Medical Coding Practice Questions, Exams of Anatomy

Download Medical Coding Practice Questions and more Exams Anatomy in PDF only on Docsity! TRUST THE PROCESS! 1 AAPC - CPC Coding Exam MOCK: The Certification Step Time: 5.40 Minutes Question 1 46 year old female had a previous biopsy that indicated positive margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn out and a 15 blade scalpel was used for full excision of an 8cm lesion. Light undermining of all margins was performed along with layered closure. The specimen was sent for permanent histopathologic examination. What are the code(s) for this procedure? A. 11426 B. 11626 C. 11626, 12044-51 D. 11426, 13132, 13133 Question 2 30 year old female is having debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer and eschar infection was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT code should be reported? A. 11000 B. 11011 C. 11044 D. 15004 Question 3 64 year old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with 6-0 Prolene sutures. The arm and leg were repaired by 6-0 Vicryl subcutaneous sutures and prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 12014, 12034-51, 12002-51, 11041-51 B. 12053, 12034-51, 12002-51 C. 12014, 12034-51, 11041-51 D. 12053, 12034-51 Question 4 52 year old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT should be reported? A. 21932, 214.9 B. 21935, 214.1 C. 21931, 214.1 D. 21925, 789.39 TRUST THE PROCESS! 2 Question 5 PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distalward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What code should be used for this procedure? A. 25628-RT B. 25624-RT C. 25645-RT D. 25651-RT Question 6 An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix figure-of- eight plate was placed and checked with x-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl. What procedure code should be used? A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50 Question 7 The patient is a 67 -year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What code should be used for this procedure? A. 36556, 77001-26 B. 36558 C. 36561, 77001-26 D. 36571 Question 8 TRUST THE PROCESS! 5 Question 16 5-year-old female has a history of post void dribbling. She was found to have extensive labial adhesions, which have been unresponsive to topical medical management. She is brought to the operating suite in a supine position. Under general anesthesia the labia majora is retracted and the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent granulation tissue was excised on either side. What code should be used for this procedure? A. 58660 B. 58740 C. 57061 D. 56441 Question 17 The patient is a 64-year-old female who is undergoing a removal of a previously implanted Medtronic pain pump and catheter due to a possible infection. The back was incised; dissection was carried down to the previously placed catheter. There was evidence of infection with some fat necrosis in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump pocket was opened with evidence of seroma. The pump was dissected from the anterior fascia. A 7-mm Blake drain was placed in the pump pocket through a stab incision and secured to the skin with interrupted Prolene. The pump pocket was copiously irrigated with saline and closed in two layers. What are the CPT and ICD-9-CM codes for this procedure? A. 62365, 62350-51, 996.75, V53.09 B. 62360, 62355, 998.51 C. 62365, 62355-51, 996.63 D. 36590, 996.75, 998.13 Question 18 The patient is a 73-year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt placement with Codman programmable valve. What is the correct code for this surgery? A. 62220 B. 62223 C. 62190 D. 62192 Question 19 What is the CPT code for the decompression of the median nerve found in the space in the wrist on the palmar side? A. 64704 B. 64713 C. 64721 D. 64719 Question 20 2-year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia. With an #11 blade the chalazion was incised and a small curette was then used to retrieve any granulomatous material on both lids. What code should be used for this procedure? A. 67801 B. 67805 C. 67800 D. 67808 Question 21 TRUST THE PROCESS! 6 80-year-old patient is returning to the gynecologist’s office for pessory cleaning. Patient offers no complaints. The nurse removes and cleans the pessory, vagina is swabbed with betadine, and pessory replaced. For F/U in 4 months. What CPT® and ICD-9 should be used for this service? A. 99201, V45.59 B. 99211,V52.8 C. 99202, 996.65 D. 99212,V53.99 Question 22 Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision making of moderate complexity. Which E/M service is reported? A. 99285 B. 99284 C. 99221 D. 99222 Question 23 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct code(s) for the physician service. A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303 C. 99460-25, 31500, 94002, 93303 D. 99291-25, 93303 Question 24 A 42-year-old with renal pelvis cancer receives general anesthesia for a laparoscopic radical nephrectomy. The patient has controlled type II diabetes otherwise no other co-morbidities. What is the correct CPT® and ICD-9-CM code for the anesthesia services? A. 00860-P1, 189.0, 250.00 B. 00840-P3, 189.1, 250.00 