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CPC Practice Questions for 2017 – Part 1

10000 Series

  1. The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a piece of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it, the mass was removed. There was a capsule around this, containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal, he wanted me to, so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene. What CPT® and ICD-10-CM codes are reported?
  2. The patient is here because the cyst in her chest has come to a head and is still painful even though she has been on antibiotics for a week. I offered to drain it for her. After obtaining consent, we infiltrated the area with 1 cc of 1% lidocaine with epinephrine, prepped the area with Betadine and incised opened the cyst in the relaxed skin tension lines of her chest, and removed the cystic material. There was no obvious purulence. We are going to have her clean this with a Q-tip. We will let it heal on its own and eventually excise it. I will have her come back a week from Tuesday to reschedule surgery. What CPT® and ICD-10-CM codes are reported?
  3. . Patient has returned to the operating room to aspirate a seroma that has developed from a surgical procedure that was performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported?
  4. Operative Report

    PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp.

    POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp.

    PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin-Yang flap repair

    ANESTHESIA: Local, using 4 cc of 1% lidocaine with epinephrine.

    COMPLICATIONS: None.

    ESTIMATED BLOOD LOSS: Less than 5 cc.

    SPECIMENS: Squamous cell carcinoma, scalp sutured at 12 o’clock, anterior tip

    INDICATIONS FOR SURGERY: The patient is a 43-year-old white man with a biopsy-proven basosquamous cell carcinoma of his scalp measuring 2.1 cm. I marked the area for excision with gross normal margins of 4 mm and I drew my planned Yin-Yang flap closure. The patient observed these markings in two mirrors, so he can understand the surgery and agreed on the location and we proceeded.

    DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The patient was placed prone, his scalp and face were prepped and draped in sterile fashion. I excised the lesion as drawn to include the galea. Hemostasis was achieved with the Bovie cautery. Pathologic analysis showed the margins to be clear. I incised the Yin-Yang flaps and elevated them with the underlying galea. Hemostasis was achieved in the donor site using Bovie cautery. The flap rotated into the defect with total measurements of 2.9 cm x 3.2 cm. The donor sites were closed and the flaps inset in layers using 4-0 Monocryl and the skin stapler. Loupe magnification was used. The patient tolerated the procedure well.

    What CPT® and ICD-10-CM codes are reported?

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  5. The patient is coming in for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest area and was continued on the right and the lateral trochanteric and posterior aspect of the medial thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a compression garment was applied. What CPT® code(s) are reported?
  6. Operative Report

    PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration.

    POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration.

    OPERATION PERFORMED: Debridement and split thickness autografting of left foot

    ANESTHESIA: General endotracheal.

    INDICATIONS FOR PROCEDURE: This patient with multiple complications from Type II diabetes has developed ulcerations which were debrided and homografted last week. The homograft is taking quite nicely; the wounds appear to be fairly clean; he is ready for autografting.

    DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the operating room and placed in the supine position on the operating table. Anesthetic monitoring was instituted, internal anesthesia was induced. The left lower extremity is prepped and draped in a sterile fashion. Staples were removed and the homograft was debrided from the surface of the wounds. One wound appeared to have healed; the remaining two appeared to be relatively clean. We debrided this sharply with good bleeding in all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked sponges. With good hemostasis a donor site was then obtained on the left anterior thigh, measuring less than 100 cm2. The wounds were then grafted with a split-thickness autograft that was harvested with a patch of Brown dermatome set at 12,000 of an inch thick. This was meshed 1.5:1. The donor site was infiltrated with bupivacaine and dressed. The skin graft was then applied over the wound, measured approximately 60 cm2 in dimension on the left foot. This was secured into place with skin staples and was then dressed with Acticoat 18’s, Kerlix incorporating a catheter, and gel pad. The patient tolerated the procedure well. The right foot was redressed with skin lubricant sterile gauze and Ace wrap. Anesthesia was reversed. The patient was brought back to the ICU in satisfactory condition.

    What CPT® and ICD-10-CM codes are reported?

  7. Operative Report

    Diagnosis: Basal Cell Carcinoma

    Procedure: Mohs micrographic excision of skin cancer.

    Site: face left lateral canthus eyelid

    Pre-operative size: 0.8 cm

    Indications for surgery: Area of high recurrence, area of functional and/or cosmetic importance Discussed procedure including alternative therapy, expectations, complications, and the possibility of a larger or deeper defect than expected requiring significant reconstruction. Patient’s questions were answered.

    Local anesthesia 1:1 marcaine and 1% lidocaine with epinephrine. Sterile prep and drape.

    Stage 1: The clinically apparent lesion was marked out with a small rim of normal appearing tissue and excised down to subcutaneous fat level with a defect size of 1.2 cm. Hemostasis was obtained and a pressure bandage placed. The tissue was sent for slide preparation. Review of the slides show clear margins for the site.

    Repair: Complex repair.

    Repair of Mohs micrographic surgical defect. Wound margins were extensively undermined in order to mobilize tissue for closure. Hemostasis was achieved. Repair length 3.4 cm. Narrative: Burrows triangles removed anteriorly (medial) and posteriorly (lateral). A layered closure was performed. Multiple buried absorbable sutures were placed to re-oppose deep fat. The epidermis and dermis were re-opposed using monofilament sutures. There were no complications; the patient tolerated the procedure well. Post-procedure expectations (including discomfort management), wound care and activity restrictions were reviewed. Written Instructions with urgent contact numbers given, follow-up visit and suture removal in 3-5 days

    What CPT® and ICD-10-CM codes are reported?

  8. PREOPERATIVE & POSTOPERATIVE DIAGNOSES:
    1. Macromastia.
    2. Back pain.
    3. Neck pain.
    4. Shoulder pain.
    5. Shoulder grooving
    6. Intertrigo.

    NAME OF PROCEDURE:

    1. Right breast reduction of 1950 g.
    2. Right free-nipple graft.
    3. Left breast reduction of 1915 g.
    4. Left free-nipple graft.

    INDICATIONS FOR SURGERY: The patient is a 43-year-old female with macromastia and associated back pain, neck pain, shoulder pain, shoulder grooving and intertrigo. She desired a breast reduction. Because of the

    extreme ptotic nature of her breasts, we felt she would need a free-nipple graft technique. In the preoperative holding area, we marked her for this free-nipple graft technique of breast reduction. The patient observed these markings so she could understand the surgery and agree on the location, and we proceeded. The patient also was morbidly obese with a body mass index of 54. Because of this, we felt she met the criteria for DVT prophylaxis, which included Lovenox injection. The patient understood this would increase her risk of bleeding. She also made it known she is a Jehovah’s Witness and refused blood products, but she did understand her risk of bleeding would significantly increase and we proceeded.

    DESCRIPTION OF PROCEDURE: The patient was given 40 mg of subcutaneous Lovenox in the preoperative holding area. She was then taken to the operating room. Bilateral thigh-high TED hose, in addition to bilateral pneumatic compression stockings were used throughout the procedure. IV Ancef 1 g was given. Anesthesia was induced. Both arms were secured on padded arm boards using Kerlix rolls. A similar body bear hugger was placed. The chest and abdomen were prepped and draped in sterile fashion. I began by circumscribing around each nipple-areolar complex using a 42-mm areolar marker. On each side the free-nipple grafts were harvested. They were marked to be side specific and were stored on the back table in moistened lap sponges. Meticulous hemostasis was achieved using Bovie cautery. The tail of the apex of each breast was deepithelialized using the scalpel. I amputated the inferior portion of the breast from the right side. Again, meticulous hemostasis was achieved using the Bovie cautery. There were also large feeder vessels divided and ligated using either a medium Ligaclip or 3-0 silk tie sutures. I then moved to the left and again amputated the inferior portion of the breast. Meticulous hemostasis was achieved using the Bovie cautery. Each of these wounds were temporarily closed using the skin stapler. The patient was then sat up. I felt we had achieved a very symmetrical result. The new positions for the nipple-areolar complexes were marked with a 42-mm areolar marker and methylene blue. The patient was then placed in the supine position and the new positions for the nipple-areolar complexes were deepithelialized using the scalpel. Meticulous hemostasis was then achieved again using the Bovie cautery. The free-nipple grafts were then retrieved from the back table. They were each defatted using scissors and were placed in an onlay fashion on the appropriate side, and each was inset using 5-0 plain sutures. Vents were made in the skin graft to allow for the egress of fluid on each side. A vertical mattress suture was used, tied over a piece of Xeroform in critical areas of each of the nipple-areolar complexes. A Xeroform bolster wrapped over a mineral oil-moistened sponge was affixed to each of the nipple-areolar complexes using 5-0 nylon suture. The vertical and transverse incisions were closed using 3-0 Monocryl, both interrupted and running suture, and 5-0 Prolene. The patient tolerated the procedure well. Again, meticulous hemostasis was achieved using the Bovie cautery. She was given another 1 g of Ancef at the 2-hour mark by our anesthesiologist, and was taken to the recovery room in good condition.

    What CPT® codes are reported?

  9. INDICATIONS FOR SURGERY: The patient is an 82-year-old white male with biopsy-proven basal cell carcinoma of his right lower eyelid and cheek laterally. I marked the area for rhomboidal excision and I drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the surgery and agreed on the location and we proceeded.

    DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was achieved using Bovie cautery. Modified Mohs analysis showed the margin to be clear. I incised the rhomboid flap as drawn and elevated the flap with a full-thickness of subcutaneous fat. Hemostasis was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap was rotated into the defect. The donor site was closed and flap inset in layers using 5-0 Monocryl and 6-0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm

    What CPT® code(s) should be reported?

  10. Wire placement in the lower outer aspect of the right breast was done by a radiologist the day prior to this procedure. During this operative session, the surgeon created an incision through the wire track and the wire track was followed down to its entrance into breast tissue. A nodule of breast tissue was noted immediately adjacent to the wire. This entire area was excised by sharp dissection, sent to pathology and returned as a benign lesion. Bleeders were cauterized, and subcutaneous tissue was closed with 3-0 Vicryl. Skin edges were approximated with 4-0 subcuticular sutures and adhesive strips were applied. The patient left the operating room in satisfactory condition. What should be the correct code(s) for the surgeon’s services?

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CPC Practice questions

Practice Questions For CPC Exam 2017 – Part Two

Question 26

General anesthesia is administered to a 9-month-old undergoing a tracheostomy. Code the anesthesia service.

  1. 00320, 99100
  2. 00320
  3. 00326
  4. 00326, 99100

Question 27

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

  1. 78806-26
  2. 78802-26
  3. 78804-26
  4. 78801-26

Question 28

Due to an elevated CEA level two years following a colon resection, the patient’s oncologist ordered a diagnostic liver ultrasound. Which radiology code is reported for this encounter.

  1. 76700
  2. 78206
  3. 76705
  4. 76970

Question 29

52-year-old male has a 3.2 cm metastasized lung cancer in his left upper lobe. The tumor can not be removed by surgery due to the patient having severe respiratory conditions. He will be receiving sterotactic body radiation therapy management under image guidance. There is a delivery of 25 Gy for four fractions under direct supervision of the radiation oncologist. The patient’s treatment set up is assessed to manage the execution of the treatment to make any adjustments needed for accuracy and safety. The oncologist reviews and approves all the images used to locate the tumor and images of fields arranged to deliver the dose.  What CPT® and ICD-9-CM codes should be reported?

  1. 77373, V58.0, 162.9
  2. 77435, V58.0, 197.0
  3. 77435, 197.0, V58.0
  4. 77402, 162.9, V58.0

Question 30

A 42-year-old has a lesion on his pancreas. The physician passes the biopsy needle through the skin and removes tissue to be sent to pathology. Fluoroscopic guidance is used to obtain the biopsy. Physician’s report and interpretation is placed in the record. Code this encounter.

  1. 48100, 77002-26
  2. 48102, 77002-26
  3. 48120, 76942-26
  4. 48102, 76942-26

Question 31

Patient is undergoing in vitro fertilization to get pregnant. Following the retrieval of follicular fluid from the patient, the physician uses a microscope to examine the fluid to identify the ooctyes. What is the code for the laboratory service?

  1. 89250
  2. 89254
  3. 89255
  4. 89258

Question 32

22-year-old comes into the Emergency Department with convulsions. The ED physician orders a drug screening without identifying any specific drug class to be tested. The lab runs a multiple drug classes screening using an immunoassay. The lab report comes back positive for alcohol and benzodiazepines. The ED physician then orders a confirmatory test to be performed by the lab to confirm both positive results. What CPT® codes are reported?

  1. 80301, 80320, 80346
  2. 80300, 80320, 80346
  3. 80302 x 2, 80320 x 2, 80346 x 2
  4. 80300 x 2, 80320 x 2, 80346 x 2

Question 33

A pathologist performs a comprehensive consultation and report after reviewing a patient’s records, specimens and official findings from other sources. What is the correct code?

  1. 88325
  2. 99244
  3. 80502
  4. 88329

Question 34

Photodynamic therapy involving application of light externally to destroy premalignant lesions on the lower lip was provided to a 63-year-old patient. Code the encounter.

