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CPC Practice Exam - 150 Questions
Surgical removal - The suffix - ectomy means Magnetic Resonance Imaging - MRI stands for The removal of the fallopian tubes and ovaries - The term "Salpingo-Oophorectomy" refers to Freezing - Cryopreservation is a means of preserving something through Paracentesis - Which of the following describes the removal of fluid from a body cavity Gastrotomy - If a surgeon cuts into a patient's stomach he has performed a Muscle - In the medical term myopathy the term pathy means disease. What is diseased? Measles, Mumps, Rubella, and Varicella - The acronym MMRV stands for Outer bone located in the forearm - The Radius is the Hemic and Lymphatic - The spleen belongs to what organ system? The distal portion - The portion of the femur bone that helps makes up the knee cap is considered what? Middle - The Midsagittal plane refers to what portion of the body? Cecum - Which of the following is not part of the small intestine? Teres - One of the six major scapulohumeral muscles Where to esophagus joins the stomach - The cardia fundus is Amputation, arm through humerus; secondary closure or scar revision - The full description of CPT code 24925 is: The condition of the patient justifies the service provided - Medical necessity means what? 45392 - Which of the following codes allows the use of modifier 51? It helps cover outpatient charges - Which of the following statements is not true regarding Medicare Part A
External cause codes are only used in the initial encounter. - Which of the following statements is false? Exploration, including enlargement, debridement, removal of foreign body(ies), minor vessel ligation, and repair - Wound exploration codes include the following service (s) : I12.9, N18.3 - What is the correct ICD- 10 - CM code(s) for malignant hypertension with stage III kidney disease? S51.822A, W07.XXXA, W25.XXXA, Y93.E9, Y92.030 - Lucy was standing on a chair in her apartment's kitchen trying to change a light bulb when she slipped and fell. She struck the glass top stove, which shattered. She presents to the ER with a simple laceration to her left forearm that has embedded glass particles. Which is the correct code(s)? T20.30XA, T24.319A, T22.299A, T31.42, X03.0XXA - Jim was at a bonfire when he tripped and fell into the flames and sustained multiple burns. He came to the emergency room via an ambulance and was treated for second and third degree burns on his face, second degree burns on his upper arms and forearms, and third degree burns on the fronts of his thighs Which is the correct code(s)? O63.0, O09.513, Z37.0 -. A 35 year old woman who is pregnant in her 38th week with her first child is admitted to the hospital. She experiences a prolonged labor during the first stage and eventually births a healthy baby boy. Which is the correct code(s)? S62.632A, Y93.64, W51.XXXA, Y92.320 - Henry was playing baseball at the town's sports field and slid for home base where he collided with another player. He presents to the emergency department complaining of pain in the distal portion of his right middle finger. It is swollen and deformed. The physician orders an x-ray and diagnoses Henry with a displaced tuft fracture. He splints the finger, provides narcotics for pain, and instructs Henry to follow-up with his orthopedist in two weeks. Which is the correct code(s)? F15.20, F10.20, F41.1, F43.10 - A 60 year old male is admitted for detoxification and rehabilitation. He has continuously abused amphetamines to the point that he cannot voluntarily stop on his own and has become dependent upon them. He also has a long documented history of alcohol abuse and alcoholism. He experiences high levels of anxiety due to PTSD, which causes him to use and abuse substances. Which is the correct code(s)? E11.319 - A patient with uncontrolled type II diabetes is experiencing blurred vision and an increase in floaters appearing in her vision. She is diagnosed with diabetic retinopathy. Which is the correct code(s)? Z21 - A patient who is known to be HIV positive but who has no documented symptoms would be assigned code L55.1 - A patient fell asleep on the beach and comes in with blistering on her back. She is diagnosed with second degree solar radiation burns. Which is the correct code(s)?
