CPC Practice Exam 2

The root word trich/o means: A. Hair B. Sebum C. Eyelid D. Trachea

Trich/o means hair. In the ICD-10-CM Alphabetical Index look for a diagnosis that starts with Trich. Trichorrhexis refers you to code L67.0. In the Tabular List category code L67 is for Hair color and hair shaft abnormalities. Answer A

Which of the following health plans does not fall under HIPAA? A. Medicaid B. Medicare C. Workers' compensation D. Private plans

Workers' compensation is excluded from the definition of a health plan under the Health Insurance Portability and Accountability Act (HIPAA). Therefore, Workers' compensation plans are not required to meet HIPAA standards for privacy, security or code sets. Answer C

A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic esophageal varices. The ICD-10-CM codes are reported: A. I85.01, K74.69 B. I85.11, K74.60 C. K74.60, I85.11 D. I85.00, K74.69

In the ICD-10-CM Alphabetic Index look for Varix/esophagus/in/cirrhosis of liver/bleeding referring you to code I85.11. This eliminates multiple choices A and D. In the Tabular List you will see an instructional note above codes I85.10 and I85.11 to Code first underlying disease. Meaning for the scenario cirrhosis of liver (K47.60) is coded first then the esophageal varices with bleeding is coded as a secondary code. Eliminating multiple choice B. Answer C

MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical laminectomy at C3 through C6 and fusion. The edges of the laminectomy were then cleaned up with a Kerrison and foraminotomies were done at C4, C5, and,C6. The stenosis is central; a facetectomy is performed by using a burr. Nerve root canals were freed by additional resection of the facet, and compression of the spinal cord was relieved by removal of a tissue overgrowth around the foramen. Which CPT® code(s) is (are) used for this procedure? A. 63045-50, 63048-50 B. 63020-50, 63035-50, 63035-50 C. 63015-50 D. 63045, 63048 x 2

Laminectomy was performed, eliminating multiple choice answer B. Facetectomy and foraminotomy were performed, eliminating multiple choice answer C. The laminectomy is performed bilaterally on three segments of the cervical. Modifier 50 is not appended to code 63045-63048, because the code descriptive has a parenthetical note indicating that these codes include unilateral or bilateral, eliminating multiple answer A. Answer D

Which of the following is an example of a case in which a diabetes-related problem exists and the code for diabetes is never sequenced first? A. If the patient has an underdose of insulin due to an insulin pump malfunction. B. If the patient is being treated for secondary diabetes. C. If the patient is being treated for Type 2 diabetes and uses insulin. D. If the patient is diabetic with an associated condition.

The ICD-10-CM guidelines (Section I.C.4.a.5): An underdose of insulin due to an insulin pump failure should be assigned T85.6-, as the principal or first listed code, followed by code T83.3X6-. Additional codes for the type of diabetes mellitus should also be assigned. Answer A

Which of the following is an example of electronic data? A. A digital X-ray B. An explanation of benefits C. An advance beneficiary notice D. A written prescription

While B, C, or D might be done electronically, by definition they aren't required to be done electronically. A digital X-ray is an X-ray with an image that is stored electronically rather than on film, and so A is the correct answer. Answer A

A patient is having knee replacement surgery. The surgeon requests that in addition to the general anesthesia for the procedure that the anesthesiologist also insert a continuous lumbar epidural infusion for postoperative pain management. The anesthesiologist performs postoperative management for two postoperative days. A. 01400-AA, 62326, 01996 x 2 B. 01402-AA, 62327, 01966 x 2 C. 01402-AA, 62326, 01996 x 2 D. 01404-AA, 62327

A code is selected for the general anesthesia performed for the total knee replacement. Look in the CPT® Index, for Anesthesia/Replacement/Knee. You are referred to 01402. The continuous lumbar epidural infusion is also reported because the purpose is for postoperative pain. There is no indication that imaging guidance was used. The procedure is reported with 62326. There is a parenthetical note following 62327 that indicates to use 01996 in conjunction with 62324-62327. 01996 is a per day code. In this scenario, the physician performs two days of daily management. Modifier AA indicates the anesthesia was performed by an anesthesiologist. Answer C

A patient came in to the ER with wheezing and a rapid heart rate. The ER physician documents a comprehensive history, comprehensive exam and medical decision of moderate complexity. The patient has been given three nebulizer treatments. The ER physician has decided to place him in observation care for the acute asthma exacerbation. The ER physician will continue examining the patient and will order additional treatments until the wheezing subsides. Select the appropriate code(s) for this visit. A. 99284, 99219 B. 99219 C. 99284 D. 99235

According to CPT® subsection guidelines under Initial Observation Care: When "observation status" is initiated in the course of an encounter in another site of service (example, hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating "observation status" are considered part of the initial observation care when performed on the same date. Meaning you will not report an emergency service code since the patient was placed in observation care from the ER on the same date of service, eliminating multiple choice C. CPT® subsection guidelines add: Evaluation and management services on the same date provided in sites that are related to initiating "observation status" should not be reported separately. This eliminates multiple choice A. Patient was not admitted and discharged in observation status on the same date of service, eliminating multiple choice D. Answer B

Which statement is TRUE about Z codes: A. Z codes are never reported as a primary code. B. Z codes are only reported with injury codes. C. Z codes may be used either as a primary code or a secondary code. D. Z codes are always reported as a secondary code.