  1. 96570
  2. 96999
  3. 96567
  4. 96913

Question 35

A four-year-old patient presents with pain in the left forearm following a fall from a chair. The injury occurred one hour ago. Her mom applied ice to the injury but it does not appear to help. The ED physician performs a detailed history, expanded problem focused examination and medical decision making of moderate complexity. An X-ray is ordered, which shows a fracture of the distal end of the radius as read by the radiologist. The ED physician consults with an orthopedic surgeon. The ED physician performs moderate conscious sedation with Ketamine for 30 minutes. The fracture is reduced and cast applied by an orthopedic surgeon. The child was monitored with pulse oximetry, cardiac monitor and blood pressure by the ED physician frequently. The patient was discharged with a sling and requested to follow up with the orthopedic surgeon. Code the services performed by the ED physician.

  1. 99284-25, 99148
  2. 99283-25, 99148
  3. 99283-25, 99143
  4. 99284-25, 99143

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Question 36

In the inpatient setting, the psychiatrist provides psychotherapy for 30 minutes to affect a change in the patient’s maladaptive behavior. What is the procedure code?

  1. 90845
  2. 90832
  3. 90847
  4. 90853

Question 37

CKD is a disease of which system?

  1. Circulatory
  2. Genitourinary
  3. Digestive
  4. Musculoskeletal

Question 38

A person who has nephritis has inflammation in what location?

  1. Gallbladder
  2. Nerve
  3. Uterus
  4. Kidney

Question 39

What is ascites?

  1. Fluid in the abdomen
  2. Enlarged liver and spleen
  3. Abdominal malignancy
  4. Abdominal tenderness

Question 40

Which of the following is a disorder of the facial nerve?

  1. Exotropia
  2. Tarsal tunnel syndrome
  3. Brachial plexis lesions
  4. Bell’s palsy

Question 41

Complete this series: Pulmonary, Aortic, Mitral, and ________are valves of the heart.

  1. Tricuspid
  2. Superior Vena Cava
  3. Carotid
  4. Atrium

Question 42

Which of the following terms is one who has an overload of sodium?

  1. Hyperkalemia
  2. Hyperpotassemia
  3. Hypernatremia
  4. Hypercalcemia

Question 43

The term paracentesis found in CPT® code 49082 means:

  1. A procedure performed to drain fluid that has accumulated in the abdominal cavity
  2. An abdominal incision is made to open the abdominal cavity for drainage
  3. Removal of tissue samples from the abdominal cavity by an open approach
  4. Removal of a cyst located in the abdominal cavity

Question 44

A 25-year-old is brought to the burn unit being rescued from a burning house. She sustained 25% second degree burns on her anterior trunk and back and 20% third degree burns on her legs and arms. Total body surface area burned is 45%. What ICD-9-CM code is reported for the burns classified according to the extent of body surface involved?

  1. 948.22
  2. 948.04
  3. 948.24
  4. 948.42

Question 45

The patient is a 75-year-old woman who is here for follow-up after an incident last week in which she had an FB lodged in her throat. An emergency esophagoscopy was performed and the piece of hamburger meat removed and biopsy performed. She is positive for Barrett’s esophagus. She has GERD which is currently being treated by medication and is here today to be evaluated for photodynamic therapy.

What diagnosis codes should be reported for today’s visit?

  1. 530.3, 530.85
  2. 935.1, 530.85, E915
  3. 935.1, 530.85, 530.81 E915
  4. 530.85, 530.81

Question 46

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

  1. C1767
  2. C1764
  3. C1777
  4. E0616

Question 47

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

  1. Q4012
  2. Q4011
  3. Q4010
  4. Q4009

Question 48

Which of the following statements regarding the ICD-9-CM coding conventions is TRUE?

  1. If the same condition is described as both acute and chronic and separate subentries exist in the Alphabetic Index at the same indentation level, code only the acute condition.
  2. Late effect codes are reported for a current acute phase of the injury or illness
  3. An ICD-9-CM code is still valid even if it has not been coded to the full number of digits required for that code.
  4. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed.

Question 49

Which modifier should be append to a CPT®, for which the provider had a patient sign an ABN form because there is a possibility the service may be denied because the patient’s diagnosis might not meet medical necessity for the covered service?

  1. GJ
  2. GA
  3. GB
  4. GY

Question 50

What is the patient’s right when it involves making changes in the personal medical record?

  1. Patient must work through an attorney to revise any portion of the personal medical information.
  2. They should be able to obtain copies of the medical record and request corrections of errors and mistakes.
  3. It is a violation of federal health care law to revise a patient medical record.
  4. Revision of the patient medical record depends solely on the facility’s compliance program policy.

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Answers – Practice Questions For CPC Exam 2017

Practice Questions For CPC Exam 2017 – Part One

CPC Practice Questions

Question 1

Indication: Patient has a hypertrophic scar on the posterior side of the left leg, at the level of the knee. This has begun to restrict his mobility. His physical therapy trial was unsuccessful. Procedure:

After the proper induction of anesthesia, the subcutaneous tissue of the patient’s left leg beneath the scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was then excised down to viable dermis. Hemostasis was obtained with epinephrine soaked pads. Skin was harvested from the patient’s thigh in a split thickness fashion and was used to cover the 90 sq cm defect created by the surgery. The graft was secured with skin staples, and then dressed with fine mesh gauze followed by medication-soaked gauze. The donor site was dressed with mesh followed by Adaptic, followed by a dry dressing and an Ace wrap.

  1. 15110-52, 15002
  2. 15100, 11406
  3. 15100, 15002
  4. 15110, 15002

Question 2

 The physician is called in to perform repairs for a 17-year-old girl involved in a motor vehicle accident. She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm laceration to her chest. The wound on her chin required a layered closure. All other wounds required complex closure.

  1.  13132, 13133 x 4, 13101, 12052
  2. 13132, 13133 x 3, 13133-52, 13101, 13102, 12052
  3. 13132, 13133 x 3, 13101, 13102, 12052
  4. 13131, 13132, 13133 x 3, 13101, 13102, 12052

Question 3

A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions on his face are destroyed and five actinic keratoses on his left arm are destroyed. Codes for the procedures are:

  1. 17000, 17003
  2. 17000, 17003 x 4, 17110
  3. 17110
  4. 17260 x 5, 17110 x 3

Question 4

Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is placed prone position. A needle is placed under fluoroscopic guidance into the SI joint and a mixture of 20 mg of Celestone and Marcaine is injected for pain relief. Code the procedure(s).

  1. 27096, 77003-26
  2. 20611
  3. 20552
  4. 27096

Question 5

Patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF procedure was performed, which included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. Which is the correct ICD-9-CM and CPT® code assignment?

  1. 24579, 29065-51, 812.52
  2. 24577, 812.42
  3. 24579, 812.42
  4. 24575, 812.52

Question 6

A 35-year-old female patient presents with acute onset of severe pain since October. Her workup has revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative findings were consistent with two large fragments of free disk fragments in the foramen at C5-C6 on the right side.

After general anesthesia, the patient was placed on the operative table in the supine position. All pressure points were cushioned and a transverse skin incision was fashioned under fluoroscopic guidance  over the C5-C6 disc space. Dissection through the platysma eventually allowed for exposure of the anterior entrance to the vertebral body of C5 and C6 and retractors were inserted to maintain adequate exposure. The operating microscope was brought into the field. Caspar posts were placed and slight distraction allowed exposure. A complete discectomy was performed at C5-C6 by using endplate curets pituitary rongeurs and Kerrison rongeurs. The posterior longitudinal ligament was resected and beneath the posterior longitudinal ligament, two significant sized disc fragments were noted in the foramen at C5-C6. These were removed using pituitary and Decker instruments. The endplates were then decorticated so that they were parallel to each other and a midline keel was performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody Kineflex-C device was placed under fluoroscopic guidance. Satisfied with the positioning of the device, the decision was made to close. What is the correct code for this procedure?

  1. 63075
  2. 63081
  3. 22856
  4. 22554

Question 7

OPERATION: Dual chamber transvenous implantable pacing cardioverter-defibrillator system implantation with leads. INDICATIONS: A 67-year-old, white gentleman has significant underlying ischemic cardiomyopathy with EF of 25 percent, prior infarcts, remote history of syncope, and at a high risk for malignant ventricular arrhythmias. He has had a recent T wave alternans test which was clearly abnormal. He has had episodes of resting bradycardia, also noted. He meets Madit II criteria for insertion  of a transvenous implantable pacing cardioverter-defibrillator (ICD). PROCEDURE: After informed consent had been obtained, the patient was brought to the outpatient hospital lab in the fasting state. The left anterior chest was prepped and draped in a sterile fashion. Intravenous sedation and local anesthetic were given. After local anesthetic, a 5 cm incision was made at the left deltopectoral groove. With blunt dissection and cautery, this was carried down through the prepectoralis fascia. The cephalic vein was identified and ligated distally. Through the venotomy, a subclavian venogram was performed to provide a roadmap. The atrial and ventricular leads were then advanced into the vessel to the level of the right atrium under fluoroscopic guidance. The ventricular lead was maneuvered to the right ventricular outflow tract, and then through the RV apex where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in diaphragmatic capture. The atrial lead was maneuvered to the anterolateral right atrial wall where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in diaphragmatic capture. A subcutaneous pocket was created with good hemostasis achieved. The pocket was subsequently irrigated with solution of Bacitracin. The generator was connected to the lead, and then placed in the pocket with no tension on the lead. The deep fascial layer was closed with interrupted 2-0 Vicryl suture. The subcutaneous closure was made with running 3-0 Vicryl suture. Subcuticular closure was made with running 4-0 Vicryl suture. Steri-strips were applied. Ventricular fibrillation was induced with a T wave shock. This was successfully sensed and terminated with a 15 joule shock to sinus rhythm. High voltage impedence was 39 ohms. Dry dressing was placed over the wound. The patient returned to the floor in stable condition without apparent complications. Which of the following codes accurately describes the basic procedure summarized in this report?

  1. 33208
  2. 33249, 76000-26
  3. 33241, 33243, 33249
  4. 33249

Question 8

The patient comes in today to have an arteriovenous fistula created to facilitate dialysis. The surgeon performs an upper arm basilic vein transposition based on the patient’s previous arterial duplex scan. Which is the appropriate code for this procedure?

  1. 36825
  2. 36830
  3. 36818
  4. 36819

Question 9

56-year-old with lung cancer developed an effusion that is suspicious for malignancy. Needle aspiration is performed to obtain a sample of the fluid for pathological examination. A needle is inserted between the ribs and into the pleural space, and the fluid is withdrawn. The specimen is sent to pathology. Choose the CPT® code that reports the procedure described.

  1. 32554
  2. 32555
  3. 32551
  4. 32400

 Question 10

A 67-year-old male patient is referred for a flex sigmoidoscopy exam to remove polyps. The physician found three polyps in the rectosigmoid junction. They were removed by hot biopsy forceps. The path report indicated the polyps were benign. Code the encounter.

  1. 45333
  2. 45315
  3. 45384
  4. 45346

Question 11

Name of Procedure: Endoscopic retrograde cholangiopancreatogram with stent placement and antral biopsy. Indications: 50-year-old male who underwent liver transplantation for end-stage liver disease secondary to chronic hepatits C and hepatocellular carcinoma in 01/2007. The patient has chloestatic liver enzymes, requiring ERCP before placement of a 7-French 12 cm stent and to evaluate the biliary system.

Description of Procedure: The patient was taken to the fluoroscopy suite in the GI lab where he was found to be alert and oriented x 3. After discussing risks and benefits of the procedure, informed consent was obtained. Patient was kept in the semi prone position. After adequated conscious sedation, an Olympus side-viewing therapeutic scope was inserted through the mouth all the way to the second portion of the duodenum. Then, the common bile duct was cannulated and the cholangiogram was obtained. After the fluoroscopy evaluation of the choangiogram a 12 cm stent was deployed for biliary drainage. A biopsy from the antrum was obtained. The patient tolerated the procedure well. There were no immediate complications. Which CPT® codes should be reported?

  1. 43276, 43261-51
  2. 43274, 43261-51
  3. 43266, 43239-51
  4. 43212, 43202-51

Question 12

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

manner. Code the procedure.

  1. 0249T
  2. 46221
  3. 46945
  4. 46930

Question 13

A neonatal male had an elective circumcision before being discharged home from the newborn nursery. The physician uses a ring block for the local anesthetic and the foreskin is placed over the glans. A clamp is selected for the size of the glans and a constricting circular ring is placed over the foreskin to compress and devascularize the foreskin. The devascularized foreskin is excised with a scalpel and the clamp is left in place. Which CPT® code should be used?

  1. 54150
  2. 54160
  3. 54161
  4. 54150-52

Question 14

A 30-year-old disabled Medicare patient is scheduled for surgery due to the discovery of what looks like an ovarian mass on the right ovary. On entering the abdomen, the surgeon finds an enlarged ovarian cyst on the right, but the ovary is otherwise normal. The left ovary is necrotic looking. The decision is made, based on the patient’s age, to remove the cyst from the right ovary and to remove the entire left ovary and fallopian tube. Code this encounter.