C. 00862-P2, 189.1, 250.00 D. 00868-P2, 198.0, 250.00 Question 25 A healthy 32-year-old with a closed distal radius fracture received monitored anesthesia care for an ORIF of the distal radius. What is the code for the anesthesia service? A. 01830-P1 B. 01860-QS-P1 C. 01830-QS-P1 D. 01860-QS-G9-P1 Question 26 A 10-month-old child is taken to the operating room for removal of a laryngeal mass. What is the appropriate anesthesia code? A. 00320 B. 00326 C. 00320, 99100 D. 00326, 99100 Question 27 A catheter is placed in the left common femoral artery in retrograde fashion which was directed into the right iliac system advancing it to the external iliac. Dye was injected and a select right lower extremity angiogram was performed which revealed patency of the common femoral and TRUST THE PROCESS! 7 profunda femoris. The catheter was then manipulated into the femoral artery in which a select lower extremity angiogram was performed which revealed occlusion from the popliteal to the peroneal artery. What are the procedure codes that describe this procedure? A. 36217, 75736-26, 75774-26 B. 36247, 75716-26 C. 36217, 75658-26 D. 36247,75710-26 Question 28 56-year-old female is having a bilateral mammogram with computer aid detection conducted as a screening since the patient has had a previous cyst in the right breast. What radiological services are reported? A. 77055, 77051 B. 77056, 77051 C. 77057, 77052 D. 77056, 77052 Question 29 63 year-old patient with bilateral ureteral obstruction presents to an outpatient facility for placement of a right and left ureteral stent along with an interpretation of a retrograde pyelogram. What codes should be reported? A. 52332, 74000 B. 52332-50, 74420-26 C. 52005, 74420 D. 52005-50, 74425-26 Question 30 Patient is coming in for a pathological examination for ischemia in the left leg. The first specimen is 1.5 cm of a single portion of arterial plaque taken from the left common femoral artery. The second specimen is 8.5 x 2.7 cm across x 1.5 cm in thickness of a cutaneous ulceration with fibropurulent material on the left leg. What surgical pathology codes should be reported for the pathologist? A. 88302, 88304 B. 88304-26, 88305-26 C. 88305-26, 88307-26 D. 88307, 88309 Question 31 During a craniectomy the surgeon performed a frozen section of a large piece of tumor and sent it to pathology. The pathologist received a rubbery pinkish tan tissue measuring in aggregate 3 x 0.8 x 0.8 cm. The entire specimen is submitted in one block and a microscope was used to examine the tissue. The frozen section and the pathology report are sent back to the surgeon indicating that the tumor was a medulloblastoma. What CPT® code(s) will the pathologist report? A. 80500 B. 88331-26 C. 80502 D. 88331-26, 88304-26 Question 32 Physician orders a comprehensive metabolic panel but also wants blood work on calcium ions and also orders a basic metabolic panel. Select the code(s) on how this is reported. A. 80053, 80047 B. 80053 C. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 D. 80053, 82330 TRUST THE PROCESS! 10 Question 45 What statement is true when reporting pregnancy codes (630-679): A. These codes can be used on the maternal and baby records. B. These codes have sequencing priority over codes from other chapters. C. Code V22.2 should always be reported with these codes. D. The fifth digits assigned to these codes indicate the complication during the pregnancy Question 46 66-year-old Medicare patient, who has a history of ulcerative colitis, presents for a colorectal cancer screening. The screening is performed via barium enema. What HCPCS Level II code is reported for this procedure? A. G0106 B. G0105 C. G0120 D. G0121 Question 47 What is PHI? A. Physician-health care interchange B. Private health insurance C. Personal health information D. Provider identified incident-to Question 48 Which of the following is a BENEFIT of electronic claims submission? A. Privacy of claims B. Security of claims C. Timely submission of claims D. None of the above Question 49 Which of the following is true regarding ICD-9-CM codes with the words “in diseases classified elsewhere” in their descriptions? A. They can never be the first listed code. B. They should always be the first listed code. C. They are unspecified codes and should be used only when more specific diagnoses cannot be found. D. None of the above. Question 50 Which of the following statements is true regarding sequencing of E codes? A. E codes for place of occurrence take priority over all other E codes. B. E codes for medical history take priority over all other E codes. C. E codes identifying screening exam as the reason for encounter take priority over all other E codes. D. E codes for transport accidents take priority over all other E codes except cataclysmic events and child and adult abuse and terrorism. Question 51 PRE OP DIAGNOSIS: Left Breast Abnormal MMX or Palpable Mass; Other Disorders Of Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast FINDINGS: Lesion is located in the lateral region, just at or below the level of the nipple on the 90 degree lateral view. There is a subglandular implant in place. I discussed the procedure with the patient today including risks, benefits and alternatives. Specifically discussed was the fact that the implant would be displaced TRUST THE PROCESS! 