CPC Practice Exam 3

When a patient has fractured the proximal end of his humerus, where is the fracture located? A. Upper end of the arm B. Lower end of the leg C. Upper end of the leg D. Lower end of the arm

Answer A

Glomerulonephritis is an inflammation affecting which system? A. Digestive B. Nervous C. Urinary D. Cardiovascular

Glomerulnephritis is a form of nephritis marked by inflammation of the glomeruli of the kidney. In the ICD-10-CM Alphabetic Index look for Glomerulnephritis referring you to code N05.9. In the Tabular List this code is found Chapter 14: Diseases of Genitourinary System. Answer C

If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines? A. As unspecified AMI B. As a subendocardial AMI C. As STEMI D. As a NSTEMI

ICD-10-CM guidelines (Section I.C.9.e.1) indicate: If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI. Answer C

What is another term for when a physician performs a reduction on a displaced fracture? A. Casting B. Manipulation C. Skeletal traction D. External fixation

In the CPT® codebook in the section for Musculoskeletal System guidelines defines Manipulation: is used throughout the musculoskeletal fracture and dislocation subsections to specifically mean the attempted reduction or restoration of a fracture or joint dislocation to its normal anatomic alignment by the application of manually applied force. Answer B

Local Coverage Determinations (LCD) are published to give providers information on which of the following? A. Information on modifier use with procedure codes B. CPT® codes that are bundled C. Fee schedule information listed by CPT® code D. Reasonable and necessary conditions of coverage for an item or service

Local Coverage Determinations (LCD) are Medicare Administrative Contractor rules indicating whether or not a particular item or service is covered. Most LCDs also provide a list of diagnosis codes for which a procedure may be covered; however, because other issues factor into payment, coverage is not guaranteed. Modifier guidelines and fee schedule information is included in the annual Medicare Physician Fee Schedule. National Correct Coding Initiative (NCCI) is used to know what CPT® codes are bundled. Answer D

Sperm is being prepared through a washing method to get it ready for the insemination of five oocytes for fertilization by directly injecting the sperm into each oocyte. Choose the CPT® codes to report this service. A. 89257, 89280 B. 89260, 89280 C. 89261, 89280 D. 89260, 89268

Sperm isolation is performed. Sperm washing refers to separating the sperm from semen and getting rid of dead or slow-moving sperm as well as additional chemicals that may impair fertilization (89260). The selection of the second listed code is for the number of oocytes fertilized. The correct code is 89280 to indicate less than 10 were fertilized. Answer B

24 year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT® code is: A. 56405 B. 10061 C. 11004 D. 11042

The abscess had already burst, with no need to perform an incision to open it, eliminating multiple choice answers A and B. The difference between multiple choice answers C and D, is that the patient is having the debridement performed due to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of necrotized infected tissue on the external genitalia. Answer C

An angiogram is a study to look inside: A. Female Reproductive System B. Urinary System C. Blood Vessels D. Breasts

The breakdown of this term is: Angi/o refers to blood vessel and the suffix -gram refers to a written record. An angiogram is an X-ray photograph or an imaging technique that uses contrast/dye to look inside blood vessels. Look in CPT® Index for Angiography referring you to codes in the Radiology section in which many arteries are listed in alphabetical order. Answer C

What does oligospermia mean? A. Presence of blood in the semen B. Deficiency of sperm in semen C. Having sperm in urine D. Formation of spermatozoa

The breakdown of this term: combining form olig/o means too few or too little and spermia refers to the condition of the sperm. The definition is too low or too few sperm. In the Alphabetic Index look for Oligiospermia N64.11. In the Tabular List oligiospermia is indicated as a type of male infertility. Answer B

The patient is here to follow up on her atrial fibrillation. Her primary care physician is not in the office. She will be seen by the partner physician that is also in the same group practice. No new problems. A problem focused history is performed. An expanded problem focused physical exam is documented with the following, Blood pressure is 110/64. Pulse is regular at 72. Temp is 98.6F Chest is clear. Cardiac normal sinus rhythm. Medical making decision is straightforward. Diagnosis: Atrial fibrillation, currently stable. What E/M code is reported for this service? A. 99201 B. 99202 C. 99212 D. 99213

According to CPT® Evaluation and Management (E/M) Service Guidelines subsection New and Established Patient indicates: An established patient is one who has received professional face-to-face services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. This eliminates multiple choices A and B. An established office visit requires at least 2 of 3 key components must meet or exceed the stated requirements to qualify for a particular level of E/M service. In the question you have: Problem Focused History + Expanded Problem Focused Exam + Straightforward MDM. The correct answer is 99212 because the two key components that meet are: Problem Focused History and Straightforward Medical Decision Making. Answer C

