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Exam
Question 1. Which CPT global period applies to a simple mastectomy without reconstruction? A) 0-10 days B) 30 days C) 60 days D) 90 days Answer: D Explanation: Simple mastectomy is classified as a major surgical procedure and carries the standard 90-day global period. Question 2. When should modifier - 22 be appended to a surgical code? A) When the procedure is performed bilaterally B) When the service required significantly more work than typical C) When two unrelated procedures are performed on the same day D) When the surgeon assisted another surgeon Answer: B Explanation: Modifier - 22 denotes increased procedural services due to unusual difficulty, time, or effort. Question 3. A surgeon performs a left-sided excision of a basal cell carcinoma on the cheek. Which laterality modifier is appropriate? A) - RT B) - LT C) - 50 D) - 51 Answer: B Explanation: The left-side of the body is identified with modifier - LT. Question 4. In skin lesion removal, how is the size of the lesion calculated for coding purposes?
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A) Area in square centimeters B) Diameter only C) Widest diameter plus narrowest margin D) Depth of the lesion Answer: C Explanation: CPT requires the widest diameter of the lesion plus the narrowest margin of normal tissue removed. Question 5. Which of the following is NOT included in the global surgical package? A) Pre-operative evaluation B) Post-operative physical therapy after day 10 C) Intra-operative anesthesia D) Post-operative pathology review Answer: B Explanation: Post-operative services beyond the global period (e.g., PT after day 10 for a major procedure) are excluded. Question 6. A surgeon repairs a 6 cm linear laceration on the forearm using simple interrupted sutures. Which repair code level is appropriate? A) Simple repair (≤5 cm) B) Intermediate repair (5- 10 cm) C) Complex repair (>10 cm) D) No repair code needed Answer: B Explanation: Simple repair is ≤5 cm; 6 cm falls into the intermediate repair range (5- 10 cm). Question 7. For a bilateral knee arthroscopy performed in the same operative session, which modifier should be used?
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A) Skin only B) Subcutaneous tissue C) Muscle D) Bone Answer: C Explanation: The CPT code for debridement must reflect the deepest tissue layer involved; muscle debridement uses the muscle depth indicator. Question 11. A patient undergoes a laparoscopic cholecystectomy with intra-operative cholangiography. How should the cholangiography be reported? A) As a separate code with modifier - 51 B) Bundled and not reported separately C) With modifier - 59 D) As an add-on code with modifier - 22 Answer: B Explanation: Intra-operative cholangiography is considered part of the laparoscopic cholecystectomy and is bundled. Question 12. Which CPT modifier is used to indicate that a procedure is a “separate procedure” and not integral to another service? A) - 51 B) - 59 C) - 76 D) - 91 Answer: B Explanation: Modifier - 59 designates a distinct procedural service when two procedures might otherwise be considered bundled. Question 13. A surgeon performs a right-hand carpal tunnel release and also removes a small lipoma from the same hand. Which coding approach is correct?
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A) Report both with modifier - 51 B) Report only the release; the lipoma removal is integral C) Report both with separate CPT codes and no modifier D) Report only the lipoma removal; the release is bundled Answer: C Explanation: The two procedures involve different anatomic sites and are distinct; they are reported separately without a modifier because they are not bundled. Question 14. When coding an autograft skin graft harvested from the thigh and applied to the forearm, which code category is used? A) 14000-14060 (Skin grafts) B) 11000-11005 (Biopsies) C) 12000-12021 (Excisional procedures) D) 11055-11057 (Shaving) Answer: A Explanation: Autograft skin grafts are coded from the 14000 series. Question 15. A surgeon places a permanent pacemaker with a dual-chamber device. Which CPT code set is appropriate? A) 33206-33207 (Temporary) B) 33210-33213 (Permanent, dual chamber) C) 33220-33223 (Defibrillator) D) 33230-33233 (Lead revisions) Answer: B Explanation: Permanent dual-chamber pacemaker implantation is coded in the 33210 - 33213 range. Question 16. In coding a thoracentesis performed under fluoroscopic guidance, which modifier should be appended? A) - LT
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A) The suction catheter is bundled and not reported. B) The catheter placement is reported with modifier - 51. C) Both procedures are reported with separate CPT codes and modifier - 59. D) Only the tracheostomy is reported; the catheter is considered routine. Answer: A Explanation: Placement of a suction catheter during tracheostomy is routine and bundled; it is not reported separately. Question 20. Which CPT code range is used for endoscopic removal of a colonic polyp larger than 2 cm? A) 45378-45385 (Colonoscopy with removal) B) 45390-45392 (Biopsy only) C) 45330-45335 (Sigmoidoscopy) D) 45345-45350 (Upper GI) Answer: A Explanation: Colonoscopic polypectomy of lesions >2 cm is coded in the 45378 - 45385 series. Question 21. A surgeon performs a right-sided mastectomy with immediate autologous tissue reconstruction. Which global period applies? A) 0-10 days B) 30 days C) 60 days D) 90 days Answer: D Explanation: Mastectomy with reconstruction is a major procedure, thus a 90-day global period applies. Question 22. Which modifier indicates that an assistant surgeon performed a portion of the procedure?