suspicious mole on Mr. Johnson's back. The Doctor completes the annual exam and documents a detailed history and exam and the time discussing the patient's need to quit smoking. Dr. Anderson then turns his attention to the mole and does a complete work up. He documents a comprehensive history and examination and medical decision making of moderate complexity. He also called a local dermatologist and made an appointment for Mr. Johnson to see him the next day for an evaluation and biopsy. Which is the correct code(s)? History, Exam, Medical Decision Making, Counseling, Coordination of Care, and Nature of Presenting Problem - An E/M is made up of seven components six of which are used in defining the levels of E/M services. The seven components include History, Exam, Medical Decision Making, Counseling, Coordination of Care, Nature of Presenting Problem, and Time. Which six of these seven parts help define the level of the E/M service? The upper central region of the abdomen - When a patient complains.of epigastric pain. Where is the pain located? 99382 - 25, 90471, 90710 - A 2 year-old comes in for an initial WCE, Morn doesn't have the child's immunization record. She states the child's last shot was when he was 5 months old. Medical review and documentation of a new patient supports one element of HPI, five- elements of the ROS, and a complete PFSH. The examination was 8+ organ systems. The physician orders the immunizations to be given in the office today. Immunizations given subcutaneously: MMRV. What CPT codes are reported? Musculoskeletal - Which system is given credit in the exam component when the provider documents "range of motion, strength, and stability" are adequate in both legs?" 99285 - A 25 year-old male is brought in by the EMS to the ER for nausea and vomiting. The patient has elevated blood sugars per EMS. EMS and the physician are unable to get a history due to patient's altered mental status. The ED physician performed a comprehensive eight organ system exam and a high level MDM. Patient was transferred to ICU in stable condition. Total critical care time 25 minutes. What CPT code is reported? 00832 - The correct anesthesia code for a ventral hernia repair on a 13 month old child is 01829 - A patient is placed under anesthesia to have an exploratory surgery done on her wrist. The surgeon utilizes a small fiber optic scope and investigates the radius, ulna, and surrounding wrist bones. What should the anesthesiologist code for? When the anesthesiologist begins preparing the patient for the induction of anesthesia - When does anesthesia time begin? 00561 - A five month old is brought into the operating room for open heart surgery. The surgeon performs a repair of a small hole that was found in the lining surrounding the patient's heart. Anesthesia was provided as well as the assistance of an oxygenator pump. Which is the correct code(s)?
01714 - P3, 99100 - A 72 year old male with a history of severe asthma is placed under anesthesia to have a long tendon in his upper arm repaired. Which is the correct code(s)? Capnography - Which of the following procedures can be coded separately when performed by the anesthesiologist? 00126 - P1 - A healthy five year old male is placed under anesthesia to have a biopsy taken from his left ear drum. Which is the correct code(s)? 00851 - P5, 99140 - A female who is 17 weeks pregnant is rushed into the OR due to a ruptured tubal pregnancy. She has a severe hemorrhage and has an emergency laparoscopic tubal ligation. Which is the correct code(s)? 12032, 12013-59, S51.802A, S41.001A, S01.81XA - John was in a fight at the local bar and presents to the ER with multiple lacerations. The physician evaluates John and determines that he has a 2.5 cm gash to his left forearm and a 4cm gash on his right shoulder, both which require layered closure. He also has a simple 3cm laceration on his forehead that requires simple closure. What are the correct codes for the laceration repairs? 17273, 17000, 17110 - A patient presents to her dermatologists office with three suspicious looking lesions. The dermatologist evaluates them and determines that the 1.3cm lesion of the scalp is benign and the 1.5cm lesion of the neck is premalignant. The 2. cm on the dorsal surface of the patient's hand is also evaluated and is determined to be malignant. The dermatologist chooses to ablate all three lesions using electrosurgery. Which is the correct code(s)? 19000 - An 18 year old female presents with a cyst of her left breast and her physician performs a puncture aspiration. Which is the correct code(s)? 17311, 17315, 17312, 12002 - OPERATIVE REPORT Preoperative Diagnosis: Basal Cell Carcinoma Postoperative Diagnosis: Basal Cell Carcinoma Location: Mid Parietal Scalp Procedure: Prior to each surgical stage, the surgical site was tested for anesthesia and re- anesthetized as needed, after which it was prepped and draped in a sterile fashion. The clinically-apparent tumor was carefully defined and de-bulked prior to the first stage, determining the extent of the surgical excision. With each stage, a thin layer of tumor-laden tissue was excised with a narrow margin of normal appearing skin, using the Mohs fresh tissue technique. A map was prepared to correspond to the area of skin from which it was excised. The tissue was prepared for the cryostat and sectioned. Each section was coded, cut and stained for microscopic examination. The entire base and margins of the excised piece of tissue were examined by the surgeon. Areas noted to be positive on the previous stage (if applicable) were removed with the Mohs technique and processed for analysis. No tumor was identified after the final stage of microscopically controlled surgery. The patient tolerated the procedure well without any complication. After discussion with the patient
