CPC Practice Exam Quizzes With Verified Solutions Graded A+ 2023, Exams of Nursing

Download CPC Practice Exam Quizzes With Verified Solutions Graded A+ 2023 and more Exams Nursing in PDF only on Docsity! CPC Practice Exam Quizzes With Verified Solutions Graded A+ 2023 1. When coding an operative report, what action would NOT be recommended? a. Starting with the procedure listed. b. Reading the body of the report. c. Coding from the header without reading the body of the report. d. Highlighting unfamiliar words. Rationale: Operative report coding tips include reviewing the documentation in the detail of the procedure to further clarify or define both procedures and diagnoses. 2. Which coding manuals do outpatient coders focus on learning? a. CPT®, HCPCS Level II, ICD-10-CM, ICD-10-PCS b. ICD-10-CM and ICD-10-PCS c. CPT®, HCPCS Level II and ICD-10-CM d. CPT® and ICD-10-CM Rationale: Outpatient coding focuses on provider services. Outpatient coders will focus on learning CPT®, HCPCS Level II and ICD-10-CM. 3. Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for? a. Standard, Objective, Activity, Period b. Scope, Observation, Action, Plan c. Subjective, Objective, Assessment, Plan d. Source, Opinion, Advice, Provider Rationale: S-Subjective, O-Objective, A-Assessment, P-Plan 4. According to the OIG, internal monitoring and auditing should be performed by what means? a. Periodic audits. b. Focused audits on problems brought to the attention of the compliance officer. c. Audits on all denied claims. d. Baseline audits. Rationale: A key component of an effective compliance program includes internal monitoring and auditing through the performance of periodic audits. This ongoing evaluation includes not only whether the provider practice’s standards and procedures are in fact current and accurate, but also whether the compliance program is working, (for example, whether individuals are properly carrying out their responsibilities and claims are submitted appropriately). 5. What type of insurance is Medicare Part D? a. A Medicare Advantage program managed by private insurers. b. Hospital coverage available to all Medicare beneficiaries. c. Prescription drug coverage available to all Medicare beneficiaries. d. Provider coverage requiring monthly premiums. Rationale: Medicare Part D is a prescription drug program available to all Medicare beneficiaries for a fee. Private companies approved by Medicare provide the coverage. 6. What type of health insurance provides coverage for low-income families? a. Medicaid c. Commercial PPO b. Medicare d. Commercial HMO Rationale: Medicaid is a health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments. 7. According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct? a. Integrity c. Efficiency b. Responsibility d. Commitment Rationale: It shall be the responsibility of every AAPC member, as a condition of continued membership, to conduct themselves in all professional activities in a manner consistent with ALL the following ethical principles of professional conduct: · Integrity · Respect · Commitment · Competence · Fairness · Responsibility 21. When coding for an ambulatory surgical procedure, how is the diagnosis determined? a. Code the preoperative diagnosis because it is the most definitive. b. Code the preoperative diagnosis and postoperative diagnosis if the diagnoses are different. c. Code the postoperative diagnosis because it is the most definitive. d. Z codes are always reported for ambulatory surgery. Rationale: For ambulatory surgery, if the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding because it is the most definitive. Refer to ICD-10-CM guideline IV.N. 22. A 32-year-old sees her obstetrician about a lump in the lower outer quadrant of the right breast. Her mother and aunt both have a history of breast cancer. What diagnosis code(s) should be reported? a. N63.13, Z85.3 c. N63.23, Z15.01 b. N63.23 d. N63.13, Z80.3 Rationale: In the ICD-10-CM Alphabetic Index look for Lump/breast/right/lower outer quadrant N63.13. Next look for History/family (of)/malignant neoplasm (of)/breast which directs the coder to Z80.3. According to ICD-10-CM guideline IV.J history codes (Z80-Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment. Verify code selection in the Tabular List. 23. A 22 year-old is in an outpatient facility for an inguinal hernia repair. Just before surgery, the surgeon discovers the patient is positive for MRSA and the surgery is canceled. Which ICD-10-CM code(s) should be reported for the outpatient service? a. A49.02 c. Z53.09 b. A49.01, K40.90, Z53.09 d. K40.90, A49.02, Z53.09 Rationale: ICD-10-CM guidelines for outpatient services IV.A.1 states to report the reason for surgery as the first listed diagnosis even if the surgery is canceled due to a contraindication. Look in the ICD-10-CM Alphabetic Index for Hernia/inguinal referring you to code K40.90. Next, look for MRSA (Methicillin resistant Staphylococcus aureus)/infection referring you to code A49.02. Lastly, look for Canceled procedure (surgical)/because of/contraindication referring you to code Z53.09. Verify code selection in the Tabular List. 24. What is the diagnosis code(s) for a patient with bronchitis and the flu? a. J40, J11.1 c. J11.1 b. J09.X2 d. J40, J09.X2 Rationale: Look in the ICD-10-CM Alphabetic Index for Bronchitis/with/influenza, flu or grippe which states to see Influenza, with, respiratory manifestations NEC. Look for Influenza/with/respiratory manifestations NEC J11.1. Verify code selection in the Tabular List 25. What is the ICD-10-CM code for an initial encounter for a closed fracture of the right wrist? a. M80.031A c. S62.102A b. S62.101A d. S12.9XXA Rationale: Look in the ICD-10-CM Alphabetic Index for Fracture/wrist which directs the coder to S62.10-. In the Tabular List the 6th character 1 is selected for the right wrist. This code also indicates a 7th character is required. A is selected for the initial encounter. 26. 41. A patient is seen in the ED for severe abdominal pain and urinary frequency. After examination and urinalysis, the patient is diagnosed with a urinary tract infection (UTI). What ICD-10- CM code(s) is/are reported? a. R10.0, R35.0 c. R10.0, N39.0 b. R10.0, R35.0, N39.0 d. N39.0 Rationale: Refer to ICD-10-CM guideline I.B.5. The abdominal pain and urinary frequency are not reported because they are symptoms of the UTI. Look in the ICD-10-CM Alphabetic Index for Infection, infected, infective/urinary (tract) which directs the coder to N39.0. Verification in the Tabular List confirms code selection. 27. When a patient has a blood test for HIV that is inconclusive, what ICD-10-CM code is assigned? a. Z21 c. B20 b. R75 d. Z11.4 Rationale: ICD-10-CM guideline I.C.1.a.2.e instructs us to use R75 for patients with inconclusive HIV serology and without definitive diagnosis or manifestations of the illness. To locate the code in the ICD- 10-CM Alphabetic Index look for Human/immunodeficiency virus (HIV) disease (infection)/laboratory evidence R75. Verify code selection in the Tabular List. 28. Patient with postoperative anemia due to acute blood loss during the surgery needs a blood transfusion. What ICD-10-CM code is reported? a. D50.0 c. D64.9 b. D62 d. D53.0 Rationale: In the ICD-10-CM Alphabetic Index look for Anemia/postoperative (postprocedural)/due to (acute) blood loss guiding you to code D62. Verify code selection in the Tabular List. 29. A lab screening shows congenital iodine-deficiency hypothyroidism for an infant with identified intellectual disability. What ICD-10-CM code(s) is/are reported? a. E00.9, F79 c. E00.9 b. E03.8, F79 d. F79, E00.9 Rationale: In the ICD-10-CM Alphabetic Index look for Hypothyroidism/iodine-deficiency/congenital and you are directed to see Syndrome, iodine-deficiency, congenital. Syndrome/iodine-deficiency, congenital which directs you to code E00.9. In the Tabular List category E00 directs us to use additional code (F70- F79) to identify associated intellectual disabilities. In the Alphabetic Index look for Disability, disabilities/intellectual which guides you to code F79. Confirm code selection in the Tabular List 30. A 32-year-old male was seen in the ASC for removal of two lipomas. One was located on his back and the other was located on the right forearm. Both involved subcutaneous tissue. What ICD-10- CM code(s) is/are reported? a. D17.39 c. D17.1, D17.23 b. D17.21, D17.1 d. D17.30 Rationale: In the ICD-10-CM Alphabetic Index, look for Lipoma/site classification/arms (skin) (subcutaneous) D17.2-. In the Tabular List, a 5th character 1 is selected to indicate the right arm. Next, look for Lipoma/site classification/trunk (skin) (subcutaneous) D17.1. Verify code selection in the Tabular List. 31. A patient with chronic back and neck pain developed a drug dependency on oxycodone (opioid). After being taken off the drug, he was seen in the clinic for withdrawal symptoms. What ICD- 10- CM codes are reported? a. F11.10, F11.23, T40.2X5A c. F11.23, T40.2X5A b. F11.24, T40.2X5D d. F11.23, T40.2X5S Rationale: Withdrawal symptoms are a result of unpleasant effects on the body when there is a sudden discontinuation/separation of drugs and/or alcohol. In the ICD-10-CM Alphabetic Index locate Dependence/drug/opioid/with/withdrawal F11.23. In the Tabular List code F11.23 identifies opioid dependence withdrawal. The patient took the medication for therapeutic reasons which had led to a drug dependency making it an adverse effect. Look in the ICD-10-CM Table of Drugs for Oxycodone. Use the code from the adverse effect column which directs the coder to T40.2X5-. In the Tabular List a 7th character A is selected because the patient is actively being treated for the adverse effects. ICD-10-CM guideline I.C.19.e.5.a instructs us to code first the nature of the adverse effect, followed by the appropriate code for the adverse effect of the drug (T code). 