11 out of the way during this biopsy procedure. Possibility of injury to the implant was discussed with the patient. Patient has signed the consent form and wishes to proceed with the biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged from the inferior approach. The lesion of interest is in the anterior portion of the breast away from the implant which was displaced back toward the chest wall. After imaging was obtained and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped with Betadine. 1% lidocaine was injected subcutaneously for local anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling needle. The SenoRx needle was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy samples using vacuum and cutting technique. The specimen radiograph confirmed representative sample of calcification was removed. The tissue marking clip was deployed into the biopsy cavity successfully. This was confirmed by final stereotactic digital image and confirmed by post core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left breast in satisfactory position. No obvious calcium is visible on the final post core biopsy image in the area of interest. The patient tolerated the procedure well. There were no apparent complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack in the usual manner. The patient did receive written and verbal post-biopsy instructions. The patient left our department in good condition. IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT BREAST CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE RECEIVE THE PATHOLOGY REPORT. What are the codes for the procedures? A. 19103, 19295, 77031-26 B. 19101, 19295 C. 19102, 19295, 76942-26 D. 19102, 77012-26 Question 52 53-year-old male for removal of 2 lesions located on his nose and lower lip. Lesions were identified and marked. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area. The lower lip lesion of 4mm in size was shaved to the level of the superficial dermis. What are the codes for these procedures? A. 11100, 11101 B. 11100-59, 11310-51 C. 17000, 17003 D. 11440, 11310-51 Question 53 76-year-old has dermatochalasis on bilateral upper eyelids. A belpharoplasty will be performed on the eyelids. A lower incision line was marked at approximately 5 mm above the lid margin along the crease. Then using a pinch test with forceps the amount of skin to be resected was determined and marked. An elliptical incision was performed on the left eyelid and the skin was excised. In a similar fashion the same procedure was performed on the right eye. The wounds were closed with sutures. The correct CPT codes are? A. 15822, 15823-51 B. 15823-50 C. 15822-50 TRUST THE PROCESS! 12 D. 15820-LT, 15820-RT Question 54 42 year old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the glenohumeral joint. The articular cartilage was normal except for some minimal grade III- IV changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The rotator interval was very thick and contracted and this was released with electrocautery and the Bovie including the superior glenohumeral ligament. After this was all released, the middle glenohumeral ligament was released as well as the tendinous portion of the subscapularis. After this was all done with a shaver and electrocautery, the arthroscope was placed anteriorly and the shaver and used to debride some of the posterior capsule and the posterior capsule was released in its posterosuperior and then posteroinferior aspect. After this was done, the arthroscope was then placed back posteriorly and used to release the anteroinferior capsule down to 6’oclock. This was done with electrocautery. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope was then placed back posteriorly and used to confirm that there was still one little strip of capsule around the biceps superiorly and there was one little strip from 6-7 o’clock posteroinferiorly that was only partially cut. The rest of the capsule was completely circumferentially released. What CPT code describes this procedure? A. 23450-LT B. 23466-LT C. 29805-LT, 29806-51-LT D. 29825-LT Question 55 After adequate anesthesia was obtained the patient was turned prone in a kneeling position on the spinal table. A lower midline lumbar incision was made and the soft tissues divided down to the spinous processes. The soft tissues were stripped way from the lamina down to the facets and discectomies and laminectomies were then carried out at L3-4, L4-5 and L5-S1. Interbody fusions were set up for the lower three levels using the Danek allografts and augmented with structural autogenous bone from the iliac crest. The posterior instrumentation of a 5.5 mm diameter titanium rod was then cut to the appropriate length and bent to confirm to the normal lordotic curve. It was then slid immediately onto the bone screws and at each level compression was carried out as each of the two bolts were tightened so that the interbody fusions would be snug and as tight as possible. Select the appropriate CPT code(s) for this visit? A. 22612, 22614 x 2, 22842, 20938, 20930 B. 22533, 22534 x 2, 22842 C. 22630, 22632 x 2, 22842, 20938, 20930 D. 22554, 22632 x 2, 22842 Question 56 PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. OPERATIVE PROCEDURE: Reduction with application external fixator, left wrist fracture FINDINGS: The patient is a 46-year-old right-hand-dominant female who fell off stairs 4 to 5 days TRUST THE PROCESS! 