16035, 16036 x2 - A patient is being treated for third degree burns to his left leg and left arm which cover a total of 18 sq cm. The burns are scrubbed clean, anesthetized, and three incisions are made with a #11 scalpel, through the tough leathery tissue that is dead, in order to expose the fatty tissue below and avoid compartment syndrome. The burns are then re-dressed with sterile gauze. Which is the correct code(s)? 29883 - Medial and lateral meniscus repair performed arthroscopically. Which is the correct code(s)? 99284 - 57 - 25, 25605- 54 - RT, 12031, S52.501B - A patient comes into the emergency department complaining of sever wrist pain after falling onto her out stretched hands. The physician evaluates the patient taking a detailed history, a detailed exam, and medical decision making of moderate complexity. Upon examination the physician notes that there is a small portion of bone protruding through the skin. After ordering x-rays of the forearm and wrist the patient is diagnosed with an open distal radius fracture of the right arm. The physician provides an IV drip of morphine to the patient for pain and reduces the fracture. 5¬0 absorbable sutures were use to close the subcutaneous layer above the fracture and the surface was closed with 6-0 nylon interrupted sutures. Wound length was measured at 2.5 cm. It was then dressed with sterile gauze and the wrist was stabilized with a Spica fiberglass cast. The physician provided the patient with a prescription for Percocet for pain and instructions for her to follow up with her orthopedist in 7 days. Which is the correct code(s)? Repair, Revision, and/or Reconstruction - A Scapulopexy is found under what heading 20552 - A patient with muscle spasms in her back was seen in her physician's office for treatment. The area over the myofascial spasm was prepped with alcohol utilizing sterile technique. After isolating it between two palpating fingertips a 25-gauge 5" needle was placed in the center of the myofascial spasms and a negative aspiration was performed. Then 4 cc of Marcaine 0.5% was injected into three points in the muscle. The patient tolerated the procedure well without any apparent difficulties or complications. The patient reported feeling full relief by the time the block had set. Which is the correct code(s)? 22554, 63081, 20931, 22845 - OPERATIVE NOTE PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4- C5 and C5-C6. POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4- C5 and C5-C6. PROCEDURE PERFORMED:
- Anterior discectomy, C5-C6.
- Arthrodesis, C5-C6.
- Partial corpectomy, C5.
- Machine bone allograft, C5-C6.
- Placement of anterior plate with a Zephyr C6. ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 60 mL. COMPLICATIONS: None. INDICATIONS: This is a patient who presents with progressive weakness in the left upper extremity as well as imbalance. He has a very large disc herniation that came behind the body at C5 as well and as well as a large disc herniation at C5-C6. Risks and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion, progressive spondylosis, and lack of improvement were all discussed. He understood and wished to proceed. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Preoperative antibiotics were given. The patient was placed in the supine position with all pressure points noted and well padded. The patient was prepped and draped in standard fashion. An incision was made approximately above the level of the cricoid. Blunt dissection was used to expose the anterior portion of the spine with carotid moved laterally and trachea and esophagus moved medially. I then placed needle into the disc spaces and was found to be at C5-C6. Distracting pins were placed in the body of C6. The disc was then completely removed at C5-C6. There was very significant compression of the cord. This was carefully removed to avoid any type of pressure on the cord. This was very severe and multiple free fragments noted. This was taken down to the level of ligamentum. Both foramen were then also opened. Part of the body of C5 was taken down to assure that all fragments were removed and that there was no additional constriction. The nerve root was then widely decompressed. Machine bone allograft was placed into C5- C6 and then a Zephyr plate was placed in the body C6 with a metal pin placed into the body at C5. Excellent purchase was obtained. Fluoroscopy showed good placement and meticulous hemostasis was obtained. Fascia was closed with 3-0 Vicryl, subcuticular 3- 0 Dermabond for skin. The patient tolerated the procedure well and went to recovery in good condition. Which is the correct code(s)? General: 22224-62 Neurosurgeon: 22224- 62 - A general surgeon and a neurosurgeon are performing an osteotomy on the L4 vertebral segment. The general surgeon establishes the opening using an anterior approach. While the neurosurgeon performs the osteotomy the general surgeon performs a discectomy. After completion the general surgeon closes the patient up. 29075 - A patient comes into his physician's office with a prior diagnosis of a Colles type distal radius fracture. He complains that the cast he currently has on is too tight and is causing numbness in his fingers. The physician removes the cast and ensures the patient's circulation is intact. He then re-applies a short arm fiberglass cast and checks the patient's neurovascular status several times during the procedure. The patient is given instructions to follow-up with his orthopedist within seven days. Which is the correct code(s)? 29819 - A patient is brought into the OR for a diagnostic arthroscopy of the shoulder. The patient has been complaining of pain since his surgery 4 months ago. The surgeon explores the shoulder and discovers a metal clamp which had been left in from the prior surgery. The surgeon removed the clamp and closed the patient up. Which is the correct code(s)?