According to ICD-10-CM Coding Guidelines (Section I.C.21.a): Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed, others only as secondary codes. Answer C

55 year-old-patient had a fracture of his left knee cap six months ago. The fracture has healed but he still has staggering gait in which he will be going to physical therapy. What ICD-10-CM codes are reported? A. S82.002A, R26.81 B. R26.0, S82.002A C. S82.092S, R26.0 D. R26.0, S82.002S

According to ICD-10-CM guidelines (Section I.B.10): A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effect. This eliminates multiple choice answers A and B. The guidelines further state: Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the sequela is sequenced first. The sequela code is sequenced second. This eliminates multiple choice C. Answer D

A new patient is having a cardiovascular stress test done in his cardiologist's office. Before the test is started the physician documents a comprehensive history and exam and moderate complexity medical decision making. The physician will be supervising and interpreting the stress on the patient's heart during the test. What procedure codes are reported for this encounter? A. 93015-26, 99204-25 B. 93016, 93018, 99204-25 C. 93015, 99204-25 D. 93018-26, 99204-25

All three components are documented to report code 93015, in which the cardiologist is supervising, he owns the equipment (tracing), because the test is being performed in the office, and the physician interpreted the test. Modifier 26 would be inappropriate to append to code 93015, it denotes the global service. Answer C

55 year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a catheter placement. The endoscope is passed through the cricopharyngeal muscle area without difficulty. Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted. Stomach significant distention with what appears to be multiple encapsulated tablets in the stomach at least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged due to high grade narrowing in the pyloric channel, the duodenum was not examined. It seems to be a high grade outlet obstruction with a superimposed volvulus. A repeat examination is not planned at this time. What code should be used for this procedure? A. 43246-52 B. 43241-52 C. 43235 D. 43191

An esophagogastroduodenoscopy (also known as an upper GI endoscopy or EGD) is performed, not an esophagoscopy which is only an inspection of the esophagus, eliminating multiple choice D. The EGD was performed along with a placement of a catheter, eliminating multiple choice answer C. Since the placement was a catheter, multiple choice answer A is eliminated. The correct answer is 43241 with modifier -52 appended to indicate that the endoscope did not pass into the duodenum . According to CPT® guidelines, if a reason is given why the duodenum was not examined and a repeat examination is not planned, append modifier 52 to the EGD codes. Answer B

50 year-old patient is coming to see her primary care physician for hypertension. The patient also discusses with her physician that the OBGYN office had just told her that her Pap smear came back with an abnormal reading and is worried because her aunt had passed away with cervical cancer. The physician documents she spent 40 minutes face-to-face time with the patient, and 25 minutes of that time is giving counseling on the awareness, other screening procedures and treatment if it turns out to be cervical cancer. What E/M code(s) is (are) reported for this visit? A. 99215 B. 99213, 99358 C. 99214, 99354 D. 99213

E/M Guidelines: "When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E/M services." E/M level 99215 is the correct code to report, because it has in its code description, "Typically, 40 minutes are spent face-to-face with the patient and/or family." In the question there is a total time given of 40 minutes spent face-to-face with the patient, in which more than half of that time (25 minutes) was on counseling the patient. Answer A

Guidelines from which of the following code sets are included as part of the code set requirements under HIPAA? A. CPT® Category III codes B. ICD-10-CM C. HCPCS Level II D. ADA Dental Codes

ICD-10-CM guidelines are the only guidelines specifically mentioned in HIPAA. While HIPAA requires the use of the other code sets listed, there is no specific mention of the other guidelines in the law. This information is found in the ICD-10-CM Official Guidelines for Coding and Reported in you ICD-10-CM codebook: These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). Answer B

PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. OPERATIVE PROCEDURE: Reduction with application of an external fixation system, left wrist fracture FINDINGS: The patient is a 46 year-old right-hand-dominant female who fell off stairs 4 to 5 days ago sustaining an impacted distal radius fracture with possible intraarticular component and an associated ulnar styloid fracture. Today in surgery, fracture was reduced anatomically and an external fixation system was applied. PROCEDURE: Under satisfactory general anesthesia, the fracture was manipulated and C-arm images were checked. The left upper extremity was prepped and draped in the usual sterile orthopedic fashion. Two small incisions were made over the second metacarpal and after removing soft tissues including tendinous structures out of the way, drawing was carried out and blunt-tipped pins were placed for the EBI external fixator. The frame was next placed and the site for the proximal pins was chosen. Small incision was made. Subcutaneous tissues were carried out of the way. The pin guide was placed and 2 holes were drilled and blunt-tipped pins placed. Fixator was assembled. C-arm images were checked. Fracture reduction appeared to be anatomic. Suturing was carried out where needed with 4-0 Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings were applied. Vascular supply was noted to be satisfactory. Final frame tightening was carried out. What CPT® code(s) is/are reported? A. 25600-LT, 20692-51 B. 25605- LT, 20690-51 C. 25606-LT D. 25607-LT

In the body of the note after the Procedure heading it states, "the fracture was manipulated", eliminating multiple choice answer A. Was the fracture treatment opened or closed? There is no indication in the operative note that the patient was surgically opened at the fracture site to treat it, eliminating multiple choice answer D. The key words to choose the correct code between B and C are external fixation system and external fixator; where pins are connected to bone and to an external fixator to help the fracture heal. The fixator was a uniplane system as only one external fixator was applied in one plane (20690). Answer B

A 37 year-old female has menorrhagia and wants permanent sterilization. The patient was placed in Allen stirrups in the operating room. Under anesthesia the cervix was dilated and the hysteroscope was advanced to the endometrium into the uterine cavity. No polyps or fibroids were seen. The Novasure was used for endometrial ablation. A knife was then used to make an incision in the right lower quadrant and left lower quadrant with 5-mm trocars inserted under direct visualization with no injury to any abdominal contents. Laparoscopic findings revealed the uterus, ovaries and fallopian tubes to be normal. The appendix was normal as were the upper quadrants. Because of the patient's history of breast cancer and desire for no further children, it was decided to take out both the tubes and ovaries. This had been discussed with the patient prior to surgery. What are the codes for these procedures? A. 58660, 58353-51 B. 58661, 58563-51 C. 58661, 58558-51 D. 58662, 58563-51

One way to narrow down the choices is to code for the endometrial ablation using the hysteroscope. Because the endometrial ablation was done with hysteroscopic guidance, multiple choice answer A is eliminated. No biopsies were taken or polyps removed eliminating multiple choice answer C. The removal of her ovaries and fallopian tubes (oophorectomy and salpingectomy) were performed by a laparoscope, eliminating multiple choice answer D. Answer B

35 year-old male sees his primary care physician complaining of fever with chills, cough and congestion. The physician performs a chest X-ray taking lateral and AP views in his office. The physician interprets the X-ray views and the patient is diagnosed with walking pneumonia. Which CPT® code is reported for the chest X-rays performed in the office and interpreted by the physician? A. 71020-26 B. 71030-26 C. 71020 D. 71010-26-TC

Only two chest X-ray views were taken (AP and lateral), eliminating multiple choices B and D. The chest X-rays were taken in the physician's office and interpreted so there are no modifiers appended to the code. If the chest X-ray was performed somewhere else (for example, outpatient facility) and the films were sent to the physician for his interpretation then modifier 26 would be appended to the code. Answer C

What is the term used for inflammation of the bone and bone marrow? A. Chondromatosis B. Osteochondritis C. Costochondritis D. Osteomyelitis

Osteomyelitis is an inflammation of bone and bone marrow caused by a bacterial infection which can lead to a reduction of blood supply to the bone. In the ICD-10-CM Alphabetical Index look for Inflammation/bone-see Osteomyelitis. Answer D

5 year-old male with a history of prematurity was found to have a chordee due to congenital hypospadias. He presents for surgical management for a plastic repair in straightening the abnormal curvature. Under general anesthesia, bands were placed around the base of the penis and incisions were made degloving the penis circumferentially. The foreskin was divided in Byers flaps and the penile skin was reapproximated at the 12 o'clock position. Two Byers flaps were reapproximated, recreating a mucosal collar which was then criss- crossed and trimmed in the midline in order to accommodate median raphe reconstruction. This was reconstructed with use of a horizontal mattress suture. The shaft skin was then approximated to the mucosal collar with sutures correcting the defect. Which CPT® code should be used? A. 54304 B. 54340 C. 54400 D. 54440

Patient does not have a penile injury, eliminating multiple choice D. The patient is not having an insertion of a penile prosthesis, eliminating multiple choice C. The surgery is not correcting a hypospadias complication such as a fistula, stricture, or diverticula, eliminating multiple choice answer B. The correct answer is A, 54304. Answer A

76 year-old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be performed on the eyelids. A lower incision line was marked at approximately 5 mm above the lid margin along the crease. Then using a pinch test with forceps the amount of skin to be resected was determined and marked. An elliptical incision was performed on the left eyelid and the skin was excised. In a similar fashion the same procedure was performed on the right eye. The wounds were closed with sutures. The correct CPT® code(s) is/are? A. 15822, 15823-51 B. 15823-50 C. 15822-50 D. 15820-LT, 15820-RT

Patient is having a blepharoplasty done on the upper eyelids, eliminating multiple choice answer D. There is no indication in the scenario that excessive skin weighing down the lid had to be excised, eliminating multiple choice answers A and B. Modifier 50 is appended to indicate the procedure was performed on both eyelids. Answer C

A cancer patient is coming in to have a chemotherapy infusion. The physician notes the patient is dehydrated and will first administer a hydration infusion. The infusion time was 1 hour and 30 minutes. Select the code(s) that is (are) reported for this encounter? A. 96360 B. 96360, 96361 C. 96365, 96366 D. 96422

Patient is having a hydration infusion eliminating multiple choices C and D. The add-on-code is incorrect to report for this scenario. A parenthetical statement states: (Report 96361 for hydration infusion intervals of greater than 30 beyond 1 hour increments) meaning if the hydration infusion is 30 minutes or less you would not report 96361. Answer A