32. A patient with metastatic bone cancer (primary site unknown) presents to the oncologist’s office for a chemotherapy treatment. On examination the oncologist finds the patient to be severely dehydrated and cancels the chemotherapy. The patient receives intravenous hydration in the office and reschedules the chemotherapy treatment. What ICD-10-CM codes are reported? a. C40.30, E86.0, C79.51 c. C79.51, E86.0 b. E86.0, C79.51, C80.1 d. E86.0, C80.1, C79.51 Rationale: Per ICD-10-CM guideline I.C.2.c.3 when the admission/encounter is for management of dehydration due to the malignancy or therapy, or a combination of both, and only the dehydration is Rationale: When a fracture and dislocation occur in the same site, only the fracture code is reported. Look in the ICD-10-CM Alphabetic Index for Dislocation/with fracture and you are referred to see Fracture. Look for Fracture, traumatic/finger (except thumb)/little/distal phalanx (displaced), which leads you to subcategory S62.63-. Refer to the Tabular List. S62.637 is reported for the left little finger and the 7th character A is chosen to indicate this is the initial encounter. 41. A 2 month-old is seeing his pediatrician for a routine health check examination. The physician notices a diaper rash and prescribes an ointment to treat it. What ICD-10-CM code(s) is/are reported? a. L22 c. L22, Z00.129 b. Z00.121, L22 d. Z00.00 Rationale: In the ICD-10-CM Alphabetic Index look for Examination (for) (following) (general) (of) (routine)/child (over 28 days-old)/with abnormal findings, which directs you to code Z00.121. In this case, the rash is an abnormal finding that was noticed during the physician’s examination of the patient for a general check-up. Per ICD-10-CM guideline I.C.21.c.13, during a routine exam, should a diagnosis or condition be discovered, it is coded as an additional code. The second code is found in the Alphabetic Index by looking for Rash/diaper which directs you to L22. Verify code selection in the Tabular List. 42. A 32-year-old who is 21 weeks pregnant (antepartum) presents with vaginal bleeding. She is admitted to the observation unit to rule out a spontaneous abortion. What ICD-10-CM code(s) is/are reported? a. O46.92, Z3A.21 c. Z33.1 b. O03.9 d. Z34.92, Z3A.21 Rationale: In the ICD-10-CM Alphabetic Index look for Hemorrhage, hemorrhagic/antepartum (with), guiding you to code O46.90. Turn to the Tabular List. The 5th character 0 is for an unspecified antepartum hemorrhage, unspecified trimester. Notes at the beginning of chapter 15 indicate that 21 weeks lies in the 2nd trimester. Further review of the codes in this category show that 5th character 2 indicates second trimester, resulting in code O46.92. Code Z33.1 is only reported when the provider documents the medical condition is not related to the pregnancy. The spontaneous abortion code O03.9 is not reported because it is documented as a rule out. Z34.92 is for supervision of a normal pregnancy, which is not the case in this scenario with vaginal bleeding. At the beginning of chapter 15, under the notes, there is a reference to use additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy.” Look in the Alphabetic Index for Pregnancy/weeks of gestation/21 weeks guiding you to code Z3A.21. Verify code selection in the Tabular List. 43. A patient was admitted three weeks following a normal vaginal delivery with a postpartum breast abscess. What ICD-10-CM code is reported? a. O91.13 c. O91.12 b. N61.1 d. O91.22 Rationale: In the ICD-10-CM Alphabetic Index look for Abscess/breast (acute) (chronic) (nonpuerperal)/puerperal, postpartum, gestational which guides you to see Mastitis, obstetric, purulent. Look for Mastitis (acute) (diffuse) (nonpuerperal) (subacute)/obstetric/purulent/associated with/puerperium guiding you to code O91.12. In the Tabular List, the description under O91.12 includes puerperal mammary abscess. The puerperium is the period of six weeks or 42 days following childbirth. 44. A 55 year-old has developed a pressure ulcer on her right hip. The base of the ulcer is covered in eschar and the provider documents that the stage of the ulcer cannot be determined. What ICD-10- CM code is reported? a. L89.219 c. L89.210 b. L89.310 d. L89.319 Rationale: Refer to ICD-10-CM guideline I.C.12. a.2. If the pressure ulcer is documented as unstageable, assign L89. --0. Unstageable is when the base of the ulcer is covered in eschar or slough so much that it cannot be determined how deep the ulcer is. This diagnosis is determined based on the clinical documentation. This code should not be used if the stage is not documented. In that instance, report the unspecified code, L89. --9. In the ICD-10-CM Alphabetic Index, look for Ulcer, ulcerated, ulcerating, ulceration, ulcerative/pressure (pressure area)/unstageable/hip which directs you to L89.2-. In the Tabular List the 5th character 1 indicates the right hip and 6th character 0 indicates unstageable. 45. Patient presents with no menses and positive pregnancy test, but an ultrasound reveals no uterine contents. An embryo has implanted on the left ovary, and this is treated with laparoscopic oophorectomy. What ICD-10-CM code is reported for this procedure? a. O00.802 c. O00.202 b. O00.09 d. O00.102 Rationale: For the diagnosis, look in the ICD-10-CM Alphabetic Index for Pregnancy/ovarian directing you to O00.20-. A 6TH character is required to identify laterality, 2 is assigned for the left ovary. In the Tabular List, there is an instructional note to use an additional code from category O08 to identify any associated complication. No complication is documented. Verify code selection in the Tabular List. 46. A 4-year-old is brought into the ED crying. He cannot bend his left arm after his older sister pulled it. The provider performs an X-ray, and it shows the patient has Nursemaid’s elbow. The ED provider reduces the elbow successfully. The patient can move his arm again after the reduction. What ICD-10-CM codes are reported? a. S53.095A, X50.9XXA c. S53.095S, X50.9XXS b. S53.032S, X50.9XXS d. S53.032A, X50.9XXA Rationale: In the ICD-10-CM Alphabetic Index look for Nursemaid’s elbow directing you to S53.03-. In the Tabular List, 6th character 2 is reported for the left elbow and 7th character A is applied for the initial encounter. The patient’s arm was injured due to his sister pulling on it. In the ICD-10-CM External Cause of Injuries Index look for Pulling, excessive which directs you to X50.9-. In the Tabular List, the code needs seven characters. Two Xs are needed as place holders for the 5th and 6th characters. The 7th character is A. 47. A 6-month-old patient is seen at the clinic for a routine well-child visit and vaccinations. During the examination the provider finds that the child has a fever and a diagnosis of acute otitis media in the right ear is documented. Vaccinations are not given at this time. What ICD-10-CM code(s) is/are reported? a. Z00.121 c. Z00.121, H66.90, Z23 b. H66.90, Z00.01 d. Z00.121, H66.91, Z28.01 Rationale: According to ICD-10-CM guideline I.C.21.13: During a routine exam, should a diagnosis or condition be discovered, it should be coded with abnormal findings. The abnormal finding should be coded as an additional code. Look in the ICD-10-CM Alphabetic Index for Examination (for) (following) (general) (of) (routine)/child (over 28 days-old)/with abnormal findings which directs you to Z00.121. To report the abnormal finding, look in the Alphabetic Index for Otitis (acute)/media/acute, subacute which directs you to H66.90. Verify code selection in the Tabular List. Subcategory code H66.9 is for Otitis media, unspecified. Report H66.91 for the right ear. Next, in the Alphabetic Index look for Vaccination/not done which states see Immunization, not done, because (of). Immunization/not done/because (of)/acute illness of patient directs you to Z28.01. Verify code selection in the Tabular List. 48. A male patient is here for his chemotherapy for metastatic carcinoma of the liver secondary to cancer of the right areola. What ICD-10-CM codes are reported? a. Z51.11, C78.7, C50.021 c. Z51.11, C50.029, C78.7 