CPC PRACTICE EXAM 1 ANSWERS

Sarcoidosis with cardiomyopathy

D86.85 reports sarcoidosis with myocarditis. When we look under cardiomyopathy in the Index, we find this code under Cardiomyopathy, in, sarcoidosis. Although cardiomyopathy and myocarditis are not identical diagnoses, the Index tells us that this is the correct code in this case.

A patient with chronic obstructive pulmonary disease is issued a medically necessary nebulizer with a compressor and humidifier for extensive use with oxygen delivery.

E0570 correctly identifies the nebulizer with compressor, and E0550 correctly identifies the humidifier.

Initial encounter to treat a fracture of the right patella with abrasion

S82.001A is correct. When a fracture is not specified as open or closed, assign a code that indicates a closed fracture. See the S82 section note regarding fractures that states to assign a closed fracture code to a fracture not specified as open or closed. The abrasion code is not assigned because the chapter-specific Guidelines in Section I.C.19.b.1.,

Which of the following is NOT considered fraud or abuse?

Going to lunch with a pharmaceutical representative is not fraud or abuse as long as there is no financial gain by either party.

This term means abnormal thickening of the skin:

pachydermaThis is a

This is a part of the inner ear:

vestibule

Glomerulonephritis due to viral hepatitis.

B19.9 describes unspecified viral hepatitis without mention of hepatic coma, and is the first-listed diagnosis; N05.9, the glomerulonephritis, is listed second.

If the anesthesia service were provided to a patient who had severe systemic disease, what would the physical status modifier be? A. P1 B. P2 C. P3 D. P4

C. P3. The physical status modifiers are found in the Anesthesia section guidelines of the CPT manual. The modifiers are assigned based on the patient's condition at the time of surgery. P3 represents a patient with a severe systemic disease.

This type of anesthesia is also known as a nerve block. A. Local B. Epidural C. Regional D. MAC

C. Regional is also known as a nerve block.

Three-week-old female with obstructive apnea.

P28.4 correctly describes obstructive apnea during the perinatal period (the first 28 days after birth).

The RBRVS is a

RBRVS is a payment reform implemented in 1992.

The term that indicates this is the type of code for which the full code description can be known only if the common part of the code (the description preceding the semicolon) of a preceding entry is referenced

The indented code indicates this is the type of code for which the full code description can be known only if the text preceding the semicolon of a preceding entry is referenced. The CPT manual is formatted in this manner in order to save space.

The middle layer of the skin, also known as the corium or true skin:

dermis

The shaft of a long bone:

diaphysis

Which of the following is a covering of the chamber walls of the heart?

endocardium

OPERATIVE REPORT OPERATIVE PROCEDURE: Excision of back lesion. INDICATIONS FOR SURGERY: The patient has an enlarging lesion on the upper midback. FINDINGS AT SURGERY: There was a 5-cm, upper midback lesion. OPERATIVE PROCEDURE: With the patient prone, the back was prepped and draped in the usual sterile fashion. The skin and underlying tissues were anesthetized with 30 mL of 1% lidocaine with epinephrine. Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 25 Through a 5-cm transverse skin incision, the lesion was excised. Hemostasis was ensured. The incision was closed using 3-0 Vicryl for the deep layers and running 3-0 Prolene subcuticular stitch with Steri-Strips for the skin. The patient was returned to the same-day surgery center in stable postoperative condition. All sponge, needle, and instrument counts were correct. Estimated blood loss is 0 mL. PATHOLOGY REPORT LATER INDICATED: Dermatofibroma, skin of back. Assign code(s) for the physician service only. A. 11406, 12002, D23.5 B. 11424, D21.6 C. 11406, 12032, D23.5 D. 11606, D04.5

11406 identifies the excision of a benign lesion larger than 4 cm; the deep layers were closed, which is a layered or intermediate closure reported in addition to the lesion removal with 12032. Diagnosis code D23.5 is accurate because it describes a benign lesion of the skin of the trunk.

What CPT and ICD-10-CM codes would be used to code a subsequent encounter in which a split-thickness skin graft, both thighs to the abdomen, measuring 45 × 21 cm is performed on a patient who has third-degree burns of the abdomen? Documentation stated 20% of the body surface was burned, with 9% third degree. The patient also sustained second-degree burns of the upper back. A. 15100 × 2, T21.32XD, T21.24XD, T31.0 B. 15100, 15101 × 9, T21.32XD, T21.23XD, T31.20 C. 15100, 15101-51 × 9, T21.32XA, T21.23XA, T31.20 D. 15100, 15101 × 8, T21.32XD, T21.23XD

15100 is the correct code for the first 100 sq cm and 15101 × 9 to report the additional 845 sq cm. To calculate the square centimeters, take 45 cm and multiply it by 21 cm, which equals 945 sq cm. As indicated above, 15100 reports the first 100 sq cm. There is a remaining 845 sq cm. The code description indicates that 15101 is for reporting each additional 100 sq cm "or part thereof." Therefore the additional 845 sq cm is reported with 9 units of 15101 (8 units accounts for an even 800 sq cm. An additional unit of 1 is added to account for the remaining 45 sq cm). 15101 is an add-on code; therefore, the modifer -51 is not appended. Diagnosis code T21.32XD describes third-degree burns of the abdominal wall in a subsequent visit (D). Code T21.23XD describes the second-degree burn of the back. Diagnosis code T31.20 is assigned to explain the percentage of body surface burned and the percentage with third-degree burns, which in this report was 20% and 9% with third-degree burns.