  1. 58920, 58940-51
  2. 58925, 58720-59
  3. 58925-50, 58720-50-59
  4. 58920-50, 58700-50-59

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Question 15

The patient is a 25-year-old G2P1 female at 13 weeks with a molar pregnancy. She has had irregular bleeding for one week. Ultrasound was performed yesterday and the physician confirms a 16 week size uterus with hydatidiform molar pregnancy. She is admitted today for a evacuation and curettage. What are the CPT® and ICD-9-CM codes?

  1. 59870, 630
  2. 59812, 640.93
  3. 57505, 640.83
  4. 59160, 630

Question 16

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

  1. 10022
  2. 55706
  3. 55700, 76942-26
  4. 55705, 76942-26

Question 17

An injection is performed to anesthetize a nerve located between two ribs to block chest wall pain. Which nerve injection code is reported?

  1. 64415
  2. 64421
  3. 64413
  4. 64420

Question 18

A 65-year-old patient presented with ectropion of the right lower eyelid. Repair with tarsal wedge excision is performed for correction. Attention was then directed to the left eye. The patient also had an ectropion of the left lower lid, which was repaired by suture. Code this procedure.

  1. 67916-50
  2. 67916-E4, 67914-E2
  3. 67914-50
  4. 67923-E4, 67921-E2

Question 19

A 42-year-old patient was in the hosptial three days ago in which a lumbar puncture was preformed to find the etiology of the patient’s headaches. Today he is in the neurology clinic because after having the lumbar puncture the headaches have increased in intensity over the past three days. The neurologist examines the patient and finds a CSF leak from the lumbar puncture. A blood patch is performed by epidural injection to repair the leak. Code the service(s) for today’s visit.

  1. 62272
  2. 62273
  3. 62270, 62273
  4. 62270, 62282

Question 20

A 63-year-old woman presented to the eye clinic as with symptoms of flashing lights and floaters in the right eye for two days. The ophthalmologist dilates her eyes and checking her with an indirect ophthalmoscope, revealing peripheral retinal break. The physician explains to the patient that there is a high likelihood of retinal detachment. The patient agrees to have the procedure done. The physician lasers the retinal tear and tells the patient to come back in 24 hours for follow-up. Code this visit.

  1. 67210
  2. 67145
  3. 67220
  4. 67141

Question 21

The patient is a 35-year-old male who presents to the emergency department (ED) after several hours of  low back pain, nausea, and chills. The ED physician takes a detailed history and performs a comprehensive examination. A urinalysis lab and CT of the abdomen is ordered. The results of the CT show two small kidney stones. The ED physician discusses the results with the patient and tells him the stones are small and will pass on their own. Medical decision making (MDM) of moderate complexity is made with the patient being discharged, with a prescription of pain medication, and with a diagnosis of kidney stones. Select the E/M code and diagnosis code(s).

  1. 99285, 592.0
  2. 99284, 724.2. 787.02, 780.64, 592.0
  3. 99283, 724.2, 787.02, 780.64, 592.0
  4. 99284, 592.0

Question 22

A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to another physician. The physician documents a detailed history. He has had it for the past five months. Sleep is disrupted by frequent awakenings and getting worse due to anxiety and snoring. Current medication that he is on now is not helping him. Physician also performs a comprehensive exam and moderate MDM. What CPT® code should be reported?

  1. 99204
  2. 99203
  3. 99243
  4. 99214

Question 23

A 55-year-old established patient is coming in for a pre-op visit; he is getting a liver transplant due  to cirrhosis. The physician performs an expanded problem-focused history, detailed examination, and moderate MDM. Patient agrees with his physician’s recommendations and the transplantation will take place as scheduled. After the evaluation, the patient expresses a number of concerns and questions for the prospective liver transplant. Physician spends an additional 45 minutes, excluding the time spent performing the E/M service, in answering questions and addressing his concerns regarding the surgery and discussing possible outcomes. What CPT® codes should be reported?

  1. 99213, 99403
  2. 99214, 99358
  3. 99213, 99356
  4. 99214, 99354

Question 24

A 56-year-old receives general anesthesia for an open pleura biopsy. An anesthesiologist medically directs two other cases, and medically directs a CRNA on this case. What are the anesthesia codes and modifiers reported for the anesthesiologist and CRNA?

  1. 00540-AA, 00540-QZ
  2. 00540-QK, 00540-QX
  3. 00541-AA, 00540-QZ
  4. 00541-QK, 00541-QX

 Question 25

A patient is given general anesthesia by the anesthesiologist for a carpal tunnel nerve release. After the surgery the anesthesiologist is called to perform an axillary block for postoperative pain management on the same patient. What are the appropriate codes?

  1. 01829, 64417-59
  2. 01840, 64417-59
  3. 01810, 64417-59
  4. 01830, 64417-59

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Find answers of these questions by visiting below link.

Answers – Practice Questions For CPC Exam 2017

CPC Exam Questions 2013CPC Exam Questions 2013

CPC Exam Questions 2013 – Part Five

Radiology

Some radiology codes include two components. Often a radiologist will use the radiology equipment, which is known as the technical component, and the physician will provide the second half of the CPT code by supervising and interpreting the study. When this occurs what should the physician report?

  • The full CPT code
  • The CPT code with a modifier TC
  • The CPT with a modifier 26
  • The CPT with a modifier 52

A patient presents to the ER with intractable nausea and vomiting, and abdominal pain that radiates into her pelvis. The physician orders a CT scan of the abdomen, first without contrast and then followed by contrast, and a CT of the pelvis, without contrast.

  • 74176, 74178-51
  • 74178 x2, 74177
  • 74178, 74176-51
  • 74178

A patient was in an MVA and his face struck the steering wheel. He had multiple contusions and facial swelling. The physician suspected a zygomatic-malar or maxilla fracture. The radiologist took an oblique anterior-posterior projection which showed the facial complex clearly. An anterior-posterior and lateral views were also taken.

  • 70250
  • 70150
  • 70120
  • 70100

If a prior study is available but it is documented in the medical records that there was inadequate visualization of the anatomy, then a diagnostic angiography may be reported in conjunction with an interventional procedure if modifier 59 is appended to the diagnostic S&I.

  • False
  • True

A physician performed a deep bone biopsy of the femur. The trocar was visualized and guided using a CAT scan and interpretation was provided.

  • 20225, 73700
  • 38221, 76998
  • 20225, 77012
  • 20245, 77012-26

HDR internal radiation therapy was performed by using a remote controlled MultiSource afterloader which was connected to 3 catheters. The 6 Ir-192 radioactive wire sources were released from the containment unit and were delivered beside the tumor within the body cavity, as pre-determined. After 15 minutes the sources were  removed from the patient and placed back into the containment unit.

  • 77777
  • 77786
  • 77790
  • 77762

A patient has a myocardial perfusion imaging study which included quantitative wall motion, ejection fraction by gated technique, and attenuation correction. The study was done during a cardiac stress test which was induced by using dipyridamole. The physician supervised, the interpretation and report were completed by the cardiologist.

  • 78453
  • 78451
  • 78453, 93016
  • 78451, 93016

A 35 year old mother carrying twin gestations, who has a three year old child with down syndrome, comes in for a prenatal screening. She is in her 12th week of pregnancy and the physician requests that the amount of fluid behind the necks of the fetuses be measured. A transabdominal approach was used.

  • 76801, 76802
  • 76811, 76812
  • 76813, 76814
  • 76816, 76816-59

A dialysis patient presents in the radiology department. His physician suspects that the tip of his Hickman’s catheter in his left forearm may have migrated from its original placement. The vascular surgeon on-call injects radiopaque iodine into the patient’s port and examines it under fluoroscopic imaging.

  • 75820
  • 36598, 75820, 76000
  • 36598, 75820
  • 36598

A written report signed by the interpreting physician should be considered an integral part of the radiological procedure or interpretation.

  • True
  • False

Pathology and Laboratory

A physician orders a patient’s blood be tested for levels of urea nitrogen, sodium, potassium, transferase alanine and aspartate amnio, total protein, ionized calcium, carbon dioxide, chloride, creatinine, glucose, and TSH.

  • 80053-52, 84443
  • 80048, 84443, 84155, 84460, 84450
  • 80047, 84460, 84450, 84155, 84443
  • 80051, 84520, 84460, 84450, 84155, 82330, 82565, 82947, 84443

A specimen labeled “right ovarian cyst” is received for examination. It consists of a smooth-walled, clear fluid filled cyst measuring 13x12x7 cm and weighing 1351 grams with fluid. Both surfaces of the wall are pink-tan, smooth and grossly unremarkable. No firm or thick areas or papillary structures are noted on the cyst wall externally or internally. After removal the fluid, the cyst weight 68 grams. The fluid is transparent and slightly mucoid.

  • 88307
  • 88305
  • 88304
  • 88300

A patient presents to the ED with chest pain, shortness of breath, and a history of congestive heart failure. The physician performs a 12 lead EKG which indicates a myocardial infarction without ST elevations. The physician immediately orders myoglobin, quantitative troponin, and CK enzyme levels to be run once every hour for three consecutive hours.

  • 83874 x3, 84484 x3, 82550 x3
  • 83874-91 x3, 84484-91 x3, 82250-91 x3
  • 83874, 83874-91 x2, 84484, 84484-91 x2, 82550, 82550-91 x2
  • 82250-76, 82250-91
  • 83874-99, 83874-76, 83874-91, 84484-99, 84484-76, 84484-91, 82250-99,

A 17 year old female presents in her family physician’s office complaining of nausea, vomiting, and weight gain. She has been experiencing these symptoms on and off for two weeks. An analysis of the urine reveals a positive pregnancy test and hCG levels of 12500 mIU/ml confirm she is in her sixth week of pregnancy.

  • 81005, 84703
  • 81025, 84703
  • 81025, 84702
  • 81005, 84702

An employee was randomly selected for a drug screen. According to the employer it is standard procedure to use a multiplex screening kit and test for barbiturates, cocaine, opiates, and methadone. Any drug with a positive result should be confirmed with a second, quantitative test. The employee showed positive for barbiturates and opiates. Secondary tests were run on the two and levels came back with 350 ng/ml for barbituates and 375 ng/ml for opiates.

  • 80101, 80101-91 x3, 80102, 80102-91
  • 80104, 80104-91 x3, 80102, 80102-91
  • 80100, 80100-91 x3, 82205, 83925
  • 80104,82205, 83925

Donloadable CPC Practice Exam

A CBC does not include which of the following:

  • RBC
  • Hgb
  • hCG
  • WBC

A couple that was unsuccessful at conceiving a child chooses to have in vitro fertilization done. The eggs and semen have been harvested and nine eggs were implanted with a sperm. The zygotes went through mitosis and produced embryos. Three embryos were then implanted in the woman and the other six were kept for later use. What codes(s) would the lab technician charge for her services in preserving the remaining six embryos?

  • 89342
  • 89268
  • 89258
  • 89255 x6

A patient in her 30th week of pregnancy has a high oral glucose reading and her physician orders a glucose tolerance test. Upon arrival the laboratory technician draws the patient’s blood and the patient then ingests a glucose drink. Her blood is then drawn one, two, and three hours after the ingestion. As the patient was leaving the laboratory the technician informs her that the samples were incorrectly labeled and that the test needed to be repeated. The patient has her blood drawn again, ingested the glucose drink again, and has her blood re-drawn at one, two, and three hour intervals.

  • 82951, 82951-91
  • 82946, 82946-91
  • 82947, 82950, 82950-91 x2
  • 82951

Carbon dioxide, total calcium, and sodium and all in what three panels?

  • 80047, 80069, 80051
  • 80048, 80053, 80069
  • 80069, 80047, 80048
  • 82374, 82310, 84295

A qualitative hCG test will provide a positive or negative result while a quantitative hCH test will provide a specific amount of hCG in the specimen.

  • True
  • False

Medicine

A 5year old is brought into the ER after being attacked by a stray dog. The stray was captured and tested positive for rabies. The patient has a 3cm laceration on his right cheek that requires simple closure and a 1cm and 4cm laceration on his upper left arm requiring layered repair. After discussing the benefits and risks with the patient’s parents they decide to have an IM rabies vaccination administered by the physician, due to the patient’s rabies exposure.

  • 873.41, 880.09, V01.5, 12032, 12013-51, 90460-51, 90375
  • 873.41, 880.09, V04.5, 12032, 12013-51, 90471-51, 90675-51
  • 873.41, 880.09, V01.5, 12032, 12013-51, 90460-51, 90675
  • 873.41, 880.03, V04.5, 12013, 12031-51, 12032-51, 96372-51, 90375

A 52 year old male is in the emergency department complaining of dizziness and states he passed out prior to arrival. The physician evaluates him, orders that a 12 lead EKG be performed, and has the nurse infuse 2 liters of NS over a 1 hour and 45 minute time period under his supervision. The EKG results were reviewed by the physician and were normal. A report was written and the patient was diagnosed with syncope due to dehydration and released. In addition to the EM service what should the physician code for?