A 2 year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedures to report for the ER physician? A. 99291-25, 36555, 31500 B. 99291-25, 36556, 31500, 82803 C. 99285-25, 36556, 31500, 82803 D. 99475-25, 36556

According to the CPT® subsection guidelines for Inpatient Neonatal and Pediatric Critical Care: To report critical care services provided in the outpatient setting (example, emergency department or office) for neonates and pediatric patients of any age, see the Critical Care codes 99291, 99292. This would eliminate multiple choice D. There is documentation in which the ER physician spent a total of 30 minutes on a critical patient, eliminating multiple choice C. Blood gas (82803) is a lab procedure that is not separately reported when billing for critical care. A list of services included in reporting critical care is found in the subsection guidelines under Critical Care Services. Modifier 25 is appended to 99291 to identify the evaluation and management service as a separately identifiable service in which billable procedures were performed on the same date of service. Answer A

45 year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported? A. 14060 B. 11642, 14060 C. 11642, 15115 D. 15574

An adjacent tissue transfer (advancement flap) was used to repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are not separately reported. This eliminates multiple choice answer B. Answer A

2 year-old is coming in with his mom to see the pediatrician for fever, sore throat, and pulling of the ears. The physician performs an expanded problem focused history. An expanded problem focused exam. A strep culture was taken for the pharyngitis and came back positive for strep throat. A diagnosis was also made of the infant having acute otitis media with effusion in both ears. The medical decision making was of moderate complexity with the giving of a prescription. What CPT® and ICD-10-CM codes are reported? A. 99212, J02.9, H66.93 B. 99213, J02.0 H65.93 C. 99212, J02.0 H65.193 D. 99213, J02.0 H65.193

An established patient office visit codes requires 2 of the 3 key components (history, exam and medical decision making) to qualify for a particular level of E/M service. The documentation in the scenario provides: Expanded Problem Focused History, Expanded Problem Focused Exam, and Medical Decision Making of moderate complexity. The two key components that meet are Expanded Problem Focused History and Expanded Problem Focused Exam, selecting code 99213. The strep culture for the pharyngitis came back positive for strep. Look in ICD-10-CM Alphabetic for Pharyngitis/streptococcal guiding you to code J02.0. Next look for Otitis/media/with effusion-see Otitits, media, nonsuppurative. Look for Otitis/media/nonsuppurative/acute or subacute guiding you to code H65.19-. Go to Tabular List to complete code, H65.193. Answer D

Documentation of a new patient in a doctor's office setting supports a detailed history in which there are four elements for an extended history of present illness (HPI), three elements for an extended review of systems (ROS) and a pertinent Past, Family, Social History (PFSH). There is a detailed examination of six body areas and organ systems. The medical making decision making is of high complexity. Which E/M service supports this documentation? A. 99205 B. 99204 C. 99203 D. 99202

Evaluation and Management Services Guidelines indicate for an office visit of a new patient all three key components (history, exam, and medical decision making) need to meet or exceed the stated requirements to qualify for that E/M service. In our question we have the following: Detailed History, Detailed Exam, and High complexity Medical Decision Making. The highest level that can be reached is 99203: Detailed History - Meets Detailed Examination - Meets Medical Decision Making of Low Complexity - Exceeds You can also determine the E/M level that requires all three key components another way. When all three key components do not exactly meet the E/M level, you report the E/M level that has the lowest key component(s) in the question. The correct code is 99203 because the lowest key components in the question are Detailed History and Detailed Exam. Answer C

PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee The patent was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT® and ICD-10-CM codes should be reported? A. 29880-RT, M23.203, M65.80, M94.261, M22.41 B. 29881-RT, M23.211, M65.861, M94.261, M22.41 C. 29881-RT, M23.221, M65.861, M94.261, M22.41 D. 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41

For this operative note the anatomic location is the knee, specifically with just the medial meniscus performed on, eliminating multiple choice answers A and D. A limited synovectomy (29875) was performed; however, it was performed in the medial compartment of the knee along with the medial meniscectomy; therefore, is not reported. Also, code 29875 is a separate procedure, 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. Debridement was performed in the lateral and patellofemoral compartments which is included in code 29881; code 29877 is not reported separately. Synovitis (M65.861), chondromalacia (M94.261) for the fibrillated articular cartilage of the tibial plateau and patella (M22.41) are reported. The patient had a meniscus tear, but the operative note indicates a more specific area of the tear. It documents that, "An upbiting basket was introduced to transect the base of the posterior horn flap tear", look in the ICD-10-CM Alphabetic Index for Tear/meniscus/old-see Derangement, knee, meniscus due to old tear. Look for Derangement/knee/meniscus/medial/posterior horn M23.22-. Go to the Tabular List to complete the code, M23.221. Answer C