coagulopathy. Chest tube was placed and meticulous hemostasis was present. The anatomy and the flow in the grafts was excellent. Closure was begun. The sternum was closed with wire, followed by linea alba and pectus fascia closure with running 6-0 Vicryl sutures in double-layer technique. The skin was closed with subcuticular 4-0 Dexon suture technique. The patient tolerated the procedure well and was transferred to the intensive care unit in stable condition. Which is the correct code(s)? 36556 - A 50-year-old gentleman with severe respiratory failure is mechanically ventilated and is currently requiring multiple intravenous drips. With the patient in his Intensive Care Unit bed, mechanically ventilated in the Trendelenburg position, the right neck was prepped and draped with Betadine in a sterile fashion. A single needle stick aspiration of the right subclavian vein was accomplished without difficulty and the guide wire was advanced and a dilator was advanced over the wire. The triple lumen catheter was cannulated over the wire and the wire was then removed. No PVCs were encountered during the procedure. All three ports to the catheter were aspirated and flushed blood easily and they were all flushed with normal saline. The catheter was anchored to the chest wall with butterfly phalange using 3-0 silk suture. Betadine ointment and a sterile Op-Site dressing were applied. Stat upright chest x-ray was obtained at the completion of the procedure to ensure proper placement of the tip in the subclavian vein. Which is the correct code(s)? 32440 - A patient with chronic emphysema has surgery to remove both lobes of the left lung. Which is the correct code(s)? 39401 - A thoracic surgeon makes an incision under the sternal notch at the base of the throat, introduces the scope into the mediastinal space and takes two biopsies of the mediastinal mass. He then retracts the scope and closes the small incision. Which is the correct code(s)? 31255, 31267 - A patient has endoscopic surgery done to remove his anterior and posterior ethmoid sinuses. The surgeon dilated the maxillary sinus with a balloon using a transnasal approach, explored the frontal sinuses, remove two polyps from the maxillary sinus, and then performed the tissue removal. Which is the correct code(s)? 33208 - Operative Note Approach: Left cephalic vein. Leads Implanted: Medtronic model 5076-45 in the right atrium, serial number PJN983322V. Medtronic 5076-52 in the right ventricle, serial number PJN961008V. Device Implanted: Pacemaker, Dual Chamber, Medtronic EnRhythm, model P1501VR, serial number PNP422256H. Lead Performance: Atrial threshold less than 1.3 volts at 0.5 milliseconds. P wave 3. millivolts. Impedance 572 ohms. Right ventricle threshold 0.9 volts at 0.5 milliseconds. R wave 10.3. Impedance 855. Procedure: The patient was brought to the electrophysiology laboratory in a fasting state and intravenous sedation was provided as needed with Versed and fentanyl. The left neck and chest were prepped and draped in the usual manner and the skin and subcutaneous
tissues below the left clavicle were infiltrated with 1% lidocaine for local anesthesia. A 2- 1/2-inch incision was made below the left clavicle and electrocautery was used for hemostasis. Dissection was carried out to the level of the pectoralis fascia and extended caudally to create a pocket for the pulse generator. The deltopectoral groove was explored and a medium-sized cephalic vein was identified. The distal end of the vein was ligated and a venotomy was performed. Two guide wires were advanced to the superior vena cava and peel-away introducer sheaths were used to insert the two pacing leads. The venous pressures were elevated and there was a fair amount of back-bleeding from the vein, so a 3 - 0 Monocryl figure-of-eight stitch was placed around the tissue surrounding the vein for hemostasis. The right ventricular lead was placed in the high RV septum and the right atrial lead was placed in the right atrial appendage. The leads were tested with a pacing systems analyzer and the results are noted above. The leads were then anchored in place with #0- silk around their suture sleeve and connected to the pulse generator. The pacemaker was noted to function appropriately. The pocket was then irrigated with antibiotic solution and the pacemaker system was placed in the pocket. The incision was closed with two layers of 3 - 0 Monocryl and a subcuticular closure of 4-0 Monocryl. The incision was dressed with Steri-Strips and a sterile bandage and the patient was returned to her room in good condition. Which is the correct code(s)? False - If a surgeon is performing a surgical sinus endoscopy to control a nasal hemorrhage and chooses to perform a necessary sinusotomy while he's there, he can bill for each individual service. 