  • 93000, 96360, 96361
  • 93010
  • 93000, 96360
  • 93010, 96360, 96361

A 45year old patient with end stage renal disease has in home dialysis services initiated on the 15th of the month. The physician provides dialysis every day. On the 19th the patient was admitted to the hospital and discharged on the 24th. The physician and patient began in-home dialysis again on the 25th and continued every day until the 31st.

  • 90970 x11
  • 90970
  • 90966
  • 90960

A patient with a dual lead implantable cardioverter-defibrillator has his physician initiate remote monitoring of the ICD and of cardiovascular monitor functionality (within the ICD), to help diagnosis the patient with what he suspects is left sided heart failure. Over the course of 90 days the physician remotely analyzes recorded data from the device, including left atrial pressure, ventricular pressure, and the patient’s blood pressure. He also remotely analyzes data from the defibrillator, including the heart rhythms and pace. After analysis and review the physician compiles reports on both. During this time period there was also one in-person interrogation of the ICM device and one in-person encounter for programming and adjusting the ICD device to ensure test functions and to optimize programming.

  • 93297 x3, 93295, 93283
  • 93297, 93295, 93283
  • 93297, 93295, 93290, 93283
  • 93297 x3, 93295, 93290, 93283

History: Past ocular surgery history is significant for neurovascular age-related dry macular degeneration. Patient has had laser four times to the macula on the right and two times to the left. Exam: Established 63 year old female patient. On examination, lids, surrounding tissues, and palpebral fissure are all unremarkable. Conjunctiva, sclera, cornea and iris were all assessed as well. Palpitation of the orbital rim revealed nothing. Visual acuity with correction measured 20/400 OU. Manifest refraction did not improve this. There was no afferent pupillary defect. Visual fields were grossly full to hand motions. Intraocular pressure measured 17 mm in each eye. Vertical prism bars were used to measure ocular deviation and a full sensorimotor examination to evaluate the function of the ocular motor system was performed. A slit-lamp examination was significant for clear corneas There was early nuclear sclerosis in both eyes. There was a sheet like 1-2+ posterior subcapsular cataract on the left. Dilated examination by way of cycloplegia showed choroidal neovascularization with subretinal heme and blood in both eyes. Magnified inspection was obtained with a Goldman 3-mirror lens and the retina, optic disc, and retinal vasculature were visualized. Macular degeneration was present in both the left and right retinas.

Assessment/Plan: Advanced neurovascular age-related macular degeneration OU, this is ultimately visually limiting. Cataracts are present in both eyes. I doubt cataract removal will help increase visual acuity; however, I did discuss with the patient, especially in the left, that cataract surgery will help us better visualize the macula for future laser treatment so that her current vision can be maintained. We discussed her current regiments and decided to continue with the high doses of the vitamins A, C and E, and the minerals zinc and copper to help slow her degeneration. After consideration the patient agreed to left cataract surgery which we scheduled for two weeks from today.

  • 92012, 92060, 92081
  • 92014, 92060
  • 92014
  • 92012

Some procedures or services are commonly carried out as an integral component of another total service or procedure and are identified by the inclusion term “separate procedure”. Codes with this inclusion term should not be reported in addition to the total procedure code or service to which it is considered an integral part, unless it is independently carried out or considered unrelated. If performed independently or as an un-related procedure it may be coded with modifier 59 appended to it.

  • False
  • True

A 73 year old group home resident with end stage renal disease has a nurse come in on Mondays, Wednesdays, and Fridays to perform peritoneal dialysis. Each dialysis session lasts three hours. Once a week, (on Friday), the nurse also assists the patient with his meals, cleaning, and grocery shopping. What should the nurse charge for a month (30 days) of services if the 1st of the month landed on a Monday?

  • 99512 x 13, 99509 x4
  • 90966, 99509 x4
  • 99601 x13, 99602 x13, 99509 x4
  • 99601, 99602 x25, 99509 x4

The physician performs a non-imaging physiological recording of pressure on the left leg with Doppler analysis of blood flow in both directions. ABIs were taken at the back and front lower aspect of the tibial and tibial/dorsalis pedis arteries. In addition 2 levels of plethymography volume and oxygen tension were taken.

  • 93922-52
  • 93922
  • 93923
  • 93923-52

Due to a suspected gastric outlet obstruction a manometric study is performed. Using nuclear medicine the physician monitors the time it takes for food to move through the patient’s stomach, the time it take the patient’s stomach to empty into the small intestine, and how fully it empties.

  • 91010
  • 91020
  • 91022
  • 0240T

Which of the following drugs is not pending FDA approval

  • 90664
  • 90666
  • 90667
  • 90668

Donloadable CPC Practice Exam

CPC Exam Questions 2013CPC Exam Questions 2013

CPC Exam 2013 Questions – Part Four

CPC Exam 2013 Questions

Digestive

The patient was scheduled for an esophagogastroduodenoscopy. Upon arrival they were placed under conscious sedation and instructed to swallow a small flexible camera. The camera was then manipulated into the esophagus, and through the entire length of the esophagus. The esophagus appeared to be slightly inflamed, but there was no sign of erosion or flame hemorrhage. A small 2cm tissue sample was taken to look for gastroesophageal reflux disease. There was no stricture or Barrett mucosa. The bony and the antrum of the stomach were normal without any acute peptic lesions. Retroflexion of the tip of the  endoscope in the body of the stomach revealed an abnormal cardia. There were no acute lesions and no evidence of ulcer, tumor, or polyp. The pylorus was easily entered, and the first, second, and third portions of the duodenum were normal.

  • 43239
  • 43235
  • 43206
  • 43202

After informed consent was obtained, the patient was placed in the left lateral decubitus position and sedated. The Olympus video colonoscope was inserted through the anus and was advanced in retrograde fashion through the sigmoid colon, descending colon, and to the splenic flexure. There was a large amount of stool at the flexure which appeared to be impacted. The physician decided not to advance to the cecum due to the impaction and the scope was pulled back into the descending colon and then slowly withdrawn. The mucosa was examined in detail along the way and was entirely normal. Upon reaching the rectum, retroflex examination of the rectum was normal. The scope was then  straightened out, the air removed and the scope withdrawn. The patient tolerated the procedure well.

  • 45378
  • 45378-53
  • 45330
  • 45330-53

Operative Note

The 45 year old male patient was taken to the operative suite, placed on the table in the supine position, and given a spinal anesthetic. The right inguinal region was shaved, prepped, and draped in a routine sterile fashion. The patient received 1 gm of Ancef IV push. A transverse incision was made in the intraabdominal crease and carried through the skin and subcutaneous tissue. The external oblique fascia was exposed and incised down to, and through, the external inguinal ring. The spermatic cord and hernia sac were dissected bluntly off the undersurface of the external oblique fascia exposing the attenuated floor of the inguinal canal. The cord was surrounded with a Penrose drain. The sac was separated from the cord structures. The floor of the inguinal canal, which consisted of attenuated transversalis fascia, was imbricated upon itself with a running locked suture of 2-0 Prolene. Marlex patch 1 x 4 in dimension was trimmed to an appropriate shape with a defect to accommodate the cord. It was placed around the cord and sutured to itself with 2-0 Prolene. The patch was then sutured medially to the pubic tubercle, inferiorly to Cooper’s ligament and inguinal ligaments, and superiorly to conjoined tendon using 2-0 Prolene. The area was irrigated with saline solution, and 0.5% Marcaine with epinephrine was injected to provide prolonged postoperative pain relief. The cord was returned to its position. External oblique fascia was closed with a running 2-0 PDS, subcu with 2-0 Vicryl, and skin with running subdermal 4-0 Vicryl and Steri-Strips. Sponge and needle counts were correct. Sterile dressing was applied.

  • 49505
  • 49505, 54520
  • 49505, 49568
  • 49505,54520, 49568

The vestibule is part of the oral cavity outside the dentoalveolar structures and includes the mucosal and submucosal tissue of the lips and cheeks.

  • True
  • False

Which of the following organs is not part of the alimentary canal?

  • Gallbladder
  • Duodenum
  • Jejunum
  • Tongue

A 13 year old child has his tonsils and adenoids removed due acute tonsillitis and chronic tonsilitis and adenoiditis.

  • 42821-50, 463, 474.0
  • 42821, 463, 474.02
  • 42826, 42836, 463, 474.02
  • 42826, 42831, 475, 474.0

Operative Note

Preoperative Diagnosis: Protein-calorie malnutrition

Postoperative Diagnosis: Protein-calorie malnutrition.

Anesthesia: Conscious sedation per Anesthesia..

Complications: None

EGD: Dr. Brown

PEG Placement: Dr. Smith

History: The patient is a 73-year-old male who was admitted to the hospital with some mentation changes. He was unable to sustain enough caloric intake and had markedly decreased albumin stores. After discussion with the patient and his son they agreed to place a PEG tube for nutritional supplementation. Procedure: After informed consent was obtained the patient was brought to the endoscopy suite. He was placed in the supine position and was given IV sedation by the Anesthesia Department. An EGD was performed from above by Dr. Brown who has dictated his finding separately. The stomach was transilluminated and an optimal position for the PEG tube was identified using the single poke method. The skin was infiltrated with local and the needle and sheath were inserted through the abdomen into the stomach under direct visualization. The needle was removed and a guidewire was inserted through the sheath. The guidewire was grasped from above with a snare by Dr. Brown. It was removed completely and the Ponsky PEG tube was secured to the guidewire. The guidewire and PEG tube were then pulled through the mouth and esophagus and snug to the abdominal wall. There was no evidence of bleeding. Photos were taken. The Bolster was placed on the PEG site. A complete dictation for the EGD will be done separately by Dr. Brown. The patient tolerated the procedure well and was transferred to recovery room in stable condition. He will be started on tube feedings in 6 hours with aspiration and dietary precautions to determine his nutritional goal. What code(s) should Dr. Smith charge?

  • 43653
  • 43752
  • 49440
  • 43246-62

An 18 year old female was found with a suicide note and an empty bottle of Tylenol. She was rushed into the emergency department where she had a large-bore gastric lavage tube inserted into her stomach and the contents were evacuated.

  • 43756
  • 43752
  • 43753
  • 43754

All endoscopies performed on the digestive system (such as an esophagoscopy, a colonoscopy, a sigmoidoscopy, etc.) do not allow moderate sedation to be coded additionally because it is bundled into the code?

  • True
  • False

Operative Note

History of Present Illness: Ms. Moore is status post lap band placement, the band was placed just over a year ago and she is here for a lap band adjustment. She has a history of problems previously with her adjustments. She has been under a lot of stress recently due to a car accident she was in a couple of weeks ago. Since the accident she has been experiencing problems of “not feel full”. She states that she is not really hungry but she does not feel full either. She also states that when she is hungry at night she is having difficulty waiting until the morning to eat. She also mentioned that she had a candy bar and that seemed to make her feel better.

Physical Examination: On exam, her temperature is 98, pulse 76, weight 197.7 pounds, blood pressure 102/72, BMI is 38.5, she has lost 3.8 pounds since her last visit. She was alert and oriented in no apparent distress.

Procedure: I was able to access her port. She does have an AP standard low profile. I aspirated 6 mL, I did add 1 mL, so she has got approximately 7 mL in her restrictive device, she did tolerate water post procedure.

Assessment: The patient’s status post lap band adjustments; doing well, has a total of 7 mL within her lap band, tolerated water pos procedure. She will come back in two weeks for another adjustment as needed.

  • 43771
  • 43886
  • 43842
  • 43848

Urinary, Male Genital, and Female Genital Systems, and Maternity Care and Delivery

 

A patient was brought to the OR and sedated. She was then placed in the supine position on a water filled cushion. The C-Arm image intensifier was positioned in the correct anatomical location above the left renal and a total of 2500 high energy shock waves were applied from the outside of the body. Energy levels were slowly started and O2 increased up to 7. Gradually the 2.5cm stone was broken into smaller pieces as the number of shocks went up. The shocks were started at 60 per minute and slowly increased up to 90 per minute. The patient’s heart rate and blood pressure were stable throughout the entire procedure. She was transported to recovery in good condition.

  • 50590
  • 50060
  • 50130, 76770
  • 50081, 74425

A patient recently underwent a total hysterectomy due to ovarian cancer, which has  metastasized. She is now having cylinder rods placed for clinical brachytherapy treatment. Treatment will consist of high dose rate (HDR) brachytherapy once correct placement of the rods have been confirmed.

  • 57156-58
  • 57155-58
  • 57156
  • 57155

The patient was brought to the suite, where after oral sedation; the scrotum was prepped and draped. 1% lidocaine was used for local anesthesia. The vas was identified, skin was incised, and no scalpel instruments were used to dissect out the vas. A segment about 3 cm in length was dissected out. It was clipped proximally and distally, and then the ends were cauterized after excising the segment. Minimal bleeding was encountered and the scrotal skin was closed with 3-0  chromic. The identical procedure was performed on the contralateral side. The patient tolerated the procedure well. He was discharged from the surgical center in good condition with Tylenol with Codeine for pain.