Patient is going back to the OR for a re-exploration L5-S1 laminectomy for a presumed cerebrospinal fluid leak following a decompression procedure. A small partial laminectomy was slightly extended, however revealed no real evidence of leak. Valsalva maneuver was performed several times, no evidence of leak. There was a hematoma, which was drained. What ICD-10-CM code(s) is (are) reported by the physician? A. G96.0 B. G97.61 C. G96.8 D. G96.0, T81.4XXA

ICD-10-CM guidelines (Section IV.H) indicate uncertain diagnosis that is documented as probable, suspected, rule out, or etc. are not coded. This eliminates multiple choice answers A and D. The patient is in a post-operative period because she is going back to the OR when just having a laminectomy performed and there was found a hematoma. This eliminates multiple choice C. This is a complication of the procedure, because a hematoma was found. Look in the Alphabetic Index for Complication/postprocedural/hematoma/nervous system/following a nervous system procedure referring you to code G97.61. Answer B

A pathologist performs a comprehensive consultation and report after reviewing a patient's records and specimens from another facility. The correct CPT® code to report this service is: A. 88325 B. 99244 C. 88323 D. 88329

In the CPT® Index, look for Surgical Pathology/Consultation referring you to 88321-88325. 88325 is the correct code. The correct code is 88325 to indicate that the comprehensive consultation is being done by reviewing the patient's records and on specimens from a different facility. Code 99244 is reported when the consultation is involving the examination and evaluation of the patient. Code 88323 is the consultation and report on referred material requiring preparing of slides. Code 88329 is when a consultation is performed during a surgery. Answer A

A patient that has hypertensive heart disease with congestive heart failure is coded: A. I11.0, I50.9 B. I13.0 C. I13.0, I11.0, I50.9 D. I50.9, I11.0

In the ICD-10-CM Alphabetic Index look for Hypertension/due to/heart disease/with/heart failure (congestive) referring you to code I11.0. This eliminates multiple choice answers B and C. In the Tabular List under code I11.0 there is an instructional note to Use additional code to identify type of heart failure (I50.-). Code I50.9 (Congestive heart failure) is reported as the second code. Answer A

When a person has labyrinthitis what has the inflammation? A. Inner ear B. Brain C. Conjunctiva D. Spine

Labyrinthitis is an inflammation of the inner ear which can cause vertigo and vomiting. In the ICD-10-CM Alphabetic Index, look for Labyrinthitis and you will see next to the term inner ear in parenthesis. Answer A

A very large lipoma is removed from the chest measuring 8 sq cm and the defect is 12.2 cm requiring a layered closure with extensive undermining. MAC is performed by a medically directed Certified Registered Nurse Anesthetist (CRNA). Code the anesthesia service. A. 00400-QX-QS B. 00400-QS C. 00300-QS D. 00300-QX-QS

Look in the CPT® Index for Anesthesia/Integumentary System/Anterior Trunk referring you to 00400 which is the correct code. The HCPCS modifier QX is appended to report the service was provided by a medically directed CRNA. Modifier QS is appended to identify that the type of anesthesia is MAC or monitored anesthesia care. Answer A

50 year-old female has recurrent lymphoma in the axilla. Ultrasound was used to localize the lymph node in question for needle guidance. An 11 blade scalpel was used to perform a small dermatotomy. An 18 x 10 cm Biopence needle was advanced through the dermatotomy to the periphery of the lymph node. A total of 4 biopsy specimens were obtained. Two specimens were placed an RPMI and 2 were placed in formalin and sent to laboratory. The correct CPT® code(s) is (are): A. 10022 B. 38500, 77002-26 C. 38505, 76942-26 D. 38525, 76942-26

Modifier needs to be appended to procedure A needle was used to obtain the biopsies, eliminating multiple choice answers B and D. An aspiration (drawing fluid out) was not performed, eliminating multiple choice answer A. There is a parenthetical note under code 38505 that indicates see imaging guidance, when performed 76942, 77012, 77021. Imaging guidance (ultrasound) was performed, correctly reporting 76942. Answer C

The patient is a 51 year-old gentleman who has end-stage renal disease. He was in the OR yesterday for a revision of his AV graft. The next day the patient had complications of the graft failing. The patient was back to the operating room where an open thrombectomy was performed on both sides getting good back bleeding, good inflow. Select the appropriate code for performing the procedure in a post-operative period: A. 36831-76 B. 36831 C. 36831-78 D. 36831-58

Modifier needs to be appended to procedure code 36831 because the patient returned to surgery within the postoperative period, eliminating multiple choice answer B. Appendix A lists the modifiers needed to append to the procedure codes. The patient did not have a planned return to surgery, eliminating multiple choice answer D. Nor did the patient have a repeat procedure on the same day of service, eliminating multiple choice answer A. The patient had to return to the operating room to have a thrombectomy and balloon angioplasty of the venous anastomosis due to the AV graft failing which is a complication that followed the initial procedure. Modifier 78 indicates is correct. Answer C

Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower quadrant transverse incision was made upon entry to the abdomen. In the right lower quadrant there was a large amount of pus consistent with a right lower quadrant abscess. Intraoperative cultures anaerobic and aerobic were taken and sent to microbiology for evaluation. Irrigation of the pus was performed until clear. The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was taken down and tied using 0-Vicryl ties and the appendix fell off completely since it was already ruptured with tissue paper thin membrane at the base. There was no appendiceal stump to close or to tie, just an opening into the cecum; therefore, the appendiceal opening area into the cecum was tied twice using figure of 8 vicryl sutures. Omentum flap was tacked over this area and anchored in place using interrupted 3-0 Vicryl sutures to secure the repair. What CPT® and ICD-10-CM codes are reported? A. 44950, K35.89 B. 44960, 49905, K35.3 C. 44950, 49905-51, K35.2 D. 44970, K37

Patient had an open surgery appendectomy, eliminating multiple choice answer D. The scenario documents that there was also an abscess, eliminating A and C. 44905 is an add-on code, which modifier 51 is not reported. Look in the ICD-10-CM Alphabetic Index for Appendicitis/with peritoneal abscess, referring you to code K35.3. Verify code in the Tabular List. Answer B

Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area of skin where the excisions of the tumor will be performed using Mohs micrographic surgery technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue blocks which were also cut and stained for microscopic examination. The entire base and margins of the excised pieces of tissue were examined by the surgeon. No tumor was identified after the final stage of the microscopically controlled surgery. What procedure codes are reported? A. 17313, 17314, 17314 B. 17313, 17315 C. 17260, 17313, 17314 D. 17313,17314, 17315

Patient is having Mohs Micrographic Surgery being performed only, eliminating multiple choice answer C. Mohs codes are based on the anatomic grouping by code, the number of stages taken, and number of blocks per stage. The surgery was on the back reporting code 17313 for stage 1 with three blocks, add-on code 17314 is for stage 2 with five blocks, and add-on code 17315 is for the sixth block in stage 2. Answer D

67 year-old female fractured a port-a-cath surgically placed a year ago. Under sonographic guidance a needle was passed into the right common femoral vein. The loop snare was positioned in the right atrium where a portion of the fractured catheter was situated. The catheter crossed the atrioventricular valve with the remaining aspect of the catheter in the ventricle. A pigtail catheter was then utilized to loop the catheter and pull the catheter tip into the inferior vena cava. The catheter was then snared and pulled through the right groin removed in its entirety. What CPT® and ICD-10-CM codes are reported? A. 37200, T81.509D B. 37197, T82.514A C. 37193, T80.219A D. 37217, T88.8XXA

Patient is having a broken tip of a catheter removed from the right ventricle, eliminating multiple choices A and D. Catheter was fractured eliminating choice C. The procedure includes imaging guidance so radiology code is not reported separately. The fracture of the port-a-cath is a mechanical complication. Look in the Alphabetic Index for Complication/catheter (device) NEC/intravenous infusion/mechanical/breakdown T82.514-. Go to the Tabular List to complete the code, T82.514A. Answer B

55 year-old female has a symptomatic rectocele. She had been admitted and taken to the main OR. An incision is made in the vagina into the perineal body (central tendon of the perineum). Dissection was carried underneath posterior vaginal epithelium all the way over to the rectocele. Fascial tissue was brought together with sutures creating a bridge and the rectocele had been reduced with good support between the vagina and rectum. What procedure code should be reported? A. 45560 B. 57284 C. 57250 D. 57240

Patient is having a repair for a rectocele, not a cystocele, eliminating multiple choice answers B and D. Selection of the code is based surgical approach and whether performed anterior or posterior. The repair of rectocele was an open surgery performed by a "posterior" colporrhaphy approach, eliminating multiple choice answer A. Answer C

53 year-old woman with ascites consented to a procedure to withdraw fluid from the abdominal cavity. Ultrasonic guidance was used for guiding the needle placement for the aspiration. What CPT® codes should be used? A. 49083 B. 49180, 76942-26 C. 49082, 77002-26 D. 49180, 76998-26

Patient is having an abdominal paracentesis performed, eliminating multiple choice answers B and D. The needle placement to withdraw the fluid was done under ultrasonic (imaging) guidance, eliminating multiple choice answer C. There is a parenthetical note under procedure code 49083 that states: Do not report 49083 in conjunction with 76942, 77002, 77012, 77021 Answer A

Which place of service code should be reported on the physician's claim for a surgical procedure performed in an ASC? A. 21 B. 22 C. 24 D. 11

Place of service codes are two digit numerical codes that define the location where services are performed and reported on the CMS-1500 form. A complete chart of Place-Of-Service codes is found on the first page in CPT® codebook. A service provided in an ASC is reported with POS code 24. Answer C

25 year-old female in the OR for ectopic pregnancy. Once the trocars were place a pneumoperitoneum was created and the laparoscope introduced. The left fallopian tube was dilated and was bleeding. The left ovary was normal. The uterus was of normal size, shape and contour. The right ovary and tube were normal. Due to the patient's body habitus the adnexa could not be visualized to start the surgery. At this point the laparoscopic approach was terminated. The pneumoperitoneum was deflated, and trocar sites were sutured closed. The trocars and laparoscopic instruments had been removed. Open surgery was performed incising a previous transverse scar from a cesarean section. The gestation site was bleeding and all products of conception and clots were removed. The left tube was grasped, clamped and removed in its entirety and passed off to pathology. What code(s) is (are) reported for this procedure? A. 59150, 59120 B. 59151 C. 59121 D. 59120

Procedure had started with a laparoscopic treatment for a tubal ectopic pregnancy. Due to the patient's body size the laparoscopic approach was terminated and an open surgery was performed instead, eliminating multiple choice answers A and B. The patient had the left fallopian tube removed (salpingectomy) removed, eliminating multiple choice answer C. When an laparoscopic surgical procedure fails, only the successful open procedure is reported (NCCI Manual, version 6.1, April-June, 2000). Answer D

A cardiologist pediatrician sends a four week-old baby to an outpatient facility to have an echocardiogram. The baby has been having rapid breathing. He is sedated and a probe is placed on the chest wall and images are taken through the chest wall. A report is generated and sent to the pediatrician. The interpretation of the report by the pediatrician reveals the baby has an atrial septal defect. Choose the CPT® code the cardiologist pediatrician should report. A. 93303 B. 93315-26 C. 93303-26 D. 93315

Selection of the codes are based on the technique used. Infant is having the echocardiogram performed through the chest (transthoracic) not through the a device in the esophagus (transesophageal), eliminating multiple choices B and D. Given the age of the patient, the use of the congenital code is correct. Congenital referring to a deformity at birth. The subsection guidelines for Echocardiography in the CPT® codebook states: When interpretation is performed separately, use modifier 26. Modifier 26 needs to be appended because only the interpretation of the echocardiogram was performed by the pediatrician. Answer C

Thoracentesis is removing fluid or air from the: A. Lung B. Chest cavity C. Thoracic vertebrae D. Heart

The breakdown of this term: thorac/o refers to chest or thorax and the suffix -centesis refers to puncture; the insertion of a needle or similar instrument into a bodily space to add or withdraw fluids. In the CPT® Index look for Thoracentesis referring you to codes 32554, 32555. There is a diagram in the CPT® codebook for these codes that indicate the procedures are for removal of accumulated fluid or air from the pleural space between the ribs. Answer B

Cells were taken from amniotic fluid for analyzation of the chromosomes for possible Down's syndrome. The geneticist performs the analysis with two G-banded karyotypes analyzing 30 cells. Select the lab code(s) for reporting this service. A. 88248 B. 88267, 88280, 88285 C. 88273, 88280, 88291 D. 88262, 88285

The chromosome analysis was taken from amniotic fluid eliminating multiple choices A, C and D. The selection of the codes are based on the type of sample used, the number of karotypes performed, and the number of cells studied. There were two karyotypes performed with analyzing 30 cells. Code 88267 identifies the sample as amniotic fluid with only one karyotype and 15 cells studied. Code 88280 is reported for the additional karyotype. Code 88285 is reported for the remaining 15 cells. Answer B

10 year-old patient had a recent placement of a cochlear implant. She and her family see an audiologist to check the pressure and determine the strength of the magnet. The transmitter, microphone and cable are connected to the external speech processor and maximum loudness levels are determined under programming computer control. Which CPT® code should be used? A. 92601 B. 92603 C. 92604 D. 92562

The coding scenario deals with a cochlear implant, eliminating multiple choice D. The patient is 10 years-old with a cochlear implant, eliminating multiple choice A. The selection of the remaining codes is based on the age of the patient and the current encounter as new vs subsequent. There is no documentation relating to a previous attempt to program the implant. The placement of the cochlear implant was recent, so this is not a subsequent reprogramming, eliminating multiple choice C. Answer B

This is a 32 year-old female who presents today with sacroilitis. On the physical exam there was pain on palpation of the left and right sacroiliac joint and fluoroscopic guidance was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 mL of bupivacaine at 0.5% was injected into the left and right sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. The correct CPT® code(s) is (are): A. 20611 B. 27096-50, 77012 C. 27096-50 D. 27096, 27096-51, 77012

The injection is being performed in the sacroiliac joint, eliminating multiple choice answer A. Fluoroscopic guidance is included and should not be reported separately because the code description for code 27096 includes imaging, eliminating multiple choice answers B and D. There is parenthetical note under code 27096 that indicates to use modifier 50 for bilateral procedure (left and right). Answer C

The patient is a 77 year-old white female who has been having right temporal pain and headaches with some visual changes and has a sed rate of 51. She is scheduled for a temporal artery biopsy to rule out temporal arteritis. A Doppler probe was used to isolate the temporal artery and using a marking pen the path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade scalpel the skin was opened in the preauricular area and dissected down to the subcutaneous tissue where the temporal artery was identified in its bed. It was a medium size artery and we dissected it out for a length of approximately 4 cm with some branches. The ends were ligated with 4-0 Vicryl, and the artery was removed from its bed and sent to Pathology as specimen. What CPT® code is reported? A. 37609 B. 37605 C. 36625 D. 37799

The key terms for this scenario are "temporal artery biopsy", which is found in the code description for multiple choice answer A. Answer A

A craniectomy is being performed on a patient who has Chiari malformation. Once the posterior inferior scalp was removed a C-1 and a partial C-2 laminectomy was then performed. The right cerebellar tonsil was dissected free of the dorsal medulla and a gush of cerebrospinal fluid gave good decompression of the posterior fossa content. Which CPT® code is reported? A. 61322 B. 61345 C. 61343 D. 61458

The keywords in this craniectomy procedure to guide you to the correct code are: cervical (C-1 and C-2) laminectomy, medulla, and Chiari malformation found in the code description of 61343. Answer C

The patient is a 66 year-old female who presents with Dupuytren's disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren's disease right ring digit and palm. An extensile Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code(s) is (are) used? A. 26123-RT, 26125-F7 B. 26121-RT C. 26035-RT D. 26040-RT

The patient is having a fasciectomy, eliminating multiple choice answers C and D. The fasciectomy was performed on the right hand supported by the documentation that states: "the fascial attachments to the flexor tendon sheath were released" and "subtotal palmar fasciectomy." Documentation also indicates the right middle finger ( modifier F7) had diseased fascia excised. Answer D

Under fluoroscopic guidance an injection of a combination of steroid and analgesic agent is performed on T2-T3, T4-T5, T6-T7 and T8-T9 on the left side into the paravertebral facet joints. The procedure was performed for pain due to thoracic root lesions. What are the procedure codes? A. 64479, 64480x3, 77003 B. 64490, 64491, 64492x2, 77003 C. 64520x4, 77003 D. 64490, 64491, 64492

The patient is having the injection in the paravertebral facet joints, eliminating multiple choice answers A and C. The selection of the injection(s) in the paravertebral facet joint codes are based on the region of the spine and the number of levels injected. The code description for code 64490 is for the thoracic and has fluoroscopic guidance included in the code, meaning code 77003 is not reported separately. Also there is a parenthetical note under code 64492 that indicates not to report 64492 more than once per day, eliminating multiple choice answer B. Answer D

An entropion repair is performed on the left lower eyelid in which undermining was performed with scissors of the inferior lid and inferior temporal region. Deep sutures were used to separate the eyelid margin outwardly along with stripping the lateral tarsus to provide firm approximation of the lower lid to the globe. The correct CPT® code is: A. 67914-E4 B. 67924-E2 C. 67921-E2 D. 67917-E1

The procedure being performed is an entropion repair on the left lower eyelid, eliminating multiple choice answers A and D. This is an extensive repair because a tarsal strip was performed, eliminating multiple choice C. HCPCS modifier E2 indicates that the procedure is performed on the lower left eyelid. Answer B

PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal. The patient is placed on heart and lung bypass during the procedure. Anesthesia time: 6:00 PM to 12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and anesthesia time? A. 00567, 6 hours B. 00566, 6 hours C. 00567, 5 hours and 30 minutes D. 00566, 5 hours and 30 minutes

The procedure performed is a coronary artery bypass. Look in the CPT® Index, for Anesthesia/Heart/Coronary Artery Bypass Grafting referring you to 00566 and 00567. The question indicates that the heart and lung bypass was used. Select 00567 because the code description includes "with pump oxygenator." Pump oxygenator describes when a cardioplumonary bypass (CPB) machine is used to function as the heart and lungs during a heart or great vessel surgery. The anesthesia start time is 6:00 PM and the anesthesia ends at 12:00 AM which is six hours. Refer to the CPT® Anesthesia Guidelines under heading Time Reporting for reporting anesthesia time. Per the guidelines anesthesia time begins when the anesthesiologist begins to prepare the patient and ends when the anesthesiologist releases the patient under postoperative supervision. Surgical times are not reported for anesthesia time. Answer A

A 61 year-old gentleman with a history of a fall while intoxicated suffered a blow to the forehead and imaging revealed a posteriorly displaced odontoid fracture. The patient was taken into the Operating Room, and placed supine on the operating room table. Under mild sedation, the patient was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy was performed to gently try to reduce the fracture. It did reduce partially without any change in the neurologic examination. More manipulation would be necessary and it was decided to intubate and use fiberoptic technique. The anterior neck was prepped and draped and an incision was made in a skin crease overlying the C4-C5 area. Using hand-held retractors, the ventral aspect of the spine was identified and the C2-C3 disk space was identified using lateral fluoroscopy. Using some pressure upon the ventral aspect of the C2 body, we were able to achieve a satisfactory reduction of the fracture. Under direct AP and lateral fluoroscopic guidance, a Kirschner wire was advanced into the C2 body through the fracture line and into the odontoid process. This was then drilled, and a 42 millimeter cannulated lag screw was advanced through the C2 body into the odontoid process. What procedure code is reported? A. 22505 B. 22326 C. 22315 D. 22318

The procedure performed is the reduction of an odontoid fracture, by incising (open treatment) the anterior neck (anterior approach) to reduce the fracture and placement of internal fixation (Kirschner wire and lag screw). Gardner-Wells tongs (20660) were applied originally to try to reduce the fracture with axial traction; however, this procedure is listed as a separate procedure and it should not be reported during the same session for reduction of the fracture. Answer D

23 year-old who is pregnant at 39-weeks and 3 days is presenting for a low transverse cesarean section. An abdominal incision is made and was extended superiorly and inferiorly with good visualization of the bladder. The bladder blade was then inserted and the lower uterine segment incised in a transverse fashion with the scalpel. The bladder blade was removed and the infant's head delivered atraumatically. The nose and mouth were suctioned with the bulb suction trap and the cord doubly clamped and cut. The placenta was then removed manually. What CPT® and ICD-10-CM codes are reported for this procedure? A. 59610, O34.211, Z37.0, Z3A.39 B. 59510, O64.1XX0, Z37.0, Z3A.39 C. 59514, O82, Z37.0, Z3A.39 D. 59515, O82, Z37.0, Z3A.39

The selection of the CPT® delivery codes listed are based on the global information of the patient's history care. The documentation does not have information on the history of either the pregnancy care or previous pregnancies so a global code cannot be coded. There is no documentation that supports the patient had a previous cesarean, eliminating multiple choice answer A. There is no documentation that supports patient having antepartum care or will be having postpartum care with the obstetrician delivering the baby, eliminating multiple choice answers B and D. In ICD-10-CM Alphabetic Index look for Delivery/cesarean/without indication referring you to 082; Outcome of delivery/single NEC/liveborn referring you to code Z37.0; and Pregnancy/weeks of gestation/39 weeks referring you to Z3A.39. Verify codes in the Tabular List. Answer C

10 year-old-male sustained a Colles' fracture in which the pediatrician performs an application of short arm fiberglass cast. Select the HCPCS Level II code that is reported. A. Q4012 B. A4580 C. A4570 D. Q4024

The selection of the code is based on the materials used, the length of the cast, and the age of the patient. The patient being 10 years-old getting a short arm fiberglass cast guides you to select code Q4012. Answer A

Patient with hemiparesis on the dominant side due to having a CVA lives at home alone and has a therapist at his home site to evaluate meal preparation for self-care. The therapist observes the patient's functional level of performing kitchen management activities within safe limits. The therapist then teaches meal preparation using one handed techniques along with adaptive equipment to handle different kitchen appliances. The total time spent on this visit was 45 minutes. Report the CPT® and ICD-10-CM codes for this encounter. A. 97530 x 3, I67.89, G81.91 B. 97535 x 3, G81.90, I69.959 C. 97530 x 3, I69.959, I67.89 D. 97535 x 3, I69.959