22 year-old is 14 weeks pregnant and wants to terminate the pregnancy. She has consented for a D&E. She was brought to the operating room where MAC anesthesia was given. She was then placed in the dorsal lithotomy position and a weighted speculum was placed into her posterior vaginal vault. Cervix was identified and dilated. A 6.5-cm suction catheter hooked up to a suction evacuator was placed and products of conception were evacuated. A medium size curette was then used to curette her endometrium. There was noted to be a small amount of remaining products of conception in her left cornua. Once again the suction evacuator was placed and the remaining products of conception were evacuated. At this point she had a good endometrial curetting with no further products of conception noted. Which CPT® code should be used? A. 59840 B. 59841 C. 59812 D. 59851

Patient is terminating her pregnancy by dilation and evacuation (D&E), eliminating multiple choice answer A. There is no documentation of this being an incomplete abortion, eliminating multiple choice answer C. The abortion was not induced by intra-amniotic injection(s), eliminating multiple choice answer D. Answer B

A patient is having pyeloplasty performed to treat an uretero-pelvic junction obstruction. What is being performed? A. Surgical repair of the bladder B. Removal of the kidney C. Cutting into the ureter D. Surgical reconstruction of the renal pelvis

Pyeloplasty is the surgical reconstruction or revision of the pelvis of the kidney (renal) to correct an obstruction. The CPT® Index refers you to codes 50400-50405, and 50544 for Pyeloplasty. The code is found under the Repair heading in the numeric section and the code description states "plastic operation on renal pelvis" to help you know what is being performed. Answer D

This gentleman has localized prostate cancer and has chosen to have complete transrectal ultrasonography performed for dosimetry purposes. Following calculation of the planned transrectal ultrasound, guidance was provided for percutaneous placement of 1-125 seeds. Select the appropriate codes for this procedure. A. 55920, 76965-26 B. 55876, 76942-26 C. 55860, 76873-26 D. 55875, 76965-26

Radioactive seeds were inserted directly into the prostate transperineally using needles (percutaneous), in selecting code 55875. Answer D

76-year-old female had a ground level fall when she tripped over her dog earlier this evening in her apartment. The Emergency Department took X-rays of the left wrist in oblique and lateral views which revealed a displaced distal radius fracture, type I open left wrist. What radiological service and ICD-10-CM codes are reported? A. 73100-26, S52.502B, W18.31XA, Y92.039 B. 73110-26, S52.602A, W18.31XA, Y92.039 C. 73115-26, S52.502A, W18.31XA, Y92.039 D. 73100-26, S52.602B, W18.31XA, Y92.039

The X-ray was taken in two views (oblique and lateral) without arthrography, eliminating multiple choice answers B and C. The fracture is an open fracture. Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/radius/lower end referring you to S52.50-. Turn to the Tabular List to complete the code, S52.502B. Answer A

27 year-old was frying chicken when an explosion of the oil had occurred and she sustained second-degree burns on her face (5%), third degree burns on both hands (5%). There was a total of 10 percent of the body surface that was burned. Select which ICD-10-CM codes are reported. A. T20.20XA, T23.301A, T23.302A, T31.10, X10.2XXA, Y93.G3 B. T23.301A, T23.302A, T20.20XA, T31.11, X10.2XXA, Y93.G3 C. T23.301A, T23.302A, T20.20XA, T31.10, X10.2XXA, Y93.G3 D. T23.601A, T23.602A, T20.60XA, T31.10, X10.2XXA, Y93.G3

The burn was not caused by a chemical, eliminating multiple choice D. According to ICD-10-CM guidelines (Section I.C.19.d.1): Sequence first the code that reflects the highest degree of burn when more than one burn is present. This eliminates multiple choice A. When reporting the percentage of body burns (T31.-) you first need to know the total percentage of the body burned. For our scenario the total percentage of the body burned is 10 percent (5% face + 5% hands = 10%) T31.1-. The hands had 5 percent third degree burn guiding you T31.10. Answer C

Question 2 53 year-old male is in the dermatologist's office for removal of 2 lesions located on his lower lip and nose. Lesions were identified and marked. The lower lip lesion of 4mm in size was shaved to the level of the superficial dermis. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area. What are the CPT® codes for these procedures? A. 11100, 11101 B. 11310, 11100-59 C. 17000, 17003 D. 11440, 11100-59

The first procedure performed was the lesion on the lower lip removed by the shaving technique. Reported with code 11310. The punch biopsy is performed on the lesion located on the nose. Reported with code 11100. Modifier 59 indicates that the biopsy was totally separate performed on another lesion, otherwise it is bundled with 11310. Answer B

The patient presents to the office for an injection. Joint prepped using sterile technique. Muscle group location: gluteus maximus. Sterilely injected with 40 mg of Kenalog-10, 2 cc Marcaine and 2 cc lidocaine 2%. Sterile bandage applied. Choose the HCPCS Level II code for this treatment. A. J3301 x 4 B. J3301 C. J3300 x 40 D. J3300

The injection given is Kenalog-10 eliminating multiple choices C and D. 40 mg of the Kenalog-10 was given. Code J3301 is reported for 10 mg so it will have to be reported four times to cover 40 mg. Answer A