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A) - 80
B) - 81
C) - 82
D) All of the above, depending on the level of assistance Answer: D Explanation: Modifier - 80 denotes a surgeon assistant, - 81 a resident, and - 82 a medical student; all indicate assistance. Question 23. For a partial nephrectomy performed laparoscopically, which code set is appropriate? A) 50220-50225 (Open partial nephrectomy) B) 50545-50548 (Laparoscopic partial nephrectomy) C) 50081-50085 (Percutaneous nephrostomy) D) 50400-50405 (Renal biopsy) Answer: B Explanation: Laparoscopic partial nephrectomy is coded from the 50545- 50548 series. Question 24. A patient undergoes a bilateral breast reduction. Which modifier should be used? A) - 50 B) - 51 C) - 59 D) - 78 Answer: A Explanation: Modifier - 50 denotes a bilateral procedure performed during the same operative session. Question 25. When coding a skin graft that uses a cadaveric allograft, which CPT series is used?
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C) - 59 for distinct procedural services D) Both A and C Answer: D Explanation: Two separate procedures on opposite hands require modifier - 51 (multiple procedures) and modifier - 59 to indicate they are distinct services. Question 29. In coding a percutaneous endoscopic gastrostomy (PEG) tube placement, which global period is assigned? A) 0-10 days B) 30 days C) 60 days D) 90 days Answer: B Explanation: PEG tube placement is a major procedure with a 30-day global period (per CMS guidelines). Question 30. Which modifier denotes a staged or related procedure performed at a later date? A) - 51 B) - 58 C) - 78 D) - 79 Answer: B Explanation: Modifier - 58 indicates a staged or related procedure. Question 31. A surgeon removes a 0.8 cm benign nevus from the forearm using shave excision. Which CPT code range is appropriate? A) 11200-11215 (Biopsy) B) 11055-11057 (Shaving) C) 11400-11446 (Excision)
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D) 11600-11646 (Destruction) Answer: B Explanation: Shave excision of a benign lesion uses the 11055-11057 series. Question 32. For an open reduction internal fixation (ORIF) of a distal radius fracture with a volar plate, which coding combination is correct? A) Primary fracture code + add-on code for plate (25405) B) Single code encompassing both fracture and fixation (25607) C) Two separate codes: fracture (25600) and hardware (25405) D) Only the hardware code is reported Answer: C Explanation: The fracture is coded with 25600 (distal radius) and the volar plate is reported with add-on code 25405; both are reported. Question 33. A patient receives a bilateral cataract extraction with intra-ocular lens implantation. Which modifier should be appended? A) - 50 B) - 51 C) - 59 D) - 78 Answer: A Explanation: Bilateral cataract surgery performed in the same session requires modifier - 50. Question 34. When coding a laparoscopic appendectomy that also includes a diagnostic laparoscopy, how should the diagnostic portion be reported? A) As a separate code with modifier - 51 B) It is bundled into the therapeutic code; no separate code. C) With modifier - 59 to indicate distinct service. D) As an add-on code.
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Answer: B Explanation: Non-contiguous level procedures require separate codes with modifier - 51 to indicate multiple procedures. Question 38. Which CPT modifier is used when a procedure is performed on a finger and a specific digit must be identified? A) - LT or - RT B) - E1 through - E C) - FA through - F D) - 59 Answer: C Explanation: Modifiers - FA through - F9 specify individual fingers (FA = thumb, FB = index, etc.). Question 39. A surgeon performs a right-sided laparoscopic inguinal hernia repair with mesh. Which code set is appropriate? A) 49505-49507 (Open repair) B) 49650-49652 (Laparoscopic repair) C) 53050-53055 (Spinal fusion) D) 47562-47564 (Appendectomy) Answer: B Explanation: Laparoscopic inguinal hernia repairs are coded in the 49650- 49652 series. Question 40. In coding a coronary artery bypass graft (CABG) using both saphenous vein and internal mammary artery grafts, which statement is true? A) Each graft is reported with a separate add-on code. B) Only the primary CABG code is reported; grafts are bundled. C) Use modifier - 51 for each additional graft. D) Use modifier - 59 for each artery used.