36247, 37252, 37253 X2 - A cardiologist manipulates a catheter through the patient's atrial system, starting in the femoral artery and manipulating to the third order, using intravascular ultrasound. The cardiologist performs radiological supervision and interpretation. Which is the correct code(s)? True - An indirect laryngoscopy, as described in code 31505, utilizes a mirror in which the physician can view the reflection of the larynx. A direct laryngoscopy, as described by code 31515, utilizes a scope in which the physician peers through and views the larynx. 38525 - A patient was taken into the operating room where after induction of appropriate anesthesia, her left chest, neck, axilla, and arm were prepped with Betadine solution and draped in a sterile fashion. An incision was made at the hairline and carried down by sharp dissection through the clavipectoral fascia. The lymph node was palpitated in the armpit and grasped with a figure-of-eight 2-0 silk suture and by sharp dissection, was carried to hemoclip all attached structures. The lymph node was excised in its entirety. The wound was irrigated. The lymph node was sent to pathology. The wound was then closed. Hemostasis was assured and the patient was taken to recovery room in stable condition. Which is the correct code(s)? 43239 - The patient was scheduled for an esophagogastroduodenoscopy. Upon arrival they were placed under conscious sedation and instructed to swallow a small flexible camera. The camera was then manipulated into the esophagus, and through the entire length of the esophagus. The esophagus appeared to be slightly inflamed, but there was no sign of
428 21, J03.90, J35.03 - A 13 year old child has his tonsils and adenoids removed due acute tonsillitis and chronic tonsilitis and adenoiditis. Which is the correct code(s)? 43246 - 62 - Operative Note Preoperative Diagnosis: Protein-calorie malnutrition Postoperative Diagnosis: Protein-calorie malnutrition. Anesthesia: Conscious sedation per Anesthesia.. Complications: None EGD: Dr. Brown PEG Placement: Dr. Smith History: The patient is a 73-year-old male who was admitted to the hospital with some mentation changes. He was unable to sustain enough caloric intake and had markedly decreased albumin stores. After discussion with the patient and his son they agreed to place a PEG tube for nutritional supplementation. Procedure: After informed consent was obtained the patient was brought to the endoscopy suite. He was placed in the supine position and was given IV sedation by the Anesthesia Department. An EGD was performed from above by Dr. Brown who has dictated his finding separately. The stomach was transilluminated and an optimal position for the PEG tube was identified using the single poke method. The skin was infiltrated with local and the needle and sheath were inserted through the abdomen into the stomach under direct visualization. The needle was removed and a guidewire was inserted through the sheath. The guidewire was grasped from above with a snare by Dr. Brown. It was removed completely and the Ponsky PEG tube was secured to the guidewire. The guidewire and PEG tube were then pulled through the mouth and esophagus and snug to the abdominal wall. There was no evidence of bleeding. Photos were taken. The Bolster was placed on the PEG site. A complete dictation for the EGD will be done separately by Dr. Brown. The patient tolerated the procedure well and was transferred to recovery room in stable condition. He will be started on tube feedings in 6 hours with aspiration and dietary precautions to determine his nutritional goal. What code(s) should Dr. Smith charge? 43753 - An 18 year old female was found with a suicide note and an empty bottle of Tylenol. She was rushed into the emergency department where she had a large-bore gastric lavage tube inserted into her stomach and the contents were evacuated. Which is the correct code(s)? False - All endoscopies performed on the digestive system (such as an esophagoscopy, a colonoscopy, a sigmoidoscopy, etc.) do not allow moderate sedation to be coded additionally because it is bundled into the code? 43771 - Operative Note History of Present Illness: Ms. Moore is status post lap band placement, the band was placed just over a year ago and she is here for a lap band adjustment. She has a history of problems previously with her adjustments. She has been under a lot of stress recently due to a car accident she was in a couple of weeks ago. Since the accident she has been experiencing problems of "not feel full". She states that she is not really hungry but she