Patient with corneal degeneration is having a cornea transplant. The donor cornea had been previously prepared by punching a central corneal button with a guillotine punch. This had been stored in Optisol GS. It was gently rinsed with BSS Plus solution and was then transferred to the patient's eye on a Paton spatula and sutured with 12 interrupted 10-0 nylon sutures. Select the HCPCS Level II code for the corneal tissue. A. V2790 B. V2785 C. V2628 D. V2799

The key word to guide you to HCPCS code V2785 is cornea. The scenario addresses the code description. The donor cornea preparation indicates the processing, then the donor cornea being stored indicates the preserving and it being rinsed and transferred indicates the transporting. Answer B

A patient uses Topiramate to control his seizures. He comes in every two months to have a therapeutic drug testing performed to assess serum plasma levels of this medication. What lab code(s) is (are) reported for this testing? A. 80305 B. 80375 C. 80201 D. 80306, 80375

The lab test being performed in this scenario is for therapeutic drug monitoring to assist the physician in drug regimen adjustment to reach an optimal drug concentration ensuring an adequate therapeutic response without drug-induced adverse effects, guiding you to codes 80150-80299. The patient is not having a drug screening test in which the physician is determining a specific drug present or not present in the patient (qualitative) eliminating multiple choice answers A and D. Therapeutic Drug Assay codes are performed to monitor clinical response to a known, prescribed medication. Answer C

A 50 year-old female had a left subcutaneous mastectomy for cancer. She now returns for reconstruction which is done with a single TRAM flap. Right mastopexy is done for asymmetry. Select the anesthesia code for this procedure. A. 00404 B. 00402 C. 00406 D. 00400

The patient had a previous mastectomy. For this encounter the mastopexy and reconstruction is performed. Look in the CPT® Index, for Anesthesia/Breast referring you to 00402-00406. Refer to the code descriptions in the numeric section. 00402 is the correct code for anesthesia administered for breast reconstruction. Answer B

This 67 year-old man presented with a history of progressive shortness of breath. He has had a diagnosis of a secundum atrioseptal defect for several years, and has had atrial fibrillation intermittently over this period of time. He was in atrial fibrillation when he came to the operating room, and with the patient cannulated and on bypass, The right atrium was then opened. A large 3 x 5 cm defect was noted at fossa ovalis, and this also included a second hole in the same general area. Both of these holes were closed with a single pericardial patch. What CPT® and ICD-10-CM codes are reported? A. 33675, Q21.0 B. 33647, Q21.1, R06.02 C. 33645, Q21.2, R06.02 D. 33641, Q21.1

The patient had an atrial septal defect, eliminating multiple choice answers A and C. The surgery was only performed on the atrial septum, eliminating multiple choice answer B. According to ICD-10-CM Coding Guidelines (Section I.B.5): Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification. Shortness of breath (R06.02) is a symptom of an atrial septum defect and would not be coded. Answer D

79 year-old male with symptomatic bradycardia and syncope is taken to the Operating Suite where an insertion of a DDD pacemaker will be performed. After the anesthesiologist provided moderate sedation, the cardiologist performed a left subclavian venipuncture was carried out. A guide wire was passed through the needle, and the needle was withdrawn. A second subclavian venipuncture was performed, a second guide wire was passed and the second needle was withdrawn. An oblique incision in the deltopectoral area incorporating the wire exit sites. A subcutaneous pocket was created with the cautery on the pectoralis fascia. An introducer dilator was passed over the first wire and the wire and dilator were withdrawn. A ventricular lead was passed through the introducer, and the introducer was broken away in the routine fashion. A second introducer dilator was passed over the second guide wire and the wire and dilator were withdrawn. An atrial lead was passed through the introducer and the introducer was broken away in the routine fashion. Each of the leads were sutured down to the chest wall with two 2-0 silk sutures each, connected the leads to the generator, curled the leads, and the generator was placed in the pocket. We assured hemostasis. We assured good position with the fluoroscopy. What CPT® code(s) is (are) reported by the cardiologist? A. 33208 B. 33212 C. 33226 D. 33235, 71090-26

The patient is having an insertion of a pace maker, eliminating multiple choice answers C and D. A subcutaneous pocket was created for the pacemaker generator and the leads connected to the generator were placed in the atrium and ventricle leading you to multiple choice answer A. Flouroscopy is included and should not be reported separately. Answer A

An infant who has chronic otitis media in the right and left ears was placed under general anesthesia and a radial incision was made in the posterior quadrant of the left and right tympanic membranes. A large amount of mucoid effusion was suctioned and then a ventilating tube was placed in both ears. What CPT® and ICD-10-CM codes are reported? A. 69436-50, H65.33 B. 69436-50, H66.43 C. 69433-50, H65.113 D. 69421-50, H65.33

The patient is under general anesthesia eliminating multiple choice answer C. A ventilating tube was placed in the ears eliminating multiple choice answer D. Look in the ICD-10-CM Alphabetic Index for Otitis/media/nonsuppurative/chronic/mucoid, mucous guiding you to code H65.3-. Go to the Tabular List to complete code, H65.33. Eliminating multiple choice answer B. Answer A