What CPT and ICD-10-CM codes would be used to code the destruction by cryosurgery of a malignant lesion on the skin of the female genitalia measuring 1.6 cm? A. 17272, C51.9 B. 11602, C57.9 C. 11420, C79.82 D. 11622, C51.9

17272 identifies the destruction by cryosurgery of a malignant lesion of the genitalia, lesion diameter 1.1 to 2 cm. Code C51.9 specifies malignant neoplasm of vulva (genitalia, NOS).

SAME-DAY SURGERY DIAGNOSIS: Inverted nipple with mammary duct ectasia, left. OPERATION: Excision of mass deep to left nipple. With the patient under general anesthesia, a circumareolar incision was made with sharp dissection and carried down into the breast tissue. The nipple complex was raised up using a small retractor. We gently dissected underneath to free up the nipple entirely. Once this was done, we had the nipple fully unfolded, and there was some evident mammary duct ectasia. An area 3 × 4 cm was excised using electrocautery. Hemostasis was maintained with the electrocautery, and then the breast tissue deep to the nipple was reconstructed using sutures of 3-0 chromic. Subcutaneous tissue was closed using 3-0 chromic, Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 31 and then the skin was closed using 4-0 Vicryl. Steri-Strips were applied. The patient tolerated the procedure well and was returned to the recovery area in stable condition. At the end of the procedure, all sponges and instruments were accounted for. A. 19120-RT, N60.42 B. 11404-LT, N62 C. 19112, N60.42 D. 19120-LT, N60.42

19120-LT identifies the excision of a single duct lesion of the left breast. N60.42 is the diagnosis code for a mammary duct ectasia of the left breast.

OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Brain tumor versus abscess. PROCEDURE: Craniotomy. DESCRIPTION OF PROCEDURE: Under general anesthesia, the patient's head was prepped and draped in the usual manner. It was placed in Mayfield pins. We then proceeded with a craniotomy. An inverted U-shaped incision was made over the posterior right occipital area. The flap was turned down. Three burr holes were made. Having done this, I then localized the tumor through the burr holes and dura. We then made an incision in the dura in an inverted U-shaped fashion. The cortex looked a little swollen but normal. We then used the localizer to locate the cavity. I separated the gyrus and got right into the cavity and saw pus, which was removed. Cultures were taken and sent for pathology report, which came back later describing the presence of clusters of gram-positive cocci, confirming that this was an abscess. We cleaned out the abscessed cavity using irrigation and suction. The bed of the abscessed cavity was cauterized. Then a small piece of Gelfoam was used for hemostasis. Satisfied that it was dry, I closed the dura. I approximated the scalp. A dressing was applied. The patient was discharged to the recovery room. A. 61154, G06.0 B. 61154, D49.6 C. 61320, G06.0, B96.89 D. 61150, D49.6

61320 identifies a craniotomy with removal of abscess. The report states that the scalp was incised in a U shape. Three burr holes were made. Then the dura was incised in a U-shaped fashion. The creation of the burr holes was followed by a craniotomy; therefore the burr hole procedure is not separately reported. G06.0 is the diagnosis for the intracranial abscess as stated in the report. The category notes for G06 include "Use additional code (B95-B97) to identify infectious agent." The infectious agent was gram-positive cocci (sphere-shaped bacteria) found in the Index under Infection, bacterial, as cause of disease classified elsewhere B96.89

John, an 84-year-old male, tripped while on his morning walk. He stated he was thinking about something else when he inadvertently tripped over the sidewalk curb and fell to his knees. X-ray indicated a fracture of his right patella. With the patient under general anesthesia, the area was opened and extensively irrigated. The left aspect of the patella was severely fragmented, and a portion of the patella was subsequently removed. The remaining patella fragments were wired. The surrounding tissue was repaired, thoroughly irrigated, and closed in the usual manner. A. 27524-RT, S82.001A, W10.1XXA B. 27520-RT, S82.001A, W10.1XXA C. 27524-RT, S82.099A, W19.XXXA D. 27524-RT, S82.001A, W19.XXXA

A. 27524-RT is an open treatment of a right patellar fracture ("...the area was opened...") that includes the placement of internal fixation ("The remaining patella were fragments wired") with modifier -RT to indicate right side. S82.001A is an unspecified closed fracture of the patella; no indication was made that the fracture was open (the bones sticking through the skin). If not stated as open or closed, the fracture is reported as closed. W10.1XXA reports a fall on or from a sidewalk or curb.

The patient was taken to the operating room for a repair of a strangulated inguinal hernia. This hernia was previously repaired 4 months ago. A. 49521, K40.31 B. 49520, K40.00 C. 49492, K40.90 D. 49521-78, K40.31

A. 49521 identifies a recurrent inguinal hernia that is strangulated. Code K40.31 describes a unilateral inguinal hernia, recurrent, strangulated. The statement "This hernia was previously repaired" identifies the hernia as recurrent.

OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Possible recurrent transitional cell carcinoma of the bladder. POSTOPERATIVE DIAGNOSIS: No evidence of recurrence. PROCEDURE PERFORMED: Cystoscopy with multiple bladder biopsies. PROCEDURE NOTE: The patient was given a general mask anesthetic, prepped, and draped in the lithotomy position. The 21-French cystoscope was passed into the bladder. There was a hyperemic area on the posterior wall of the bladder, and a biopsy was taken. Random biopsies of the bladder were also performed. This area was fulgurated. A total of 7 sq cm of bladder was fulgurated. A catheter was left at the end of the procedure. The patient tolerated the procedure well and was transferred to the recovery room in good condition. The pathology report indicated no evidence of recurrence. A. 52224, N32.89, Z85.51 B. 51020, 52204, Z80.52 C. 52234, Z85.51 D. 52224 × 4, D41.4

A. 52224 identifies the cystoscopy with fulguration of minor lesions (hyperemic area) and multiple biopsies. Hyperemia/bladder is indexed to N32.89. The diagnosis code for personal history of bladder cancer is Z85.51. You would not code the possibility of a recurrent cancer because the pathology findings indicated no evidence of recurrence. Also, you never code "possible, maybe, consistent with or rule out" for a diagnosis in an outpatient setting.

OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Herniated disc L4-5 on the left. PROCEDURE PERFORMED: Laminotomy, foraminotomy, removal of herniated disc L4-5 on the left. PROCEDURE: Under general anesthesia, the patient was placed in the prone position and the back was prepped and draped in the usual manner. An incision was made in the skin extending through subcutaneous tissue. Lumbodorsal fascia was divided. The erector spinae muscles were bluntly dissected from the lamina of L4-5 on the left. The interspace was localized. I then performed a generous laminotomy and foraminotomy here, and retracted on the nerve root. It was obvious there was a herniated disc. I removed it, entered the space, and removed degenerating material, satisfied that I had decompressed the root well. There were free fragments lying around beneath the nerve root. We removed all of these. I was able to pass a hockey stick down the foramen across the midline, satisfied I had taken out the large fragments from the interspace at L4-5, and decompressed it well. I irrigated the wound well, put a Hemovac drain in the wound, and then closed the wound in layers using double-knotted 0 chromic on the lumbodorsal fascia with Vicryl 2-0 plain in the subcutaneous tissue, and surgical staples on the skin. A dressing was applied. The patient was discharged to the recovery room. A. 63030-LT, M51.26 B. 63012-LT, M51.46 C. 63047-LT, M51.9 D. 63047-LT, 63048-LT, M51.26

A. 63030-LT identifies the posterior approach hemilaminectomy (laminotomy) and foraminotomy with excision of herniated disc from one interspace, lumbar region (L4-5). Modifier -LT indicates the left side. M51.26 is the diagnosis for the herniated disc, lumbar region (L4-5).

This is the area behind the cornea:

A. anterior chamber

This 66-year-old male has been diagnosed with a senile cataract of the posterior subcapsular and is scheduled for a cataract extraction by phacoemulsification of the right eye. The physician has taken the patient to the operating room to perform a posterior subcapsular cataract extraction with IOL placement, diffuse of the right eye. A. 66982-RT, H25.031 B. 66984-RT, H25.041 C. 66983-RT, H25.031 D. 66830-RT, H25.041

B. 66984-RT is the extracapsular cataract extraction (ECCE), in which the nucleus of the lens capsule and the front (anterior) shell are removed. An intracapsular cataract extraction (ICCE) is when both the lens and the capsule are totally removed intact. Phacoemulsification is a process in which the lens is softened with ultrasound and the fragments are aspirated out of the area and an IOL (intraocular lens) prosthesis is inserted. H25.041 is a posterior subcapsular senile cataract of the right eye, as indicated in the report.

EXAMINATION OF: Abdomen and pelvis. CLINICAL SYMPTOMS: Ascites. CT OF ABDOMEN AND PELVIS: Technique: CT of the abdomen and pelvis was performed without oral or IV contrast material per physician request. No previous CT scans for comparison. FINDINGS: No ascites. Moderate-sized pleural effusion on the right. A. 74160-26, R18.8 B. 74150-26, J90 C. 74150, J90 D. 74160, R18.8

B. 74176-26 identifies the professional component of a CT scan of the abdomen and pelvis without contrast material. J90 is the diagnosis code for the pleural effusion. You would not code the clinical symptoms of ascites when the more definitive diagnosis ruled out ascites and documented pleural effusion.