does not feel full either. She also states that when she is hungry at night she is having difficulty waiting until the morning to eat. She also mentioned that she had a candy bar and that seemed to make her feel better. Physical Examination: On exam, her temperature is 98, pulse 76, weight 197.7 pounds, blood pressure 102/72, BMI is 38.5, she has lost 3.8 pounds since her last visit. She was alert and oriented in no apparent distress. Procedure: I was able to access her port. She does have an AP standard low profile. I aspirated 6 mL, I did add 1 mL, so she has got approximately 7 mL in her restrictive device, she did tolerate water post procedure. Assessment: The patient's status post lap band adjustments; doing well, has a total of 7 mL within her lap band, tolerated water pos procedure. She will come back in two weeks for another adjustment as needed. Which is the correct code(s)? The CPT with a modifier 26 - Some radiology codes include two components. Often a radiologist will use the radiology equipment, which is known as the technical component, and the physician will provide the second half of the CPT code by supervising and interpreting the study. When this occurs what should the physician report? 74178 - A patient presents to the ER with intractable nausea and vomiting, and abdominal pain that radiates into her pelvis. The physician orders a CT scan of the abdomen, first without contrast and then followed by contrast, and a CT of the pelvis, without contrast. Which is the correct code(s)? 70150 - A patient was in an MVA and his face struck the steering wheel. He had multiple contusions and facial swelling. The physician suspected a zygomatic-malar or maxilla fracture. The radiologist took an oblique anterior-posterior projection which showed the facial complex clearly. An anterior-posterior and lateral views were also taken. Which is the correct code(s)? True - If a prior study is available but it is documented in the medical records that there was inadequate visualization of the anatomy, then a diagnostic angiography may be reported in conjunction with an interventional procedure if modifier 59 is appended to the diagnostic S&I (Supervision and Interpretation). 20225, 77012 - A physician performed a deep bone biopsy of the femur. The trocar was visualized and guided using a CAT scan and interpretation was provided. Which is the correct code(s)? 77771 - HDR internal radiation therapy was performed by using a remote controlled MultiSource afterloader which was connected to 3 catheters. The 6 Ir-192 radioactive wire sources were released from the containment unit and were delivered beside the tumor within the body cavity, as pre-determined. After 15 minutes the sources were removed from the patient and placed back into the containment unit. Which is the correct code(s)? 78451, 93016 - A patient has a myocardial perfusion imaging study which included quantitative wall motion, ejection fraction by gated technique, and attenuation correction.
back with 350 ng/ml for barbiturates and 375 ng/ml for opiates. Which is the correct code(s)? hCG - A CBC does not include which of the following: 89258 - A couple that was unsuccessful at conceiving a child chooses to have in vitro fertilization done. The eggs and semen have been harvested and nine eggs were implanted with a sperm. The zygotes went through mitosis and produced embryos. Three embryos were then implanted in the woman and the other six were kept for later use. What codes(s) would the lab technician charge for her services in preserving the remaining six embryos? 82951 - A patient in her 30th week of pregnancy has a high oral glucose reading and her physician orders a glucose tolerance test. Upon arrival the laboratory technician draws the patient's blood and the patient then ingests a glucose drink. Her blood is then drawn one, two, and three hours after the ingestion. As the patient was leaving the laboratory the technician informs her that the samples were incorrectly labeled and that the test needed to be repeated. The patient has her blood drawn again, ingested the glucose drink again, and has her blood re-drawn at one, two, and three hour intervals. Which is the correct code(s)? 80048, 80053, 80069 - Carbon dioxide, total calcium, and sodium and all in what three panels? Which is the correct code(s)? True - A qualitative hCG test will provide a positive or negative result while a quantitative hCH test will provide a specific amount of hCG in the specimen. S41.112A, S01.411A, Z20.3, 12032, 12013-51, 90460-51, 90675 - A 5 year old is brought into the ER after being attacked by a stray dog. The stray was captured and tested positive for rabies. The patient has a 3cm laceration on his right cheek that requires simple closure and a 1cm and 4cm laceration on his upper left arm requiring layered repair. After discussing the benefits and risks with the patient's parents they decide to have an IM rabies vaccination administered by the physician, due to the patient's rabies exposure. Which is the correct code(s)? 