AAPC Quiz A, AAPC Exam B

A patient is given general anesthesia by the anesthesiologist for a carpal tunnel nerve release. After the surgery the anesthesiologist is called to perform an axillary block for postoperative pain management on the same patient. A. 01829, 64417-59 B. 01840, 64417-59 C. 01840, 64417-59 D. 01830, 64417-59

C. 01810, 64417-59

A patient presents to her oncologist's office for scheduled chemotherapy. The patient is severely dehydrated. The physician decides to schedule the chemotherapy for another day and orders hydration therapy to be performed today instead of the chemotherapy. The therapy is ordered and administered for one hour and 10 minutes. A. 96413-53, 96360 B. 96360 C. 96360, 96361 D. 96413, 96361

B. 96360

58-yr-old female has lumbar degenerative spondylolisthesis with severe stenosis & instability. The spinous process of L4 & L5 are decompressed bilaterally by performing a laminectomies, right-sided forminotomies & then left-sided facetectomy completely decompressing the nerve roots as well as the dura. How is this procedure reported? A. 63047, 63048 B. 63030-50, 63035-50 C. 63017 D. 63047-50, 63048-50

A. 63047, 63048

A patient with colon cancer receives five sessions of radiation treatments. During the course of treatments, the physician views the port films, reviews the treatment parameters, and assesses the patient's response to the treatment. The patient receives two more treatment sessions when ending the course of treatment. Code the radiation treatment management. A 77427 B. 77431 X 7 C. 77427 x 2 D. 77427, 77431

A. 77427

A patient with a manic depressive disorder is being treated with lithium. The physician orders a therapeutic drug test to measure the level of lithium. A. 80178 B. 80375 C. 80302 D. 80299

A. 80178

A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to another physician. The physician documents a detailed history. He has had it for the past five months. Sleep is disrupted by ???????????? and getting worse due to anxiety and snoring. Current medication that he is on now is not helping him. Physician also performs a comprehensive exam and moderate MDM. A. 99204 B. 99203 C. 99243 D. 99214

B. 99203

The patient has a history of symptomatic HIV and has been treated for an HIV related illness. A. Z21 B. B20 C. Z26.6 D. B75

B. B20

A neonatal male had an elective circumcision before being discharged home from the newborn nursery. The physician uses a ring block for the local anesthetic and the foreskin is placed over the glans. A clamp is selected for the size of the glans and a constricting circular ring is placed over the foreskin to compress and devascularize the foreskin. The devascularized foreskin is excised with a scalpel and the clamp is left in place. A. 54150 B. 54160 C. 54161 D. 54150-52

A. 54150

A healthy 45-year-old is having a needle thyroid biopsy. The anesthesiologist begins to prepare the patient for surgery at 009:00 am. The surgery begins at 09:16 am and ends at 09:45 am. The anesthesiologist turns over the patient's care to the recovery room nurse at 10:00 am. What is the appropriate anesthesia code and what is his time? A. 00320, One hour B. 00320, 45 minutes C. 00322, 45 minutes D. 00322, One hour

A. 00320, One hour

The left breast was prepped & draped in a sterile fashion. An incision from the 3 around to the 9 o'clock position on the areolar border on its inferior aspect was made in the skin & extended to the subcutaneous tissue. The breast mass was excised by sharp dissection. The mass was found to be approximately 1.5-2 cm in maximum dimension. Hemostasis was made adequate using electrocautery & the Argon beam coagulator. After this was accomplished, the skin margins were reapproximated w/running inverted 3-0 Vicryl subcuticular suture. Select procedure & diagnosis codes. A. 19120, N63 B. 19301, D49.3 C. 19125, N60.82 D. 19101, N64.51

A. 19120, N63

This 25-yr-old male presents with deviated nasal septum. After intubation, a left hemitransfixion incision was made with elevation of the mucoperichondrium. Cartilage from the bony septum was detached & the nasoseptum was realigned & removed in a piecemeal fashion from the obstructed perpendicular plate of the ethmoid. Thereafter, 4-0 chronic was used to approximate mucous membranes. A small amount of silver nitrate cautery was used to achieve hemostasis. A dressing consisted of a fold of Telfa with a ventilating tube for nasal airway on each side achieved good hemostasis, patient went to recovery in good condition. What is the correct code for this procedure? A. 30520 B. 30420 C. 30620 D. 30450

A. 30520

56-year-old with lung cancer developed an effusion that is suspicious for malignancy. Needle aspiration is performed to obtain a sample of the fluid for pathological examination. A needle is inserted between the ribs and into the pleural space, and the fluid is withdrawn. The specimen is sent to pathology. A. 32554 B. 32555 C. 32551 D. 32400

A. 32554

Mr. Y presents to outpatient surgery for placement of a dual chamber pacemaker after multiple attempts to manage his bradycardia medically. Atrial & ventricular leads were placed under fluoroscopic guidance via the subclavian vein. Testing confirmed appropriate placement & conduction. The left chest was then infiltrated with epinephrine & a pocket was opened for placement of the generator. The leads were attached to the generator & the generator was programmed. Appropriate pacing was confirmed. The skin pocket was closed in layers & dressing placed. Select the appropriate CPT codes. A. 33208 B. 33213, 33217 C. 33235, 33208 D. 33214

A. 33208

A 67-year-old male patient is referred for a flex sigmoidoscopy exam to remove polyps. The physician found three polyps in the rectosigmoid junction. They were removed by biopsy forceps. The path report indicated the polyps were benign. A. 45333 B. 45315 C. 45384 D. 45346

A. 45333

PREOPERATIVE DIAGNOSIS: History of prior colon polyps. POSTOPERATIVE DIAGNOSIS: Colon polyps diverticulosis, hemorrhoids. PROCEDURE: A rectal exam was performed & revealed small external hemorrhoids. The video colonoscope was passed without difficulty from anus to cecum. The colon was well prepped. The instrument was slowly withdrawn with good views obtained throughout. There was a 3 mm polyp in the proximal ascending colon. This polyp was removed with hot biopsy forceps & retrieved. There was a 4 mm rectal polyp located 10 cm from the anus in the proximal rectum. The polyp was removed by hot biopsy forceps. There was also moderate diverticulosis extending from the hepatic flexure to the distal sigmoid colon. Code the CPT procedure(s). A. 45384 B. 45385 C. 45388 D. 45384 x 2, 45378-59