  • 55250
  • 55400-50
  • 55400
  • 55450

Operative Note

Epidural anesthesia was administered in the holding area, after which the patient was transferred into the operating room. General endotracheal anesthesia was administered,

after which the patient was positioned in the flank standard position. A left flank incision

was made over the area of the twelfth rib. The subcutaneous space was opened by using

the Bovie. The ribs were palpated clearly and the fascia overlying the intercostal space

between the eleventh and twelfth rib was opened by using the Bovie. The fascial layer

covering of the intercostal space was opened completely until the retroperitoneum was

entered. Once the retroperitoneum had been entered, the incision was extended until the

peritoneal envelope could be identified. The peritoneum was swept medially. The

Finochietto retractor was then placed for exposure. The kidney was readily identified and

was mobilized from outside Gerota’s fascia. The ureter was dissected out easily and was

separated with a vessel loop. The superior aspect of the kidney was mobilized from the

superior attachment. The pedicle of the left kidney was completely dissected revealing the vein and the artery. The artery was a single artery and was dissected easily by using a right-angle clamp. A vessel loop was placed around the renal artery. The tumor could be easily palpated in the lateral lower pole to mid pole of the left kidney. The Gerota’s fascia overlying that portion of the kidney was opened in the area circumferential to the tumor. Once the renal capsule had been identified, the capsule was scored using a Bovie about 0.5 cm lateral to the border of the tumor. Bulldog clamp was then placed on the renal artery. The tumor was then bluntly dissected off of the kidney with a thin rim of a normal renal cortex. This was performed by using the blunted end of the scalpel. The tumor was removed easily. The argon beam coagulation device was then utilized to coagulate the base of the resection. The visible larger bleeding vessels were oversewn by using 4-0 Vicryl suture. The edges of the kidney were then reapproximated by using 2-0 Vicryl suture with pledgets at the ends of the sutures to prevent the sutures from pulling through. Two horizontal mattress sutures were placed and were tied down. The Gerota’s fascia was then also closed by using 2-0 Vicryl suture. The area of the kidney at the base was covered with Surgicel prior to tying the sutures. The bulldog clamp was removed and perfect hemostasis was evident. There was no evidence of violation into the calyceal system. A 19-French Blake drain was placed in the inferior aspect of the kidney exitingthe  left flank inferior to the incision. The drain was anchored by using silk sutures. The flank fascial layers were closed in three separate layers in the more medial aspect. The lateral posterior aspect was closed in two separate layers using Vicryl sutures. The skin was finally re-approximated by using metallic clips. The patient tolerated the procedure well.

  • 50545
  • 50240
  • 50220
  • 50290

 

Donloadable CPC Practice Exam

A 26 year old patient who is Gravida 2 Para 1 presents to the ER in her 36th week of pregnancy with twin gestations who are monochorionic and monoamniotic. She is in active labor, 6 cm dilated, and her water is intact. Her OBGYN, who provided 12 antepartum visits, admitted her to labor & delivery. Although the patient had a previous cesarean during her first pregnancy the physician allowed her to attempt a vaginal birth. After pushing for three hours the patient was exhausted and taken to the OR for a cesarean delivery with a transverse incision. Two healthy newborns were born 15 minutes later. During the hospital stay and afterward the same physician provided the postpartum care to the mother.

  • 59426, 59622,59620, 651.01, 644.21, V31.1, V91.01
  • 59618, 59620-51, 651.01, 644.21,669.71, V27.2, V91.01
  • 59618, 59618-51, 651.01, V27.2, V91.01
  • 59618-22, 669.71, 644.21, V31.1, V91.01

When reporting delivery only services the discharge should be reported by using an E/M.

  • True
  • False

A 74 year old male with a weak urinary stream had his PSA tested. Results read 12.5 and he was scheduled for a biopsy to determine whether he had a malignancy or BPH. He arrived for surgery and was placed in the left lateral decubitus position and he was sedated. The surgeon used ultrasonic guidance to percutaneously retrieve 3 biopsies, using the transperineal approach. The biopsies were examined and the patient was diagnosed with secondary prostate cancer with the primary site unknown. He was directed to schedule a PET scan and discharged in good condition.

  • 55875, 76965
  • 55706, 76942
  • 55700, 76942
  • 55705, 76942

procedure: Hydrocelectomy

A scrotal incision was made and further extended with electrocautery. Once the hydrocele sac was reached we then opened and delivered the testis which drained clear fluid. There was moderate amount of scarring on the testis itself from the tunica vaginalis. The hydrocele sac was completely removed. A drain was then placed in the base of the scrotum and then the testis was placed back into the scrotum in the proper orientation. The same procedure was performed on the left. The skin was then sutured with a running interlocking suture of 3-0 Vicryl and the drains were sutured to place with 3-0 Vicryl. Bacitracin dressing, ABD dressing, and jock strap were placed. The patient was in stable condition upon transfer to recovery.

  • 55041
  • 54861
  • 55000-50
  • 55060

A urologist performs a cystometrogram with intra-abdominal voiding pressure studies in a hospital using calibrated electronic equipment that is provided for his use. He interprets the study and diagnosis the patient with neurogenic bladder.

  • 51726, 51797
  • 51729-26, 51797-26
  • 51726-26, 51797-26
  • 51729, 51797

Transvaginal sonographically controlled retrieval of a 26 year old female’s eggs by piercing the ovarian follicle with a very fine needle.

  • 58976, 76948
  • 58672
  • 58970, 76948
  • 58940, 76948

 

Endocrine, Nervous, Ocular, and Auditory Systems

 The hammer, anvil, and stirrup are the English terms for the three auditory ossicles, whose Latin names are:

  • Stapes, Utricle, and cochlea
  • Malleus, incus, and stapes
  • Utricle, incus, and vestibular nerve
  • Malleus, stapes, Utricle

Operative Note

Pre-operative Diagnosis: Increased intracranial pressure and cerebral edema due to severe brain injury.

Post operative Diagnosis: Increased intracranial pressure and cerebral edema due to severe brain injury.

Procedure: Scalp was clipped. Patient was prepped with ChloraPrep and Betadine. Incisions are infiltrated with 1% Xylocaine with epinephrine 1:200000. Patient did receive antibiotics post procedure and was draped in a sterile manner. The incision made just to the right of the right mid-pupillary line 10 cm behind the nasion. A self-retaining retractor was placed. A hole was then drilled with the cranial twist drill and the dura was punctured. A brain needle was used to localize the ventricle and it took 3 passes to localize the ventricle. The pressure was initially high. The CSF was clear and colorless . The CSF drainage rapidly tapered off because of the brain swelling. With two tries, the ventricular catheter was then able to be placed into the ventricle and then brought out through a separate puncture site; the depth of catheter was 7 cm from the outer table of the skull. There was intermittent drainage of CSF after that. The catheter was secured to the scalp with #2-0 silk sutures and the incision was closed with Ethilon suture. The patient tolerated the procedure well. No complications. Sponge and needle counts were correct. Blood loss is minimal.

  • 61107, 62160
  • 61210
  • 61107
  • 61210, 62160

Using the posterior approach the surgeon made a midline incision above the underlying vertebrae and dissected down to the paravertabral muscles and retracted then. The ligamentum flavum, lamina, and fragments of a ruptured C3-C4 intervertebral disc were all removed. The surgeon also removed a portion of the facet to relieve the compressed nerve of the C4 vertebrae. He then placed a free-fat graft over the exposed nerve and the paravertabral muscles were repositioned. The patient was then closed using layered sutures and taken to recovery.

  • 63040
  • 63075
  • 63081
  • 63170

A procedure in which corneal tissue from a donor is frozen, reshaped, and implanted into the anterior corneal stroma of the recipient to modify refractive error.

  • 65710
  • 65760
  • 65765
  • 65770

Which of the following organs is not part of the endocrine system

  • Thyroid
  • Pancreas
  • Lymph nodes
  • Adrenal Glands

Using an operating microscope the ophthalmologist places stay sutures into the rectus muscle. A cold probe is then placed over the sclera and is depressed sealing the choroid to the retina at the original tear site. He then performs a sclerotomy and places mattress sutures across the incision. Subretinal fluid is then drained. Next a silicone sponge, followed by a silicone band, are placed around the eye and sutured into place to help support the healing scar. Rectus sutures are removed.

  • 67101
  • 67101, 69990
  • 67107
  • 67107, 69990

Following a motor vehicle collision a 28 year old male was given a CT scan of the brain which indicated an infratentorial hematoma in the cerebellum. The patient was taken to the OR where the neurosurgeon, using the CT coordinates, incised the scalp and drilled a burr hole into the cranium above the hematoma. Under direct visualization he then evacuated the hematoma using suction and irrigated with NS. Hemorrhaging was controlled and the dura was closed. The skull piece was then placed back into the drill hole and screwed into place. The scalp was closed and the patient was sent to recovery.

  • 61154
  • 61253, 61315
  • 61315
  • 61154, 61315

An incision was made right in the mid palm area between the thenar and hypothenar eminence. Meticulous hemostasis of any bleeders was done. The fat was identified. The palmar aponeurosis was identified and cut and this was traced down to the wrist. There was severe compression of the median nerve. Additional removal of the aponeurosis was performed to allow for further decompression. After this was all completed, the area was irrigated with saline and bacitracin solution and closed as a single layer using Prolene 4-0 as interrupted vertical mattress stitches. Dressing was applied. The patient was brought to the recovery.

  • 64702
  • 64704
  • 64719
  • 64721

 

A postaurical incision is made on the right ear. With the use of an operating microscope the surgeon visualizes and reflects the skin flap and posterior eardrum forward. A small leak from the middle ear into the round window is noted. The surgeon then roughens up the surface of the window and packs it with fat. Upon retraction the eardrum and skin flap are replaced and the canal is packed. The surgeon then sutures the postaurical incision. He then repeats the procedure on the left ear.

  • 69666-50, 69990
  • 69667-50, 69990
  • 69666, 69990
  • 69667-50

Code 60512 should not be used:

  • In conjunction with code 60260
  • As a primary code
  • As an additional code following a total thyroidectomy
  • After code 60500

Donloadable CPC Practice Exam

CPC Exam 2013 Questions – Part Three

An 81 year old female patient with a history of well controlled type two diabetes and a mild history of asthma presents in the operating room for an open reduction with internal fixation for a displaced fracture of the right distal radius. The patient was laid in the supine position on the operating table. The right arm was prepped and draped in the normal sterile fashion. Prior to the surgery the patient was given 1g of cefazolin intravenously. A tourniquet was place on the upper arm and inflated to 250 mmHg. An incision was made along the dorsal aspect of the forearm and subcutaneous tissue was dissected to reveal the fractured radius. A curette was used to remove the splintered ends of the radius on each side of the fracture and a K-wire was then introduced along the radius to stabilize it. A guide pin was then placed down the central axis of the radius. A 20mm hole was then drilled and a screw was introduced. The K-wire was then removed and the wound was thoroughly irrigated with normal saline. The fascia layer was closed with absorbable sutures and the epidermis was closed with Monocryl. The wound was dressed with Vaseline gauze, 4x4s, and sterile Sof-Rol. A long arm Velcro splint was then placed over this and placed in a sling. The tourniquet was deflated after a total time of 60 minutes. The patient was awakened, placed in his hospital bed, and taken to the recovery room in fair condition. Estimated blood loss was 15cc. Sponge and needle counts were correct.

  • 01830-P2, 99100, 813.42, 250.00, 493.90
  • 10830-P3, 99100, 813.52. 250.00, 493.90
  • 01810-P2, 99100, 813.42, V12.2, V12.69
  • 01820-P3, 99100, 813.52, V12.2, V12.69

Integumentary

John was in a fight at the local bar and presents to the ER with multiple lacerations. The physician evaluates John and determines that he has a 2.5 cm gash to his left forearm and a 4cm gash on his right shoulder, both which require layered closure. He also has a simple 3cm laceration on his forehead that requires simple closure. What are the correct codes for the laceration repairs?

  • 12032-RT, 12031-LT, 12013-59, 881.10, 880.10, 873.42
  • 12032, 12013-59, 881.00, 880.00, 873.42
  • 13121, 12052-59, 884.1, 873.42
  • 12032-RT-LT, 12013-59, 881.00, 880.00, 873.42

A patient presents to her dermatologists office with three suspicious looking lesions. The dermatologist evaluates them and determines that the 1.3cm lesion of the scalp is benign and the 1.5cm lesion of the neck is premalignant. The 2.5 cm on the dorsal surface of the patient’s hand is also evaluated and is determined to be malignant. The dermatologist chooses to ablate all three lesions using electrosurgery.

  • 17273, 17003, 17110
  • 17273, 17000, 17003
  • 17273, 17000, 17110
  • 17273, 17003

An 18 year old female presents with a cyst of her left breast and her physician performs a puncture aspiration.