A 6 month-old patient is administered general anesthesia to repair a cleft palate. What anesthesia code(s) is (are) reported for this procedure? A. 00170, 99100 B. 00172 C. 00172, 99100 D. 00176

The patient receives general anesthesia for the repair of a cleft palate. Look in the CPT® Index, for Anesthesia/Cleft Palate Repair referring you to 00172. Verify the code description in the numeric section for accuracy. The patient is 6 months old, 99100 is appropriate for this scenario. Answer C

A patient with severe asthma exacerbation has been admitted. The admitting physician orders a blood glass for oxygen saturation only. The admitting physician performs the arterial puncture drawing blood for a blood gas reading on oxygen saturation only. The physician draws it again in an hour to measure how much oxygen the blood is carrying. Select the codes for reporting this service. A. 82805, 82805-51 B. 82810, 82810-91 C. 82803, 82803-51 D. 82805, 82805-90

The physician requests a blood gas for oxygen saturation (0₂) only, guiding you to code 82810. Modifier 51 is appended to surgical procedure codes meaning because this code is a lab code, modifier 51 is inappropriate, eliminating multiple choice answers A and C. There is no mention of an outside lab, eliminating multiple choice D. The physician would also report 36600 for the arterial puncture. Answer B

Patient has lung cancer in his upper right and middle lobes. Patient is in the operating suite to have a video-assisted thorascopy surgery (VATS). A 10-mm-zero-degree thoracoscope is inserted in the right pleural cavity through a port site placed in the ninth and seventh intercostal spaces. Lung was deflated. The tumor is in the right pleural. Both lobes were removed thorascopically. Port site closed. A chest tube was placed to suction and patient was sent to recovery in stable condition. Which CPT® code is reported for this procedure? A. 32482 B. 32484 C. 32670 D. 32671

The removal of the lobes are performed thoracoscopically not by an open approach, eliminating multiple choices A and B. The entire right lung is not removed, only two lobes (upper and middle) in the right lung are removed, eliminating mulitple choice D. Answer C

A patient was admitted yesterday to the hospital for possible gallstones. The following day the physician who admitted the patient performed a detailed history, a detailed exam and a medical decision making of low complexity. The physician tells her the test results have come back positive for gallstones and is recommending having a cholecystectomy. What code is reported for this evaluation and management service for the following day? A. 99253 B. 99221 C. 99233 D. 99234

The scenario indicates to select an evaluation and management service for the physician evaluating the patient on the following day of admission, eliminating multiple choice B; code 99221 is reported for when the patient is initially admitted to the hospital. The patient is not in observation status in which the patient was admitted and discharged on the same date of service, eliminating multiple choice answer D. There is no request documented in the scenario for another physician to recommend care for the condition, eliminating multiple choice A. Subsequent hospital care codes require meeting or exceeding two of three key components. Code 99233 is correct because a detailed and detailed exam are the two key components that meet. Answer C

Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________. A. Medulla lobe B. Occipital lobe C. Middle lobe D. Inferior lobe

The series of terms are lobes found in the brain. You can find an illustration of the brain showing the different lobes in your CPT® codebook in the beginning of the Nervous System section. Answer B

An extracapsular cataract removal is performed on the right eye by manually using an iris expansion device to expand the pupil. A phacomulsicfication unit was used to remove the nucleus and irrigation and aspiration was used to remove the residual cortex allowing the insertion of the intraocular lens. What CPT® code is reported? A. 66985 B. 66984 C. 66982 D. 66983

The surgery is an extracapsular cataract removal, eliminating multiple choice D. The removal of the cataract and the insertion of the lens were performed at the same time, eliminating multiple choice A. The keyword to choose between codes 66982 and 66984 is "iris expansion device" which was used to remove the cataract, eliminating multiple choice answer B. Answer C

PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula POST OPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula PROCEDURE: Hartmann procedure, which is a sigmoid resection with Hartmann pouch and colostomy. DESCRIPTION OF THE PROCEDURE: Patient was prepped and draped in the supine position under general anesthesia. Prior to surgery patient was given 4.5 grams of Zosyn and Rocephin IV piggyback. A lower midline incision was made, abdomen was entered. Upon entry into the abdomen, there was an inflammatory mass in the pelvis and there was a large abscessed cavity, but no feces. The abscess cavity was drained and irrigated out. The left colon was immobilized, taken down the lateral perineal attachments. The sigmoid colon was mobilized. There was an inflammatory mass right at the area of the sigmoid colon consistent with a divertiliculitis or perforation with infection. Proximal to this in the distal left colon, the colon was divided using a GIA stapler with 3.5 mm staples. The sigmoid colon was then mobilized using blunt dissection. The proximal rectum just distal to the inflammatory mass was divided using a GIA stapler with 3.5 mm staples. The mesentary of the sigmoid colon was then taken down and tied using two 0 Vicryl ties. Irrigation was again performed and the sigmoid colon was removed with inflammatory mass. The wall of the abscessed cavity that was next to the sigmoid colon where the inflammatory mass was, showed no leakage of stool, no gross perforation, most likely there is a small perforation in one of the diverticula in this region. Irrigation was again performed throughout the abdomen until totally clear. All excess fluid was removed. The distal descending colon was then brought out through a separate incision in the lower left quadrant area and a large 10 mm 10 French JP drain was placed into the abscessed cavity. The sigmoid colon or the colostomy site was sutured on the inside using interrupted 3-0 Vicryl to the peritoneum and then two sheets of film were placed into the intra- abdominal cavity. The fascia was closed using a running #1 double loop PDS suture and intermittently a #2 nylon retention suture was placed. The colostomy was matured using interrupted 3-0 chromic sutures. I palpated the colostomy; it was completely patent with no obstructions. Dressings were applied. Colostomy bag was applied. Which CPT® code should be used? A. 44140 B. 44143 C. 44160 D. 44208