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Answer: A Explanation: Each conduit (vein or artery) is reported with its respective add-on code in addition to the primary CABG code. Question 41. A surgeon performs a right-sided thoracoscopic lung wedge resection. Which coding guideline applies to the thoracoscopy? A) It is always reported separately. B) It is bundled into the wedge resection code. C) Use modifier - 51 for the thoracoscopy. D) Use modifier - 59 for the thoracoscopy. Answer: B Explanation: Thoracoscopic approach is considered part of the wedge resection and is bundled. Question 42. Which CPT code range is used for a percutaneous kidney stone lithotripsy (ESWL)? A) 50590-50592 (Ureteroscopy) B) 50597-50599 (ESWL) C) 50400-50405 (Renal biopsy) D) 50220-50225 (Nephrectomy) Answer: B Explanation: Extracorporeal shock wave lithotripsy (ESWL) is coded in the 50597 - 50599 series. Question 43. A surgeon performs a left-sided thyroid lobectomy with intra-operative nerve monitoring. How should the monitoring be reported? A) Separate CPT code with modifier - 51 B) Bundled; no separate code C) Use modifier - 59 D) Use modifier - 78
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Explanation: Modifier - 52 denotes a reduced service when a planned procedure is partially performed due to a patient condition such as an allergy. Question 47. A surgeon performs a right-sided knee arthroscopy with meniscectomy and also repairs a lateral collateral ligament. How should the ligament repair be coded? A) Bundled with the arthroscopy B) Separate code with modifier - 59 C) Separate code with modifier - 51 D) Not reported because it is considered incidental Answer: B Explanation: Ligament repair is a distinct therapeutic service; modifier - 59 indicates it is separate from the arthroscopy. Question 48. Which CPT code range is used for removal of a breast fibroadenoma via excision? A) 19120-19125 (Mastectomy) B) 19180-19184 (Excision of breast mass) C) 19170-19175 (Biopsy) D) 19300-19301 (Reconstruction) Answer: B Explanation: Excision of a benign breast mass, such as a fibroadenoma, is coded in the 19180-19184 series. Question 49. A surgeon performs a right-sided laparoscopic adrenalectomy. Which global period applies? A) 0-10 days B) 30 days C) 60 days D) 90 days
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Answer: B Explanation: Laparoscopic adrenalectomy is a major procedure with a 30-day global period. Question 50. When coding a bilateral breast reconstruction using tissue expanders, which modifier is required? A) - 50 B) - 51 C) - 59 D) - 78 Answer: A Explanation: Bilateral reconstruction performed in the same session uses modifier - 50. Question 51. A surgeon performs a left-sided total knee arthroplasty and also removes a small synovial cyst from the same knee. How should the cyst removal be reported? A) Separate CPT code with modifier - 51 B) Bundled; no separate code needed C) Use modifier - 59 D) Use modifier - 78 Answer: B Explanation: Removal of a synovial cyst during the same operative field is considered part of the total knee arthroplasty and is bundled. Question 52. Which CPT series is used for a percutaneous transluminal coronary angioplasty (PTCA) without stent placement? A) 92980-92984 (Cardiac catheterization) B) 93458 (PTCA) C) 93571-93573 (Stent placement)
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D) Bone (if bone is entered) Answer: D Explanation: The deepest structure explored determines the depth indicator; if bone is entered, the bone indicator is used. Question 56. A surgeon performs a right-sided laparoscopic cholecystectomy and also places a percutaneous cholecystostomy tube intra-operatively. How is the tube placement reported? A) Separate code with modifier - 51 B) Bundled; no separate code C) Use modifier - 59 D) Use modifier - 78 Answer: B Explanation: Placement of a cholecystostomy tube during cholecystectomy is considered part of the primary procedure and is bundled. Question 57. Which CPT code range is used for a percutaneous endoscopic gastrostomy (PEG) tube removal? A) 43246 (Gastrostomy tube removal) B) 43247 (Gastrostomy tube replacement) C) 44005 (Enterostomy closure) D) 43235 (Gastrostomy creation) Answer: A Explanation: Removal of a gastrostomy tube is coded with 43246. Question 58. A surgeon performs a left-sided total hip arthroplasty with cemented components. Which code series is appropriate? A) 27130-27134 (Hip replacement) B) 27447 (Knee replacement) C) 27506 (Femur fracture)
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D) 27486 (Patellar resurfacing) Answer: A Explanation: Total hip arthroplasty, cemented or uncemented, is coded in the 27130 - 27134 series. Question 59. When coding a bilateral mastectomy with immediate reconstruction, which global period applies? A) 0-10 days B) 30 days C) 60 days D) 90 days Answer: D Explanation: Bilateral mastectomy with reconstruction is a major surgery, thus a 90 - day global period. Question 60. Which modifier denotes that a service was performed on a patient who was under anesthesia administered by another provider? A) - 52 B) - 53 C) - 56 (Anesthesia rendered by another provider) D) - 57 (No anesthesia) Answer: C Explanation: Modifier - 56 indicates anesthesia services were provided by a different provider. Question 61. A surgeon performs a right-sided laparoscopic adrenalectomy and also removes a 2 cm adrenal cortical adenoma. How should the adenoma removal be reported? A) Separate code with modifier - 51 B) Bundled; no separate code needed