A. 45384

The patient is a 25-year-old G2P1 female at 13 weeks with a molar pregnancy. She has had irregular bleeding for one week. Ultrasound was performed yesterday and the physician confirms a 16 week size uterus with hydatidiform molar pregnancy. She is admitted today for an evacuation and curettage. A. 59870, O01.9 B. 59812, O02.89 C. 57505, O02.0 D. 59160, O01.9

A. 59870, O01.9

22-yr-old has had no prenatal care. Fundal height indicates a term fetus & by dates it is determined she is 38 weeks pregnant. Few hours prior to admission to Labor & Delivery her membranes ruptured spontaneously. She does not have a fever, but the physician performs a rapid antigen test for group B strep. An enzyme immunoassay method is performed. Physician obtains a lower vaginal swab, then observes that it visually shows the patient is negative for the antigen. If clinical risk factors appear, intrapartum antibiotics will be initiated. Which lab test is reported? A. 87802 B. 87653 C. 86317 D. 87450

A. 87802

Left heart catheterization retrograde from the femoral artery with injection procedures for selective coronary angiography and selective left ventriculography, including imaging supervision and interpretation with report, are performed. The cardiologist performed all of the services at the hospital A. 93458-26 B. 93459-26 C. 93452-26 D. 93460-26

A. 93458-26

Mary, who has food allergies, came to her physician for her weekly allergen immune therapy that consists of two injections prepared & provided by the physician. The correct code is? A. 95125 B. 95117 C. 95144 D. 95146

A. 95125

Physician performs a medical review & documentation on an 83-yr-old patient who has been in the hospital for the last two days with confusion. Problem focused exam where she is alert & oriented x 3 today. Low medical decision making by ordering an echocardiogram & to continue IV fluids. Patient is not safe to return home. What CPT code should be reported for this visit? A. 99231 B. 99221 C. 99224 D. 99234

A. 99231

In order to use the critical care codes, which of the following statements is TRUE? A. Critical care services can be provided in an internist's office. B. Critical care services provided for more than 15 minutes but less than 30 minutes should be billed with 99291 & modifier 52. C. Time spent reviewing laboratory test results or discussing the critically ill patient's care with other medical staff in the unit or at the nursing station on the floor cannot be included in the determination of critical care time. D. Physician can provide services to another patient during the same time providing critical care services to a critically ill patient.

A. Critical care services can be provided in an internist's office

A 67-year-old newly diagnosed with DM type 1 is being seen in the office today for dietetic training with the office's dietitian. The training was for an hour and covered special diet instructions, blood glucose monitoring, and instruction on how to administer daily insulin injections. Which HCPCS Level II codes(s) will be reported for this session. A. G0108 x 2 B. G0109 x 2 C. A9275, A4211 D. S9214

A. G0108 x 2

Mr. Jones is here today to receive an intercostal nerve block to mitigate the debilitating pain of his malignancy. His treatment is for the cancer that has metastasized to his right lung. Select ICD-10-CM's? A. G89.3, C78.01 B. C34.91, G89.3 C. G89.3, C34.91 D. C78.01, G89.3

A. G89.3, C78.01

Which of the following anatomical sites have septums? A. Nose, heart B. Kidney, lung C. Sternum, coccyx D. Orbit, ovary

A. Nose, heart

While playing softball a 12-yr-old boy sustains a blowout fracture. What is the anatomical location? A. Orbit B. Clavicle C. Patella D. Femur

A. Orbit

Lordosis is a disorder of which anatomical site? A. Spine B. Hand C. Male genitalia D. Nasal sinus

A. Spine

When coding for a patient who has had a primary malignancy of the thyroid cartilage that was completely excised a year ago, which of the following statements is TRUE? A. When the cancer is surgically removed with no further treatment provided & there is no evidence of any existing primary malignancy, code Z85.80. B. When further treatment is provided & there is evidence of an existing metastasis, code first Z85.80 & then C32.9. C. Any mention of extension, invasion, or metastasis to another site is coded as a D49.1, Z85.80. D. When the cancer is surgically removed but the patient is receiving chemotherapy treatment report Z85.80

A. When the cancer is surgically removed with no further treatment provided & there is no evidence of any existing primary malignancy, code Z85.80.

A healthy 11-month-old patient with bilateral cleft lip & palate undergoes surgery. The surgeon performs a bilateral cleft lip repair, single stage. Code the anesthesia service. A. 00170-P1, 99100 B. 00102-P1 C. 00102-P1, 99100 D. 00170-P1

C. 00102-P1, 99100

Angiograms reveal three artery blockages. The patient has COPD, which is a severe systemic disease. The patient undergoes a CABG x 3 venous grafts on cardiopulmonary bypass & cell saver. Code the anesthesia service. A. 00562-P3 B. 00560-P4 C. 00567-P3 D. 00566-P4

C. 00567-P3

A 65-year-old patient presented with actropion of the right eyelid. Repair with tarsal wedge excision is performed of correction. Attention was then directed to the left eye. The patient also had an ectropion of the left lower lid, which was repaired by suture. A. 67916-50 B. 67916-E4, 67914-E2 C. 67914-50 D. 67141

B. 67916-E4, 67914-E2

The patient presents with burning urination & frequency. Physician performs a UA dipstick, which shows elevated WBC. He orders a urine culture with identification for each isolate to determine which antibiotic to give to the patient for the infection. What are the appropriate lab codes? A. 81000, 81007 B. 81002, 87088 C. 81001, 87086 D. 87086, 87088