The surgery was not performed by a laparoscope, eliminating multiple choice answer D. The patient had a colostomy (Artificial surgical opening anywhere along the length of the colon to the skin surface for the diversion of feces) done, not an anastomosis (surgically creating a connection between bowel segments to allow flow from one to the other), eliminating multiple choice answer A. The operative note documents that the distal left colon was divided and the sigmoid colon excised, eliminating multiple choice answer C. Answer B

The patient is a 78 year-old white female with morbid obesity that presented with small bowel obstruction. She had surgery approximately one week ago and underwent exploration, which required a small bowel resection of the terminal ileum and anastomosis leaving her with a large inferior ventral hernia. Two days ago she started having drainage from her wound which has become more serious. She is now being taken back to the operating room. Reopening the original incision with a scalpel, the intestine was examined and the anastomosis was reopened , excised at both ends, and further excision of intestine. The fresh ends were created to perform another end- to-end anastomosis. The correct procedure code is: A. 44120-78 B. 44126-79 C. 44120-76 D. 44202-58

The surgery was not performed with a laparoscope, eliminating multiple choice answer D. The patient did not have a diagnosis of congenital atresia, eliminating multiple choice answer B. This was an unplanned return to the operating room due to the patient having a complication from the original surgery that was performed a week ago, eliminating multiple choice answer C. Answer A

Patient that is a borderline diabetic has been sent to the laboratory to have an oral glucose tolerance test. Patient drank the glucose and five blood specimens were taken every 30 to 60 minutes up to three hours to determine how quickly the glucose is cleared from the blood. What code(s) is (are) reported for this test? A. 82947 x 5 B. 82946 C. 80422 D. 82951, 82952 x 2

The test being performed is a glucose tolerance test (GTT) guiding you to code 82951. Five blood specimens were taken in which the first three blood specimens are reported with code 82951. The last two blood specimens will be reported with code 82952 twice. Answer D

A patient that has multiple sclerosis has been seeing a therapist for four visits. Today's visit the therapist will be performing a comprehensive reevaluation to determine the extent of progress. There was a revised plan assessing the changes in the patient's functional status. Initial profile was updated to reflect changes that affect future goals along with a revised plan of care. A total care of 30 minutes were spent in this re-evaluation. What CPT® and ICD-10-CM codes should be reported? A. 97168, Z51.89, G35 B. 97164, Z56.89, G35 C. 97167, G35 D. 97163, Z56.9, G35

This patient is coming in for occupational therapy which helps a patient to improve basic motor functions and reasoning abilities for independent daily living. This eliminates multiple choices B and D. This is a re-evaluation visit eliminating multiple choice C. The first listed diagnosis code is Z51.89 because the patient is receiving after care for occupational therapy. Answer A

An 82 year-old female had a CAT scan which revealed evidence of a proximal small bowel obstruction. She was taken to the Operating Room where an elliptical abdominal incision was made, excising the skin and subcutaneous tissue. There were extensive adhesions along the entire length of the small bowel: the omentum and bowel were stuck up to the anterior abdominal wall. Time consuming, tedious and spending an extra hour to lysis the adhesions to free up the entire length of the gastrointestinal tract from the ligament to Treitz to the ileocolic anastomosis. The correct CPT® code is: A. 44005 B. 44180-22 C. 44005-22 D. 44180-59

This surgical procedure was not performed by a laparoscope, it was an open surgery, eliminating multiple choice answers B and D. It is documented that the adhesions were "extensive," "time consuming," and "spending an extra hour" to free up the attachments to the gastrointestinal tract. These are key words in indicating modifier 22 should be appended to the procedure code. Appendix A lists the modifiers. Answer C

42 year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The rotator interval was very thick and contracted. Adhesions were destroyed with electrocautery and the Bovie. The superior glenohumeral ligament, the middle glenohumeral ligament and the tendinous portion of the subscapularis were released. The arthroscope was placed anteriorly, adhesions were destroyed and the shaver was used to debride some of the posterior capsule and the posterior capsule was released in its posterosuperior and then posteroinferior aspect. What CPT® code(s) is (are) reported? A. 23450-LT B. 23466-LT C. 29805-LT, 29806-51-LT D. 29825-LT

To narrow down your choices decide if the procedure is an open procedure or performed with an arthroscope? It was performed with an arthroscope, eliminating multiple choice answers A and B. The diagnostic arthroscopy (29805) is a separate procedure, and according to CPT® Surgery Guidelines: The codes designated as "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. Meaning code 29806 already includes the diagnostic arthroscopy code, so you only report code 29806. Code 29806 represents suturing of the capsule (capsulorrhaphy); however, this was not the procedure performed. The procedure performed was a lysis of adhesions for a frozen shoulder (29825) noted in multiple choice answer D.