15 entire length of the small bowel: the omentum and bowel were stuck up to the anterior abdominal wall. Time- consuming tedious lysis of adhesions was performed to free up the entire length of the gastrointestinal tract from the ligament to Treitz to the ileocolic anastomosis. The correct CPT code is: A. 44005 B. 44180-22 C. 44005-22 D. 44180-59 Question 62 55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a catheter placement. The endoscope is passed through the cricopharyngeal muscle area without difficulty. Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted. Stomach significant distention with what appears to be multiple encapsulated tablets in the stomach at least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged due to high grade narrowing in the pyloric channel. It seems to be a high grade outlet obstruction with a superimposed volvulus. What code should be used for this procedure? A. 43246-52 B. 43241-52 C. 43235 D. 43234 Question 63 The patient is a 78-year-old white female with morbid obesity that presented with small bowel obstruction. She had surgery approximately one week ago and underwent exploration, which required a small bowel resection of the terminal ileum and anastomosis leaving her with a large inferior ventral hernia. Two days ago she started having drainage from her wound which has become more serious. She is now being taken back to the operating room. Reopening the original incision with a scalpel, the intestine was examined and the anastomosis was reopened , excised at both ends, and further excision of intestine. The fresh ends were created to perform another end- to-end anastomosis. The correct procedure code is: A. 44120-78 B. 44126-79 C. 44120-76 D. 44202-58 Question 64 PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula POST OPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula PROCEDURE: Hartman procedure, which is a sigmoid resection with Hartman pouch and colostomy. DESCRIPTION OF THE PROCEDURE: Patient was prepped and draped in the supine position under general anesthesia. Prior to surgery patient was given 4.5 grams of Zosyn and Rocephin IV piggyback. A lower midline incision was made, abdomen was entered. Upon entry into the abdomen, there was an inflammatory mass in the pelvis and there was a large abscessed cavity, but no feces. The abscess cavity was drained and irrigated out. The left colon was immobilized, taken down the lateral perineal attachments. The sigmoid colon was mobilized. There was an inflammatory mass right at the area of the sigmoid colon consistent with a divertiliculitis or perforation with infection. Proximal to this in the distal TRUST THE PROCESS! 16 left colon, the colon was divided using a GIA stapler with 3.5 mm staples. The sigmoid colon was then mobilized using blunt dissection. The proximal rectum just distal to the inflammatory mass was divided using a GIA stapler with 3.5 mm staples. The mesentary of the sigmoid colon was then taken down and tied using two 0 Vicryl ties. Irrigation was again performed and the sigmoid colon was removed with inflammatory mass. The wall of the abscessed cavity that was next to the sigmoid colon where the inflammatory mass was, showed no leakage of stool, no gross perforation, most likely there is a small perforation in one of the diverticula in this region. Irrigation was again performed throughout the abdomen until totally clear. All excess fluid was removed. The distal descending colon was then brought out through a separate incision in the lower left quadrant area and a large 10 mm 10 French JP drain was placed into the abscessed cavity. The sigmoid colon or the colostomy site was sutured on the inside using interrupted 3-0 Vicryl to the peritoneum and then two sheets of film were placed into the intra- abdominal cavity. The fascia was closed using a running #1 double loop PDS suture and intermittently a #2 nylon retention suture was placed. The colostomy was matured using interrupted 3-0 chromic sutures. I palpated the colostomy; it was completely patent with no obstructions. Dressings were applied. Colostomy bag was applied. Which CPT code should be used? A. 44140 B. 44143 C. 44160 D. 44208 Question 65 5-year-old male with a history of prematurity was found to have penile curvature, congenital hypospadias. He presents for surgical management for straightening the curvature. Under general anesthesia, bands were placed around the base of the penis and incisions were made degloving the penis circumferentially. The foreskin was divided in Byers flaps and the penile skin was reapproximated at the 12 o’clock position. Two Byers flaps were reapproximated, recreating a mucosal collar which was then criss- crossed and trimmed in the midline in order to accommodate median raphe reconstruction. This was reconstructed with use of a horizontal mattress suture. The shaft skin was then approximated to the mucosal collar with sutures correcting the defect. Which CPT code should be used? A. 54304 B. 54340 C. 54360 D. 54440 Question 66 The patient is a 22-year-old who was found to be 7-1/2 weeks pregnant. She has consented for a D&E .She was brought to the operating room where MAC anesthesia was given. She was then placed in the dorsal lithotomy position and a weighted speculum was placed into her posterior vaginal vault. Cervix was identified and dilated. A 6.5-cm suction catheter hooked up to a suction evacuator was placed and products of conception were evacuated. A medium size curette was then used to curette her endometrium. There was noted to be a small amount of remaining products of conception in her left cornua. Once again the suction evacuator was placed and the remaining products of conception were evacuated. At this point she had a good endometrial curetting with no further products of conception noted. Which CPT code should be used? A. 59840 TRUST THE PROCESS! 17 B. 59841 C. 59812 D. 59851 Question 67 A 37-year-old female has menorrhagia and wants permanent sterilization. The patient was placed in Allen stirrups in the operating room. Under anesthesia the cervix was dilated and the hysteroscope was advanced to the endometrium into the uterine cavity. No polyps or fibroids were seen. The Novasure was used for endometrial ablation. A knife was then used to make an incision in the right lower quadrant and left lower quadrant with 5-mm trocars inserted under direct visualization with no injury to any abdominal contents. Laparoscopic findings revealed the uterus, ovaries and fallopian tubes to be normal. The appendix was normal as were the upper quadrants. Because of the patient's history of breast cancer and desire for no further children, it was decided to take out both the tubes and ovaries. This had been discussed with the patient prior to surgery. What are the codes for these procedures? A. 58660, 58353 B. 58661,58563-51 C. 58661, 58558 D. 58662, 58563-51 Question 68 MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical laminectomy at C3 through C6 and fusion. The edges of the laminectomy were then cleaned up with a Kerrison and foraminotomies were done at C4, C5, and,,C6. The stenosis is central: a facetectomy is performed by using a burr. Nerve root canals were freed by additional resection of the facet, and compression of the spinal cord was relieved by removal of a tissue overgrowth around the foramen. Which CPT codes should be used for this procedure? A. 63045-50, 63048-50 B. 63020-50, 63035-50, 63035-50 C. 63015-50 D. 63045, 63048 x 3 Question 69 An extracapsular cataract removal is performed on the right eye by manually using an iris expansion device to expand the pupil. A phacomulsicfication unit was used to remove the nucleus and irrigation and aspiration was used to remove the residual cortex allowing the insertion of the intraocular lens. What code should be used for this procedure? A. 66985 B. 66984 C. 66982 D. 66983 Question 70 An infant who has chronic otitis media was placed under general anesthesia and a radial incision was made in the posterior quadrant of the left tympanic membrane. A large amount of mucoid effusion was suctioned and then a ventilating tube was placed in both ears. What CPT and ICD- 9-CM codes should be reported: A. 69436-50, 381.20 TRUST THE PROCESS! 20 Question 80 18-year-old female with a history of depression comes into the ER in a coma. The ER physician orders a drug screen on antidepressants, phenothiazines, and benzodiazepines. The lab performs a screening for each single drug class using an immunoassay in a random access analyzer. Presence of antidepressants is found and a drug confirmation is performed to identify the particular antidepressant. What correct CPT® codes are reported? A. 80101 x 3, 80102 B. 80100, 80102 C. 80101 x 3, 80102 x 3 D. 80100 x 3, 80102 x 3 Question 81 A patient uses Topiramate to control his seizures. He comes in every two months to have a therapeutic drug testing performed to assess serum plasma levels of this medication. What lab code is reported for this testing? A. 80101 B. 80102 C. 80201 D. 80201, 80102 Question 82 Patient that is a borderline diabetic has been sent to the laboratory to have an oral glucose tolerance test. Patient drank the glucose and five blood specimens were taken every 30 to 60 minutes up to three hours to determine how quickly the glucose is cleared from the blood. What code(s) should be reported for this test? A. 82947 x 5 B. 82946 C. 80422 D. 82951, 82952 x 2 Question 83 A patient with severe asthma exacerbation has been admitted. The admitting physician orders a blood glass for oxygen saturation only. The admitting physician performs the arterial puncture drawing blood for a blood gas reading on oxygen saturation only. The physician draws it again in an hour to measure how much oxygen the blood is carrying. Select the codes for reporting this service. A. 82805, 82805-51 B. 82810, 82810-91 C. 82803, 82803-51 D. 82805, 82805-90 Question 84 A new patient is having a cardiovascular stress test done in his cardiologist’s office. Before the test is started the physician documents a comprehensive history and exam and moderate complexity medical decision making. The physician will be supervising and interpreting the stress on the patient’s heart during the test. What procedure code should be documented for this encounter? A. 93015-26, 99204-25 TRUST THE PROCESS! 