed in the codebook. D - ANSWER What surgical status indicator represents the Global Surgical Package for endoscopic procedures (without an incision) where there is no postoperative period after the day of the surgery?? A) 010 B) XXX C) 090 D) 000 C - ANSWER What is the appropriate modifier to use when two surgeons perform separate distinct portions of the same procedure?