93010, 96360, 96361 - A 52 year old male is in the emergency department complaining of dizziness and states he passed out prior to arrival. The physician evaluates him, orders that a 12 lead EKG be performed, and has the nurse infuse 2 liters of NS over a 1 hour and 45 minute time period under his supervision. The EKG results were reviewed by the physician and were normal. A report was written and the patient was diagnosed with syncope due to dehydration and released. In addition to the EM service what should the physician code for? 90970 x11 - A 45 year old patient with end stage renal disease has in home dialysis services initiated on the 15th of the month. The physician provides dialysis every day. On the 19th the patient was admitted to the hospital and discharged on the 24th. The
physician and patient began in-home dialysis again on the 25th and continued every day until the 31st. Which is the correct code(s)? 93297 x3, 93295, 93283 - A patient with a dual lead implantable cardioverter-defibrillator has his physician initiate remote monitoring of the ICD and of cardiovascular monitor functionality (within the ICD), to help diagnosis the patient with what he suspects is left sided heart failure. Over the course of 90 days the physician remotely analyzes recorded data from the device, including left atrial pressure, ventricular pressure, and the patient's blood pressure. He also remotely analyzes data from the defibrillator, including the heart rhythms and pace. After analysis and review the physician compiles reports on both. During this time period there was also one in-person interrogation of the ICM device and one in-person encounter for programming and adjusting the ICD device to ensure test functions and to optimize programming. Which is the correct code(s)? 92014 - History: Past ocular surgery history is significant for neurovascular age-related dry macular degeneration. Patient has had laser four times to the macula on the right and two times to the left. Exam: Established 63 year old female patient. On examination, lids, surrounding tissues, and palpebral fissure are all unremarkable. Conjunctiva, sclera, cornea and iris were all assessed as well. Palpitation of the orbital rim revealed nothing. Visual acuity with correction measured 20/400 OU. Manifest refraction did not improve this. There was no afferent pupillary defect. Visual fields were grossly full to hand motions. Intraocular pressure measured 17 mm in each eye. Vertical prism bars were used to measure ocular deviation and a full sensorimotor examination to evaluate the function of the ocular motor system was performed. A slit-lamp examination was significant for clear corneas OU. There was early nuclear sclerosis in both eyes. There was a sheet like 1-2+ posterior subcapsular cataract on the left. Dilated examination by way of cycloplegia showed choroidal neovascularization with subretinal heme and blood in both eyes. Magnified inspection was obtained with a Goldman 3-mirror lens and the retina, optic disc, and retinal vasculature were visualized. Macular degeneration was present in both the left and right retinas. Assessment/Plan: Advanced neurovascular age-related macular degeneration OU, this is ultimately visually limiting. Cataracts are present in both eyes. I doubt cataract removal will help increase visual acuity; however, I did discuss with the patient, especially in the left, that cataract surgery will help us better visualize the macula for future laser treatment so that her current vision can be maintained. We discussed her current regiments and decided to continue with the high doses of the vitamins A, C and E, and the minerals zinc and copper to help slow her degeneration. After consideration the patient agreed to left cataract surgery which we scheduled for two weeks from today. Which is the correct code(s)? True - Some procedures or services are commonly carried out as an integral component of another total service or procedure and are identified by the inclusion term "separate procedure". Codes with this inclusion term should not be reported in addition to the total procedure code or service to which it is considered an integral part, unless it is independently carried out or considered unrelated. If performed independently or as an un-related procedure it may be coded with modifier 59 appended to it.
59618, 59620-51, O75.81, O30.013, O60.14X0, O66.41, O82, Z37.2, Z3A.36 - A 26 year old patient who is Gravida 2 Para 1 presents to the ER in her 36th week of pregnancy with twin gestations who are monochorionic and monoamniotic. She is in active labor, 6 cm dilated, and her water is intact. Her OBGYN, who provided 12 antepartum visits, admitted her to labor & delivery. Although the patient had a previous cesarean during her first pregnancy the physician allowed her to attempt a vaginal birth. After pushing for three hours the patient was exhausted and taken to the OR for a cesarean delivery with a transverse incision. Two healthy newborns were born 15 minutes later. During the hospital stay and afterward the same physician provided the postpartum care to the mother. Which is the correct code(s)? 55700, 76942 - A 74 year old male with a weak urinary stream had his PSA tested. Results read 12.5 and he was scheduled for a biopsy to determine whether he had a malignancy or BPH. He arrived for surgery and was placed in the left lateral decubitus position and he was sedated. The surgeon used ultrasonic guidance to percutaneously retrieve 3 biopsies, using the transperineal approach. The biopsies were examined and the patient was diagnosed with secondary prostate cancer with the primary site unknown. He was directed to schedule a PET scan and discharged in good condition. 55041 - Procedure: Hydrocelectomy A scrotal incision was made and further extended with electrocautery. Once the hydrocele sac was reached we then opened and delivered the testis which drained clear fluid. There was moderate amount of scarring on the testis itself from the tunica vaginalis. The hydrocele sac was completely removed. A drain was then placed in the base of the scrotum and then the testis was placed back into the scrotum in the proper orientation. The same procedure was performed on the left. The skin was then sutured with a running interlocking suture of 3-0 Vicryl and the drains were sutured to place with 3-0 Vicryl. Bacitracin dressing, ABD dressing, and jock strap were placed. The patient was in stable condition upon transfer to recovery. Which is the correct code(s)? 51729 - 26, 51797- 26 - A urologist performs a cystometrogram with intra-abdominal voiding pressure studies in a hospital using calibrated electronic equipment that is provided for his use. He interprets the study and diagnosis the patient with neurogenic bladder. Which is the correct code(s)? 58970, 76948 - Transvaginal sonographically controlled retrieval of a 26 year old female's eggs by piercing the ovarian follicle with a very fine needle. Which is the correct code(s)? Malleus, incus, and stapes - The hammer, anvil, and stirrup are the English terms for the three auditory ossicles, whose Latin names are: 61107 - Operative Note Pre-operative Diagnosis: Increased intracranial pressure and cerebral edema due to severe brain injury. Post-operative Diagnosis: Increased intracranial pressure and cerebral edema due to severe brain injury.
Procedure: Scalp was clipped. Patient was prepped with ChloraPrep and Betadine. Incisions are infiltrated with 1% Xylocaine with epinephrine 1:200000. Patient did receive antibiotics post procedure and was draped in a sterile manner. The incision made just to the right of the right mid-pupillary line 10 cm behind the nasion. A self-retaining retractor was placed. A hole was then drilled with the cranial twist drill and the dura was punctured. A brain needle was used to localize the ventricle and it took 3 passes to localize the ventricle. The pressure was initially high. The CSF was clear and colorless. The CSF drainage rapidly tapered off because of the brain swelling. With two tries, the ventricular catheter was then able to be placed into the ventricle and then brought out through a separate puncture site; the depth of catheter was 7 cm from the outer table of the skull. There was intermittent drainage of CSF after that. The catheter was secured to the scalp with #2-0 silk sutures and the incision was closed with Ethilon suture. The patient tolerated the procedure well. No complications. Sponge and needle counts were correct. Blood loss is minimal. Which is the correct code(s)? 63040 - Using the posterior approach the surgeon made a midline incision above the underlying vertebrae and dissected down to the paravertabral muscles and retracted then. The ligamentum flavum, lamina, and fragments of a ruptured C3-C4 intervertebral disc were all removed. The surgeon also removed a portion of the facet to relieve the compressed nerve of the C4 vertebrae. He then placed a free-fat graft over the exposed nerve and the paravertabral muscles were repositioned. The patient was then closed using layered sutures and taken to recovery. Which is the correct code(s)? 65765 - A procedure in which corneal tissue from a donor is frozen, reshaped, and implanted into the anterior corneal stroma of the recipient to modify refractive error. Which is the correct code(s)? Lymph nodes - Which of the following organs is not part of the endocrine system 67107 - Using an operating microscope the ophthalmologist places stay sutures into the rectus muscle. A cold probe is then placed over the sclera and is depressed sealing the choroid to the retina at the original tear site. He then performs a sclerotomy and places mattress sutures across the incision. Subretinal fluid is then drained. Next a silicone sponge, followed by a silicone band, are placed around the eye and sutured into place to help support the healing scar. Rectus sutures are removed. Which is the correct code(s)? 61315 - Following a motor vehicle collision a 28 year old male was given a CT scan of the brain which indicated an infratentorial hematoma in the cerebellum. The patient was taken to the OR where the neurosurgeon, using the CT coordinates, incised the scalp and drilled a burr hole into the cranium above the hematoma. Under direct visualization he then evacuated the hematoma using suction and irrigated with NS. Hemorrhaging was controlled and the dura was closed. The skull piece was then placed back into the drill hole and screwed into place. The scalp was closed and the patient was sent to recovery. Which is the correct code(s)?