B. 81002, 87088

A 56-year-old receives general anesthesia for an open pleura biopsy. An anesthesiologist medically directs two other cases, and medically directs a CRNA on this case. What are the anesthesia codes and modifiers reported for the anesthesiologist and CRNA. A. 00540-AA, 00540-QZ B. 00540-QK, 00540-QX C. 00541-AA, 00540-QZ D. 00541-QK, 00541-QX

B. 00540-QK, 00540-QX

INDICATIONS: 55-yr-old female had a sizeable 1.5 cm basal cell carcinoma on the right upper lip. She had a 2 cm defect. After excision, it was reconstructed in a first stage with a nasolabial cheek flap. The margins were clear & she planned for the second stage. OPERATIVE PROCEDURE: Under intravenous sedation, patient in supine position, the ace was prepped & draped. Division performed to the bridge between the base of the flap of the upper lip. Unfurled the base of the flap that was excised until it was soft & pliable. It is defatted & laid back onto the cheek with interrupted 5-0 Monocryl & running 6-0 plain catgut. Similar procedure was performed on the redundant portion of the flap & permanently set into the upper lip. Steri-strips applied. A. 15758-79 B. 15630-58 C. 15758-76 D. 15630-78

B. 15630-58

A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions on his face are destroyed and five actinic keratoses on his left arm are destroyed. A. 17000, 17003 B. 17000, 17003 x 4, 17110 C. 17110 D. 17260 x 5, 17110 x 3

B. 17000, 17003 x 4, 17110

A surgical specimen was removed from the proximal jejunum during a resection for adenocarcinoma and was submitted to surgical pathology for gross and microscopic examination. A. 88307 B. 88309 C. 88304 D. 88305

B. 88309

25-yr-old male has a ruptured distal biceps tendon at the proximal end of the radius. An incision is made overlying the antecubital fossa. The biceps tendon was tagged using #1 Vicryl-suture. The second incision made on the superior border of the ulna. The supinator was incised deep to expose the radial tuberosity. Drill holes are made at the radial tuberosity in which sutures & the distal biceps tendon are placed in the hole of the radial tuberosity. Two sutures are placed in the biceps tendon in horizontal mattress type fashion pulled tight & secured. The distal biceps tendon is reattached to the radius to restore elbow function. Closure was then accomplished with sutures & staples. What is the correct code for this procedure? A. 24342 B. 24340 C. 23430 D. 23440

B. 24340

A grade I, high velocity type 1 open right femur shaft fracture was incurred when a 15-yr-old female pedestrian was hit by a car. She was taken to the operating room within four hours of her injury for thorough irrigation & debridement, including excision of devitalized bone. The patient was then re-prepped, re-draped, & repositioned, intramedullary rodding was then carried out with proximal & distal locking screws. What are the correct codes for this diagnosis & procedure? A. 27506, 11044-51, S72.301B, V03.90XXA, Y93.01 B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01 C. 27507, 11012-51, S72.301A, V03.90XXA, Y93.01 D. 27507, 11044-51, S72.91XA, V03.90XXA, Y93.01

B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01

Patient with RUQ pain & nausea suspected of having a stone or other obstruction in the biliary tract is brought in for ERCP under radiologic guidance. PROCEDURE: The patient was brought to the outpatient endoscopy suite & placed supine on the table. The mouth & throat were anesthetized. Under radiologic guidance, the scope was inserted thru the oropharynx, esophagus, stomach, & into the small intestine. The ampulla of Vater was cannulated & filled w/contrast. It was clear that there was an obstruction in the common bile duct. The endoscope was advanced retrograde to the point of the obstruction, which was found to be a stone that was removed with a stone basket. The rest of the biliary tract was visualized & no other obstructions or anomalies were found. The scope was removed without difficulty. The patient tolerated the procedure well. A. 47554, 74363-26 B. 43264, 74328-26 C. 43265, 74328-26 D. 43275, 74329-26

B. 43264, 74328-26

PROCEDURE: Endoscopic retrograde cholangiopancreatogram with stent placement and antral biopsy. INDICATIONS: 50-year-old male who underwent liver transplantation for end-stage liver disease secondary to chronic hepatitis C and hepatocellular carcinoma in 01/2007. The patient has chloestatic liver enzymes, requiring ERCP before placement of a 7-French 12 cm stent and to evaluate the biiary system. DESCRIPTION OF PROCEDURE: The patient was taken to the fluoroscopy suite in the GI lab where he was found to be alert and oriented x 3. After discussing risks and fenefits of the procedure, informed consent was obtained. Patient was kept in the semi prone position. After adequate conscious sedation, an Olympus side-viewing therapeutic scope was inserted through the mouth all the way to the second portion of the duodenum. Then, the common bile duct was cannulated and the cholangiogram was obtained. After the fluoroscopy evaluation of the choangiogram a 12 cm stent was deployed for biliary drainage. A biopsy from the antrum was obtained. The patient tolerated the procedure well. There were no immediate complications. A. 43276, 43261-51 B. 43274, 43261-51 C. 43266, 43239-51 D. 43212, 43202-51

B. 43274, 43261-51

A patient comes in for surgery today to address complications from his previous partial enterectomy performed 5 mos. ago. Upon reopening the patients previous incision the surgeon resected the ileum & a portion of the colon. An ileocolostomy was performed to complete the procedure with no complications. The appropriate CPT code is? A. 44144 B. 44160 C. 44150 D. 44205

B. 44160

A patient with rectal bleeding underwent a proctosigmoidoscopy that showed she had two internal hemorrhoids. The anus was prepped and draped. A field block with marcaine 0.25% was then placed. There was an internal prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by applying two bands. In the posterior midline, there was another internal hemorrhoid that was banded in the same manner. A. 0249T B. 46221 C. 46945 D. 46930

B. 46221

Newborn male is scheduled for a circumcision. He is sterilely prepped & draped; a penile nerve block is performed. The circumcision is performed by a ring device. Hemostasis is achieved. Vaseline Gauze dressing applied. Patient tolerated the procedure well. How would this encounter be coded? A. 54160 B. 54150 C. 54161, 64450 D. 54150, 64450