134. CLINICAL HISTORY: Necrotic soleus muscle, right leg. SPECIMEN RECEIVED: Soleus muscle, right leg. Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 111 GROSS DESCRIPTION: Submitted in formalin, labeled with the patient's name and "soleus muscle right leg," are multiple irregular fragments of tan, gray, brown soft tissue measuring 8 × 8 × 2.5 cm in aggregate. Multiple representative fragments are submitted in four cassettes. MICROSCOPIC DESCRIPTION: The slides show multiple sections of skeletal muscle showing severe coagulative and liquefactive necrosis. Patchy neutrophilic infiltrates are present within the necrotic tissue. DIAGNOSIS: Soft tissue, soleus muscle, right leg debridement; necrosis and patchy acute inflammation, skeletal muscle—infective myositis. A. 88305-26, M60.003 B. 88304-26, M60.061 C. 88307-26, I96 D. 88304-26, M62.561

B. 88304-26 correctly reports the pathology examination of a soft tissue specimen from a debridement and is not suspected of neoplastic behavior, and M60.061 correctly identifies infective myositis (infected and inflamed muscle) of the lower right leg. The soleus muscle is in the calf

Report the global service. CLINICAL HISTORY: Mass, left atrium. SPECIMEN RECEIVED: Left atrium. GROSS DESCRIPTION: The specimen is labeled with patient's name and "left atrial myxoma" and consists of a 4 × 4 × 2-cm ovoid mass with a partially calcified hemorrhagic white-tan tissue. INTRAOPERATIVE FROZEN SECTION DIAGNOSIS: Myxoma. MICROSCOPIC DESCRIPTION: Sections show a well-circumscribed mass consisting of fibromyxoid tissue showing numerous vascular channels. Areas of superficial ulceration and chronic inflammatory infiltrate are noted. Areas of calcification are also present. DIAGNOSIS: Myxoma, benign, left atrium. A. 88305, D49.89 B. 88307-26, 88331-26, D15.1 C. 88307, 88331-26, D15.1 D. 88305, D15.1

B. 88307-26 identifies the pathologic gross and microscopic exam and interpretation of the specimen. 88331-26 identifies the intraoperative consultation with frozen section of the atrium mass. D15.1 is the diagnosis code for the benign neoplasm of the atrium.

DIALYSIS INPATIENT NOTE: This 24-year-old male patient is on continuous ambulatory peritoneal dialysis (CAPD) using 1.5% dialysate. He drains more than 600 mL. He is tolerating dialysis well. He continues to have some abdominal pain, but his abdomen is not distended. He has some diarrhea. His abdomen does not look like acute abdomen. His vitals, other than blood pressure in the 190s over 100s, are fine. He is afebrile. At this time, I will continue with 1.5% dialysate. Because of diarrhea, I am going to check stool for white cells, culture. Next we will see what the primary physician says today. His HIDA scan was normal. The patient suffers from ESRD and has had 6 encounters this month. Code this service. A. 90947, 90960, N18.6, R19.7, Z99.2 B. 90945, N18.6, R19.7, Z99.2 C. 90960, N18.6, Z99.2 Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 122 D. 90945, N18.6

B. 90945 identifies peritoneal dialysis with the physician performing a single evaluation. CAPD is continuous ambulatory peritoneal dialysis. N18.6 reports the end stage renal disease (ESRD). R19.7 is the diagnosis code for the diarrhea; because the physician is addressing the diarrhea, this condition would be reported. Z99.2 is the correct code to show that a patient requires dialysis.

What CPT code would be used to code the technical aspect of an evaluation of swallowing by video recording using a flexible fiberoptic endoscope? A. 92611 B. 92612 C. 92610 D. 92613

B. 92612 correctly identifies the evaluation by video recording of the patient swallowing by means of a flexible fiberoptic endoscope

OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Compound fracture, left humerus, with possible loss of left radial pulse. PROCEDURE PERFORMED: Open reduction internal fixation, left compound humerus fracture. PROCEDURE: While under a general anesthetic, the patient's left arm was prepped with Betadine and draped in sterile fashion. We then created a longitudinal incision over the anterolateral aspect of his left arm and carried the dissection through the subcutaneous tissue. We attempted to identify the lateral intermuscular septum and progressed to the fracture site, which was actually fairly easy to do because there was some significant tearing and rupturing of the biceps and brachialis muscles. These were partial ruptures, but the bone was relatively easy to expose through this. We then identified the fracture site and thoroughly irrigated it with several liters of saline. We also noted that the radial nerve was easily visible, crossing along the posterolateral aspect of the fracture site. It was intact. We carefully detected it throughout the remainder of the procedure. We then were able to strip the periosteum away from the lateral side of the shaft of the humerus both proximally and distally from the fracture site. We did this just enough to apply a 6-hole plate, which we eventually held in place Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 38 with six cortical screws. We did attempt to compress the fracture site. Due to some comminution, the fracture was not quite anatomically aligned, but certainly it was felt to be very acceptable. Once we had applied the plate, we then checked the radial pulse with a Doppler. We found that the radial pulse was present using the Doppler, but not with palpation. We then applied Xeroform dressings to the wounds and the incision. After padding the arm thoroughly, we applied a long-arm splint with the elbow flexed about 75 degrees. He tolerated the procedure well, and the radial pulse was again present on Doppler examination at the end of the procedure. A. 24515-RT, S42.352A B. 24500-LT, S42.392B C. 24515-LT, S42.352B D. 24505-LT, S42.352B

C. 24515-LT indicates open treatment of humeral shaft fracture with plates/screws with modifier -LT to indicate the left side; S42.352B reports comminuted and open fracture of the shaft of the left humerus. The following statement from the operative report confirms that the fracture is of the humeral shaft: "We then were able to strip the periosteum away from the lateral side of the shaft of the humerus both proximally and distally from the fracture site."

OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: 1. Hypoxia. 2. Pneumothorax. POSTOPERATIVE DIAGNOSIS: 1. Hypoxia. 2. Pneumothorax. PROCEDURE: Chest tube placement. DESCRIPTION OF PROCEDURE: The patient was previously sedated with Versed and paralyzed with Nimbex. Lidocaine was used to numb the incision area in the midlateral left chest at about nipple level. After the lidocaine, an incision was made, and we bluntly dissected to the area of the pleural space, making sure we were superior to the rib. On entrance to the pleural space, there was immediate release of air noted. An 18-gauge chest tube was subsequently placed and sutured to the skin. There were no complications for the procedure, and blood loss was minimal. DISPOSITION: Follow-up, single-view, chest x-ray showed significant resolution of the pneumothorax except for a small apical pneumothorax that was noted. A. 32556, R09.02, J93.9 B. 32551, 71010, R09.02, J93.9 C. 32551, J93.9, R09.02 D. 32556, R09.02, J93.0

C. 32551 correctly reports the chest tube placement by thoracostomy ("incision was made ..."). J93.9 reports an unspecified pneumothorax and R09.02 reports the hypoxia.

What CPT and ICD-10-CM codes report a percutaneous insertion of a dualchamber pacemaker by means of the subclavian vein? The diagnosis is sick sinus syndrome, tachy-brady. A. 33249, I47.1, I49.5 B. 33217, I49.5 C. 33208, I49.5 D. 33240, I44.0, I47.1

C. 33208 reports insertion of a permanent dual-chamber (atrial and ventricular) pacemaker with transvenous (by means of a vein) electrode placement. Code I49.5 describes sick sinus syndrome

This 70-year-old male is brought to the operating room for a biopsy of the pancreas. A wedge biopsy is taken and sent to pathology. The report comes back immediately indicating that primary malignant cells were present in the specimen. The decision was made to perform a total pancreatectomy. Code the operative procedure(s) and diagnosis only. Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 58 A. 48100, C78.89 B. 48155, C25.8 C. 48155, 48100-51, C25.9 D. 48155, 48100-51, 88309, C25.9

C. 48155 identifies the total pancreatectomy. 48100-51 indicates an open wedge biopsy of the pancreas with modifier -51 to indicate a multiple procedure. Diagnosis code C25.9 describes the primary malignant neoplasm of the pancreas.

This gentleman has worsening bilateral hydronephrosis. He did not have much of a post void residual on bladder scan. He is taken to the operating room to have a bilateral cystoscopy and retrograde pyelogram. The results come back as gross prostatic hyperplasia with urinary retention as the cause of the hydronephrosis. A. 52005, N40.0 B. 52000, N13.39, N40.1 C. 52005, N40.0, N13.39 D. 52000-50, N13.39, N40.1

C. 52005 identifies a cystoscopy with bilateral ureteral catheterization and injection of dye for a retrograde pyelogram (x-ray of the kidney and ureter). N40.0 is the correct diagnosis code for hyperplasia of prostate. Although the patient has hydronephrosis caused by the prostate problem, there is no mention of lower urinary symptoms. N13.39 indicates "other" hydronephrosis. Hydronephrosis in this case is caused by enlargement of the prostate, which causes urinary retention with backup of urine to the kidneys.

EXAMINATION OF: Chest. CLINICAL SYMPTOMS: Pneumonia. PA AND LATERAL CHEST X-RAY WITH FLUOROSCOPY. CONCLUSION: Ventilation within the lung fields has improved compared with previous study. A. 71020-26, J15.8 B. 71034, J15.8 C. 71023-26, J18.9 D. 71023, J18.9

C. 71023-26 identifies the two views of the chest with fluoroscopy, with modifier -26 to identify only the professional component of the service. J18.9 is the diagnosis code for organism unspecified pneumonia.

This is a patient with atrial fibrillation who comes to the clinic laboratory routinely for a total digoxin level. This test was performed today. A. 80162, 80102, I50.9 B. 81001, Z51.81, Z79.899, I49.01 C. 80162, Z51.81, Z79.899, I48.91 D. 80162, I48.91

C. 80162 identifies the quantitative testing for total digoxin levels in the body. Z51.81 is the correct code for therapeutic drug monitoring. Z79.899 is the correct code for long-term use of digoxin. If you were uncertain what type of drug digoxin is when seeking the correct drug therapy code, you could have looked up digoxin in the Table of Drugs and Chemicals, and looked up the adverse effect codes presented there. This would have given you the information that digoxin is a cardiac stimulant. Because no code specific to cardiac stimulants is available in category Z79, you would know that Z79.899 is the correct choice. I48.91 is the correct diagnosis code for atrial fibrillation, which is a form of tachycardia.