  • 10160
  • 10060
  • 10021
  • 19000

OPERATIVE REPORT

Preoperative Diagnosis: Basal Cell Carcinoma

Postoperative Diagnosis: Basal Cell Carcinoma

Location: Mid Parietal Scalp

Procedure:

Prior to each surgical stage, the surgical site was tested for anesthesia and re-anesthetized as needed, after which it was prepped and draped in a sterile fashion.  The clinically-apparent tumor was carefully defined and de-bulked prior to the first stage, determining the extent of the surgical excision. With each stage, a thin layer of tumor-laden tissue was excised with a narrow margin of normal appearing skin, using the Mohs fresh tissue technique. A map was prepared to correspond to the area of skin from which it was excised. The tissue was prepared for the cryostat and sectioned. Each section was coded, cut and stained for microscopic examination. The entire base and margins of the excised piece of tissue were examined by the surgeon. Areas noted to be positive on the previous stage (if applicable) were removed with the Mohs technique and processed for analysis. No tumor was identified after the final stage of microscopically controlled surgery. The patient tolerated the procedure well without any complication. After discussion with the patient regarding the various options, the best closure option for each defect was selected for optimal functional and cosmetic results.

Preoperative Size: 1.5 x 2.9 cm

Postoperative Size: 2.7 x 2.9 cm

Closure: Simple Linear Closure, 3.5cm, scalp

Total # of Mohs Stages: 2

tage Sections Positive

  • 17311, 17315, 17312, 12002
  • 17311, 17312, 12002
  • 17311, 17315, 17312
  • 17311, 17312

 

 

A patient with a non-healing burn wound on her right cheek, and is admitted to the OR for surgery. The physician had the patient prepped with a Betadine scrub and draped in the normal sterile fashion. The cheek was anesthetized with 1% Lydocain with 1:800,000 epinephrine (6 cc), and SeptiCare was applied. A skin graft of the epidermis and a small portion of the dermis was taken with a Goulian Weck blade with a six-thousands-of-an–inch-thick shim on the blade. The 25 sq cm graft was flipped and sewn to the adjacent defect with running 5-0 Vicryl. The wound was then dressed with Xeroform and the patient was taken to recovery.

  • 14041
  • 15115
  • 15120
  • 15758

A child is brought into the emergency department after having her fingers on her right hand closed in a car door. The physician evaluates the patient and diagnosis her with a 3cm laceration to her second finger and a subungual hematoma to her third finger. The physician then  proceeds to cleanse the fingers with an iodine scrub and injects both digits with 2 mL of 1% lidocaine with epinephrine. The wound on the second finger was then irrigated with 500 cc of NS and explored for foreign bodies or structural damage. No foreign bodies were found, tendons and vessels were intact. The wound was then re-approximated. Three 5-0 absorbable mattress sutures were used to close the subcutaneous tissue and six 6-0 nylon interrupted sutures were used to close the epidermis. The finger was then wrapped in sterile gauze and placed in an aluminum finger splint. The physician then check that the digital block performed on the third finger was still effective. After ensuring the patient’s finger was still numb he then proceeded to take an electronic cautery unit and created a small hole in the nail. Pressing slightly on the nail he evacuated the hematoma. The hole was then irrigated with 500cc of NS and the finger was wrapped in sterile gauze. The patient tolerated both procedures well without complaint.

  • 20103, 12042-51, F6, 11740-51, F7
  • 20103, 12042-F6, 11740-F7
  • 64400 (x2), 20103-51, 12042-51, 11740-51,59
  • 12042-F6, 11740-F7

The size of an excision of a benign lesion is determined by:

  • The depth of the lesion plus the full diameter of the lesion.
  • The diameter of the lesion only, excluding any margins excised with it.
  • Adding together the lesion diameter and the narrowest margins necessary to adequately excise the lesion.
  • Adding together the lesion diameter and the widest margins necessary to adequately excise the lesion.

A simple, single layered laceration requires extensive cleaning due to being heavily contaminated. The code selected would come from code range 12031-12057.

  • False
  • True

A skin graft where the donor skin comes from another human (often a cadaver) is known as a/an:

  • Autograft
  • Acellulargraft
  • Allograft
  • Xenograft

 

A patient is being treated for third degree burns to his left leg and left arm which cover a total of 18 sq cm. The burns are scrubbed clean, anesthetized, and three incisions are made with a #11 scalpel, through the tough leathery tissue that is dead, in order to expose the fatty tissue below and avoid compartment syndrome. The burns are then re-dressed with sterile gauze.

  • 97597
  • 97602
  • 16035, 16036 x2
  • 16030, 16035, 16036 x2

Musculoskeletal

Medial and lateral meniscus repair performed arthroscopically.

  • 27447
  • 29868
  • 29882
  • 29883

 

A patient comes into the emergency department complaining of sever wrist pain after falling onto her out stretched hands. The physician evaluates the patient taking a detailed history, a detailed exam, and medical decision making of moderate complexity. Upon examination the physician notes that there is a small portion of bone protruding through the skin. After ordering x-rays of the forearm and wrist the patient is diagnosed with an open distal radius fracture of the right arm.The physician provides an IV drip of morphine to the patient for pain and reduces the fracture. 5-0 absorbable sutures were use to close the subcutaneous layer above the fracture and the surface was closed with 6-0 nylon interrupted sutures. Wound length was measured at 2.5 cm. It was then dressed with sterile gauze and the wrist was stabilized with a Spica fiberglass cast. The physician provided the patient with a prescription for Percocet for pain and instructions for her to follow up with her orthopedist in 7 days.

  • 99284-25, 25574-RT, 813.52
  • 99284-57-25, 25605-54-RT, 12031 , 813.52
  • 99284-57, 25574-54, 813.52
  • 99284-25, 25605-RT, 12031, 813.52

 

A Scapulopexy is found under what heading

  • Incision
  • Excision
  • Introduction
  • Repair, Revision, and/or Reconstruction

 

A patient with muscle spasms in her back was seen in her physician’s office for treatment. The area over the myofascial spasm was prepped with alcohol utilizing sterile technique. After isolating it between two palpating fingertips a 25-gauge 5″ needle was placed in the center of the myofascial spasms and a negative aspiration was performed. Then 4 cc of Marcaine 0.5% was injected into three points in the muscle. The patient tolerated the procedure well without any apparent difficulties or complications. The patient reported feeling full relief by the time the block had set.

  • 20553
  • 64520
  • 20552
  • 64400

OPERATIVE NOTE

PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4- C5 and C5-C6.

POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4-C5 and C5-C6.

PROCEDURE PERFORMED:

  1. Anterior discectomy, C5-C6.
  2. Arthrodesis, C5-C6.
  3. Partial corpectomy, C5.
  4. Machine bone allograft, C5-C6.
  5. Placement of anterior plate with a Zephyr C6.

 

ANESTHESIA: General.

ESTIMATED BLOOD LOSS: 60 mL.

COMPLICATIONS: None.

INDICATIONS: This is a patient who presents with progressive weakness in the left upper extremity as well as imbalance. He has a very large disc herniation that came behind the body at C5 as well and as well as a large disc herniation at C5-C6. Risks and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion, progressive spondylosis, and lack of improvement were all discussed. He understood and wished to proceed.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Preoperative antibiotics were given. The patient was placed in the supine position with all pressure points noted and well padded. The patient was prepped and draped in  standard fashion. An incision was made approximately above the level of the cricoid. Blunt dissection was used to expose the anterior portion of the spine with carotid moved laterally and trachea and esophagus moved medially. I then placed needle into the disc spaces and was found to be at C5-C6. Distracting pins were placed in the body of C6. The disc was then completely removed at C5-C6. There was very significant compression of the cord. This was carefully removed to avoid any type of pressure on the cord. This was very severe and multiple free fragments noted. This was taken down to the level of ligamentum. Both foramen were then also opened. Part of the body of C5 was taken down to assure that all fragments were removed and that there was no additional constriction. The nerve root was then widely decompressed. Machine bone allograft was placed into C5-C6 and then a Zephyr plate was placed in the body C6 with a metal pin placed into the body at C5. Excellent purchase was obtained. Fluoroscopy showed good placement and meticulous hemostasis was obtained. Fascia was closed with 3-0 Vicryl, subcuticular 3-0 Dermabond for skin. The patient tolerated the procedure well and went to recovery in good condition.

  • 22554, 63081, 63082, 20931, 22845
  • 22551, 63081, 20931, 22840
  • 22551, 63081, 63082, 20931, 22845
  • 22554, 63081, 20931, 22840

 

Donloadable CPC Practice Exam

A general surgeon and a neurosurgeon are performing an osteotomy on the L4 vertebral segment. The general surgeon establishes the opening using an anterior approach. While the neurosurgeon performs the osteotomy the general surgeon performs a discectomy. After completion the general surgeon closes the patient up.

  • General: 22224-59 Neurosurgeon: 22224-54
  • General: 22224-62 Neurosurgeon: 22224-62
  • General: 22224-66 Neurosurgeon: 22224-66
  • General: 22224 Neurosurgeon: 22224-80

A patient comes into his physician’s office with a prior diagnosis of a Colles type distal radius

fracture. He complains that the cast he currently has on is too tight and is causing numbness in his fingers. The physician removes the cast and ensures the patient’s circulation is intact. He then re- applies a short arm fiberglass cast and checks the patient’s neurovascular status several times during the procedure. The patient is given instructions to follow-up with his orthopedist within seven days.

  • 25600-77
  • 25600-52
  • 29705, 29075
  • 29075

 

A patient is brought into the OR for a diagnostic arthroscopy of the shoulder. The patient has been complaining of pain since his surgery 4 months ago. The surgeon explores the shoulder and discovers a metal clamp which had been left in from the prior surgery. The surgeon removed the clamp and closed the patient up.

  • 29819
  • 29819-78
  • 29805, 29819
  • 29805, 23331

This 59 year-old female was brought to the operating room and placed on the surgical table in a supine position. Following anesthesia, the surgical site was prepped and draped in the normal sterile fashion. Attention was then directed to the right foot where, utilizing a # 15 blade, a 6 cm. linear incision was made over the 1st metatarsal head, taking care to identify and retract all vital structures. The incision was medial to and parallel to the extensor hallucis longus tendon. The incision was deepened through subcutaneous underscored, retracted medially and laterally – thus exposing the capsular structures below, which were incised in a linear longitudinal manner, approximately the length of the skin incision. The capsular structures were sharply underscored off the underlying osseous attachments, retracted medially and laterally. Utilizing an osteotome and mallet the medial eminence of the metatarsal bone was removed and the head was remodeled with the Liston bone forceps and the bell rasp. The surgical site was then flushed with saline. The base of the proximal phalanx of the great toe was osteotomized approximately 1 cm distal to the base and excised to toto from the surgical site. There was no hemi implant used and Kirschner wire was used to hold the joint in place. Superficial closure was accomplished using Vicryl 5-0 in a running subcuticular fashion. Site was dressed with a light compressive dressing. The tourniquet was released. Excellent capillary refill to all the digits was observed without excessive bleeding noted.

  • 28290
  • 28292
  • 28294
  • 28298

Respiratory, Cardiovascular, Hemic and Lymphatic, Mediastinum, and Diaphragm 

Operative Note

PREOPERATIVE DIAGNOSIS: Angina and coronary artery disease.

POSTOPERATIVE DIAGNOSIS: Angina and coronary artery disease.

PROCEDURE DETAILS: The patient was brought to the operating room and placed in the supine position upon the table. After adequate general anesthesia, the patient was prepped with Betadine soap and solution in the usual sterile manner. Elbows were protected to avoid ulnar neuropathy and phrenic nerve protectors were used to protect the phrenic nerve. All were removed at the end of the case. A midline sternal skin incision was made and carried down through the sternum which was divided with the saw. Pericardial and thymus fat pad was divided. The left internal mammary artery was harvested and spatulated for anastomosis. Heparin was given.  The Femoropopliteal vein was resected from the thigh, side branches secured using 4-0 silk and Hemoclips. The thigh was closed multilayer Vicryl and Dexon technique. A Pulsavac wash was done, drain was placed The left internal mammary artery is sewn to the left anterior descending using 7-0 running Prolene technique with the Medtronic off-pump retractors. After this was done, the patient was fully heparinized, cannulated with a 6.5 atrial cannula and a 2-stage venous catheter and begun on cardiopulmonary bypass and maintained normothermia. Medtronic retractors used to expose the

circumflex. Prior to going on pump, we stapled the vein graft in place to the aorta. Then, on pump, we did the distal anastomosis with a 7-0 running Prolene technique. The right side graft was brought to the posterior descending artery using running 7-0 Prolene technique. Deairing procedure was carried out. The bulldog clamps were removed. The patient maintained good normal sinus rhythm with good mean perfusion. The patient was weaned from cardiopulmonary bypass. The arterial and venous lines were removed and doubly secured. Protamine was delivered. Meticulous hemostasis was present. Platelets were given for coagulopathy. Chest tube was placed and meticulous hemostasis was present. The anatomy and the flow in the grafts was excellent. Closure was begun. The sternum was closed with wire, followed by linea alba and pectus fascia closure with running 6-0 Vicryl sutures in double-layer technique. The skin was closed with subcuticular 4-0 Dexon suture technique. The patient tolerated the procedure well and was transferred to the intensive care unit in stable condition.