b. C78.7, C50.021, Z51.11 d. C22.9, C50.019, Z51.11 Rationale: ICD-10-CM guideline I.C.2.e.2 states that if a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy, or radiation therapy, assign code Z51.0 Encounter for antineoplastic radiation therapy, or Z51.11 Encounter for antineoplastic chemotherapy, or Z51.12 Encounter for antineoplastic immunotherapy as the first listed or principal diagnosis. In the ICD-10-CM Alphabetic Index look for Encounter (with health service) (for)/chemotherapy for neoplasm guiding you to code Z51.11. Next, look in the Alphabetic Index for Metastasis, metastatic/cancer/from specified site and you are directed to see Neoplasm, malignant, by site. In the ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/liver and select the code from the Malignant Secondary column, guiding you to code C78.7. Next look for Neoplasm, neoplastic/areola and select the code from the Malignant Primary column or Neoplasm, neoplastic/breast/areola and select the code from the Malignant Primary column, guiding you to subcategory code C50.0-. In the Tabular List, the 5th character is reported for the sex of the patient. In this case the patient is a male resulting in a 5th character of 2. The 6th character is for laterality; 1 is for right. The complete code is C50.021 for primary cancer of the right male areola. When assigning breast cancer codes make sure to select for the correct sex of the patient. The secondary cancer is listed first because the chemotherapy is directed to the secondary site per ICD-10-CM guideline I.C.2.b. Verify code selection in the Tabular List. 49. A 16 year-old male is brought to the ED by his mother. He was riding his bicycle in the park when he fell off the bike. The patient’s right arm is painful to touch, discolored, and swollen. The X-ray shows a closed fracture of the ulna. What ICD-10-CM codes are reported? a. S52.201A, V18.0XXA, Y92.830 c. S52.201A, V18.4XXA, Y92.831 55. What does “non-facility” describe when calculating Medicare Physician Fee Schedule payments? a. Hospitals b. Nursing homes c. Non-hospital owned physician practices d. Hospital owned physician practices Rationale: “Non-facility” location calculations are for private practices or non-hospital-owned physician practices. Reimbursement is higher for private practices because the practice incurs the full expense of providing the service 56. What is the code for partial laparoscopic colectomy with anastomosis and coloproctostomy? a. 44208 c. 44145 b. 44210 d. 44207 Rationale: In the CPT® Index, look for Laparoscopy/Colectomy/Partial. You are directed to codes 44204- 44208 and 44213. In the Digestive numeric section, upon review of the codes, 44207 represents a partial colectomy with anastomosis and coloproctostomy performed laparoscopically. 57. What is the correct CPT® code for a MRI performed on the brain first without contrast and then with contrast? a. 70554 c. 70552 b. 70553 d. 70551 Rationale: In the CPT® Index, look for Magnetic Resonance Imaging (MRI)/Diagnostic/Brain. You are directed to see codes 70551-70555. Upon review of the codes in the Radiology numeric section, code 70553 represents an MRI performed on the brain first without contrast material, then with contrast material. 58. What type of print indicates new additions and revisions in the CPT® codebook each year? a. Italic print c. Green print b. Red print d. Bold print Rationale: New additions and revisions in the CPT® code book each year appear in green print. 59. If a CPT® code and a HCPCS Level II code exist for the same service, which one does Medicare prefer to report? a. HCPCS Level II code c. CPT® and HCPCS Level II codes b. CPT® code d. It depends on the payer Rationale: CMS prefers the HCPCS Level II code be reported for Medicare rather than the CPT® code when a code for the same service exists in both code sets. 60. What is another term for hives? a. Rash c. Urticaria b. Eruption d. Dermatitis Rationale: Urticaria can also be described as hives and shows on the skin as raised, red, itchy wheals. 61. What term best describes a mass of hypertrophic scar tissue? a. Keloid c. Dermatofibroma b. Pilonidal cyst d. Congenital nevus Rationale: A keloid scar is excess growth of connective tissue during the healing process. 62. A patient presents with a recurrent seborrheic keratosis of the left cheek. The area was marked for a shave removal. The area was infiltrated with local anesthetic, prepped and draped in a sterile fashion. The lesion measuring 1.8 cm was shaved using an 11-blade. Meticulous hemostasis was achieved using light pressure. The specimen was sent for permanent pathology. The patient tolerated the procedure well. What CPT® code is reported? a. 11200 c. 11442 b. 11312 d. 11642 Rationale: In the CPT® Index look for Shaving/Skin Lesion and you are referred to range 11300-11313. Code selection is based on location and size. This lesion is on the left cheek narrowing the range to 11310-11313. The size is 1.8 cm making 11312 the correct code choice. 63. 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, D23.4 c. 11200, 11201 x 4, 11201-52, L91.8 b. 11200, 11201-51 x 5, D23.5, D23.4 d. 11200, 11201 x 5, L91.8 Rationale: In the CPT® Index look for Skin/Tags/Removal and you are directed to codes 11200, 11201. Code selection is based on the number of skin tags removed. A total of 59 skin tags were removed. Code 11200 is reported for the first 15. Add-on code 11201 is reported for each remaining 10 (or part thereof) removed. The words “part there of” means you do not need to have a complete total of 10 lesions to report the add-on code. The add-on code can be reported if the additional lesions are 10 and under; it is not appropriate to append modifier 51 to an add-on code. Codes 11200, 11201 x 5 are correct. 64. 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, D49.2 c. 17000, 17003 x 11, L57.0 b. 17003 x 19, D48.5 d. 17000, 17003, 17004, L57.0 Rationale: In the CPT® Index look for Destruction/Lesion/Skin/Premalignant, and you are directed to code ranges 17000-17004, 96567, 96573, and 96574. 96567, 96573, and 96574 are for photodynamic therapy. Actinic keratosis is a premalignant lesion, so a code is chosen from code rage 17000-17004. Code selection is based on the number of lesions destroyed. In this case, 12 lesions were destroyed making CPT ® codes 17000, 17003 the correct code choices. Add-on code 17003 has the word each in its code description meaning this code can be reported in units when each lesion is destroyed from the second lesion through 14 lesions. In this case report 17003 x 11. Note: Code 17004 is only reported once when 15 or more lesions are removed and is not reported with codes 17000, 17003. In the ICD-10-CM Alphabetic Index look for Keratosis/actinic and you are directed to code L57.0. Verification of the code in the Tabular List confirms code selection. 65. Operative Report Pre-Operative and Post-Operative Diagnosis: Squamous cell carcinoma, left leg Open wound, right leg Personal history of squamous cell carcinoma, right leg INDICATIONS FOR SURGERY: The patient is an 81-year-old white man with biopsy proven squamous cell carcinoma of his left leg. I marked the areas for excision with gross normal margins of 5 mm, and I drew my planned skin graft donor site from his left lateral thigh. He also had an open wound of his right leg from a squamous cell carcinoma excised four months ago; the skin graft had not taken. We plan on re- skin grafting the area. The patient is aware of all of these markings and understands the surgery and location. DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. IV Ancef was given. I used plain lidocaine for his local anesthetic throughout the procedure until the skin grafts were inset. The anterior of his leg and the thigh were infiltrated with local anesthetic. Both lower extremities were prepped and draped circumferentially, which included the left thigh on the left side. I excised the lesion on his left leg as drawn into the subcutaneous fat. Hemostasis achieved with the Bovie cautery. I then excised the wound on his right leg to lower the bacterial counts. I took a 1-2 mm margin around the wound and excised the granulation tissue as well. Hemostasis was achieved using the Bovie cautery. I then changed gloves. A split-thickness skin graft was harvested from the left thigh using the Zimmer dermatome. This was meshed 1:5:1. By this time, the pathology returned showing the margins were clear. Skin grafts were inset on each leg wound using the skin stapler. Xeroform and gauze bolster was placed over the skin graft using 4-0 nylon. The skin graft donor site was dressed with OpSite. The legs were further dressed with heavy cast padding and the double Ace wrap. The patient tolerated the procedure well.PROCEDURES: Excision squamous cell carcinoma, left leg with excised diameter of 2.5 cm, repaired with a split-thickness skin graft measuring 5.1 cm2. Excisional preparation of right leg wound repaired with a split-thickness skin graft measuring 3.2 cm2. What CPT® codes are reported? b. bursitis knee & arthritis d. below knee amputation Rationale: BKA is the acronym for below-knee amputation. 