CLINICAL HISTORY: Boil, left groin. SPECIMEN RECEIVED: Necrotic fascia left groin and leg (anterior and posterior). GROSS DESCRIPTION: The specimen is labeled with the patient's name and "fascia left groin and leg" and consists of multiple segments of skin and soft tissue measuring up to 30 cm in greatest dimension. The skin is unremarkable, with the soft tissue being hemorrhagic and friable and foul smelling. MICROSCOPIC DESCRIPTION: Sections of skin and soft tissue show coagulative necrosis with neutrophilic exudates. DIAGNOSIS: Skin and soft tissue, left groin and leg, anterior and posterior showing coagulative necrosis and acute inflammation. A. 88304, L02.92 B. 88305-26, I96 C. 88304-26, I96, L02.224 D. 88305, L03.314

C. 88304-26 identifies the pathology of the skin and soft tissue debrided from the groin and leg. I96 is the code indexed under Necrosis, skin, and L02.224 captures the boil, which is located in the Index under Furuncle, groin. Note that the final diagnosis includes "acute inflammation." This is captured as a common symptom seen in a boil.

Karra Hendricks, a 37-year-old female, is an established patient who presents to the office with right lower quadrant abdominal pain with fever. The patient states she has had the pain for 3 days. She has taken Tylenol for her fever with some relief. The patient does have occasional diarrhea and headaches. She smokes approximately 5-10 cigarettes a day and drinks socially. The physician performs a detailed examination. The medical decision making is noted to be of a moderate complexity. A. 99203, R10.31 B. 99213, R10.32, R50.9 C. 99214, R10.31, R50.9 D. 99221, R10.33, R50.9

C. 99214 reports an office visit. This is an established patient as stated in the first sentence of the report. The HPI included the location (right lower abdominal quadrant), duration (3 days), modifying factors (Tylenol), and associated signs and symptoms (fever) for a detailed HPI. The ROS included 2 elements of gastrointestinal (diarrhea) and neurologic (headaches) for a detailed ROS. Only 1 of the elements of the PFSH was performed (social history) for a detailed PFSH. Even though the HPI is comprehensive, the other two items of this component are detailed. This is a detailed history. The note also included a detailed physical examination with medical decision making of moderate complexity. R10.31 is the correct diagnosis code for right lower quadrant pain and R50.9 is the correct code to report the fever.

A neurological consultation in the emergency department of the local hospital is requested by the ED physician for a 25-year-old male with suspected closed head trauma. The neurologist saw the patient in the ED. The patient had a loss of consciousness this morning after receiving a blow to the head in a basketball game. He presents to the emergency department with a headache, dizziness, and confusion. During the course of the history, the patient relates that he has been very irritable, confused, and has had a bit of nausea since the incident. All other systems reviewed and are negative: Constitutional, ophthalmologic, otolaryngologic, cardiovascular, respiratory, genitourinary, musculoskeletal, integumentary, psychiatric, endocrine, hematologic, lymphatic, allergic, and immunologic. The patient states that he does have a history of headaches and that both parents have hypertension, also a grandfather with heart disease. He also states that he does drink beer on the weekends and does not smoke. Physical examination reveals the patient to be unsteady and exhibiting difficulty in concentration when stating months in reverse. The pupils dilate unequally (anisocoria). The physician continues with a complete comprehensive examination involving an extensive review of neurological function. The neurologist orders a stat CT and MRI. The physician suspects a subdural hematoma or an epidural hematoma and the medical decision making complexity is high. The neurologist admits the patient to the hospital. Assign codes for the neurologist's services only. A. 99285, R41.82, R42, R51, W22.8XXA, Y93.67 B. 99253, R51, R41.82, R42, W22.8XXA, Y93.67 C. 99255, H57.02, R51, R41.0, R42, W22.8XXA, Y93.67 D. 99245, R51, R41.82, R42, W22.8XXA, Y93.67

C. 99255 reports a consultation that takes place in an outpatient department (emergency department) but is followed by an admission to the hospital. Code the inpatient consultation code. The HPI included 4 elements of location (head), timing (this morning), context (basketball game), associated signs and symptoms (loss of consciousness) for an extended HPI. The ROS is complete stating 2 elements of gastrointestinal (nausea) and neurologic (confusion) and all other systems negative for a complete ROS. All 3 of the PFSH elements were included for a complete PFSH. This is a comprehensive history. The service also includes a comprehensive physical exam with high level medical decision making. Code H57.02 describes anisocoria or uneven pupil size. R51 describes headache symptom, code R41.0 describes confusion state, and code R42 describes dizziness. Also report W22.8XXA to indicate the patient was struck by something, initial encounter, and Y93.67 to indicate the patient was struck while playing basketball.

This patient is in for a recurrent herniated disc at L5-S1 on the left. The procedure performed is a repeat laminotomy and foraminotomy at the L5-S1 interspace. A. 63030-LT, M51.27 B. 63030-LT, M51.07 C. 63042-LT, M51.07 D. 63042-LT, M51.27

D. 63042-LT identifies the reexploration of a lumbar interspace with excision of a herniated disc. Modifier -LT indicates the left side was done. M51.27 is the diagnosis of a herniated lumbosacral disc without mention of other symptoms.

PREOPERATIVE DIAGNOSIS: Atelectasis of the left lower lobe. Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 47 PROCEDURE PERFORMED: Fiberoptic bronchoscopy with brushings and cell washings. PROCEDURE: The patient was already sedated, on a ventilator, and intubated; so his bronchoscopy was done through the ET tube. It was passed easily down to the carina. About 2 to 2.5 cm above the carina, we could see the trachea, which appeared good, as was the carina. In the right lung, all segments were patent and entered, and no masses were seen. The left lung, however, had petechial ecchymotic areas scattered throughout the airways. The tissue was friable and swollen, but no mucous plugs were noted, and all the airways were open, just somewhat swollen. No abnormal secretions were noted at all. Brushings were taken as well as washings, including some with Mucomyst to see whether we could get some distal mucous plug, but nothing really significant was returned. The specimens were sent to appropriate cytological and bacteriological studies. The patient tolerated the procedure fairly well. A. 31622, 31623-51, J98.11 B. 31623, P28.0 C. 31623-LT, J98.11 D. 31624, P28.0

C. Code 31623-LT indicates that a lung bronchoscopy with washings and brushings was performed on the left side. Code 31622 identifies a bilateral diagnostic bronchoscopy and also a separate procedure (CPT Assistant, March 2013). As a separate procedure, 31622 would be bundled into 31623. Code J98.11 reports the atelectasis (a condition in which the lung does not completely inflate).

119. The anesthesiologist provides anesthesia services for a kidney harvest from a living donor for transplant. A. 00868 B. 01990 C. 00860 D. 00862

D. 00862 is the correct anesthesia code assigned for a living donor nephrectomy.

OPERATIVE PROCEDURE PREOPERATIVE DIAGNOSIS: 68-year-old male in a coma. POSTOPERATIVE DIAGNOSIS: 68-year-old male in a coma. PROCEDURE PERFORMED: Placement of a triple lumen central line in right subclavian vein. With the usual Betadine scrub to the right subclavian vein area and with a second attempt, the subclavian vein was cannulated and the wire was threaded. The first time the wire did not thread right, and so the attempt was aborted to make sure we had good identification of structures. Once the wire was in place, the needle was removed and a tissue dilator was pushed into position over the wire. Once that was removed, the central lumen catheter was pushed into position at 17 cm and the wire removed. All three ports were flushed. The catheter was sewn into position, and a dressing applied. A. 36011, R40.20X0 B. 36011, R40.20 C. 36556, R40.20X0 D. 36556, R40.20

D. 36556 identifies the placement of a nontunneled central venous catheter for a patient older than the age of 5 years. R40.20 is the correct diagnosis code for an unspecified coma, and the duration is excluded from reporting, according to the instructions under R40.2.

This patient is a 35-year-old at 36 weeks' gestation. She presents in spontaneous labor. Because of her prior cesarean section, she is taken to the operating room to have a repeat lower-segment transverse cesarean section performed. The patient also desires sterilization, so a bilateral tubal ligation will also be performed. A single, liveborn infant was the outcome of the delivery. A. 59510, 58600-51, Z30.2, Z3A.36 B. 59620, 58615-51, O60.14X0, Z38.01, Z3A.36 C. 59514, 58605-51, Z30.2, O34.21, Z3A.36 D. 59514, 58611, O34.21, O60.14X0, Z37.0, Z30.2, Z3A.36

D. 59514 identifies the C-section. 58611 identifies the tubal ligation done at the time of cesarean delivery and is not a separate procedure; rather, it is listed separately in addition to the primary procedure. Modifier -51 is not required because 58611 is an add-on code. O34.21 is the diagnosis code for previous cesarean section. O60.14X0 is the diagnosis code for early onset of delivery before 37 weeks, indicating third trimester and one fetus. Z37.0 is for single, liveborn infant. Z30.2 is the diagnosis code for the encounter for sterilization (tubal ligation). According to the ICD-10-CM Official Guidelines for Coding and Reporting, when a Csection is performed, the reason for the C-section is the principal diagnosis. Code Z3A.36 reports 36 weeks' gestation

OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: FUO. PROCEDURE PERFORMED: Lumbar puncture. DESCRIPTION OF PROCEDURE: The patient was placed in the lateral decubitus position with the left side up. The legs and hips were flexed into the fetal position. The lumbosacral area was sterilely prepped. It was then numbed with 1% Xylocaine. I then placed a 22-gauge spinal needle on the first pass into the intrathecal space between the L4 and L5 spinous processes. The fluid was minimally xanthochromic. I sent the fluid for cell count for differential, protein, glucose, Gram stain, and culture. The patient tolerated the procedure well without apparent complication. The needle was removed at the end of the procedure. The area was cleansed, and a Band-Aid was placed. A. 62272, R68.12 B. 62268, R50.9 C. 62272, R60.9, R50.9 D. 62270, R50.9

D. 62270 indicates aspiration of fluid from the spine (lumbar puncture) for diagnostic purposes. R50.9 correctly reports the only diagnosis listed, that of fever of unknown origin.