The selection of the code is based on the type of activities completed in the session, the use of equipment used in the training, and the amount of time the session lasted. The therapist is at the patient's home site to teach home management for self care, guiding you to code 97535 reporting the code three times to indicate the total time of 45 minutes were spent with the patient. The patient has a residual effect of hemiparesis from having a CVA. According to ICD-10-CM Coding Guidelines, I.C.9.d.1, Category I69 is used to indicate conditions classifiable to categories I60-I67 as the causes of sequela (neurologic deficits), themselves classified elsewhere. These "late effects" include neurologic deficits that persist after initial onset of conditions classifiable to I60-I67. The late effect codes for CVA's are combination codes which means code I69.959 reports both the residual and cause in one code. In the ICD-10-CM Alphabetic Index look for Hemiparesis which directs you to see Hemiplegia. Look for Hemiplegia/following cerebrovascular disease referring you to I69.959. Answer D

34 year-old male developed a ventral hernia when lifting a 60 pound bag. The patient is in surgery for a ventral herniorrhaphy. The abdomen was entered through a short midline incision revealing the fascial defect. The hernia sac and contents were able to easily be reduced and a large plug of mesh was placed into the fascial defect. The edge of the mesh plug was sutured to the fascia. What procedure code(s) is (are) reported? A. 49560 B. 49561, 49568 C. 49652 D. 49560, 49568

The selection of the hernia repair codes are based on the type of hernia, surgical approach (open vs laparoscopy), and complication factor if it is reduced vs incarcerated or strangulated. Some hernia codes are based on age. The surgery was not performed by a laparoscope, eliminating multiple choice answer C. There is no mention of the hernia being incarcerated or strangulated, eliminating multiple choice answer B. According to CPT® guidelines in the hernia repair section, codes 49560-49566 can be reported with mesh add-on code, 49568. You will also see a parenthetical under add-on code 49568 that also indicates what codes can be reported with it. Answer D

15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was digitalized. No significant adenoid tissue was felt. The tonsils were then removed bilaterally by dissection. The uvula was a huge size because of edema, a part of this was removed and the raw surface oversewn with 3-0 chromic catgut. Which CPT® code(s) is (are) reported? A. 42821 B. 42825, 42104-51 C. 42826, 42106-51 D. 42842

The selection of your code is based on the age of the patient and what was excised. The age of this patient is 15, eliminating multiple choice answer B. The patient only had tonsils removed eliminating multiple choice A. Part of the uvula was also removed, eliminating multiple choice answer D. Answer C

The patient is 15-weeks pregnant with twins coming back to her obstetrician to have a transabdominal ultrasound performed to reassess anatomic abnormalities of both fetuses that were previously demonstrated in the last ultrasound. What ultrasound code(s) is (are) reported? A. 76815 B. 76816, 76816-59 C. 76801, 76802 D. 76805, 76810

This is a follow-up ultrasound because she is being reassessed due to a previous ultrasound that showed abnormalities of the fetuses. The patient has twins and a parenthetical note under 76816 indicates to report 76816 with modifier 59 for each additional fetus. Answer B

A CT density study is performed on a post-menopausal female to screen for osteoporosis. Today's visit the bone density study will be performed on the spine. Which CPT® code is reported? A. 77075 B. 77080 C. 77078 D. 72081

This radiological service is a bone density study using computed tomography (CT) to asses bone mass or density of the spine. The correct code is 77078 to indicate that the study was completed with a CT or computed tomography on the spinal area. Answer C

35 year-old-female is getting a Levonorgestrel implant system with supplies. The HCPCS Level II code is: A. S4989 B. J7306 C. A4264 D. J7301

When reviewing each code in the HCPCS Level II codebook, code J7306 is the correct code to report for the levonorgestrel implant and supplies. Answer B

76 year-old female had a recent mammographic and ultrasound abnormality in the 6 o'clock position of the left breast. She underwent core biopsies which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hookwire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o'clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, we performed a generous excisional biopsy around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology. Once hemostasis was assured, digital palpation of the depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound was closed in 2 layers with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local anesthetic was infiltrated for postoperative analgesia. What CPT® and ICD-10-CM codes describe this procedure? A. 19100, N63 B. 19285, C50.912 C. 19120, R92.8 D. 19125, D24.2

You can narrow your choices down by the diagnosis. The beginning of the operative note documents that core biopsies showed "papilloma". In the ICD-10-CM Alphabetic Index, look for Papilloma-see also Neoplasm, benign, by site. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/breast/Benign (column) refers you to code D24.-. Turn to the Tabular List to complete the code, D24.2. Procedure code 19125 is correct because preoperative placement of radiologic marker (preoperative needle localization with hookwire needle injection with methylene blue) was used to excise the lesion. Answer D