18 year-old female with a history of depression comes into the ER in a coma. The ER physician orders a drug screen on antidepressants, phenothiazines, and benzodiazepines. The lab performs a screening for single drug class using an immunoassay in a random access chemistry analyzer. Presence of antidepressants is found and a drug confirmation is performed to identify the particular antidepressant. What correct CPT® codes are reported? A. 80307, 80338 B. 80305, 80338 C. 80306 x 3, 80332 D. 80307 x 3, 80333

To report codes for drug testing depends on the method of the testing. The scenario indicates a chemistry analyzer utilizing immunoassay method was used, guiding you to code 80307. Subsection guidelines for Presumptive Drug Class Screening indicates: Use 80307 once to report single or multiple procedures, classes, or results on any date of service. A drug confirmation was performed on antidepressants, reporting code 80338 because the type of antidepressant is not documented. Answer A

After adequate anesthesia was obtained the patient was turned prone in a kneeling position on the spinal table. A lower midline lumbar incision was made and the soft tissues divided down to the spinous processes. The soft tissues were stripped away from the lamina down to the facets and discectomies and laminectomies were then carried out at L3-4, L4-5 and L5-S1. Interbody fusions were set up for the lower three levels using the Danek allografts and augmented with structural autogenous bone from the iliac crest. The posterior instrumentation of a 5.5 mm diameter titanium rod was then cut to the appropriate length and bent to confirm to the normal lordotic curve. It was then slid immediately onto the bone screws and at each level compression was carried out as each of the two bolts were tightened so that the interbody fusions would be snug and as tight as possible. Select the appropriate CPT® codes for this visit? A. 22612, 22614 x 2, 22842, 20938, 20930 B. 22533, 22534 x 2, 22842 C. 22630, 22632 x 2, 22842, 20938, 20930 D. 22554, 22632 x 2, 22842

To start narrowing the correct arthrodesis code to report, you first need to determine the surgical approach. The scenario tells us that the patient was placed in prone position (lying face down) on the table and a lumbar incision was made indicating a posterior approach, eliminating multiple choices B and D. The next bit of information to look for is the technique that was used for the arthrodesis, which was the interbody fusion technique guiding you to code 22630. Answer C

PRE OP DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast FINDINGS: Lesion is located in the lateral region, just at or below the level of the nipple on the 90 degree lateral view. There is a subglandular implant in place. I discussed the procedure with the patient today including risks, benefits and alternatives. Specifically discussed was the fact that the implant would be displaced out of the way during this biopsy procedure. Possibility of injury to the implant was discussed with the patient. Patient has signed the consent form and wishes to proceed with the biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged from the inferior approach. The lesion of interest is in the anterior portion of the breast away from the implant which was displaced back toward the chest wall. After imaging was obtained and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped with Betadine. 1% lidocaine was injected subcutaneously for local anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling needle. The SenoRx needle was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy samples using vacuum and cutting technique. The specimen radiograph confirmed representative sample of calcification was removed. The tissue marking clip was deployed into the biopsy cavity successfully. This was confirmed by final stereotactic digital image and confirmed by post core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left breast in satisfactory position. No obvious calcium is visible on the final post core biopsy image in the area of interest. The patient tolerated the procedure well. There were no apparent complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack in the usual manner. The patient did receive written and verbal post-biopsy instructions. The patient left our department in good condition. IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT BREAST CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE RECEIVE THE PATHOLOGY REPORT. What is (are) the CPT® code(s)? A. 19081 B. 19283 C. 19081, 19283 D. 19100, 19283

To start narrowing your choices was the biopsy performed percutaneously or by an open incision? The operative note documents that a "SenoRx needle" was used to obtain the biopsy, which is percutaneous. Because there was a biopsy and a placement of a localization device (clip), you eliminate multiple choice B. Code 19283 is reported only for the placement of the localization device. Stereotactic image was used to perform the needle biopsy and placement of the clip. This eliminates multiple choice D, because code 19100 is for needle biopsy without imaging guidance. Code 19081 is the only code reported for the operative note because its code description reports both the biopsy and the placement of the clip under stereotactic imaging, eliminating multiple choice C. Answer A

The patient is a 58 year-old white male, one month status post pneumonectomy. He had a post pneumonectomy empyema treated with a tunneled cuffed pleural catheter which has been draining the cavity for one month with clear drainage. He has had no evidence of a block or pleural fistula. Therefore a planned return to surgery results in the removal of the catheter. The correct CPT® code is: A. 32440-78 B. 32035-58 C. 32036-79 D. 32552-58

You can start narrowing your choices by the modifiers. Appendix A in the CPT® codebook lists the numeric modifiers. The key phrase to choose the correct modifier is "planned return", which is found in the descriptive for modifier 58. The patient is returning to surgery to remove the pleural catheter, eliminating multiple choice B. Answer D