B. 54150

A laparoscopic assisted total hysterectomy is planned for a patient who has severe intramural fibroids. After inserting the laparoscope, extensive adhesions are noted to the extent that the ligaments supporting the uterus cannot be visualized. The physician decides to convert the procedure to an open abdominal hysterectomy in which the uterus & cervix are removed. What CPT code(s) should be reported? A. 58262, 58570-53 B. 58150 C. 58260, 58550-22 D. 58570

B. 58150

A 30-year-old disable Medicare patient is scheduled for surgery due to the discovery of what looks like an ovarian mass on the right ovary. On entering the abdomen, the surgeon finds an enlarged ovarian cyst on the right, but the ovary is otherwise normal. The left ovary is necrotic looking. The decision is made, based on the patient's age to remove the cyst from the right ovary and to remove the entire left ovary and fallopian tube. A. 58920, 58940-51 B. 58925, 58720-59 C. 58925-50, 58720-50-59 D. 58920-50, 58700-50-59

B. 58925, 58720-59

A 42-year-old patient was in the hospital three days ago in which a lumbar puncture was performed to find the etiology of the patient's headaches. Today his is in the neurology clinic because after having the lumbar puncture the headaches have increased in intensity over the past three days. The neurologist examines the patient and finds a CSF leak from the lumbar puncture. A blood patch is performed by epidural injection to repair the leak. A. 62272 B. 62273 C. 62270, 62273 D. 62270, 62282

B. 62273

A 63-year-old woman presented to the eye clinic as with symptoms of flashing lights and floaters in the right eye for two days. The opthalmologist dilates her eyes and checking her with an indirect opthalmoscope, revealing peripheral retinal break. The physician explains to the patient that there is high likelihood of retinal detachment. The patient agrees to have the procedure done. The physician lasers the retinal tear and tells the patient to come back in 24 hours for follow-up. A. 67210 B. 67145 C. 67220 D. 67141

B. 67145

What is the full CPT code description for 61535. A. Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) C. For removal of epidural of subdural electrode array, without exicision of cerebral tissue (separate procedure) D. For excision of epileptogenic gocus without electrocorticography during surgery; for removal of epidural or subdural electrod array, without excision of cerebra tissue (separate procedure)

B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure)

55-yr-old female presents to the office with ongoing history of diabetes which has been controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetes on her left great tow. Patient is recommended to see a general surgeon for treatment of the gangrene on her left great toe. Select the diagnosis codes to report. A. E10.610,Z79.4 B. E11.52, Z79.4 C. E10.52, Z79.2 D. E11.610, Z79.2

B. E11.52, Z79.4

A 35-year-old female returns to her primary care provider for follow up of an upper respiratory infection diagnosed the previous week. Her condition has not improved and her cough has increased. She has a long history of smoking and currently smokes one pack a day. She uses a bronchodilator for her chronic bronchitis which is caused by her smoking history. The physician changes her antibiotics to treat both her chronic and acute bronchitis. A. J44.9, Z72.0 B. J20.9, J41.0, Z72.0 C. J20.9, Z72.0 D. J41.0, J20.9, Z72.0

B. J20.9, J41.0, Z72.0

Which of the following services are covered by Medicare Part B? A. Inpatient chemotherapy B. Minor surgery performed in a physician's office C. Routine dental care D. Assisted living facility

B. Minor surgery performed in a physician's office

The physician is called in to perform repairs for a 17-year-old girl involved in a motor vehicle accident. She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm laceration to her chest. The wound on her chin required a layered closer. All other wounds required complex closure. A. 13132, 13133 x 4, 13101, 12052 B. 13132, 13133 x 3, 13133-52, 13101, 13102, 12052 C. 13132, 13133 x 3, 13101, 13102, 12052 D. 13131, 13132, 13133 x 3, 13101, 13102, 12052

C. 13132, 13133 x 3,13101, 13102, 12052

INDICATION: Patient has a hypertrophic scar on the posterior side of the left leg, at the level of the knee. This has begun to restrict his mobility. His physical therapy trial was unsuccessful. PROCEDURE: After the proper induction of anesthesia, the subcutaneous tissue of the patient's left leg beneath the scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was then excised down to viable dermis. Hemostasis was obtained with epinephrine soaked pads. Skin was created by the surgery. The graft was secured with skin staples, and then dressed with fine mesh guaze followed by medication-soaked gauze. The donor site was dressed with mesh followed by Adaptic followed by a dry dressing and an Ace wrap. A. 15110-52, 15002 B. 15100, 11406 C. 15100, 15002 D. 15110, 15002

C. 15100, 15002

INDICATIONS: 15-yr-old boy was burned in a fire & assessed to have received burns to 75% of his total body surface area. He was transferred to a burn center for definitive treatment. Once stable, he was brought to the OR. PROCEDURE: Due to extent of the patients burns & lack of sufficient donor sites, his full-thickness burns will be excised & covered with xenograft (skin substitute graft), & a split-thickness skin biopsy will be harvested for preparation of autologous grafts to be applied in the coming weeks, when available. After induction of anesthesia, extensive debridement of the full-thickness burns was undertaken. Attention was first directed to the patients face, neck, & scalp. A total of 500 sq cm in this area received full-thickness burns. The eschar involving this area was excised down to viable tissue. Hemostasis was achieved using electrocautery. Attention was then turned to the trunk. A total of 950 sq cm in this area received full-thick burns. The eschar involving this area was excised down to viable tissue. Hemostasis was achieved. Attention was then turned to the arms & legs. A total of 725 sq cm received full-thick burns. The eschar involving this area was excised down to viable tissue. Hemostasis was achieved. Attention was then turned to the hands & feet. A total of 300 sq cm in this area received full-thick burns. The eschar involving this area was excised down to viable tissue. All involved areas were then covered with xenograft. Finally a split thickness skin graft of 0.015 in, in depth was harvested using a dermatome from a separate donor site. A total of 85 sq cm was recovered. What procedures codes would be reported service? A. 15200, 15201 x 123, 15004, 15005, 15002, 15003 B. 15275, 15276 x 31, 15271, 15272 x 66, 15004, 15005 x 16, 15002, 15003 x 7 C. 15277, 15278 x 7, 15272, 15274 x16, 15004, 15005 x7, 15002, 15003 x 16, 15040 D. 15130, 15131 x 7, 15135, 15136 x 16, 15004, 15005 x 7, 15002, 15003 x 16