  • 35572, 33533, 33517, 32551, 36825, 33926
  • 33533, 33517, 35572
  • 33510, 33533, 35572, 32551, 36821
  • 33510, 33533, 33572

A 50-year-old gentleman with severe respiratory failure is mechanically ventilated and is currently requiring multiple intravenous drips. With the patient in his Intensive Care Unit bed, mechanically ventilated in the Trendelenburg position, the right neck was prepped and draped with Betadine in a sterile fashion. A single needle stick aspiration of the right subclavian vein was accomplished without difficulty and the guide wire was advanced and a dilator was advanced over the wire. The triple lumen catheter was cannulated over the wire and the wire was then removed. No PVCs were encountered during the procedure. All three ports to the catheter were aspirated and flushed blood easily and they were all flushed with normal saline. The catheter was anchored to the chest wall with butterfly phalange using 3-0 silk suture. Betadine ointment and a sterile Op-Site dressing were applied. Stat upright chest x-ray was obtained at the completion of the procedure to ensure proper placement of the tip in the subclavian vein.

  • 36557
  • 36555
  • 36558
  • 36556

 

A patient with chronic emphysema has surgery to remove both lobes of the left lung.

  • 32310
  • 32663×2
  • 32482
  • 32440

A thoracic surgeon makes an incision under the sternal notch at the base of the throat, introduces the scope into the mediastinal space and takes two biopsies of the tissue. He then retracts the scope and closes the small incision.

  • 39400
  • 32606
  • 39000
  • 32405

A patient has endoscopic surgery done to remove his anterior and posterior ethmoid sinuses. The surgeon dilated the maxillary sinus with a balloon using a transnasal approach, explored the frontal sinuses, remove two polyps from the maxillary sinus, and then performed the tissue removal.

  • 31255, 31295, 31237
  • 31201, 31295, 31237
  • 31255, 31267
  • 31255, 31295, 31267

 

Operative Note

Approach: Left cephalic vein.

Leads Implanted: Medtronic model 5076-45 in the right atrium, serial number PJN983322V.

Medtronic 5076-52 in the right ventricle, serial number PJN961008V.

Device Implanted: Pacemaker, Dual Chamber, Medtronic EnRhythm, model P1501VR, serial number PNP422256H.

Lead Performance: Atrial threshold less than 1.3 volts at 0.5 milliseconds. P wave 3.3 millivolts. Impedance 572 ohms. Right ventricle threshold 0.9 volts at 0.5 milliseconds. R wave 10.3. Impedance 855.

Procedure: The patient was brought to the electrophysiology laboratory in a fasting state and intravenous sedation was provided as needed with Versed and fentanyl. The left neck and chest were prepped and draped in the usual manner and the skin and subcutaneous tissues below the left clavicle were infiltrated with 1% lidocaine for local anesthesia. A 2-1/2-inch incision was made below the left clavicle and electrocautery was used for hemostasis. Dissection was carried out to the level of the pectoralis fascia and extended caudally to create a pocket for the pulse generator. The deltopectoral groove was explored and a medium-sized cephalic vein was identified. The distal end of the vein was ligated and a venotomy was performed. Two guide wires were advanced to the superior vena cava and peel-away introducer sheaths were used to insert the two pacing leads. The venous pressures were elevated and there was a fair amount of back-bleeding from the vein, so a 3-0 Monocryl figure-of-eight stitch was placed around the tissue surrounding the vein for hemostasis. The right ventricular lead was placed in the high RV septum and the right atrial lead was placed in the right atrial appendage. The leads were tested with a pacing systems analyzer and the results are noted above. The leads were then anchored in place with #0-silk around their suture sleeve and connected to the pulse generator. The pacemaker was noted to function appropriately. The pocket was then irrigated with antibiotic solution and the pacemaker system was placed in the pocket. The incision was closed with two layers of 3-0 Monocryl and a subcuticular closure of 4-0 Monocryl. The incision was dressed with Steri-Strips and a sterile bandage and the patient was returned to her room in good condition.

  • 33240, 33225, 33202
  • 33208, 33225, 33202
  • 33213, 33217
  • 33208

 

 

If a surgeon is performing a surgical sinus endoscopy to control a nasal hemorrhage and chooses to perform a necessary sinusotomy while he’s there, he can bill for each individual service.

  • True
  • False

A cardiologist manipulates a catheter through the patient’s atrial system, starting in the femoral artery and manipulating to the third order, using intravascular ultrasound.

  • 36217, 37250
  • 36217, 75945
  • 36247, 37250
  • 36247, 75945

An indirect laryngoscopy, as described in code 31505, utilizes a mirror in which the physician can view the reflection of the larynx. A direct laryngoscopy, as described by code 31515, utilizes a scope in which the physician peers through and views the larynx.

  • True
  • False

 

A patient was taken into the operating room where after induction of appropriate anesthesia, her left chest, neck, axilla, and arm were prepped with Betadine solution and draped in a sterile fashion. An incision was made at the hairline and carried down by sharp dissection through the clavipectoral fascia. The lymph node was palpitated in the armpit and grasped with a figure-of- eight 2-0 silk suture and by sharp dissection, was carried to hemoclip all attached structures. The lymph node was excised in its entirety. The wound was irrigated. The lymph node was sent to pathology. The wound was then closed. Hemostasis was assured and the patient was taken to recovery room in stable condition.

  • 38308
  • 38500
  • 38510
  • 38525

Donloadable CPC Practice Exam

CPC Exam 2013 Questions – Part Two

CPC Exam 2013 Questions

ICD-9-CM

What is the correct ICD-9-CM code(s) for malignant hypertension with stage III kidney disease?

  • 403.00, 585.3
  • 401.0
  • 403.00
  • 401.0, 585.3

Lucy was standing on a chair in her kitchen trying to change a light bulb when she slipped and fell. She struck the glass top stove, which shattered. She presents to the ER with a simple laceration to her forearm that has embedded glass particles.

  • 881.10, E888.1, E920.8
  • 881.00, E888.1, E849.0
  • 881.10, E888.0, E920.8
  • 881.00, E888.0, E849.0

Jim was at a bonfire when he tripped and fell into the flames. Jim sustained multiple burns. He came to the emergency room via an ambulance and was treated for second and third degree burns on his face, second degree burn on his shoulders and forearms, and third degree burns on the fronts of his thighs.

  • 941.30, 943.29, 945.36, 948.64, E897
  • 941.09, 943.09, 945.09, 948.64, E897
  • 941.30, 945.36, 943.29, 948.42, E897
  • 941.20, 941.30, 943.25, 943.21, 945.36, 948.42, E897

A 35 year old woman who is pregnant with her first child is admitted to the hospital. She experiences a prolonged labor during the first stage and eventually births a healthy baby boy.

  • 662.01, 659.5, V27.0
  • 650, 662.01, 659.6, V27.0
  • 650, V27.0
  • 662.00, 659.6, V27.0

Henry was playing baseball and slid for home base where he collided with another player. He presents to the emergency department complaining of pain in the distal portion of his right middle finger. It is swollen and deformed. The physician orders an x-ray and diagnoses Henry with a tuft fracture. He splints the finger, provides narcotics for pain, and instructs Henry to follow-up with his orthopedist in two weeks.

  • 815.04, E917.0
  • 814.09, E007.3
  • 815.03, E917.0
  • 816.02, E007.3

A 60 year old male is admitted for detoxification and rehabilitation. He has continuously abused amphetamines to the point that he cannot voluntarily stop on his own and has become dependent upon them. He also has a long documented history of alcohol abuse and alcoholism. He experiences high levels of anxiety due to PTSD, which causes him to use and abuse substances.

  • 305.71, 304.41, 305.00, 303.91, 300.00, 309.81
  • 304.71, 305.00, 300.00, 309.81
  • 304.41, 303.91, 300.00, 309.81
  • 305.71, 304.41, 305.00, 303.91, 300.02, 309.81

A patient with uncontrolled type II diabetes is experiencing blurred vision and an increase in floaters appearing in her vision. She is diagnosed with diabetic retinopathy.

  • 362.10, 250.02
  • 250.52, 362.01
  • 362.01, 250.52
  • 250.00, 362.0

Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by classification.

  • True
  • False

 

A patient who is known to be HIV positive but who has no documented symptoms would be assigned code

  • 079.53
  • V08
  • 795.71
  • 042

A patient fell asleep on the beach and comes in with blistering on her back. She is diagnosed with second degree solar radiation burns.

  • 692.76
  • 692.72
  • 942.24
  • 692.82

HCPCS

A patient has a home health aide come to his home to clean and dress a burn on his lower leg. The aide uses a special absorptive, sterile dressing to cover a 20 sq. cm. area. She also covers a 15sq area with a self adhesive sterile gauze pad.

  • A6204, A6219
  • A6252, A6219
  • A6252, A6403
  • A6204, A6403

A 12 year old arrives in his pediatrician’s office after colliding with another player during a soccer game. He is complaining of pain in his right wrist. The physician orders an x-ray and diagnoses him with a hairline fracture of the distal radius. He has a short arm fiberglass cast applied and discharges him with follow up instructions.

  • Q4010
  • Q4022
  • Q4012
  • Q4009

A patient with Hodgkin’s disease takes Neosar as part of his chemotherapy regiment. He receives 100 mg once a week through intravenous infusion.

  • J8999
  • J9070
  • J7502
  • J9100

A patient with diabetes is fitted for custom molded shoes. What is the code range for such a fitting?

  • E0100-E8002
  • K0001-K0899
  • A5500-A5513
  • L3201-L3649

A 300lb. paraplegic needs a special sized wheelchair with fixed arm rests and elevating leg rests.

  • E1195
  • E1222
  • E1160
  • E1087

Donloadable CPC Practice Exam

E/M

A patient comes into her doctor’s office for her weekly blood sugar check. Her blood is drawn by the LPN on staff, the visit takes about 5 minutes total.

  • 99211
  • 99212
  • 99201

A three year old child is brought into the ER after swallowing a penny. A detailed history and exam are taken on the child and medical decision making is of moderate complexity. The child is admitted to observation for three hours and is then discharged home.

  • 99234
  • 99218; 99217
  • 99235
  • 99218

A 20 month old child is admitted to the hospital with pneumonia and acute respiratory distress. The physician spends 3 minutes intubating the child and spends 90 minutes of Critical Care time stabilizing the patient.

  • 99471; 518.82; 486
  • 99291-25; 99292-25; 31500; 786.09; 486
  • 99471-25; 31500; 786.09; 486
  • 99291; 99292-25; 31500; 518.82; 486

At the request of a physician who is delivering for a high risk pregnancy, Dr. Smith, a pediatrician, is present in the delivery room to assist the infant if needed. After thirty minutes the infant is born, but is not breathing. The delivering physician hands the infant to Dr. Smith who provides chest compressions and resuscitates the infant. The pediatrician then performs the initial evaluation and management and admits the healthy newborn to the nursery. What codes should Dr. Smith submit on a claim?

  • 99360; 99465
  • 99465; 99460
  • 99360; 99460
  • 99360;99465; 99460

 

Mr. Johnson is a 79 year old established male patient that is seen by Dr. Anderson for his annual physical exam. During the examination Dr. Anderson notices a suspicious mole on Mr. Johnson’s back. The Doctor completes the annual exam and documents a detailed history and exam and the time discussing the patient’s need to quit smoking. Dr. Anderson then turns his attention to the mole and does a complete work up. He documents a comprehensive history and examination and medical decision making of moderate complexity. He also called a local dermatologist and made an appointment for Mr. Johnson to see him the next day for an evaluation and biopsy.

  • 99397, 99215
  • 99397, 99205
  • 99387, 99215
  • 99387, 99205

An E/M is made up of seven components six of which are used in defining the levels of E/M services. The seven components include History, Exam, Medical Decision Making, Counseling, Coordination of Care, Nature of Presenting Problem, and Time. Which six of these seven parts help define the level of the E/M service?

  • History, Exam, Medical Decision Making, Coordination of Care, Nature of Presenting Problem, and Time
  • History, Exam, Medical Decision Making, Counseling, Nature of Presenting Problem, and Time
  • History, Exam, Medical Decision Making, Counseling, Coordination of Care, and Nature of Presenting Problem
  • History, Exam, Medical Decision Making, Counseling, Coordination of Care, and Time

Anesthesia

The correct anesthesia code for a ventral hernia repair on a 13 month old child is

  • 00820
  • 00832
  • 00834
  • 00830

A patient is placed under anesthesia to have an exploratory surgery done on her wrist. The surgeon utilizes a small fiber optic scope and investigates the radius, ulna, and surrounding wrist bones. What should the anesthesiologist code for?

  • 29840
  • 01830
  • 01820
  • 01829

When does anesthesia time begin?

  • After the induction of anesthesia is complete
  • During the pre-operative exam prior to entering the OR
  • When the anesthesiologist begins preparing the patient for the induction of anesthesia
  • Once the supervising physician signs over the patient’s care to the anesthesiologist

 

A five month old is brought into the operating room for open heart surgery. The surgeon performs a repair of a small hole that was found in the lining surrounding the patient’s heart. Anesthesia was provided as well as the assistance of an oxygenator pump.

  • 00560, 99100
  • 00561
  • 00567, 99100
  • 00561, 99100

A 72 year old male with a history of severe asthma is placed under anesthesia to have a long tendon in his upper arm repaired

  • 01714-P4
  • 01714-P3, 99100
  • 01716-P3
  • 01712-P4, 99100

Which of the following procedures can be coded separately when performed by the anesthesiologist?

  • Monitoring of an EKG
  • Capnography
  • Monitoring of a central venous line
  • Administration of blood

A female who is 17 weeks pregnant is rushed into the OR due to a ruptured tubal pregnancy. She has a severe hemorrhage and has an emergency laparoscopic tubal ligation.

  • 00851-P5, 99140
  • 00880-P4
  • 01965-P5
  • 00880-P5, 99140

 

A healthy five year old male is placed under anesthesia to have a biopsy taken from his left ear drum.

  • 00120-P1
  • 00124-P2
  • 00170-P2
  • 00126-P1

 

A 75 year old healthy male patient sustained a hip dislocation following a fall. He is taken to the OR and plans to be placed under general anesthesia prior to the hip reduction. The anesthesiologist begins preparing the patient at 8:15am. AT 8:30am the patient is induced with anesthesia and the anesthesiologist is monitoring the patient’s vitals, ECG, pulse ox, and capnography. The surgeon begins the reduction at 8:45am and completes the procedure at 9:15am. The anesthesiologist monitors the patient until 9:30am when he releases the patient to the nurse for post operative supervision. At 9:45am the patient is fully alert and taken to recovery.How many minutes of anesthesia time should the anesthesiologist charge for?

  • 30 minutes
  • 45 minutes
  • 1 hour
  • 1 hour and 15 minutes

Donloadable CPC Practice Exam

CPC Exam 2013 Questions – Part 1

CPC Exam 2013 Questions

Medical Terminology

  1. The suffix –ectomy means
  • Cutting into
  • Surgical removal
  • A permanent opening
  • Surgical repair
  1. The acronym MMRV stands for
  • Measles, Mumps, and Rubella vaccine
  • Measles, Mumps, and Rosella vaccine
  • Measles, Mumps, Rubella, and Varicella
  • Measles, Mumps, Rosella, and Varicella

 

  1. MRI stands for
  • Micro-wave Recording Instrument
  • Medical Recording Instrument
  • Magnetic Resolution Image
  • Magnetic Resonance Imaging

 

  1. The term “Salpingo-Oophorectomy” refers to
  • The removal of the fallopian tubes and ovaries
  • The surgical sampling or removal of a fertilized egg
  • Cutting into the fallopian tubes and ovaries for surgical purposes
  • Cutting into a fertilized egg for surgical purposes

 

  1. PERRLA stands for what?
  • Pupils Equivalent, Rapid in Response to Light and Accommodation
  • Pupil Equal , Rapid in Response to Light and Accommodation
  • Pupil Equivalent, Round, Reactive to Light and Accommodation
  • Pupils Equal, Round, Reactive to Light and Accommodation

 

  1. Cryopreservation is a means of preserving something through
  • Saturation
  • Heat
  • Freezing
  • Chemicals

 

  1. Which of the following describes the removal of fluid from a body cavity
  • Arthrocentesis
  • Amniocentesis
  • Pericardiocentesis
  • Paracentesis

 

  1. If a surgeon cuts into a patient’s stomach he has performed a
  • Gastrectomy
  • Gastrotomy
  • Gastrostomy
  • Gastrorrhaphy

 

  1. The terms Nephro and Renal both refer to the same organ
  • True
  • False

 

  1. In the medical term myopathy the term pathy means disease. What is diseased?
  • Mind
  • Muscle
  • Eye
  • Nervous System

 

Anatomy

 

  1. The Radius is the
  • Outer bone located in the forearm
  • Outer bone located in the lower leg
  • Inner bone located in the forearm
  • Inner bone located in the lower leg

 

  1. The spleen belongs to what organ system?
  • Endocrine
  • Hemic and Lymphatic
  • Digestive
  • Nervous

 

  1. The portion of the femur bone that helps makes up the knee cap is considered what?
  • The posterior portion
  • The proximal portion
  • The distal portion
  • The dorsal portion

 

  1. How many regions are in the abdominopelvic cavity?
  • Four
  • Six
  • Eight
  • Nine

 

  1. The Midsagittal plane refers to what portion of the body?
  • Top
  • Middle
  • Bottom
  • Back

Donloadable CPC Practice Exam

  1. Which of the following is not part of the small intestine?
  • Duodenum
  • Ileum
  • Jejunum
  • Cecum

 

 

  1. The round window is located in the
  • Pericardium
  • Anterior aqueous chamber of the eye
  • Inner ear
  • Middle ear

 

  1. The point of an organ or body part nearest the point of attachments is
  • Distal
  • Proximal
  • Lateral
  • Medial

 

  1. One of the six major scapulohumeral muscles
  • Temporalis
  • Trapezius
  • Teres
  • Trigone

 

  1. The cardia fundus is
  • Part of the heart wall that causes contractions
  • Where to esophagus joins the stomach
  • A fungal infection that attacks the heart
  • Part of the female reproductive system

 

Coding Concepts

 

  1. CPT codes 22840-22848 are modifier 62 exempt?
  • True
  • False

 

  1. An ABN must be signed when?
  • Once the insurance company has denied payment
  • Before the service or procedure is provided to the patient
  • After services are rendered, but before the claim is filed
  • Once the denied claim has been appealed at the highest level

 

  1. Wound exploration codes include the following service (s) :
  • Exploration and repair
  • Exploration, including enlargement, removal of foreign body(ies), repair
  • Exploration, including enlargement, repair, and necessary grafting
  • Exploration, including enlargement, debridement, removal of foreign body(ies), minor vessel ligation, and repair

 

  1. The full description of CPT code 24925 is:
  • Secondary closure or scar revision
  • Amputation, secondary closure or scar revision
  • Amputation, arm through humerus; secondary closure or scar revision
  • Amputation, arm through humerus; with primary closure, secondary closure or scar revision

 

  1. Medical necessity means what?
  • Without treatment the patient will suffer permanent disability or death
  • The service requires medical treatment
  • The condition of the patient justifies the service provided
  • The care provided met quality standards

 

  1. The following statement does not apply to what code type: These codes are never stand alone codes and never primary codes.
  • E codes
  • Add on codes
  • Late effect codes
  • V codes

 

  1. Which of the following codes allows the use of modifier 51?
  • 20975
  • 93600
  • 31500
  • 45392

 

  1. Category III codes are temporary codes for emerging technology, services, and procedures. If a category III code exists it should be used instead of an “unlisted procedure” code in category I (example of an unlisted category I code: 60699).
  • True
  • False

 

  1. Which of the following statements is not true regarding Medicare Part A
  • It helps cover home health care charges
  • It helps cover skilled nursing facility charges
  • It helps cover hospice charges
  • It helps cover outpatient charges

 

  1. Which of the following is not one of the three components of HIPAA that is enforced by the office for civil rights?
  • Protecting the privacy of individually identifiable health information
  • Setting national standards for the security of electronic protected health information
  • Protecting identifiable information being used to analyze patient safety events and improve patient safety
  • Setting national standards regarding the transmission and use of protected health information

Donloadable CPC Practice Exam

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150-CPC-Exam-2008-questions

CPC 2008 ANSWERS

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CPC 2010 ANSWERS

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CPC 2011 ANSWERS

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DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

 

CPC Practice Paper 2008 Exam

Practice CPC Examination

Section 1

Number of questions from each code range:

  • Surgery, integumentary system (nine questions)
  • Musculoskeletal system (10 questions)
  • Respiratory system (10 questions)
  • Digestive system (10 questions)
  • Urinary system, male and female genital system (11 questions)
  • Nervous system, eye and ocular adnexa, and auditory system (10 questions)
  1. James suffered a severe crushing injury to his left upper leg. Two days after surgery, Dr. Barnes completed a dressing change under general anesthesia. How would you report this service?
  2. 16020-LT
  3. 15852, 01232, J2060
  4. 01232-P6
  5. 15852-LT
  1. Dr. Jess removed a 4.5 cm (excised diameter) cystic lesion from Amy’s forehead. The ulcerated lesion was anesthetized with 20 mg of 1% Lidocaine and then elliptically excised. The wound was closed with a layered suture technique and a sterile dressing applied. The wound closure, according to Dr. Jess’s documentation, was 5.3 cm. How would you report this procedure?
  2. 11446, 12053-51
  3. 11646, 12013-51
  4. 11446, J2001 x 2, 12013-59
  5. 11313, 12053-59
  1. Martha has a non-healing wound on the tip of her nose. After an evaluation by Dr. Martino, a dermatologist, Martha is scheduled for a procedure the following week. Dr. Martino documented an autologous split thickness skin graft to the tip of Martha’s nose. A simple debridement of granulated tissues is completed prior to the placement. Using a dermatome, a split thickness skin graft was harvested from the left thigh. The graft is placed onto the nose defect and secured with sutures. The donor site is examined, which confirms good hemostasis. How would you report this procedure?
  2. 99213-25, 15050
  3. 15050, 15004, 15005-59
  4. 15335, 11041-59
  5. 15120
  1. A patient had a chest wall tumor excised. The procedure involved the ribs with plastic reconstruction, and mediastinal lymphadenectomy. How would you report this procedure?
  2. 19272, 32503-59
  3. 19272
  4. 32503, 19271-59, 21632-59
  5. 32422, 19260-51
  1. Dr. Alexis completed Mohs surgery on Ralph’s left arm. She reported routine stains on all slides, mapping, and color coding of specimens. The procedure was accomplished in three stages with a total of seven blocks in the second stage. How would you report Dr. Alexis’ services?
  2. 17313, 17314-58, 17315-59, 88314-59
  3. 17311, 17312 x 7
  4. 17313, 17314 x 2, 17315 x 2
  5. 17311, 88302, 17314 x 3, 17312 x 7
  1. How should you code an excision of a lesion when completed with an adjacent tissue transfer or rearrangement?
  2. The excision is always reported in addition to the adjacent tissue transfer or rearrangement.
  3. The excision is not separately reported with adjacent tissue transfer or rearrangement codes.
  4. Code only malignant lesions in addition to the adjacent tissue transfer or rearrangement codes.
  5. Code the lesion with a modifier -51 and code in addition to the adjacent tissue transfer or rearrangement codes
  1. Tina fell from a step ladder while clearing drain gutters at her home. She suffered contusions and multiple lacerations. At the emergency room she received sutures for lacerations to her arm, hand, and foot. The doctor completed the following repairs: superficial repair to the arm of 12.8 cm, a single-layered closure of 7.9 cm that required extensive cleaning and removal of glass from the hand, and a simple repair to the foot of 9.6 cm How would you report the wound repairs?
  2. 12034, 12036, 12046, 12007
  3. 12006, 12034-59
  4. 12044, 12006-51
  5. 12005, 12004 x 2
  1. Which modifier would you use if a re-excision procedure is performed during the postoperative period of the primary excision of a malignant lesion?
  2. 76
  3. 59
  4. 58
  5. 79
  1. James had a malignant lesion removed from his right arm (excised diameter 4.6 cm). During the same visit the dermatologist noticed a new growth on James’ left arm. Dr. Terry took a biopsy of the new lesion and sent it in for pathology. The biopsy site required a simple closure. How would Dr. Terry report the biopsy procedure?
  2. The biopsy is included in the primary procedure and not reported
  3. 11100-59
  4. 11406, 11100-59
  5. 11100, 12001, 11406-51
  1. Sally suffered a burst fracture to her lumbar spine during a skiing accident. Dr. Phyllis performed a partial corpectomy to L2 by a transperitoneal approach followed by anterior arthrodesis of L1-L3. She also positioned anterior instrumentation and placed a structural allograft to L1-L3. How would Dr. Phyllis report this procedure?
  2. 63090, 22558-51, 22585, 22845, 20931
  3. 63085, 22533, 22585-51, 22808-59
  4. 22612 x 2, 22808, 22840-51, 20931
  5. 22558, 22858-51, 22845-51, 20931-59
  1. A patient suffered a fracture of the femur head. He had an open treatment of the femoral head with a replacement using a Medicon alloy femoral head and methyl methacrylate cement. How would you report this procedure?
  2. 27236
  3. 27235
  4. 27238
  5. 27275, 27236-59
  1. What modifier should you report when the same physician provided a re-reduction of a fracture?
  2. 76
  3. 59
  4. 77
  5. 54
  1. A patient suffered a penetrating knife wound to his back. A surgeon performed wound exploration with enlargement of the site, debridement, and removal of gravel from the site. The surgeon decided a laparotomy procedure was not necessary at this time. How would you report this procedure?
  2. This procedure is bundled with the laparotomy
  3. 49000, 97602-51, 20100-59
  4. 49000, 20102-59
  5. 20102
  1. While playing at home, Riley dislocated his patella, when he fell from a tree. The surgeon documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would you report the treatment and diagnoses?
  2. 27420, 836.3
  3. 27562, 836.4, E884.9, E849.0
  4. 27840, 27562-51, 836.3, E884.9
  5. 27562, 836.4
  1. Sarah presented to her primary care physician with pain and swelling in the right elbow. After careful examination he referred her to an orthopedic surgeon for a second opinion. