CPC Practice Exam F

Procedure Diagnosis: Basal cell carcinoma, left chin. Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell carcinoma of the left chin with a 4 cm closure. Procedure: The patient's left chin was examined. The site of intended excision was marked out. The site was then prepped. The patient was then prepped and draped in the usual fashion. A 15 blade scalpel was then used to make an incision in the previously marked site. It was carried down to the subcuticular fat. The lesion was then sharply dissected off underlying tissue bed using a 15-blade scalpel. It was tagged for pathologic orientation. The hyfrecator was used for hemostasis. The wound was then closed by advancing the tissue surrounding the lesion and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin. The skin closure was in a running subcuticular fashion. Steri-Strips were then applied. What are the procedure and diagnosis codes? A. 11644, 12052-51, C44.319 B. 11643, 12013-51, C44.319 C. 11444, 12052-51, D49.2 D. 11443, 12013-51, D49.2

A. 11644, 12052-51, C44.319 You need to first find out if this lesion is benign or malignant. For this scenario the patient has a basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as they deal with benign lesions. Now you need to find out where the lesion is located and the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm + .3 cm = 3.6 cm, leading you to code 11644. CPT® subsection guidelines for Excision-Malignant Lesions state: For excision of malignant lesion(s) requiring intermediate or complex closures should be reported separately. For this scenario the wound was closed in two layers qualifying the closure to be coded with an intermediate repair of the chin (4 cm), 12052. The diagnosis, basal cell carcinoma of the chin, look in the ICD-10-CM Table of Neoplasms, for Neoplasm, neoplastic/skin NOS/face NOS/basal cell carcinoma C44.31-. In the Tabular List complete the code with the 6th character 9.

This 45-year-old male presents to the operating room with a painful mass of the right upper arm. General anesthesia was induced. Soft tissue dissection was carried down thru the proximal aspect of the teres minor muscle. Upon further dissection a large mass was noted just distal of the IGHL(inferior glenohumeral ligament), which appeared to be benign in nature. With blunt dissection and electrocautery, the 4.5 cm mass was removed en bloc and sent to pathology. The wound was irrigated, and repair of the teres minor with subcutaneous tissue was then closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. What is the correct CPT® code for this service? A. 23076 B. 23066 C. 23075 D. 23077

A. 23076 The selection of codes are based on the anatomic location, the deepness of the excision, and the size of the tumor/mass. This patient is having a mass removed from the shoulder area, eliminating multiple choice B, which is a biopsy. This is not a radical resection because that includes removal of the entire tumor along with large surrounding tissue, including adjacent lymph nodes. The size of the mass that was excised was 4.5 cm, which leads you to code 23076.

A 47-year-old patient was previously treated with external fixation for a type IIIA open left tibia fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Interfragmentary compression was applied and three screws and the harvested bone graft were packed into the fracture site. What are the correct codes for this diagnosis and procedure? A. 27724, S82.102N B. 27758, S82.202S C. 27722, S82.202P D. 27759, S82.102N

A. 27724, S82.102N

.Impingement syndrome left shoulder. 2. AC synovitis left shoulder Procedure: Arthroscopy with subacromial decompression and AC resection left shoulder. Procedure Description: The patient was placed supine on the operating table and prepped and draped in usual sterile fashion. The scope was introduced from a posterior portal and the joint was inspected. The rotator cuff looked in good condition. The articular surfaces looked good. The bicep also was in good condition. We went subacromially and there was a fair amount of bursal inflammation encountered. We did a thorough bursectomy. A ligament chisel was used to take down the coracoacromial ligament. A high-speed bur was used to do a subacromial decompression going from lateral to medial. We took off about 2 cm of bone anteriorly. Part of the acromion is surgically corrected. Next we opened the AC joint through an anterosuperior portal. High-speed bur was used to grind off about 10 mm of distal clavicle because there was a large subchondral cyst and we wanted to get this totally ground out, which we did. Then the wounds were irrigated out, Nylon suture was placed in our portals. The patient was placed in a bulky dressing and an arm sling and sent to the recovery room in stable condition. What CPT® codes are reported? A. 29824-LT, 29826-LT B. 29825-LT, 29827-LT C. 23120-LT, 23130-LT D. 29827-LT, 29826-LT

A. 29824-LT, 29826-LT This surgery is being performed by arthroscopy, eliminating multiple choice answer C, which is an open procedure code without using any type of scope. The key words in the operative note are "subacromial decompression" with release of the coracoacromial ligament was performed, leads you to code 29826. The scenario does not mention that the physician lyses and resects adhesions, eliminating multiple choice answers B and D. 29824 is performed when the physician grinds off (technique used to remove) 10 mm of "distal clavicle" due to a cyst.

Preoperative Diagnosis: Lower left inguinal pain Postoperative Diagnosis: Inguinal hernia Procedure: Laparoscopic reduction of inguinal hernia with mesh Indications: This 30 year-old patient presented with lower left inguinal pain and on examination was found to have a left inguinal hernia. The decision to perform a left inguinal hernia repair was made. The procterm-46edure was performed in the outpatient hospital surgery center. Risks and benefits of the surgery were discussed with the patient and the patient decided to proceed with the surgery. Procedure Description: A skin incision was placed at the umbilicus where the left rectus fascia was incised anteriorly. The rectus muscle was retracted laterally. Balloon dissector was passed below the muscle and above the peritoneum. Insufflation and deinsufflation were done with the balloon removed. The structural balloon was placed in the preperitoneal space and insufflated to 10 mm Hg carbon dioxide. The other trocars were placed in the lower midline times two. The hernia sac was easily identified and was well-defined. It was dissected off the cord anteromedially. It was an indirect sac. It was taken back down and reduced into the peritoneal cavity. Mesh was then tailored and placed overlying the defect, covering the femoral, indirect, and direct spaces, tacked into place. After this was completed, there was good hemostasis. The cord, structures, and vas were left intact. The trocars were removed. The wounds were closed with 0 Vicryl for the fascia, 4-0 for the skin. Steri-Strips were applied. The patient was awakened and carried to the recovery room in good condition, having tolerated the procedure well. What are the correct procedure and diagnosis codes? A. 49650-LT, K40.90 B. 49651-LT, 49568, K40.90 C. 49650-LT, K40.20 D. 49652-LT, K40.20

A. 49650-LT, 550.90 The selection of the CPT® code is based on the type of hernia and clinical presentation of the hernia (reducible, incarcerated, or strangulated). To start narrowing down your choices, you need to identify the type of hernia. The operative note indicates that it is an inguinal hernia. This eliminates code 49652. Next does the operative note mention if the hernia is recurrent, incarcerated or strangulated? No, so this eliminates code 49651. Add-on code 49568 (mesh) is not coded. According to CPT® guidelines the mesh is reported only with hernia repair codes 49560-49566. There is a parenthetical note under add-on code 49568 indicating which codes to report it with. In the ICD-10-CM Alphabetic Index look for Hernia/inguinal/unilateral referring you to K40.90. The operative note does not document that there were bilateral hernias, code K40.20 is not reported; making answer choices C and D incorrect.

A pathologist performs a comprehensive consultation and report for surgical pathology on referred material that involves reviewing a patient's records, specimens and official findings from other sources after a surgery. What is the correct code? A. 88325 B. 99244 C. 80505 D. 88329

A. 88325 The selection of the code is based on the timing of the consultation, such as during surgery or not, the data to be reviewed such as the specimens or medical history. E/M code 99244 is not reported because the patient was not evaluated or examined. Code 88329 is not reported because that is if the consultation was performed during a surgery. The pathologist is presented with specimens, medical records for review and a report on referred material for surgical pathology. This eliminated code 80505 which is for clinical consultation reviewing pathology and laboratory findings (eg., radiology findings).

The term paracentesis found in CPT® code 49082 means: A. A procedure performed to drain fluid that has accumulated in the abdominal cavity B. Biopsy of an abdominal mass C. Removal of tissue samples from the abdominal cavity by an open approach D. Removal of a cyst located in the abdominal cavity

A. A procedure performed to drain fluid that has accumulated in the abdominal cavity The term breaks down as follows: prefix par or para refers near, beside or outside and the suffix -centesis refers to puncture or insertion of the insertion of a needle to withdraw fluids. As it relates to code 49082 the surgical procedure is performed by inserting a needle in the abdominal (peritoneal) cavity to drain fluid that has accumulated, or to obtain a fluid sample for testing.

What is ascites? A. Fluid in the abdomen B. Enlarged liver and spleen C. Abdominal malignancy D. Abdominal tenderness

A. Fluid in the abdomen

Complete this series: Pulmonary, Aortic, Mitral, and ________are valves of the heart. A. Tricuspid B. Superior Vena Cava C. Carotid D. Atrium

A. Tricuspid

The anesthesiologist performed MAC (monitored anesthesia care) for a patient undergoing an arthroscopy of the right knee. Code the anesthesia service. A. 01382-AA B. 01382-AA-QS C. 01400-AA D. 01400-AA-QS

B. 01382-AA-QS In this case MAC is performed, which requires modifier QS. This eliminates answer options A and C. The selection of the code is based on the procedure being diagnostic or surgical. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was performed, eliminating choice D. Because the service was provided by an anesthesiologist, modifier AA is appended to the anesthesia code. Anesthesia modifiers are found in your HCPCS Level II codebook.

A 55-year-old male presents in the office with an ingrown toenail on the right and left foot. The procedure was discussed in detail and the patient elected to have it performed. The right foot was prepped and draped in sterile fashion. The right great toe was anesthetized with 50/50 solution of 2 percent lidocaine and .05 percent Marcaine. A mini-tourniquet was placed around the toe for hemostasis in which part of the nail plate and matrixectomy were performed. Phenol was then applied, the toe was then flushed. Tourniquet was released and dressing applied. At this time the patient elected to only have one performed and will return in two weeks for the left foot. Code the procedure. A. 11765-T5 B. 11750-T5 C. 11730-T5 D. 11740-T5

B. 11750-T5

The patient presented for medial meniscal bucket-handle tear left knee. Arthroscopy with partial medial meniscectomy left knee and arthroscopic picking (drilling pick holes) of the lateral femoral condyle left knee was performed. Code the procedure and diagnosis codes. A. 29880-LT, 29879-51-LT, S83.212A B. 29881-LT, 29879-51-LT, S83.212A C. 29882-LT, 29885-51-LT, S83.282A D. 29881-RT, 29885-51-LT, S83.242A

B. 29881-LT, 29879-51-LT, S83.212A One way to narrow down the choices is to code for the diagnosis first, which is a medial meniscus tear of the left knee. In the ICD-10-CM Alphabetic Index, look for Tear/meniscus/medial/bucket-handle; you are referred to code S83.21-. Complete code in the Tabular List, S83.212A. You eliminated choices C and D. 29881 (medial OR lateral) is the correct procedure code, because the menisectomy (removing torn fragments) was performed on the medial meniscus only.

Pre-Operative Diagnosis: Right lung mass Indications: Patient with a mass in the right lung identified on routine X-ray presents for bronchoscopy and biopsy. Procedure: Bronchoscopy with lung biopsy Procedure Description: The patient was brought to the endoscopy suite and the mouth and throat were anesthetized. The bronchoscope was inserted and advanced through the larynx to the bronchus. The bronchoscope was introduced into the right bronchus. Using fluoroscopic guidance, the tip of the bronchoscope was maneuvered into the area of the mass. A closed biopsy forceps was passed through the channel in the bronchoscope and then through the bronchial wall. A tissue sample was obtained. There were no other abnormalities appreciated in the right side and the bronchoscope was removed. The specimen was labeled and sent to pathology for testing. The patient tolerated the procedure well. Pathology indicates that the lung mass is cancer. What are the procedure and diagnosis codes reported? A. 31628, R22.2 B. 31628, C34.91 C. 31628, 31622-51, C34.91 D. 31625, R22.2

B. 31628, C34.91

Diagnostic esophagogastroduodenoscopy of the esophagus, stomach, and duodenum was performed after esophageal balloon dilation (less than 30 mm diameter) was done at the same operative session. Code the procedure(s). A. 43249, 43235-51 B. 43249 C. 43220, 43200-51 D. 43220

B. 43249 Patient is having an esophagogastroduodenoscopy, eliminating multiple choice answers C and D, which reports an esophagoscopy. Your key terms to look for are "balloon dilation" which is in code description 43249. Code 43235 is noted as a separate procedure and a diagnostic procedure which means it is included in a surgical endoscopy (43249) when performed at the same time, not coded separately

A 42-year-old has a lesion on his pancreas. The physician passes the biopsy needle through the skin and removes tissue to be sent to pathology. Fluoroscopic guidance is used to obtain the biopsy. Physician's report and interpretation is placed in the record. Code this encounter. A. 48100, 77002-26 B. 48102, 77002-26 C. 48120, 76942-26 D. 48102, 76942-26

B. 48102, 77002-26 first listed CPT® code is based on the technique used to obtain the sample. The physician inserts the needle through the skin which indicates this is a percutaneous approach and not an open procedure. Answer options A and C can be eliminated. Fluoroscopic guidance was used, which is reported with 77002 for this type of procedure.

A 70-year-old with significant pelvic prolapse and grade IV cystocele who has failed previous primary repair and is status post hysterectomy. She presents for anterior repair and colpopexy. Procedure: Patient placed in the dorsal lithotomy position and general anesthetic was induced without problems. A midline incision is made from just above the bladder neck to the vaginal cuff. She is noted to have a grade IV cystocele. Vaginal flaps were dissected to the level of the pubocervical fascia. Her vaginal mucosa was in good condition but near the urethra and bladder neck it was a little thinner. There is significant scarring on the left side from previous procedures. Ishcial spine is identified and swept fiber fatty tissue off of the sacrospinous ligament bilaterally. No scarring or adhesions in this area. Anterior needles were passed into place on the elevate mesh and these were fixed in a manner similar to the MiniArc. They were passed along just below the bladder neck toward the obturator foramen and fixed in place. An anterior support was created without tension at the vesicourethral junction. Apical needles were then used to pass the apical arms into place. There were gently fixed into place along the sacrospinous ligament approximately 2cm away from the ischial spine. This was done bilaterally. They passed in a single pass and were fixed in place confirmed by gentle tugging on both arms. Three Vicryl sutures had been placed and the vaginal apex were then passed over into the mesh and tied down. The apical arms were placed through the eyelets of the mesh and passed down toward the sacrospinous ligament bilaterally to create good apical support. Eyelet fasteners placed bilaterally and mesh arms trimmed providing excellent apical and anterior support. Vaginal mucosa was closed and vaginal packed placed. No complications. What CPT® code(s) describe(s) this procedure? A. 57250, 57280 B. 57240, 57282 C. 57240, 57283 D. 57250, 57283

B. 57240, 57282

A 52-year-old male has a 3.2 cm metastasized lung cancer in his left upper lobe. The tumor cannot be removed by surgery due to the patient having severe respiratory conditions. He will be receiving stereotactic body radiation therapy management under image guidance. There is a delivery of 25 Gy for four fractions under direct supervision of the radiation oncologist. The patient's treatment set up is assessed to manage the execution of the treatment to make any adjustments needed for accuracy and safety. The oncologist reviews and approves all the images used to locate the tumor and images of fields arranged to deliver the dose. What CPT® and ICD-10-CM codes should be reported? A. 77373, Z51.0, C34.92 B. 77435, Z51.0, C78.02 C. 77435, C78.02, Z51.0 D. 77402, C34.92, Z51.0

B. 77435, V58.0, 197.0 Documentation supports stereotactic body radiation therapy, treatment management. This eliminates multiple choices A and D. According to ICD-10-CM guidelines (Section I.C.2.e.2): If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy, assign code Z51.0 (radiation), Z51.11 (chemotherapy), or Z51.12 (immunotherapy) as the first listed or principal diagnosis, and the diagnosis or problem for which the service is being performed as a secondary diagnosis. For the metastasized or secondary neoplasm in the left upper lobe lung, look in the Table of Neoplasm for Neoplasm/lung/upper lobe/Malignant Secondary referring you to code C78.0-. Complete code in the Tabular List, C78.02.

A 22-year-old comes into the Emergency Department with convulsions. The ED physician orders a drug screening without identifying any specific drug class to be tested. The lab runs two drug classes screening using an immunoassay multiplex strip (dipstick) and the results are visually read. The lab report comes back positive for alcohol and benzodiazepines. The ED physician then orders a confirmatory test to be performed by the lab to confirm both positive results. What CPT® codes are reported? A. 80307, 80320, 80346 B. 80305, 80320, 80346 C. 80305 x 2, 80320, 80346 D. 80306 x 2, 80320 x 2, 80346 x 2

B. 80305, 80320, 80346 The selection of codes are based on identifying the possible use or non-use of a drug class or drug. To report codes for drug testing depends on the testing method used. The scenario documents the immunoassay dipstick method, guiding you to code 80305. CPT® subsection guidelines for Presumptive Drug Class Screening indicates to report 80305 once, irrespective of the number of direct observation drug class procedures performed or results on any date of service. A drug confirmation was performed for both the alcohol and benzodiazepines, report codes 80320 for alcohol and 80346 for benzodiazepines.

Patient is undergoing in vitro fertilization to get pregnant. Following the retrieval of follicular fluid from the patient, the physician uses a microscope to examine the fluid to identify the oocytes. What is the code for the laboratory service? A. 89250 B. 89254 C. 89255 D. 89258

B. 89254

In the inpatient setting, the psychiatrist provides psychotherapy for 30 minutes to affect a change in the patient's maladaptive behavior. What is the procedure code? A. 90845 B. 90832 C. 90847 D. 90853

B. 90832

CC: Shortness of breath History: A 62-year-old female returns to a family practice having shortness of breath for the last week. It has been two years since her last visit to the practice. She also has nausea, diaphoresis, chest pressure. Past History: Celebrex® for her arthritis. Hysterectomy 1 year ago. Social History: Smoker-No Alcohol-No Allergies: Penicillin PHYSICAL EXAM Vital Signs: BP 195/95 sitting, left arm General/Constitutional: Mild distress. Some diaphoresis. Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions. Neck/Thyroid: Supple, without adenopathy or enlarged thyroid. Respiratory: Shallow breathing, no wheezing. Cardiovascular: Unequal pulses in both arms. Abnormal heart sounds heard. EKG ordered. Assessment/Plan Severe exacerbation of congestive heart failure Patient is sent to the hospital to be admitted. Will send hospital orders to start her on IV, order chest X-ray and CBC. A. 99202 B. 99215 C. 99204 D. 99214

B. 99215 · High for number and complexity of problem addressed at the encounter - 1 acute or chronic illness or injury that poses a threat to life or bodily function · Moderate for amount /or complexity of data to be reviewed and analyzed - ordering of 3 unique tests (EKG, CBC, and X-ray). · High risk of complication and/or morbidity or mortality of patient management - Decision regarding hospitalization. To qualify for a particular level of MDM, two of three elements for that level of MDM must be met or exceeded. The overall E/M level is low reporting 99215.

15-year-old male is seen by the pediatrician in his office for having excessive thirst and frequent urination. A urine dip is performed showing +3 sugar and with some ketones. Glucometer reading is done showing a blood sugar range of 500-600. Physician sends the patient with his father to the hospital for emergency admission and insulin drip. The pediatrician meets the patient at the hospital and performs a detailed history, comprehensive exam and a high complexity medical decision making. How should the pediatrician code the E/M service for this visit? A. 99214 B. 99221 C. 99223 D. 99285

B. 99221 Patient was not seen in the Emergency Department, eliminating multiple choice answer D. According to CPT® subsection guidelines for Initial Hospital Care: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (eg, hospital emergency department, observation status in the hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same of admission. The means the evaluation that was performed in the physician's office will not be reported since the physician also admitted the patient to the hospital on the same date of service, eliminating multiple choice A. For the Initial Hospital Care codes (99221-99223) all three key components (History, Examination, and Medical Making Decision) must meet or exceed to qualify for a particular service Code 99221 requires a detailed or comprehensive history, detailed or comprehensive examination, and medical decision making that is straightforward or of low complexity. Because the lowest component is a detailed history, the highest level that can be reached is 99221. To report code 99223 you need a comprehensive history.

injury occurred one hour ago. Her mom applied ice to the injury but it does not appear to help. The ED physician performs a detailed history, expanded problem focused examination and medical decision making of moderate complexity. An X-ray is ordered, which shows a fracture of the distal end of the radius as read by the radiologist. The ED physician consults with an orthopedic surgeon. The ED physician performs moderate conscious sedation with Ketamine for 30 minutes. The fracture is reduced and cast applied by an orthopedic surgeon. The child was monitored with pulse oximetry, cardiac monitor and blood pressure by the ED physician frequently. The patient was discharged with a sling and requested to follow up with the orthopedic surgeon. Code the services performed by the ED physician. A. 99284-25, 99151, 99153 B. 99283-25, 99155, 99157 C. 99283-25, 99152, 99157 D. 99284-25, 99151, 99157-51

B. 99283-25, 99155, 99157

A 78-year-old patient, with known arrhythmia, presented to an outpatient clinic for the insertion of a cardiac event recorder. What is the proper HCPCS Level II code for this device? A. C1767 B. C1764 C. C1777 D. E0616

B. C1764

Which modifier is appended to a CPT®, for which the provider had a patient sign an Advance Beneficiary Notice (ABN) form because there is a possibility the service may be denied because the patient's diagnosis might not meet medical necessity for the covered service? A. GJ B. GA C. GB D. GY

B. GA

CKD is a disease of which system? A. Circulatory B. Genitourinary C. Digestive D. Musculoskeletal

B. Genitourinary CKD is the abbreviation for Chronic Kidney Disease. The abbreviation is found in the ICD-10-CM Tabular List for category code N18 which falls under the Genitourinary System.

What is the patient's right when it involves making changes in the personal medical record? A. Patient must work through an attorney to revise any portion of the personal medical information. B. They should be able to obtain copies of the medical record and request corrections of errors and mistakes. C. It is a violation of federal health care law to revise a patient medical record. D. Revision of the patient medical record depends solely on the facility's compliance program policy.

B. They should be able to obtain copies of the medical record and request corrections of errors and mistakes.

General anesthesia is administered to a 9-month-old undergoing a tracheostomy. Code the anesthesia service. A. 00320, 99100 B. 00320 C. 00326 D. 00326, 99100

C. 00326 The patient receives anesthesia for a tracheostomy. In the CPT® Index, look for Anesthesia/Trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-old which eliminates answer options A and B. There is a parenthetical note under code 00326 which states: Do not report 00326 in conjunction with 99100.

Patient had a dual chamber pacemaker put in two days ago. He is having problems with the battery and the cardiologist found that it is malfunctioning. He is taken to the operating suite to replace the pacemaker battery. What CPT® and ICD-10-CM codes are reported? A. 33226-76, T82.111A B. 33235-52, T82.110A C. 33228-78, T82.111A D. 33213-58, T82.119A

C. 33228-78, T82.111A

A 2-year-old male requires a central venous catheter. Using xylocaine local anesthesia a percutaneous approach is used in the neck and venous access is achieved. A subcutaneous tunnel is created from the anterior chest wall to the venotomy site and the catheter passed through the tunnel. The CV catheter is then placed at the superior vena cava and sutured in position. Which procedure code is reported? A. 36568 B. 36555 C. 36557 D. 36560

C. 36557

The physician performs a right thyroid lobectomy. The patient was prepped and draped. After adequate general anesthesia, the neck was incised on the right side and sharp dissection was then used to cut down onto the strap muscles and sternocleidomastoid muscles. The strap muscles were separated and transected on the right side. A small thyroid lobe was visualized and dissected free. There was no evidence of a tumor. The wound was closed with 3-0 interrupted Vicryl for the platysma, 4-0 Vicryl for the deep tissues and 6-0 fast absorbing gut for the skin. Code the encounter. A. 60252-RT B. 60210-RT C. 60220-RT D. 60260-RT

C. 60220-RT The patient is having a right "thyroid lobectomy," eliminating multiple choice answers A and D, which is a thyroidectomy (removal of the entire thyroid). 60220 is the correct code since the scenario indicates that a small thyroid lobe (total lobe) is dissected free; it does not indicate that part of the lobe was removed, eliminating multiple choice B.

A 5-year-old male has diminished hearing in the left ear due to chronic otitis media. He has had hearing aid prosthetic devices in the ear which have resulted in additional infections. Parents have decided on an osseointegrated implant to restore hearing. The mastoid cortex is exposed. Spiral drilling is performed to create a pilot hole. The stem of the titanium pedestal is placed in the tunnel adjacent to the cochlea and abutment subsequently secured to the fixture. Which CPT® code is reported? A. 69717-LT B. 69719-LT C. 69714-LT D. 69716-LT

C. 69714-LT

Due to an elevated CEA level two years following a colon resection, the patient's oncologist ordered a diagnostic liver ultrasound. Which radiology code is reported for this encounter? A. 76700 B. 76705 C. 76706 D. 76970

C. 76705 Ultrasound codes are selected by anatomic site. The liver is an organ in the abdomen. The selection of the code is based on complete vs limited scan. Because the ultrasound is performed on one organ, it is reported as limited. Note the parentheses in the code description for 76705 it states "single organ." Code 76970 is not appropriate because this is an initial ultrasound and not a follow-up.

A 65-year-old woman is one year post with B-cell non-Hodgkin's lymphoma. She is having recurrent fever and pain. Tumor recurrence was confirmed by CT studies and chest X-ray. She has failed prior chemotherapy and radiation treatments. A new treatment is being contemplated and she is referred for a radiopharmaceutical distribution imaging as a requirement before starting this new treatment. The provider injects small amounts of gamma-emitting radioactive material paying particular attention for potential reaction. A gamma camera is used to take planar images of the whole body for three days. Three sets of image data are interpreted. Qualitative assessment of distribution and determination of treatment with monoclonal antibody are provided. A report is dictated and placed in the medical record. Which CPT® code is reported? A. 78803-26 B. 78802-26 C. 78804-26 D. 78801-26

C. 78804-26

Photodynamic therapy involving application of light externally to destroy premalignant lesions on the lower lip was provided to a 63 year-old patient. Code the encounter. A. 96570 B. 96999 C. 96567 D. 96913

C. 96567

This morning a 48-year-old is placed in observation status from the emergency room with severe diarrhea and extreme thirst. The physician performs a comprehensive history, comprehensive examination and determines the patient is suffering from dehydration. The physician places the patient on IV saline 500 ml and conducts normal saline hydration for a couple hours. The medical making decision making is of moderate complexity. Patient is discharged home in the late evening on the same day and is told to return if symptoms occur again. The E/M service(s) for this encounter is: A. 99285 B. 99219, 99217 C. 99235 D. 99217

C. 99235 The patient is designated as being in observation status, eliminating multiple choice A. According to the Initial Observation Care guidelines it states: For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236.

Physician was called to the floor to evaluate a 94 year-old that had sudden weakness, hypotension, and diaphoresis. Physician found the patient in mild distress and dyspneic. Her BP 101/60, pulse 85. Labs were still pending. Arterial blood gas was drawn and interpreted by the physician. She was admitted to CCU for Acute Antero-lateral MI and hypotension. Physician spent total critical care time of 65 minutes. Select the appropriate CPT® coding for this visit: A. 99291, 99292 B. 99233, 82803-26 C. 99291 D. 99291, 82803-26

C. 99291

Which term is one who has an overload of sodium? A. Hyperkalemia B. Hyperpotassemia C. Hypernatremia D. Hypercalcemia

C. Hypernatremia In the ICD-10-CM Alphabetic Index look for each of the listed terms. Cross reference each code in the Tabular List to note a brief definition. Hypernatremia is the when one has too much sodium in the system. Hypernatremia is indexed to code E87.0.

The physician performed manipulation of a closed fracture of the distal radius on a 12- year-old male. He placed a short arm fiberglass cast. What is the HCPCS Level II code for the supply? A. Q4012 B. Q4011 C. Q4010 D. Q4009

C. Q4010 The correct selection of this code is based on the length of the cast, anatomic location, material used for the cast and age. The patient is a 12 years-old, which eliminates Q4011 and Q4012. The cast is made of fiberglass, which makes Q4010 the correct answer.

PROCEDURE: Bilateral lumbar medial branch block under ultrasound guidance for the L3, L4, L5 medial branches injecting the L4-L5, L5-S1 facets for diagnostic and therapeutic purposes. PROCEDURE: The patient was placed in the prone position and automated blood pressure cuff and pulse oximeter applied. The skin entry points for approaching the anatomic target points of the bilateral segmental medial branches or dorsal ramus of L3, L4, L5 were identified with a 22.5 degree from an ultrasound view and marked. Following thorough Chloraprep preparation of the skin and draping and 1% lidocaine infiltration of the skin entry points and subcutaneous tissues, a 22 gauge 6" spinal needle was placed under ultrasound guidance for the L4-L5 and L5-S1 facet joints. At each joint 1 mL consisting of 0.5% bupivacaine and Depo-Medrol was injected. A total of 80 mg of Depo-Medrol was given in both sides. Which CPT® codes are reported? A. 0216T-50, 0217T x 2, 0218T x 2, 76942-26 B. 64493-50, 64494-50, 64495-50 C. 64493-50, 64494-50, 76942-26 D. 0216T-50, 0217T x 2

D. 0216T-50, 0217T x 2 When coding for facet joint or facet joint nerve injections, you report each level that is injected. In this case, the joints for L4-L5 and L5-S1 were injected. A parenthetical note states: If ultrasound guidance is used, report 0213T-0218T. The codes for facet joint and facet joint nerve injections are unilateral. The procedure was performed bilaterally at each level, therefore modifier 50 is reported on code 0216T. A parenthetical note is given for add-on code 0127T that indicates to report it twice when performed bilaterally, not with modifier 50. The ultrasound guidance is not reported separately, eliminating answer choice A.

A 7-year-old riding his bike struck a tree stump throwing him off his bike. He received multiple lacerations. He had a 3 cm dermis laceration on his scalp with two 0.5 cm lacerations on his face. His right arm had a 5 cm laceration and right leg has a 5 cm laceration. The physician stapled the laceration for the scalp. Physician used steri-strips (adhesive strips) to close the wounds on the face. The legs and arms were cleaned by heavily irrigating them with normal saline and removal of embedded debris performed on both wounds, followed with a single-layer closure. Select the repair codes to report. A. 12032, 12032-59, 12011-59, 12002-59 B. 12002, 12002-59, 12011-59, 12002-59 C. 12005, 11042-59 D. 12034, 12002-59

D. 12034, 12002-59 The two face lacerations were closed with steri-strips (adhesive strips). When adhesive strips are the only repair material used to close an open wound a repair code is not reported. According to CPT® subsection guidelines for Repair (Closure), when wound closure uses adhesive strips as the only repair material it should be coded using the appropriate E/M service. Code 12011 is inappropriate to report for this scenario, eliminating multiple choices A and B. The repairs for the wounds on the arm and leg are intermediate closures. According to CPT® subsection guidelines for Repair (Closure), single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair. This eliminates multiple choice C. To report multiple wounds that are repaired in the same classification and from the anatomic sites that are grouped together into the same code descriptor, add the length of the wounds. The subsection guidelines also indicates when more than one classification of wounds is repaired, append modifier 59 to the least complicated repair(s).