C. 15277, 15278 x 7, 15272, 15274 x16, 15004, 15005 x7, 15002, 15003 x 16, 15040

A 35-year-old female patient with acute onset of severe pain since October. Her workup has revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative findings were consistent with two large fragments of free disk fragments in the foramen at C5-C6 on the right side. After general anesthesia, the patient was placed on the operative table in the supine position. All pressure ???????????????????????ed and a transverse skin incision was fashioned under fluoroscopic guidance over the C5-C6 disc space. Dissection through the platysma eventually allowed for exposure of the anterior entrance to the vertebral body of C5 and C6 and retractors were inserted to maintain adequate exposure. ????????????????? allowed exposure. A complete discectomy was performed at C5-C6 by using endplate curets pituitary rongeurs and Kerrison rongeurs. The posterior longitudinal ligament was resected and beneath the posterior longitudinal ligament, two significant sized disc fragments were noted in the foramen at C5-C6. These were removed using pituitary and Decker instruments. The endplates were then decorticated so that they were parallel to each other and a midline keel was performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody Kineflex-C device was placed under fluoroscopic guidance. Satisfied with the positioning of the device, the decision was made to close. A. 63075 B.63081 C. 22856 D. 22554

C. 22856

Patient is seen in the hospital's outpatient surgical area witha diagnosis of a displaced comminluted closed fracture of the lateral condyle, right elbow. An ORIF procedure was performed, which included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees. It was possible to manually reduce the quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. A. 24579-RT, 29065-51-RT, S42.451B B. 24577-RT, S42.451A C. 24579-RT, S42.451A D. 24575-RT, S42.451B

C. 24579-RT, S42.451A

A 62-yr-old female with three-vessel disease & supraventricular tachycardia, which has been refractory to other management. She previously had pacemaker placement & stenting of the coronary artery stenosis, which has failed to solve the problem. She will undergo CABG with autologous saphenous vein & a modified MAZE procedure to treat the tachycardia. The risks & benefits have been discussed & the patient wishes to proceed. She is brought to the cardiac OR & placed supine on the OR table. She is prepped & draped & adequate endotracheal anesthesia is assured. A median stemotomy incision is made & cardiopulmonary bypass is initiated. The endoscope is used to harvest an adequate length of saphenous vein from her left leg. This is uneventful & bleeding is easily controlled. The vein graft is prepared & cut to the appropriate lengths for anastomosis. Three bypasses are performed, on to the LAD, one to the circumflex & another distally on the circumflex. A modified maze procedure was then performed & the patient was weaned from bypass. Once the heart was once beating on its own again, we attempted to induce an arrhythmia & this could not be done. At this point, the sternum was closed with wires & the skin reapproximated with staples. The patient tolerated the procedure without difficulty & was taken to the PACU. Choose the procedure code(s) for this service. A. 33512, 33254-51, 33508 B. 33535, 33254-51, 33508 C. 33512, 33257, 33508 D. 33512, 33257-51, 33508-51

C. 33512, 33257, 33508

A 55-year-old man with complaints of an elevated PSA of 6.5 presents to the outpatient surgical facility for prostate biopsies. The patient is placed in the lateral position. Some calcifications were found in the right lobe, with no obvious hypoechogenic abnormality. The base of the prostate was infiltrated and random ?????? performed under ultrasonic guidance by the physician. His interpretation was reported in the record. A. 10022 B. 55706 C. 55700, 76942-26 D. 55705, 76942-26

C. 55700, 76942-26

Patient has consented for further testing to determine the extent of her cervical dysplasia. A cervical cone biopsy of endocervical tissue was cut using a laser. It was tagged with a single stitch. Dilation & curettage was performed. Small amount of tissue was obtained & sent to pathology. Which procedure code(s) should be used? A. 57520, 58120 B. 57461 C. 57520 D. 57500, 57505

C. 57520

OPERATION: Replacement of shunt valve with medium pressure ventriculo-peritoneal shunt assembly with in-line 0-25 Aesculap Shunt Assistant Implant ICP Monitor. PROCEDURE: After obtaining general anesthesia, patient prepped & draped. Right parietal scalp incision was reopened & shunt catheter identified. The shunt reservoir was delivered from the wound & the distal catheter freed from it. Abdominal incision reopened, shunt passer was used to bring the distal catheter from the head wound to the abdominal wound. The old ventricular catheter was removed. A new ventricular-catheter was inserted into the tract of the old catheter & fed. Good flow seen. It was then attached to the shunt reservoir that was then seated after attaching a 0-25 shunt assistant valve to it. The distal catheter was then fed into the peritoneal cavity. Subcutaneous tissues were closed in multi-layer fashion & skin with staples. Patient tolerated the procedure well & taken to PICU in stable condition. Code this procedure. A. 62223, 62225-51 B. 62258, 62160 C. 62230, 62225-51 D. 62256, 62225-51

C. 62230, 62225-51

A 78-yr-old with lower back pain & leg pain is scheduled for a MRI of lumbar spine w/out contrast. Following the MRI, the patient is diagnosed with spinal stenosis of the lumbar region. What are the procedure & diagnosis codes? A. 72020-26, M54.5, M79.606, M48.06 B. 72149-26, M48.06 C. 72148-26, M48.06 D. 72158-26, M48.07, M54.5, M79.606

C. 72148-26, M48.06

A 32-year-old pregnant female has gestational diabetes at 34 weeks gestation. Her doctor is concerned about decreased fetal movement. The patient is sent to the radiology department of the hospital for a biophysical profile (BPP). The radiologist performs and interprets four elements scored by the ultrasound and is was reassuring. 8/8. A non-stress test will be performed by the obstetrician at the patient's next office visit. What is the correct code for the fetal profile. A. 76818 B. 76815 C. 76819 D. 76820

C. 76819

The physician performs the following tests on her automated equipment: HDL, total serum cholesterol, triglycerides, and a quantitative glucose. A. 83718, 82465, 84478, 82947 B. 83721, 82465, 82951 C. 80061, 82947 D. 80061. 82950

C. 80061, 82947

Which of the following coding combinations is an example of unbundling? A. 80048, 80061 B. 80076, 80300 C. 80061, 83718, 84478 D. 82310, 82355, 82374

C. 80061, 83718, 84478

Patient presents to the ED w/crushing chest pain radiating down the left arm & up under the chin. There are elevated S-T segments on EKG. The cardiologist sees & admits the patient to CCU. He orders three serial CPK enzymes levels w/instructions that the tests are also to be done with isoenzymes if the initial tests are elevated for that date of service. The CPK enzyme levels were elevated, the lab codes would be: A. 82550, 82552, 82550-76 x 2, 82552-76 x 2 B. 82550, 82552, 82552-91 x 2 C. 82550, 82550-91 x 2, 82552, 82552-91 x 2 D. 82550 x 3, 82554 x 3

C. 82550, 82550-91 x 2, 82552, 82552-91 x 2

69-yr-old female has been having chest tightness. Cardiologist orders percutaneous transluminal coronary angioplasty (PCTA) of the right coronary artery & left anterior descending coronary artery. The procedure revealed atherosclerosis in the native vessel of the left anterior descending coronary artery & right coronary artery. Stents were inserted in both arteries to keep the arteries opened. Patient was placed under moderate conscious sedation during the procedure for a total of 30 minutes. What CPT codes should be reported for this procedure? A. 92928-LT, 92929-RT B. 92928-LD, 92929-RC, 99144 C. 92928-LD, 92928-RC D. 92928-LD, 92928-RC, 99144

C. 92928-LD, 92928-RC

A plastic surgeon is called to the ED at the request of the ED physician to evaluate a patient that arrived w/multiple facial fractures that may need surgery. Patient was in an auto accident & an opinion is needed for reconstructive surgery. The plastic surgeon arrived at the ED, obtains detailed history & performs a detailed exam. The plastic surgeon performs a moderate medical decision making, in deciding that the patient needs major surgery to repair the injuries. The plastic surgeon schedules the patient for surgery the next day & documents her full note w/findings in the ED chart. The E/M service reported by the plastic surgeon is: A. 99284-57 B. 99243-32 C. 99243-57 D. 99284-32

C. 99243-57

Which of the following statements regarding advanced beneficiary notices (ABN) is TRUE: A. ABN must specify only the CPT code that Medicare is expected to deny. B. Generic ABN which states that a Medicare denial of payment is possible, or the internist is unaware whether Medicare will deny payment or not is acceptable. C. An ABN must be completed before delivery of items or services are provided. D. An ABN must be obtained from a patient even in a medical emergency when the services to be provided are not covered.

C. An ABN must be completed before delivery of items or services are provided.B. Minor surgery performed in a physician's office

70-yr-old had fallen breaking her jaw. She has had difficulty eating after having her jaw wired. Her doctor ordered a stationary parenteral nutrition infusion pump for her TPN. A seven day supply of a parenteral home mix nutrition supply kit was also given. What HCPCS Level II codes are reported? A. B9000, B4220 x 7 B. B9004, B4222 C. B9006, B4222 x 7 D. B9006, B4172

C. B9006, B4222 x 7

Which of the following is an example of fraud? A. Reporting the code for ultrasound guidance when used to perform a liver biopsy B. Reporting a biopsy and excision performed on the same skin lesion during the same encounter C. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physicians office D. Reporting a lab panel with an additional lab test that is not included in the lab panel

C. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physicians office.

Following the MUGA scan, the physician documents that the patient has developed congestive heart failure as an adverse affect of the Trastuzumab she received as a treatment for her breast cancer. Thetrastuzumab antineoplastic antibiotic therapy is being discontinued while the heart failure management is attempted pharmaceutically. A. I50.9, T45. 1X4A, Z85.3 B. I50.9, T45. 1X1A, C50.919 C. I50.9, T45. 1X5A, C50.919 D. ?????????????????????

C. I50.9, T45. 1X5A, C50.919

What is orchitis? A. Inner ear imbalance B. Lacrimal infection C. Inflammation of testis D. Inflammation of an ilioinguinel hernia

C. Inflammation of testis

A patient has an insulin pump of 100 units. The pump is filled. Which code reports the supply? A. J1817 B. J1815 x 20 C. J1817 x 2 D. J1835

C. J1817 x 2

A pediatrician examines an adolescent that has a thoracic curvature of the spine which is called? A. Sclerosis B. Osteochondrosis C. Kyphosis D. Neurofibromatosis

C. Kyphosis

Which of the following patients might be documented as having meconium staining? A. Woman with renal failure B. Teenage boy with sickle cell anemia C. Newborn with pneumonia D. Man with alcoholic cirrhosis of liver

C. Newborn with pneumonia

32-yr-old delivered a baby girl one week ago via cesarean section. She is in the obstetrician's office with complaint of her cesarean would bleeding. The wound is cleaned & a small hematoma removed. The edges are pulled with steri-strips, & a clean dressing is applied. What ICD-10-CM code reported? A. L76.02 B. O90.1 C. O90.2 D. O82

C. O90.2

The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A laparoscopy found several small cysts in the area of the fallopian tubes. These cysts are called: A. Follicle cysts B. Myomas C. Paratubal cysts D. Accessory ovary cysts

C. Paratubal cysts

42-yr-old male was previously treated with external fixation of an ankle trimalleolar fracture. He is now presenting with a nonunion fracture of the trimalleolar. What is the ICD-10-CM code to report? A. S82.853D B. S82.853S C. S82.853K D. S82.53XA