21 B. 93016, 93018, 99204-25 C. 93015, 99204-25 D. 93018-26, 99204-25 Question 85 A cancer patient is coming in to have a chemotherapy infusion. The physician notes the patient is dehydrated and will first administer a hydration infusion. The infusion time was 1 hour and 30 minutes. Select the code(s) that should be reported for this encounter? A. 96360 B. 96360, 96361 C. 96365, 96366 D. 96422 Question 86 A patient that has multiple sclerosis has been seeing a therapist for four visits. Today’s visit the therapist will be performing a comprehensive reevaluation to determine the extent of progress in parameters and if the patient is reaching his goals for common impairments associated with this neurologic condition, which includes performing activities of daily living, movement, muscle strength and reasoning abilities for independent living. What CPT® and ICD-9-CM codes should be reported? A. 97004, V57.21, 340 B. 97002, V57.1, 340 C. 97003, V57.22, 340 D. 97004, V57.89, 340 Question 87 What is the term used for inflammation of the bone and bone marrow? A. Chondromatosis B. Osteochondritis C. Costochondritis D. Osteomyelitis Question 88 The root word trich/o means: A. Hair B. Sebum C. Eyelid D. Trachea Question 89 Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________. A. Medulla lobe B. Occipital lobe C. Middle lobe D. Inferior lobe Question 90 TRUST THE PROCESS! 22 A patient is having pyeloplasty performed to treat a uretero-pelvic junction obstruction. What is being performed? A. Surgical repair of the bladder B. Removal of the kidney C. Cutting into the ureter D. Surgical reconstruction of the renal pelvis Question 91 27-year-old was frying chicken when an explosion of the oil had occurred and she sustained second-degree burns on her face (3%), third degree burns on both hands (4%), and second degree burns on her lower left arm (3%). There was a total of 10 percent of the body surface that was burned. Select which ICD-9-CM codes should be used. A. 941.20, 944.30, 943.20, 948.10, E924.0 B. 944.30, 941.20, 943.20, 948.01, E924.0 C. 944.30, 941.20, 943.21, 948.10, E924.0 D. 944.30, 946.20, 948.01, E924.0 Question 92 A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic esophageal varices. The ICD-9-CM codes should be reported: A. 456.20, 571.5 B. 456.21, 571.5 C. 571.5, 456.20 D. 456.0, 571.5 Question 93 55 year-old-patient had a fracture of his left knee cap six months ago. The fracture has healed but he still has staggering gait in which he will be going to physical therapy. What ICD-9-CM codes should be reported? A. 822.0, 781.2 B. 905.4, 781.2, 822.0 C. 905.4, 781.2 D. 781.2, 905.4 Question 94 Which statement is true about V codes: A. V codes are never reported as a primary code B. V codes are only reported with injury codes C. V codes may be used either as primary code or secondary code D. V codes do not have to correspond with procedure codes Question 95 Patient with corneal degeneration is having a cornea transplant. The donor cornea had been previously prepared by punching a central corneal button with a guillotine punch. This had been stored in Optisol GS. It was gently rinsed with BSS Plus solution and was then transferred to the patient’s eye on a Paton spatula and sutured with 12 interrupted 10-0 nylon sutures. Select the HCPCS Level II code for the corneal tissue. A. V2790 TRUST THE PROCESS! 25 B. 19102, 174.9 C. 19120, 793.80 D. 19125, 217 Question 105 The patient is a 66-year-old female who presents with Dupuytren's disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren's disease right ring digit and palm. An extensile Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code should be used? A. 26123-RT, 26125 B. 26121-RT C. 26035-RT D. 26040-RT Question 106 This is a 32 year old female who presents today with sacroilitis. On the physical exam there was pain on palpation of the left sacroiliac joint and imaging confirmation was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 mL of bupivacaine at 0.5% was injected into the left sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. The correct CPT code is: A. 20610, 77003-26 B. 20551 C. 27096-LT, 77003-26 D. 20555 Question 107 PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee The patent was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose TRUST THE PROCESS! 