The physician removes a tumor from the patient's neck using the Mohs micrographic surgery technique. During the first stage, the physician takes four tissue blocks and reviews them under a microscope. The exam of the tissue blocks reveals a second stage is necessary to remove areas where the tumor is still present. The physician examines two additional tissue blocks. What are the appropriate CPT® codes for reporting the procedure? A. 17311, 17312, 17315 B. 17313, 17315 C. 17313, 17314, 17315 D. 17311, 17312

D. 17311, 17312

A 46-year-old female with history of cervical carcinoma underwent placement of an ileal conduit, with subsequent development of left hydronephrosis. A retrograde ureteral catheter was recently placed. She returns today for catheter exchange. Patient was placed in the supine on the operating table. The ileal conduit was accessed. The existing catheter was removed over a guidewire and replaced with a similar 10 French 50 cm long locking pigtail catheter. Contrast was injected for monitoring, confirming good position of the catheter placement. Interpretation and report is in the record. IMPRESSION: Left retrograde ureteral catheter exchange via the ileal conduit. How is this reported? A. 50435 B. 50693 C. 50385 D. 50688, 75984-26

D. 50688, 75984-26 The patient presents for a ureteral catheter exchange via the ileal conduit. 50435 is not correct because it is an exchange of the catheter percutaneously. 50693 is performed using a percutaneous approach for placement of a ureteral stent, which is not performed in this case. 50385 is performed using a transurethral approach, which is not correct. The exchange is performed via the ileal conduit, which is reported with 50688. Monitoring contrast imaging is performed. There is a parenthetical note under 50688 that states that imaging is reported with 75984.

Preoperative Diagnosis: Right hydronephrosis Postoperative Diagnosis: Right hydronephrosis Procedure: Cystoscopy and right retrograde pyelogram Procedure Description: Patient prepped and draped in the dorsolithotomy position. Placed under general anesthesia a 23 French cystoscope was passed into the bladder. No tumors were visualized. Urine from the bladder was sent for urine cytology. Then a 6 French access catheter was passed into the right ureteral orifice. Contrast was injected and there were no filling defects noted. There was no fixed tumor and no stone. There was mild hydroureteral nephrosis against the bladder. There was a narrowing at the UVJ no abnormalities. Renal pelvis barbotaged with saline and renal pelvis urine sent to pathology for urine cytology. After the retrograde pyelogram was performed the access catheter was removed. Interpretation and report are in the medical record. What CPT® codes are reported? A. 52000-RT, 74420-26 B. 52281-RT, 74425-26 C. 52007-RT, 74400-26 D. 52005-RT, 74420-26

D. 52005-RT, 74420-26

Which one of the following is a disorder in causing paralysis of the facial nerve? A. Exotropia B. Tarsal tunnel syndrome C. Brachial plexus lesions D. Bell's palsy

D. Bell's palsy

The patient is a 75-year-old woman who is here for follow-up after an incident last week in which she had an FB lodged in her throat. An emergency esophagoscopy was performed and the piece of hamburger meat removed and biopsy performed. She is positive for Barrett's esophagus. She has GERD which is currently being treated by medication and is here today to be evaluated for photodynamic therapy.What diagnosis codes should be reported for today's visit? A. K22.2, K22.70 B. T18.12XA, K22.70 C. T18.12XA, K22.70, K21.9 D. K22.70, K21.9

D. K22.70, K21.9 The selection of the code is based on the reason the patient presents for the encounter. The results from the biopsy showed she has Barrett's esophagus (K22.70). It is usually caused by gastrointestinal reflux disease (GERD, K21.9). The FB (T18.12XA) has been resolved, and would not be reported. Proper coding would be for the Barrett's and the GERD, multiple choice D.

A person who has nephritis has inflammation in what location? A. Gallbladder B. Nerve C. Uterus D. Kidney

D. Kidney

Which statement regarding an ICD-10-CM coding conventions is TRUE? A. If the same condition is described as both acute and chronic and separate subentries exist in the Alphabetic Index at the same indentation level, code only the acute condition. B. Sequela (Late effect) codes are reported for a current acute phase of the injury or illness C. An ICD-10-CM code is still valid even if it has not been coded to the full number of characters required for that code. D. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed.

D. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed. Multiple choice D is the correct answer, according to the ICD-10-CM Official Coding Guidelines, I.B.5. indicates not to report signs and symptoms that are integral to a definitive diagnosis and are not assigned unless otherwise instructed. When the same condition is diagnosed as acute and chronic and there is a separate code for both, report both codes (I.B.8). Sequela (Late Effect) codes are the residual effect (condition produced) after the acute phase of an illness or injury has terminated (I.B.10). An ICD-10-CM code is not valid unless it is coded to the highest level of specificity. Do not rely solely on the ICD-10-CM Alphabetic Index to Diseases and Injuries to select the correct code.

A 25-year-old is brought to the burn unit being rescued from a burning house. She sustained 25% second degree burns on her anterior trunk and back and 20% third degree burns on her legs and arms. Total body surface area burned is 45%. What ICD-10-CM code is reported for the burns classified according to the extent of body surface involved? A. T31.22 B. T32.42 C. T31.24 D. T31.42

D. T31.42