C. S82.853K

The mother, at 38-weeks gestation, advances to severe pre-eclampsia during labor. Fetal heart rate decelerations during contractions are not improved with the administration of oxygen, so low traverse cesarean section is performed in the hospital. There is evidence of intrauterine growth retardation. The male infant weighs 1587 gm and has Apgars of 3 and 5. Select the ICD-10-CM codes for the newborn's chart. A. Z37.0, P00.0, P03.811, P05.9 B. Z38.01, P00.0, P03.810, P05.9 C. Z38.01, P00.0, P03.811, P05.9 D. Z37.0, P00.0, P03.810, P05.9

C. Z38.01, P00.0, P03.811, P05.9

Patient is admitted in labor for delivery. She received a labor neuraxial epidural for a vaginal delivery. The baby goes into fetal distress & a cesarean section is performed. Following delivery the patient starts to hemorrhage. The physician decides, with family approval, to perform a hysterectomy. Code the anesthesia services. A. 01967, 00840 B. 01962 C. 01968 D. 01967, 01969

D. 01967, 01969

Patient complains of chronic/acute arm & shoulder pain following bilateral carpal tunnel surgery. Patient is followed by pain management for over a year. Physician finally diagnoses patient with reflex dystrophy syndrome (RSD). Physician performs six trigger point injections into four muscle groups. Code the procedure(s). A. 20552 B. 20553 x 6 C. 20551 x 6 D. 20553

D. 20553

Which of the following place of service codes is reported for fracture care performed by an orthopedic physician in the ED? A. 11 B. 20 C. 22 D. 23

D. 23

Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is placed prone position. A needle is placed under fluoroscopic guidance into the SI joint and a mixture of 20 mg of Celestone and Marcaine is injected for pain relief. A. 27096, 77003-26 B. 20611 C. 20552 D. 27096

D. 27096

OPERATION: Dual chamber transvenous implantable pacing cardioverter-defibrilator system implantation with leads. INDICATIONS: A 67-year-old white gentleman has significant underlying ischemic cardiomyopathy with EF of 25 percent, prior infarcts, remote history of syncope, and at a high risk for malignant ventricular arrhythmias. He has had a recent T wave alternans test which was clearly abnormal. He has had episodes of resting bradycardia, also noted. He meets Madit II criteria for insertion of a transvenous implantable pacing cardioverter-defibrilator (ICD) PROCEDURE: After informed consent had been obtained, the patient was brought to the outpatient hospital lab in the fasting state. The left anterior chest was prepped and draped in a sterile fashion. Intravenous sedation and local anesthetic were given. After local anesthetic were given. After local anesthetic, a 5 cm incision was made at the left deltopectoral groove. With blunt dissection and cautery, this was carried down through the prepectoralis fascia. The cephalic vein was identified and ligated distally. Through the venotomy, a subclavian venogram was performed to provide a roadmap. The atrial and ventricular leads were then advanced into the vessel to the level of the right atrium under fluoroscopic guidance. The ventricular lead was maneuvered to the right ventricular outflow tract, and then through the RV apex where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in diaphragmatic capture. The atrial lead was maneuvered to the anterolateral right atrial wall where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in diaphragmatice capture. A subcutaneous pocket was created with good hemostasis achieved. The pocket was subsequently irrigated with solution of Bacitracin. The generator was connected to the lead, and then placed in the pocket with no tension on the lead. The deep fascial layer was closed with interrupted 2-0 Vicryl suture. The subcutaneous closure wa made with running 4-0 Vicryl suture. Steri-strips were applied. Ventricular fibrillation was induced with a T wave shock. This was successfully sensed and terminated with a 15 joule shock to sinus rhythm. High voltage impedence was 39 ohms. Dry dressing was placed over the wound. The patient returned to the floor in stable condition without apparent complications. A 33200 B.33249, 76000-26 C. 33241, 33242, 33249 D. 33249

D. 33249

A 67-yr-old female has CAD, atrial fibrillation, claudication & several chronic conditions that have been marginally controlled with medication. The doctor decided that the benefits outweigh the risks for her having a single vessel cardiopulmonary bypass using an arterial graft. Her medication Heparin has been stopped for several days. She was admitted in the hospital a day before the surgery. In the operating room, general anesthesia was administered. After the chest is opened the patient begins to hemorrhage & drops in blood pressure. The decision is made to stop the procedure & close the chest. How should this service be coded? A. Service is not coded due to not completing the procedure B. 33533-52 C. 33533-74 D. 33533-53

D. 33533-53

The physician performs a selective catheterization of the right renal artery and renal angiography. The puncture site was the right femoral artery. A. 36251-RT, 36200-51, 75625-26 B. 36245-RT C. 36215-RT, 36200-51, 75625-26 D. 36251-RT

D. 36251-RT

The patient comes in today to have an arteriovenous fistula created to facilitate dialysis. The surgeon performs an upper arm basilic vein transposition based on the patient's previous arterial duplex scan A. 36825 B. 36830 C. 36818 D. 36819

D. 36819

A patient with esophageal cancer is brought to the OR for subtotal esophagectomy. A thoracotomy incision is made & the esophagus is identified. The tumor is carefully dissected free of the surrounding structures. No invasion of the aorta or IVC is identified. The cervical esophagus is controlled with pursestring sutures & then transected above the sternal notch. The esophagus is then dissected free of the stomach & the entire specimen is removed from the chest cavity & sent to pathology. The stomach is then pulled into the chest cavity & anastomosed to the remaining cervical esophageal stump. The anastomosis is tested for patency & no leaks are found. Hemostasis is assured. The chest is examined for any signs of additional disease but is grossly free of cancer. The check is closed in layers & a chest tube is place through a separated stab incision. The patient tolerated the procedure well & was taken to the PACU in stable condition. A. 43101 B. 43117 C. 43107 D. 43112

D. 43112

An injection is performed to anesthetize a nerve located between two ribs to block chest wall pain. A. 64415 B. 64421 C. 64413 D. 64420

D. 64420

Physician is performing an intracapsular cataract extraction. The anterior chamber of the eye is entered performing an anterior capsulotomy using forceps. The lens nucleus was hydrodissected & loosened. Using phacoemulsification unit, the lens nucleus was divided & emulsified. Cortical & capsular fragments were removed. The anterior chamber & capsule bag inflated. Using lens inserter an intraocular lens prosthesis, Cystalens, was inserted & rotated to the horizontal position. Topical solution applied, conjunctiva repositioned over the wound with wet field cautery & patch applied. Which CPT code(s) should be used? A. 66984, 66985 B. 66983, 66985 C. 66985 D. 66983

D. 66983

22-yr-old driver lost control of her car & crashed into a light pole on the highway. She arrived at the hospital, had CT scans w/out contrast of the brain & chest. She had X-rays of the AP & PA views of her left ribs & AP & PA views of her right ribs with a posterioanterior view of the chest. The CT scan of the brain showed a fracture of the skull base with no hemorrhage of the brain. The CT of the lung showed no puncture of the lungs. The X-ray showed fractures in the R & L 2nd, 3rd, & 5th ribs. What CPT & ICD-10-CM codes should be reported? A. 70450-26, 71250-26, 71101-26, S02.10XA, S22.43XA, V47.32XA, Y92.411 B. 70450-26, 71260-26, 71110-26, S02.01XA, S22.49XB, V47.0XXA, Y92.411 C. 70450-26, 71250-26, 71111-26, 71010-26, S01.10XA, S22.49XA, V47.32XA, Y92.411 D. 70450-26, 71250-26, 71111-26, S02.10XA, S22.43XA, V47.52XA, Y92.411

D. 70450-26, 71250-26, 71111-26, S02.10XA, S22.43XA, V47.52XA, Y92.411

Physician orders an ultrasound on patient 25 wks pregnant with twins to access fetal heart rate & fetal position. Select the code(s). A. 76805, 76810 B. 76811, 76812 C. 76816 x 2 D. 76815

D. 76815

The patient is admitted to the hospital for a radio 16 channel EEG to determine the focus of her cerebral seizures. The test also consists of video recording and interpretation with nurse attendance. The EEG is performed in 12 hours. A. 95950-26 B. 95953-26-52 C. 95951-26 D. 95956-26-52

D. 95956-26-52

A patient is coming in to have osteopathic manipulative treatment (OMT) performed on two root lesions in his cervical region and three root lesions in the throracic region. Which code is reported by the physician for the OMT. A. 98927 B. 98940 C. 98940 D. 98925

D. 98925

A 65-year-old established patient is coming in for a pre-op visit. He is getting a liver transplant due to cirrhosis. The physician performs an expanded problem-focused history, detailed exam, and moderate MDM. Patient agrees with his physician's recommendations and the transplantation will take place as scheduled. After the evaluation, the patient expresses a number of concerns and questions for the prospective liver transplant. Physician spends an additional 45 minutes, excluding the time spent performing the E/M service, in answering questions and addressing his concerns regarding the surgery and discussing possible outcomes. A. 99213, 99403 B. 99214, 99358 C. 99213, 99356 D. 99214, 99354

D. 99214, 99354

The patient is a 35-year-old male who presents to the emergency department (ED) after several hours of low back pain, nausea and chills. The ED physician takes a detailed history and performs a comprehensive examination. A urinalysis lab and CT of the abdomen is ordered. The results of the CT show two small kidney stones. The ED physician discusses the results with the patient and tells him the stones are small and will pass on their own. Medical decision making (MDM) of moderate complexity is made with the patient being discharged, with a prescription of pain medication, and a diagnosis of kidney stones. A. 99285, N20/0, M54.5, R11.2, R68.83 B. 99284, M54.5, R11.2, R68.83, N20.0 C. 99283, N20.0 D. 99284, N20.0

D. 99284, N20.0

A two-month-old returns for a well checkup & several shots (Rota, DTaP-HepB-IPV, Pneumococcal PCV13) with her pediatrician. He offers suggestions to the mom, completes the exam, & counsels her on the vaccinations. How should this be coded? A. 99391-25, 90460, 90461 x 2, 90680, 90723, 90670 B. 99381-25, 90471, 90472 x 2, 90474, 90680, 90700, 90648, 90670 C. 99381-25, 90471, 90472 x 3, 90680, 90723, 90670 D. 99391-25, 90460 x 3, 90461 x 4, 90680, 90723, 90670

D. 99391-25, 90460 x 3, 90461 x 4, 90680, 90723, 90670

At the request of the mother's obstetrician, a neonatologist is called to attend the birth of an infant being delivered at 29 weeks gestation. During delivery, the neonate was pale & bradycardic needing resuscitation. Neonatologist performs the suctioning & bag ventilation on this 1000 gram neonate was performed with 100 percent oxygen. Brachycardia worsened, requiring endotracheal intubation & insertion of an umbilical line for fluid resuscitation. Later this critically ill neonate was moved from the delivery room & admitted to the NICU with severe respiratory distress & continued hypotension. What are the appropriate procedure codes reported by the neonatologist? A. 99465, 99468 B. 99465, 99464, 99468-25, 31500-59, 36510-59 C. 99468, 99464 D. 99465, 99468-25, 31500-59, 36510-59

D. 99465, 99468-25, 31500-59, 36510-59

According to the CPT Appendix L, when performing a selective vascular catheterization, which vessels would you pass through to place the catheter into the right middle cerebral artery? A. Innominate, right common carotid, right external carotid B. Innominate, right subclavian & axillary C. Left common carotid, left internal carotid D. Innominate, the right common, & internal carotid

D. Innominate, the right common, & internal carotid

The root metr/o means? A. Menstruation B. Breast C. Mammary gland D. Uterus

D. Uterus

Which of the following Z codes categories can only be reported as a first listed diagnosis code? A. Z67 B. Z69 C. Z58 D. Z03

D. Z03