26 fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT and ICD-9-CM codes should be reported? A. 29880-RT, 717.0, 727.00, 733.92, 717.7 B. 29881-RT, 717.1, 727.09, 733.92, 717.7 C. 29881-RT, 29822-59-RT, 717.2, 727.09, 733.92, 717.7 D. 29880-RT, 29822-59-RT, 717.2, 727.09, 733.92, 717.7 Question 108 A 61 year-old gentleman with a history of a fall while intoxicated suffered a blow to the forehead and imaging revealed a posteriorly displaced odontoid fracture. The patient was taken into the Operating Room, and placed supine on the operating room table. Under mild sedation, the patient was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy was performed to gently try to reduce the fracture. It did reduce partially without any change in the neurologic examination. More manipulation would be necessary and it was decided to intubate and use fiberoptic technique. The anterior neck was prepped and draped and an incision was made in a skin crease overlying the C 4-C5 area. Using hand-held retractors, the ventral aspect of the spine was identified and the C2-C3 disk space was identified using lateral fluoroscopy. Using some pressure upon the ventral aspect of the C2 body, we were able to achieve a satisfactory reduction of the fracture. Under direct AP and lateral fluoroscopic guidance, a Kirschner wire was advanced into the C2 body through the fracture line and into the odontoid process. This was then drilled, and a 42 millimeter cannulated lag screw was advanced through the C2 body into the odontoid process. What procedure code should be used? A. 22505 B. 22305 C. 22315 D. 22318 Question 109 The patient is a 51 year old gentleman who has end-stage renal disease. He was in the OR yesterday for a revision of his AV graft. The next day the patient had complications of the graft failing. The patient was back to the operating room where an open thrombectomy was performed on both sides getting good back bleeding, good inflow. An arteriogram was shot. There was a small amount of what looked like pseudo-intima in the distal anastomosis of the venous tract that was causing a flow defect which was taken out with a Fogarty catheter. A Conquest balloon was ballooned up again with a 6 millimeter and a 7 millimeter. An arteriogram was reshot in both directions. The arterial anastomosis looked fine as did the venous anastomosis. Select the appropriate codes for this visit: A. 36831-76, 35460-51-76, 75978-26 B. 36831, 35460-51, 75978-26 C. 36831-78, 75791-26, 35460-78, 75978-26 D. 36831-58, 35460-51-58, 75978-26 Question 110 The patient is a 77 year-old white female who has been having right temporal pain and headaches with some visual changes and has a sed rate of 51. She is scheduled for a temporal TRUST THE PROCESS! 27 artery biopsy to rule out temporal arteritis. A Doppler probe was used to isolate the temporal artery and using a marking pen the path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade scalpel the skin was opened in the preauricular area and dissected down to the subcutaneous tissue where the temporal artery was identified in its bed. It was a medium size artery and we dissected it out for a length of approximately 4 cm with some branches. The ends were ligated with 4-0 Vicryl, and the artery was removed from its bed and sent to Pathology as specimen. What code should be used for this procedure? A. 37609 B. 37605 C. 36625 D. 37799 Question 111 50-year-old female has recurrent lymphoma in the axilla. Ultrasound was used to localize the lymph node in question for needle guidance. An 11 blade scalpel was used to perform a small dermatotomy. An 18 x 10 cm Biopence needle was advanced through the dermatotomy to the periphery of the lymph node. A total of 4 biopsy specimens were obtained. Two specimens were placed an RPMI and 2 were placed in formalin and sent to laboratory. The correct CPT code is: A. 10022 B. 38500, 77002-26 C. 38505, 76942-26 D. 38525, 76942-26 Question 112 Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower quadrant transverse incision was made upon entry to the abdomen. In the right lower quadrant there was a large amount of pus consistent with a right lower quadrant abscess. Intraoperative cultures anaerobic and aerobic were taken and sent to microbiology for evaluation. Irrigation of the pus was performed until clear. The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was taken down and tied using 0-Vicryl ties and the appendix fell off completely since it was already ruptured with tissue paper thin membrane at the base. There was no appendiceal stump to close or to tie, just an opening into the cecum; therefore, the appendiceal opening area into the cecum was tied twice using figure of 8 vicryl sutures. Omentum was tacked over this area and anchored in place using interrupted 3-0 Vicryl sutures to secure the repair. What CPT and ICD-9-CM codes should be reported? A. 44950, 540.1 B. 44960, 49905, 540.1 C. 44950, 49905, 540.0 D. 44970, 541 Question 113 15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was digitalized. No significant adenoid tissue was felt. The tonsils were then removed bilaterally by dissection. The uvula was a huge size because of edema, a part of this was removed and the raw surface oversewn with 3-0 chromic catgut. Which CPT code(s) should be used? A. 42821 B. 42825, 42104-51 TRUST THE PROCESS! 