PREOPERATIVE DIAGNOSIS: Mechanical ectropion, left lower eye. PROCEDURE PERFORMED: Medial tarsorrhaphy, left lower eye. In the operating room, after intravenous sedation, the patient was given a total of about 0.5 mL of local infiltrative anesthetic. The skin surfaces on the medial area of the lid, medial to the punctum, were denuded. A bolster had been prepared and double 5-0 silk suture was passed through the bolster, which was passed through the inferior skin and raw lid margin, then through the superior margin, and out through the skin. A superior bolster was then applied. The puncta were probed with wire instrument and found not to be obstructed. The suture was then fully tied and trimmed. Bacitracin ointment was placed on the surface of the skin. The patient left the operating room in stable condition, without complications, having tolerated the procedure well. A. 67875-LT, H02.125 B. 67710-LT, H02.135 C. 67882-LT, H02.109 D. 67880-LT, H02.125

D. 67880-LT is an operative procedure in which the surgeon temporarily sutures the eyelid closed; this is used with some conditions of the eyelid in which the margins of the eyelid are rough and irritate the cornea. Before the closure, the surgeon repairs the eyelid, and so when the sutures are removed, the margin irregularity will have been repaired Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 76 and no longer cause irritation. Modifier -LT indicates that the procedure was performed on the left eye. H02.125 correctly describes the condition stated in the report of paralytic (mechanical) ectropion of the left lower eyelid.

This patient is in for a kidney biopsy (50200) because a mass was identified by ultrasound. The specimen is sent to pathology for gross and microscopic Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 112 examination. Report the technical and professional components for this service. The results are pending. A. 88305-26, N28.89 B. 88307-26, N28.9 C. 88307, N28.89 D. 88305, N28.89

D. 88305 identifies the gross and microscopic exam of the kidney specimen and reports both the technical and professional portions of the service, as directed in this case. N28.89 is the diagnosis code for diseases of the kidney that include a mass not otherwise specified. It is found by looking in the Index under Mass, kidney, and verifying in the Tabular List

What CPT code would you use to report a bilirubin, total (transcutaneous)? A. 82252 B. 82247 C. 82248 D. 88720

D. 88720 correctly reports a transcutaneous total bilirubin that uses a subcutaneous tissue sample to measure the bilirubin.

Dr. Black admits a patient with an 8-day history of a low-grade fever, tachycardia, tachypnea, and possible radiologic evidence of basal consolidation of the lung and limited pleural effusion on the left side, per patient as seen at outside clinic several days prior. The patient has also been experiencing swelling of the extremities. The pulse is rapid and thready, as checked by patient on her own during the past couple days. A complete ROS of constitutional factors, ophthalmologic, otolaryngologic, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary, neurologic, psychiatric, endocrine, hematologic, lymphatic, allergic, and immunologic was performed and negative except for the symptoms described above. Past history includes tachycardia and pneumonia. Family history includes heart disease, hypertension and high cholesterol in both parents. The patient drinks only occasionally and quit smoking 4 years ago. The comprehensive examination was performed and diminished bowel sounds were noted. The physician orders laboratory tests and radiographic studies, including a follow-up chest x-ray as he Exam Format A: Final Examination with Answers and Rationales Copyright © 2016 by Elsevier Inc. 84 considers the extensive diagnostic options and the medical decision making complexity is high for this patient. A. 99233, R00.0, R50.9, R06.82, J90, R19.15, Z87.891 B. 99233, R00.0, I47.9, R06.82, J18.1, J90 C. 99223, R00.0, R50.9, R06.82 D. 99223, R50.9, R00.0, R06.82, J90, R19.15, Z87.891, Z82.49

D. 99223 reports a hospital admission. The HPI is comprehensive and contains 4 elements of location (lung), duration (8 days), severity (rapid and thready pulse), and associated signs and symptoms (swelling). A complete ROS was performed and found negative. The PFSH included all 3 elements of past (tachycardia and pneumonia), family (heart disease, hypertension and high cholesterol in both parents), and social (drinks only occasionally and quit smoking 4 years ago). This is a comprehensive history. The description of the service states that this was a hospital admission involving a comprehensive exam and high-complexity medical decision making. R50.9 reports a fever not otherwise specified or of unknown origin, R00.0 indicates unspecified tachycardia, and R06.82 reports tachypnea. J90 is a pleural effusion that is not further specified. R19.15 is abnormal bowel sounds to report "feeble bowel sounds." Z87.891 reports the patient's history of tobacco use and Z82.49 reports the patient's pertinent family history of cardiovascular disease.

A patient is issued a 22-inch seat cushion for his wheelchair

E2602 is for a seat cushion for a wheelchair 22 inches wide or greater, any depth.

A lethargic patient presents with vomiting and severe cramping and the physician determines during the initial encounter that the condition was caused by the ingestion of five tablets of Tylenol with codeine and half a bottle of whiskey.

T40.2X4A (codeine), T39.1X4A (acetaminophen), and T51.0X4A (alcohol, beverage) report initial encounter for treating a patient for poisoning or toxic effects of these substances when it is unknown whether the overdose was intentional. The 7th character "A" indicates the initial encounter. Symptoms of toxic effects are reported with R53.83 (lethargy), R11.10 (vomiting), and R10.9 (abdominal pain and cramping) report the symptoms caused by these substances.

Which HCPCS modifier indicates the great toe of the right foot?

T5 is the great toe of the right foot

This term is also known as a homograft

allograft

Which of the following terms does NOT describe a receptor of the body

endoreceptor