70. A patient presents to the ED with back pain and is diagnosed with a lumbar sprain. What ICD- 10-CM code is reported? a. S33.5XXA c. M53.3 b. S33.8XXA d. M54.5 Rationale: In the ICD-10-CM Alphabetic Index, look for Sprain/lumbar (spine) and you are directed to S33.5-. In the Tabular List this code requires a 7th character to describe the episode of care. Because the patient is presenting to the ED, this supports the definition of initial encounter. For the 5th and 6th characters use the X placeholder to maintain the 7th character position of A. Back pain is not reported because a definitive diagnosis was documented, and pain is a symptom of lumbar sprain. (See ICD-10- CM guideline I.B.6.). 71. A patient presented with a right ankle fracture. After induction of general anesthesia, the right leg was elevated and draped in the usual manner for surgery. A longitudinal incision was made parallel and posterior to the fibula. It was curved anteriorly to its distal end. The skin flap was developed and retracted anteriorly. The distal fibula fracture was then reduced and held with reduction forceps. A lag screw was inserted from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then applied to the lateral contours of the fibula with cortical and cancellous bone screws. Final radiographs showed restoration of the fibula. The wound was irrigated and closed with suture and staples on the skin. Sterile dressing was applied followed by a posterior splint. What CPT® code is reported? a. 27814-RT c. 27823-RT b. 27792-RT d. 27784-RT Rationale: In the CPT® Index look for Fracture/Fibula/Open Treatment and you are referred to 27784, 27792, 27814. Code 27784 reports open treatment of a proximal fibular fracture or shaft fracture. The correct code is 27792 for the open treatment and internal fixation. Modifier RT is appended to indicate the procedure is performed on the right side. 72. A 25 year-old male presents with a deviated nasal septum. The patient undergoes a nasal septum repair and submucous resection. Cartilage from the bony septum was detached and the nasoseptum was realigned and removed in a piecemeal fashion. Thereafter, 4-0 chronic was used to approximate mucous membranes. Next, submucous resection of the turbinates was handled in the usual fashion by removing the anterior third of the bony turbinate and lateral mucosa followed by bipolar cauterization. What CPT® codes are reported? a. 30520, 30140-51 c. 30620, 30999-51 b. 30420, 30140-51 d. 30450, 30999-51 Rationale: Septum repair is a septoplasty. In the CPT® Index Septoplasty or Resection/Nasal Septum Submucous refers you to see Nasal Septum, Submucous Resection directing you to 30520. Under the code, there is a parenthetical statement to use 30140 for submucous resection of the turbinates. Modifier 51 is used to indicate multiple procedures. 73. The pulmonologist in a multispecialty group refers a patient to the otolaryngologist 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? a. 31575, 31231-59, J32.4, J37.1 b. 31575, 31231-50-59, J32.4, J37.1 c. 31576, 31231-51, J32.4, J02.9, J41.8 d. 31576, 31237-50-59, J32.4, J37.0, J41.8 Rationale: The nasal endoscopy and laryngoscopy can both be performed via the nasal cavity. In the CPT ®Index look for Laryngoscopy/Fiberoptic/Diagnostic directing you to code 31575. Next in the CPT® Index look for Endoscopy/Nose/Diagnostic referring you to 31231, 31233, 31235. The correct code is 31231 because there is no mention of entering the maxillary or sphenoid sinuses. Modifier 50 is not needed because 31231 describes a unilateral or bilateral procedure. Code 31231 is listed as a separate procedure; therefore, modifier 59 is appended. These procedures are indeed separate because a nasal endoscope was used and then the provider used a flexible laryngoscope. Look for Complication/prosthetic device or implant /infection or inflammation referring you T85.79. Verification in the Tabular List indicates seven characters is required for a complete code. Add placeholder X for the 6th character and A, initial encounter, for the 7th character. The ICD-10-CM code for the lung cancer is found in the Table of Neoplasms. Look for Neoplasm, neoplastic/lung/lower lobe and select from the Malignant Primary column directing you to code C34.3-. Verification in the Tabular List indicates the need for a 5th character to identify right or left. The patient has bilateral lower lobe lung cancer there is no bilateral code choice, report code C34.31 for right and C34.32 for the left. (See ICD-10-CM guideline I.B.13) 74. A 78 year-old patient with bilateral, lower lobe lung cancer has been in the hospital for seven days with a tunneled chest tube in place to drain fluid from the pleural space. The chest tube currently is inserted between the 4th and 5th intercostal space on the left side. There is a very bad infection at the insertion site. The provider removes this chest tube and inserts another chest tube between the 5th and 6th intercostal space on the left side to continue fluid drainage. The tube placed today is just the same as the one removed, only sterile. What CPT® and ICD-10-CM codes are reported? a. 32560, 32552-51, T81.89XA, C34.80 b. 32550, 32552-51, T85.79XA, C34.31, C34.32 c. 32551, 32552-51, T85.79XA, C78.01, C78.02 d. 32561, 32552-51, T81.89XA, C34.90 Rationale: Code 32552 represents the indwelling tunneled chest tube removal and code 32550 the insertion of a new indwelling catheter/tube. In the CPT® Index look for Catheterization/Pleural Cavity which directs you to 32550-32552. Read both codes to confirm the selections. The infection is at the insertion site of the chest tube. Look for Complication/prosthetic device or implant /infection or inflammation referring you T85.79. Verification in the Tabular List indicates seven characters is required for a complete code. Add placeholder X for the 6th character and A, initial encounter, for the 7th character. The ICD-10-CM code for the lung cancer is found in the Table of Neoplasms. Look for Neoplasm, neoplastic/lung/lower lobe and select from the Malignant Primary column directing you to code C34.3-. Verification in the Tabular List indicates the need for a 5th character to identify right or left. The patient has bilateral lower lobe lung cancer there is no bilateral code choice, report code C34.31 for right and C34.32 for the left. (See ICD-10-CM guideline I.B.13) 75. A returning 2 year-old child is seen in the pediatrician’s office with stridor and a bark like cough. The pediatrician examines the child quickly and determines the child has stridulous croup. The child is given a nebulizer breathing treatment in the office to improve PO2 levels. Medication used is breathable Epinephrine. What CPT® and ICD-10-CM codes are reported? a. 94644, J04.2 c. 94642, J38.5, R05, R06.1 b. 94640, J38.5 d. 94644, R06.1, R05 Rationale: To code the nebulizer treatment look in the CPT® index for Inhalation Treatment/for Airway Obstruction Pressurized or Nonpressurized directing you to code 94640. This code accurately represents a nebulizer treatment. A definitive diagnosis of stridulous croup is given and the signs and symptoms the child presented with is not coded (ICD-10-CM guideline I.B.4 or I.C.18.b). In the ICD-10-CM Alphabetic Index look for Croup/stridulous directing you to J38.5. Verification in the Tabular List confirms code selection. 76. Which main coronary artery bifurcates into two smaller ones? a. Right c. Inverted b. Left d. Superficial Rationale: The left main coronary artery branches into two slightly smaller arteries: the left anterior descending coronary artery and the left circumflex coronary artery. 77. A physician places a centrally inserted, tunneled central venous access device with a subcutaneous pump in a 7 year-old patient. a. 36561 c. 36560 Rationale: Only one base code is reported per major coronary artery. In this case angioplasty and stent placement was performed in the right coronary artery (92928-RC) and in the left anterior descending (92928-LD). Look in the CPT® Index for Coronary Artery/Angioplasty/with Stent Placement referring you to 92928-92929. A thrombectomy was performed by AngioJet in the LD reported with 92973. Look in the CPT Index for Coronary Artery/Thrombectomy referring you to 92973. A temporary pacemaker was inserted through the femoral vein; however, it is bundled with the cardiac catheterization. At the end of the procedure, an intra-aortic balloon pump was inserted, 33967. Look in the CPT® Index for Insertion/Balloon/Intra-Aortic referring you to 33967, 3397 80. A patient is brought to the operating suite when she experiences a large output of blood in her chest tubes post CABG. The physician performing the original CABG yesterday is concerned about the post-operative bleeding. He explores the chest and finds a leaking anastomosis site and he resutured. What CPT® code is? reported? a. 35211 c. 35820-78 b. 35820 d. 35241 Rationale: This is a postoperative exploration and modifier 78 is necessary because this is an unplanned return to the OR by the same physician during the global period of another procedure. Modifier 78 is used for a return to the OR for complications. This was an exploration for postoperative hemorrhage of the chest. Look in the CPT® Index for Exploration/Blood Vessel/Chest referring you to 35820. 