30 Question 122 Documentation of a new patient in a doctor’s office setting supports the History in four elements for an extended history of present illness (HPI), three elements for an extended review of systems (ROS) and three elements for a complete Past, Family, Social History (PFSH) . There is an extended examination of six body areas and organ systems. The medical making decision making is of high complexity. Which E/M service supports this documentation? A. 99205 B. 99204 C. 99203 D. 99202 Question 123 Two-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedures to report for the ER physician? A. 99291-25, 36555, 31500 B. 99291, 36556, 31500, 82803 C. 99285-25, 36556, 31500, 82803 D. 99475, 36556 Question 124 2-year-old is coming in with his mom to see the pediatrician for fever, sore throat, and pulling of the ears. The physician performs a brief history along with a problem pertinent review of systems. A limited exam was performed on the ears, nose and throat and respiratory systems. A strep culture was taken and came back positive. A diagnosis was also made of the infant having acute otitis media with effusion. The medical decision making was of moderate complexity with the giving of a prescription. What CPT® and ICD-9-CM codes should be reported? A. 99212, 462, 382.9 B. 99213, 034.0, 381.4 C. 99212, 034.0, 381.00 D. 99213, 034.0, 381.00 Question 125 A very large lipoma is removed from the chest measuring 8 sq cm and the defect is 12.2 cm requiring a layered closure with extensive undermining. MAC is performed by a medically directed Certified Registered Nurse Anesthetist (CRNA). Code the anesthesia service. A. 00400-QS-QX B. 00400-QS C. 00300-QS D. 00300-QS-QX Question 126 PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal. The patient is placed on heart and lung bypass during the TRUST THE PROCESS! 31 procedure. Anesthesia time: 6:00 PM to 12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and anesthesia time? A. 00567, 6 hours B. 00566, 6 hours C. 00567, 5 hours and 30 minutes D. 00566, 5 hours and 30 minutes Question 127 A CT density study is performed on a post-menopausal female to screen for osteoporosis. Today’s visit the bone density study will be performed on the spine. Which CPT code should be used? A. 77075 B. 77080 C. 77078 D. 72010 Question 128 The patient is 15 weeks pregnant with twins coming back to her obstetrician to have a transabdominal ultrasound performed to reassess anatomic abnormalities of both fetuses that were previously demonstrated in the last ultrasound. What code(s) should be used for this procedure? A. 76815 B. 76816, 76816-59 C. 76801, 76802 D. 76805, 76810 Question 129 67-year-old female fractured a port-a-cath surgically placed a year ago. Under sonographic guidance a needle was passed into the right common femoral vein. The loop snare was positioned in the right atrium where a portion of the fractured catheter was situated. The catheter crossed the atrioventricular valve with the remaining aspect of the catheter in the ventricle. A pigtail catheter was then utilized to loop the catheter and pull the catheter tip into the inferior vena cava. The catheter was then snared and pulled through the right groin removed in its entirety. What CPT and ICD-9 codes should be reported? A. 37204, 75960-26, 998.4 B. 37203, 75961-26, 996.1 C. 37203, 75902-26, 999.31 D. 37204, 75894-26, 998.9 Question 130 53-year-old woman with ascites consented to a procedure to withdraw fluid from the abdominal cavity. Ultrasonic guidance was used for guiding the needle placement for the aspiration. What CPT codes should be used? A. 49080, 76942-26 B. 49180, 76942-26 C. 49080, 77002-26 D. 49180, 76998-26 TRUST THE PROCESS! 32 Question 131 Cells were taken from amniotic fluid for analyzation of the chromosomes for possible Down’s syndrome. The geneticist performs the analysis with two G-banded karyotypes analyzing 30 cells. Select the lab codes for reporting this service. A. 88248 B. 88267, 88280, 88285 C. 88273, 88280, 88291 D. 88262, 88285 Question 132 Sperm is being prepared through a washing method to get it ready for the insemination of five oocytes for fertilization by directly injecting the sperm into each oocyte. Choose the CPT® codes to report this service. A. 89257, 89280 B. 89260, 89280 C. 89261, 89280 D. 89260, 89268 Question 133 A pathologist performs a comprehensive consultation and report after reviewing a patient’s records and specimens from another facility. The correct CPT® code to report this service is: A. 88325 B. 99244 C. 80502 D. 88329 Question 134 Patient with hemiparesis on the dominant side due to having a CVA lives at home alone and has a therapist at his home site to evaluate meal preparation. The therapist observes the patient’s functional level of performing kitchen management activities within safe limits. The therapist then teaches meal preparation using one handed techniques along with adaptive equipment to handle different kitchen appliances. The total time spent on this visit was 45 minutes. Report the CPT® and ICD-9-CM codes for this encounter. A. 97530 x 3, 436, 342.91 B. 97535 x 3, 342.91, 438.21 C. 97530 x 3, 438.21, 436 D. 97535 x 3, 438.21 Question 135 10-year-old patient had a recent placement of a chochlear implant. She and her family see an audiologist to check the pressure and determine the strength of the magnet. The transmitter, microphone and cable are connected to the external speech processor and maximum loudness levels are determined under programming computer control. Which CPT® code should be used? A. 92601 B. 92603 C. 92562 D. 92626