81. What is the CPT® code for a test used to diagnose lactase intolerance? It involves the patient ingesting lactose sample followed by collection of exhaled air at different time intervals to measure the hydrogen levels in the breath. a. 91040 c. 82373 b. 91065 d. 94250 Rationale: This scenario is describing a diagnostic GI study/test. It indicates testing of breath hydrogen. In the CPT® Index, look for Gastroenterology, Diagnostic/Breath Test/Hydrogen; you are directed to code 91065. The code descriptor for 91065 indicates it is reported when determining lactase deficiency, fructose intolerance, bacterial overgrowth or orocecal gastrointestinal transit. A parenthetical note below the code description instructs that the code should be used once for each administered challenge. 82. What is the correct coding for a physician who performs an UGI radiological evaluation of the esophagus, stomach and first portion of the duodenum with barium and double-contrast in the hospital GI lab? (Physician is not employed by the hospital) a. 74246 c. 74246-26 b. 74251 d. 74251-26 Rationale: A radiological evaluation is an X-ray. UGI stands for Upper Gastrointestinal (GI). Look in the CPT® Index for X ray/Gastrointestinal Tract follow the further pathway given. The first portion of duodenum was performed on making 74246 the most appropriate code. The UGI is performed in the hospital using hospital equipment. The physician is not indicated to be an employee of the hospital so we must report the professional services (component) only by appending modifier 26. 83. A 56 year-old patient complains of occasional rectal bleeding. His physician decides to perform a rigid proctosigmoidoscopy. During the procedure, two polyps are found in the rectum. The polyps are removed by a snare. What CPT® and ICD-10-CM codes are reported? a. 45320, K62.1 c. 45309, 45309, K63.5 b. 45385, K63.5 d. 45315, K62.1 Rationale: In the CPT® Index, look for Proctosigmoidoscopy/Removal/Polyp referring you to 45308- 45315. During the proctosigmoidoscopy, polyps were removed by snare technique. 45315 is the correct code for the removal of more than one polyp by snare technique. The polyps are located in the rectum. In the ICD-10-CM Alphabetic Index, look for Polyp, polypus/rectum, referring to K62.1.Verify code selection in the Tabular List. The other code, K63.5, is for polyps that are located in the large intestine and would be inappropriate in this case. 84. A 66 year-old female is admitted to the hospital with a diagnosis of stomach cancer. The surgeon performs a total gastrectomy with formation of an intestinal pouch. Due to the spread of the disease, the physician also performs a total en bloc splenectomy. What CPT® codes are reported? a. 43622, 38100-51 c. 43634, 38115-51 b. 43622, 38102 d. 43634, 38102-51 Rationale: In the CPT® Index, look for Gastrectomy/Total referring you to 43620-43622. A review of the code descriptors confirms CPT® code 43622 represents the complete gastrectomy with intestinal pouch formation. Code 38102 represents the en bloc total splenectomy and is an add-on code so it is modifier 51 exempt. In the CPT® Index, look for Splenectomy/Total/En bloc referring you to 38102. 85. Left ureteral stent placement and Extracorporeal Shock Wave Therapy or Lithotripsy (ESWL) of the left kidney are performed. What CPT® code(s) is/are reported for this service? a. 52332-LT c. 50590-LT b. 52353-LT d. 50590-LT, 52332-51-LT Rationale: Two procedures are performed. CPT® code 52353 describes laser lithotripsy and does not include ESWL. CPT® code 52332 describes the stent placement, but does not include the ESWL. CPT® code 50590 describes the ESWL but not the placement of the stent. CPT® codes 50590 and 52332 describe both procedures performed. Modifier LT is appended to 50590 to indicate the lithotripsy was performed on the left kidney. Modifiers 51 and LT are appended to code 52332 to indicate more than one procedure was performed on the left side. Look in the CPT® Index for Lithotripsy/Kidney and Insertion/Stent/Ureteral. 86. Patient is a 40 year-old female presenting for repeat urethral dilation for urethral stricture using the instillation of a saline solution. What CPT® code is reported for this service? a. 53665 c. 53661 b. 53660 d. 53605 Rationale: In the CPT® Index look for Urethra/Dilation/Suppository and/or Instillation. CPT® code 53660 is for the initial dilation. CPT® codes 53605 and 53665 are reported when general or spinal anesthesia is provided. No type of anesthesia is indicated in the note. This is a repeat procedure and the subsequent CPT® code 53661 is reported. 87. Patient is status post radical retropubic prostatectomy with erectile dysfunction, presenting for penile implant. An inflatable penile prosthesis is inserted. What CPT® code is reported for this service? a. 54400 c. 54408 b. 54416 d. 54401 Rationale: Penile prosthesis insertion codes are described as either noninflatable or inflatable. CPT® code 54416 is removal and replacement of an inflatable penile prosthesis. CPT® code 54408 is for repair of an inflatable penile prosthesis. Code 54400 is reported for the insertion of a noninflatable prosthesis. Code 54401 is the correct code to report for the initial insertion of an inflatable penile prosthesis. Look in the CPT® Index for Prosthesis/Penis/Insertion. 88. A fracture of the corpus cavernosum penis is repaired. What is the correct code? a. 54440 c. 54430 b. 54420 d. 54435 Rationale: Repair for penile injury is reported using CPT® code 54440. Do not report CPT® codes used for treatment of priapism when there is injury to the penis. In the CPT® Index look for Repair/Penis/Injury. 89. The patient is a very pleasant 72 year-old female noted to have bilateral nephrolithiasis. Her left stones were treated ureteroscopically. Her right stone was very large and was treated with an ureteroscopic procedure (there were no global days). She comes in today for her second ureteroscopic procedure to remove the remaining stone fragments. Right ureteroscopy, laser lithotripsy and right ureteral stent exchange were performed. What CPT® code(s) is/are reported for this service? a. 52356-58, 52332-58 c. 52356 b. 52353, 52310-51, 52332-51 d. 52353-76, 52332-76 diabetes/pre-existing/type 1 directing you to O24.03. Verification in the Tabular List shows O24.03 indicates pre-existing type 1 diabetes mellitus in the puerperium (post-partum) period. Code P70.1 is reported on the newborn’s record not the mother’s record. Code O24.03 is a combination code in which Type 1 diabetes E10.9 is already noted in O24.03, so it is not reported. Only report E10 category when there are diabetic manifestations as indicated in the Tabular List, for exam diabetic neuropathy or diabetic ketoacidosis. 96. A patient with severe adenomyosis has a vaginal hysterectomy with bilateral salpingo- oophorectomy. After the uterus is removed it is weighed at 300 grams. What is the CPT® code reported for this procedure? a. 58262 c. 58290 b. 58292 d. 58291 Rationale: A vaginal hysterectomy code can be selected based on the weight of the uterus and additional procedures included with the hysterectomy. In the CPT® Index look for Hysterectomy/Vaginal/Removal Tubes/Ovaries directing you to codes 58262, 58263, 58291, 58292, 58552, 58554. A vaginal hysterectomy for a uterus greater than 250 grams is reported from code range 58290-58294. Further selection of removal of tubes and ovaries defines code 58291. 97. 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? a. 58673-50, 58672-51-RT c. 58750-50, 58760-51-RT b. 58750-50 d. None of these Rationale: There are two different procedures performed in this scenario. The first one is the reversal of the tubal ligation. The closed portions of the fallopian tube are excised (removed) and are connected by suturing the clean edges together (anastomosis). In the CPT® Index look for Anastomosis/Fallopian tube or Tubotubal directing you to code 58750. The question indicates tubes, meaning the anastomosis was performed on both tubes and modifier 50 is appended to the code. The second procedure performed is reconstruction of the fimbriae (finger-like projections at the end of the fallopian tubes) or fimbrioplasty due to adhesions found at the end of the right tube. In the CPT® Index, look for Fimbrioplasty/Uterus guiding you to code 58760. Two modifiers are appended to this code: Modifier 51 to indicate more than one procedure was performed and modifier RT to indicate only the right tube was involved. Both of these procedures were performed with an incision, not laparoscopically 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? a. 58548, C54.1 c. 58210, C54.1 b. 58210, C55, C77.5 d. 58150, 38770-51, C54.1, C77.5 Rationale: An open approach is performed to remove the uterus, cervix, tubes, ovaries and bilateral pelvic lymph nodes along with sampling (biopsy) the peri-aortic lymph nodes. In the CPT® Index look for Hysterectomy/Abdominal/Radical referring you to 58210. The key to choosing this code from the other choices is the removal of the pelvic lymph nodes and a biopsy of the peri-aortic lymph nodes (radical procedure) which is located in the description for code 58210. Because the lymph nodes were benign, the endometrial cancer is the only diagnosis to report. Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic/endometrium/Malignant Primary column referring you to C54.1. Verify in the Tabular List. 99. A patient with a long history of endometriosis has an open surgical approach to perform an exploratory laparotomy for an enlarged right ovary seen on ultrasound with other possible masses on the uterus and in the peritoneum. Exploration reveals these masses to be endometriosis including a chocolate cyst (endometrioma) of the right ovary, right fallopian tube and peritoneum. The endometriomas are all small, less than 5 cm, and laser is used to ablate them, except the ovarian cyst, which is excised. During the procedure the patient also has a tubal ligation. What are the CPT® and ICD- 10-CM codes reported for this service? a. 49000, 58662-51, 58925-51, 58671-51, N80.1, N80.2, N80.3, Z30.2 b. 49203, 58671-51, N80.8 c. 58662, 58600-51, N80.1, N80.2, N80.3, Z30.2 d. 49203, 58611, N80.1, N80.2, N80.3, Z30.2 Rationale: The exploratory laparotomy is not a separately billable service because it is no longer just examination of the intraabdominal organs; it became a surgical procedure in which the endometriomas were destroyed by laser. Remember a surgical laparotomy always includes a diagnostic (exploratory) laparotomy. Look in the CPT® Index for Endometrioma/Abdomen/Destruction/Excision referring you to 49203-49205. 49203 is correct for destruction for 1 or more tumors with the largest less than 5 cm in diameter. The second procedure is a tubal ligation (female sterilization in which the fallopian tubes are sealed or severed). Look in the CPT® Index for Fallopian tube/Ligation referring you to 58600, 58611. Add-on code 58611 is correct to report because the tubal ligation was performed at the same time as another intra-abdominal surgery. Modifier 51 is not appended because 58611 is an add-on code. The endometriosis included the ovary and the right fallopian tube. Look in the ICD-10-CM Alphabetic Index for Endometriosis/ovary guiding you to code N80.1. Next look in the Alphabetic Index for Endometriosis/fallopian tube referring you to code N80.2. Then look for Endometriosis/peritoneal directing you to code N80.3. Reporting a diagnosis for the tubal ligation is found by looking in the Alphabetic Index for Encounter (with health service) (for)/sterilization guiding you to code Z30.2. Verify all codes in the Tabular List. 100. A 27 year-old woman’s regular obstetrician delivers twins by cesarean delivery. Both are delivered without complications. Patient will have postpartum care in two weeks. What is/are the CPT® code(s) reported for this service? a. 59510 c. 59400 b. 59510, 59514-51 d. 59510, 59510-51 Rationale: When reporting a procedure code for an uncomplicated twin delivery by cesarean delivery, you code the global cesarean code once, because there is only one incision to deliver both babies by a cesarean delivery. Many payers will not provide additional reimbursement for a twin delivery by cesarean. Look in the CPT® Index for Cesarean Delivery/Routine Care referring you to 59510. Verify in the numeric section. 101. A patient with a previous low transverse incision cesarean delivery is attempting VBAC (vaginal birth after cesarean), also known as TOLAC (trial of labor after cesarean) with her second child. During labor her uterus ruptured. She had an emergency cesarean section followed immediately by hysterectomy to remove her ruptured uterus. Mother and baby survived. The same obstetrician provided her antepartum and postpartum care. What are the CPT® and ICD-10-CM codes reported for this service? a. 59510, 58150-51, O71.1, Z3A.00, Z37.0 b. 59618, 59525, O71.1, O34.211, Z3A.00, Z37.0 c. 59614-22, 59525, O71.1, Z3A.00, O34.212 d. 58150, 59514-51, O71.1, Z3A.00, Z37.0 Rationale: This patient has a previous history of caesarean delivery and is attempting to deliver her second child vaginally (VBAC). Due to her uterus rupturing, the planned vaginal delivery was changed to a caesarean delivery. Look in the CPT® Index for Cesarean Delivery/Previous Cesarean/Unsuccessful Attempted Vaginal Delivery/Routine Care referring you to code 59618. After the delivery a hysterectomy was performed. The procedure is located in the CPT® Index by looking for Cesarean Delivery/with hysterectomy referring you to 59525. Modifier 51 is not appended to this code, because it is an add-on code. The first-listed diagnosis will reflect the rupture of the uterus during labor which is the reason for the cesarean. Look in the ICD-10-CM Alphabetic Index for Rupture/uterus/during or after labor O71.1. Next look for Delivery/cesarean (for)/previous/cesarean delivery/classical (vertical) scar, O34.212. Notes at the beginning of Chapter 15 states to use an additional code from category Z3A to identify the weeks of gestation. The weeks of gestation are not provided. In the ICD-10-CM Alphabetic Index look for Pregnancy/weeks of gestation/not specified and you are referred to Z3A.00. The last code to report is the outcome of the delivery. In the Alphabetic Index look for Outcome of delivery/single NEC/live born, referring you to Z37.0. Verify the codes in the Tabular List 102. What CPT® code is reported for a subtotal thyroidectomy for malignancy, with removal of only a few selected lymph nodes? a. 60271 c. 60240 Rationale: Two co-surgeons performed distinct parts of the same surgery. The surgery performed is a vertebral corpectomy, thoracic. Look in the CPT® Index for Vertebral/Corpectomy directing you to code range 63081-63103, 63300-63308. 63300-63308 are for excision of intraspinal lesions. The code selection for 63081-63103 is based on location, approach and number of vertebral segments. Code 63085 is for a transthoracic approach, thoracic, single segment. The additional two segments are reported with code 63086. As indicated by the CPT® subsection guidelines for this section, codes 63075- 63091, each provider will report the same CPT® code and append a modifier 62. 110. A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear medicine scan) and ultrasound and is found to have only one diseased parathyroid. A minimally invasive parathyroidectomy is performed. What CPT® and ICD-10-CM codes are reported for the surgery? a. 60500, E21.3 c. 60505, E21.0 b. 60502, E21.3 d. 60500, E21.0 Rationale: In the CPT® Index look for Parathyroidectomy or Parathyroid Gland/Excision directing you to code range 60500-60505. The parathyroidectomy is coded with 60500. Code 60502 is a re-exploration and code 60505 is used for a mediastinal exploration or transthoracic approach. In the ICD-10-CM Alphabetic Index look for Hyperparathyroidism/primary directing you to E21.0. Verification in the Tabular list confirms code selection. 111. A 41 year-old female has carpal tunnel syndrome in her left hand. The patient underwent release of the carpal ligament with internal neurolysis. An incision was made directly over the carpal ligament through the skin to the carpal ligament. Under direct vision the carpal ligament was divided then internal neurolysis of the median nerve was performed using a magnifying loupes. What CPT® code is reported? a. 64704-LT c. 64721-LT b. 64719-LT d. 64722-LT Rationale: In the CPT® Index look for Carpal Tunnel Syndrome/Decompression. 64721 is the correct code because it is the median nerve being stretched (neurolysis) to relieve the pain in the wrist for a person with carpal tunnel syndrome. 112. A 26 year-old patient presents with headache, neck pain and fever and is concerned he may have meningitis. The patient was placed in the sitting position and given 0.5 mg Ativan IV. His back was prepped and a 20-gauge needle punctured the spine between L4 and L5 with the return of clear fluid. The cerebrospinal fluid was reviewed and showed no sign of meningitis. What CPT® code is reported? a. 62270 c. 62282 b. 62272 d. 62326 Rationale: In the CPT® Index look for Puncture/Spinal Cord/Diagnostic or Spinal Tap/Lumbar. 62270 is the correct code because a spinal puncture was performed without fluoroscopic or CT guidance in the lumbar region (L4 and L5). It was done to withdraw cerebrospinal fluid for testing to determine if the patient had meningitis (diagnostic). 113. What specificity is added to Alzheimer’s disease in ICD-10-CM? a. The stage of Alzheimer’s disease. b. The onset of Alzheimer’s disease. c. Neurological manifestations of Alzheimer’s disease. d. Visual disturbances associated with Alzheimer’s disease. Rationale: In ICD-10-CM the codes for Alzheimer’s disease are expanded to specify early or late onset, other or unspecified. 114. A surgeon performed a cataract extraction with an intraocular lens implant on the right eye of a Medicare patient. What modifier(s) would be reported? a. 50 c. E2 b. E1, E2 d. RT Rationale: Modifiers RT and LT are used to identify procedures performed on paired organs such eyes, ears, breasts (excluding skin) or on sides of the body. 115. What is the abbreviation for EACH EYE? a. O.D. c. A.U. b. O.S. d. O.U. Rationale: O. U. stands for each eye or both eyes. O.D. stands for the right eye. O.S. stands for the left eye 116. What ICD-10-CM code is used to report acute actinic otitis externa of the left ear? a. H66.90 c. H60.62 b. H60.512 d. H60.542 Rationale: In the ICD-10-CM Alphabetic Index look for Otitis/externa/acute/actinic and you are directed to H60.51-. Verification in the Tabular List indicates a 5th character is reported for laterality. 5th character of 2 is for left ear 117. A 53 year-old woman with scarring of the right cornea has significant corneal thinning with a high risk of perforation and underwent reconstruction of the ocular surface. The eye is incised and an operating microscope is used with sponges and forceps to debride necrotic corneal epithelium. Preserved human amniotic membrane is first removed from the storage medium and transplanted by trimming the membrane to fit the thinning area of the cornea then sutured. This process was repeated three times until the area of thinning is flush with surrounding normal thickness cornea. All of the knots are buried and a bandage contact lens is placed with topical antibiotic steroid ointment. What CPT® code is reported? a. 65780 c. 65710 b. 65781 d. 65435 Rationale: In the CPT® Index look up Transplantation/Eye/Amniotic Membrane. You are referred to 65778-65780. Verify in the numeric section. Code 65780 is the correct code because the amniotic membrane transplantation is for an ocular surface reconstruction for corneal defects of scarring and perforation. 118. What intraperitoneal organs are found in the lower abdomen? a. Appendix, cecum, ileum, sigmoid colon b. Liver, appendix, gallbladder, ileum, sigmoid colon c. Gallbladder, cecum, spleen, ileum, sigmoid colon d. Spleen, liver, appendix, stomach, cecum Rationale: Intraperitoneal organs in the lower abdomen include the appendix, cecum, ileum and sigmoid colon. 119. A 77 year-old patient was scheduled for a total hip replacement due to degenerative joint disease (DJD) and the anesthesiologist documented the DJD as primary. The pre-anesthesia assessment indicates the patient had surgery in 2015 for gastroesophageal reflux disease (GERD). What ICD-10-CM code(s) is/are reported? a. K21.9 c. M16.10 b. M16.7 d. M16.9, K21.9 Rationale: The patient’s previous surgery (GERD) has no relevance to the anesthesia care provided for the hip surgery and is not reported with a diagnosis code. In the ICD-10-CM Alphabetic Index look for Degeneration/joint disease which states to see Osteoarthritis. Look for Osteoarthritis/hip or Osteoarthritis/primary/hip which directs you to M16.1-. In the Tabular List confirm the subcategory code. M16.1- indicates that a 5th character is needed to indicate laterality. We are not told which hip has the DJD so the coder would report M16.10. 120. What is the anesthesia code for an insertion of a penile prosthesis performed via a perineal approach? b. 51700, 58340, 76831-26, N93.9 c. 51701, 58340, 74740-26, N92.5, N84.0 d. 58340, 76831-26, N93.8, N84.0 Rationale: The uterus is being catheterized not the bladder. Look in the CPT® Index for Sonohysterography/Saline Infusion/Injection Procedure directing you to 58340. The catheterization is included in the code description for 58340. A parenthetical note under this code states “For radiological supervision and interpretation of saline infusion, use 76831.” Modifier 26 is reported for the professional service. The diagnosis to report is the dysfunctional uterine bleeding, which is found in the ICD-10-CM Alphabetic Index by looking for Bleeding/uterus, uterine NEC/dysfunctional of functional which guides you to code N93.8. According to ICD-10-CM guideline IV.H you do not code for a condition documented as suspected such as the endometrial polyps in the outpatient setting. 128. A patient has a history of chronic venous embolism in the superior vena cava (SVC) and is having a radiographic study to visualize any abnormalities. In outpatient surgery center, the physician accesses the subclavian vein and the catheter is advanced to the SVC for injection and imaging. The supervision and interpretation of the images is performed by the physician. What codes are reported for this procedure? a. 36010, 75827-26 c. 36000, 75827-26 b. 36000, 75820-26 d. 36010, 75820-26 Rationale: A radiographic study of the SVC is performed to visualize and evaluate any abnormalities. For the insertion of the catheter look in the CPT® Index for Catheterization/Vena Cava referring you to code 36010. For the radiology code look in the CPT® Index for Venography/Vena Cava guiding you to code range 75825-75827. Radiology code 75827 is correct for the SVC. Modifier 26 is appended to the radiology code because the physician is performing the procedure in an outpatient facility setting and does not own the radiology equipment. 129. Tests in the Chemistry section of CPT® are what types of tests unless specified otherwise? a. Qualitative c. Semi-quantitative b. Quantitative d. Surgical Rationale: The codes in the Chemistry section (82009-84999) identify how much of a substance is present in the specimen. According to the guidelines, “The examination is quantitative unless specified.” 130. What do the services in the Reproductive Medicine Procedures section of the Pathology and Laboratory chapter of CPT® report? a. Services to test for the health of a pregnant woman b. Services related to in vitro fertilization c. Services to test for the health of a growing fetus d. Services to test for multiple gestations Rationale: These codes describe services related to in vitro fertilization. 131. A patient has a cholecystectomy and a soft tissue lipoma removed during the same operative session. Both specimens were sent to pathology in separate containers are examined by the pathologist. What CPT® code(s) are reported? a. 88305, 88304 c. 88304, 88302 b. 88304 x 2 d. 88305 x 2 Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam. Under Gross and Micro Exam, Levels II-VI are listed. Read these codes to determine the correct code. Both of these specimens (gallbladder and soft tissue lipoma) are coded under 88304. Sometimes it is helpful to know the names of surgical procedure to select the correct pathology code. A cholecystectomy is excision of the gallbladder. 132. What is the code and any required modifier(s) for dipstick urinalysis, automated, without microscopy performed in a physician office for a Medicare patient? a. 81000-26-QW c. 81003-QW b. 81002-26-QW d. 81001 Rationale: In the CPT® Index, look for Urinalysis/Automated. Code 81003 is for dipstick urinalysis, automated, without microscopy. Modifier 26 is not needed in the physician office but QW is required as this is a CLIA waived test. Modifier QW is found in HCPCS Level II codebook. 133. A 17 year-old female has a bone marrow biopsy for examination as a potential volunteer stem cell donor for her mother who has acute monocytic leukemia (AML). What diagnosis code(s) is/are used for the typing of the stem cell specimens? a. C93.00 c. Z52.3, C93.00 b. Z00.5 d. C93.00, Z52.3 Rationale: Only the donor code is used. The bone marrow specimen is being examined to identify a potential donor. The diagnosis of the potential recipient is not coded. In the ICD-10-CM Alphabetic Index look for Donor/potential/examination of you are directed to Z00.5. 134. A patient arrives at to the ED. It appears the patient has been suffering from periods of disorientation, persistent stomachache, fatigue, over the past several months but the persistent patch of dark skin that appeared on the patient’s chest has prompted his visit. The treating ED physician orders a stimulation panel for adrenocorticotropic hormone (ACTH) consisting of two cortisol injections, 60 minutes apart. Blood tests reveal ACTH levels are at 300 nmol/L, and diagnoses the patient with adrenal insufficiency. What CPT® codes are reported for the lab services? a. 82533 x 2 c. 80408 b. 80400 d. 82533 x 2, 83498 x 2 Rationale: Each cortisol injection is included in the ACTH Stimulation Panel. Looking in the CPT® Index under Evocative/Suppression Test referring you to 80400-80439. There is a note See Pathology and Laboratory, Evocative/Suppression Test. Look for Pathology and Laboratory/Evocative/Suppression Test/ Stimulation Panel/ACTH. Reviewing the codes, confirms the only code that applies to and ACTH Stimulation Panel is 80400 135. Flow cytometry is performed for DNA analysis. What CPT® code is reported? a. 88182 c. 88187 b. 88184 d. 88189 Rationale: Flow cytometry is a cytopathologic study. Look in the CPT® Index for Flow Cytometry, which directs you to code range 88182-88189. Code 88182 specifies flow cytometry for DNA analysis. 136. A lab test reveals an excessive level of alcohol in the blood. What ICD-10-CM code is reported? a. R78.0 c. R78.89 b. R78.4 d. R78.9 Rationale: Look in the ICD-10-CM Alphabetic Index for Findings, abnormal, inconclusive, without diagnosis/in blood (of substance not normally found in blood)/alcohol (excessive level) referring you to R78.0. Verification in Tabular List confirms R78.0 is for finding of alcohol in blood. 137. A provider admits Mrs. Smith to the hospital. She is there for five days. The provider sees her each day she’s in the hospital. What subcategory of E/M codes would be used for days two, three and four? a. Office or Other Outpatient Services; Established patient b. Subsequent Observation Care c. Initial Hospital Care d. Subsequent Hospital Care Rationale: Codes from the Subsequent Hospital Care subcategory would be used for days two, three and four. The code for the first day would be from the Initial Hospital Care subcategory. Day five could be reported with either subsequent hospital care or hospital care discharge depending on the role of the provider. 138. Where are clinical examples for evaluation and management codes found in the CPT® code book? a. CPT® Assistant c. Appendix B b. Appendix A d. Appendix C Rationale: Appendix C of the CPT® code book contains clinical examples of evaluation and management codes. The appendix may be used in addition to the E/M code descriptors. cause code is used to identify the activity. In the External Cause of Injuries Index look for Activity/maintenance/property referring you to Y93.H9. Verification in the Tabular List confirms code selection. 144. A patient who has psoriasis vulgaris on his back has not responded to topical applications. He is treated with laser therapy on a total area of 260 sq. cm. a. 17108, L44.0 c. 96921, L40.0 b. 17108, L20.0 d. 96921, L20.0 Rationale: In the CPT® Index look for Psoriasis/Treatment. Codes 96910-96913 are for photochemotherapy. Codes 96920-96922 are for laser treatment and code selection is based on the size of the area treated. 260 sq. cm is reported with 96921. In the ICD-10-CM Alphabetic Index, look for Psoriasis/vulgaris referring you to L40.0. Verification in the Tabular List confirms code selection. 145. A young child received a mumps, measles, rubella and varicella (MMRV) injection at a neighborhood clinic with provider counseling. What CPT® code(s) are reported? a. 90707, 90716, 90471, 90472 x 3 c. 90710, 90460 b. 90707, 90716, 90460, 90461 x 3 d. 90710, 90460, 90461 x 3 Rationale: In the CPT® Index look for Vaccine and Toxoids/Measles, Mumps, Rubella and Varicella (MMRV) referring you to 90710. According to the CPT® guidelines for Vaccines and Toxoids, an administration code from 90460-90474 is also reported. In the CPT® Index look for Immunization Administration/Toxoid/with Counseling. Because counseling was included, a code from 90460-90461 is used for the administration. According to the guidelines, 90460 and 90461 are reported per component of the vaccine. Although it is one vaccination, there are four separate components, 90460 is reported for mumps and 90461 x 3 (measles, rubella, and varicella). 146. A patient with carcinoma of the descending colon presents for chemotherapy administration at the infusion center. The infusion was started with 1000 cc of normal saline. Heparin, 1000 units was added and then Fluorouracil, 800 mg was added and infused over 2 hours. Dexamethasone, 20 mg was administered, IV push. At the end of the 2 hours, the IV was disconnected and the patient was discharged. What codes are reported? a. 96413, 96415, 96375, J9190 x 2, J1100 x 20, J1644, Z51.11, C18.6 b. 96413, 96375, J9190 x 2, J1100 x 20, Z51.12, C18.8 c. 96413, J9190, J1100, J1642, Z51.11, C18.6 d. 96415, 96375, J9190, J1100, J1644, Z51.0, C18.9 Rationale: In the CPT® Index look for Chemotherapy/Intravenous/Infusion. Chemotherapy infusion administration ran for two hours and is reported with 96413 for the 1st hour and 96415 for each additional hour. Dexamethasone was administered as a push technique. Dexamethasone is not a chemotherapy agent. In the CPT® Index, look for Injection/Intravenous Push referring you to 96374- 96376. This is a sequential infusion following the initial service of chemotherapy and is reported with add-on code 96375. The chemotherapy drugs are Fluorouracil and Heparin. The Fluorouracil is reported with J9190 (HCPCS Level II). It is listed as 500 mg therefore 2 units are charged for 800 mg administered. Heparin (J1644) is listed as 1,000 units, therefore one unit is reported for the 1000 units given. Dexamethasone is packaged in 1 mg; charge 20 units for the 20 mg administered (J1100). Per ICD-10-CM guideline I.C.2.e.2 a visit for the purpose of chemotherapy is reported with Z51.11 with the primary and the malignancy sequenced second. In the ICD-10-CM Alphabetic Index, look for Chemotherapy(session) (for)/cancer which directs you to Z51.11. Report also the reason for the chemotherapy. In this case, it is carcinoma of the descending colon. Look in the Alphabetic Index for Carcinoma which states see also Neoplasm, by site, malignant. Go to the ICD-10-CM Table of Neoplasms and look for Neoplasm, neoplastic/intestine, intestinal/large/descending and select from the Malignant Primary column which refers you to C18.6. Verification in the Tabular List confirms code selection. 147. What ICD-10-CM code is reported for an anaphylactic reaction to peanuts, initial encounter? a. T78.00XA c. T78.1XXA b. T78.01XA d. Z91.010 Rationale: In the ICD-10-CM Alphabetic Index look for Anaphylactic/shock or reaction which states see Shock, anaphylactic. Look for Shock/anaphylactic/due to food (nonpoisonous)/peanuts referring you to T78.01. In the Tabular List, a 7th character is required. Placeholder X is used for the 6th character. The initial encounter is specified with 7th character A for the initial encounter. 148. What ICD-10-CM code(s) is/are reported for a diabetic foot ulcer on the right foot? a. L97.519 c. E11.621, L97.519 b. L89.619 d. E11.8, L97.519 Rationale: ICD-10-CM guideline I.C.4.a.2. instructs you to use the default code E11- for type 2 diabetes when the type is not indicated. Look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/with/foot ulcer referring you to E11.621. In the Tabular List there is a note to use an additional code to identify the site of the ulcer (L97.4-, L97.5-). Look in the Alphabetic Index for Ulcer/lower limb/foot specified NEC/right referring you to L97.519. The severity of the ulcer is not documented in this scenario. Verification in the Tabular List confirms E11.621 is for type 2 diabetes mellitus with foot ulcer and L97.519 is for non-pressure chronic ulcer of other part of right foot with unspecified severity. 149. A pediatrician is asked to be in the room during the delivery of a baby at risk for complications. The pediatrician is in the room for 45 minutes. The baby is born and is completely healthy, not requiring the services of the pediatrician. What CPT® code(s) is/are reported by the pediatrician? a. 99219 c. 99360 b. 99252 d. 99360 x 2 Rationale: The physician provider standby services. In the CPT® Index look for Standby Services and you are directed to 99360. 99360 is reported based on time. Each 30 minutes is reported if only the entire 30 minutes is met. 99360 with 1 unit is the correct code choice. 150. A 37-year-old female is seen in the clinic for follow-up of lower extremity swelling. HPI: Patient is here today for follow-up of bilateral lower extremity swelling. The swelling responded to hydrochlorothiazide. DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have moderate pulmonary hypertension. Exam: Patient is in no acute distress. ASSESSMENT: 1. Bilateral lower extremity swelling. This has resolved with diuretics; it may be secondary to problem #2. 2. Pulmonary hypertension: Etiology is not clear at this time, will work up and possibly refer to a pulmonologist. PLAN: Will evaluate the pulmonary hypertension. Patient will be scheduled for a sleep study. a. 99213 c. 99214 b. 99212 d. 99215 Rationale: This is a follow-up visit indicating an established patient seen in the clinic. In the CPT® Index look for Established Patient/Office Visit. The code range to select from is 99211-99215. Based on the unclear etiology, this is a chronic and progressive disease (Moderate). Data reviewed and analyzed includes the lab and echocardiogram that were reviewed and the order for the sleep study (Moderate). The risk of morbidity is high as pulmonary hypertension can cause systemic problems. This makes the medical decision making moderate for this visit.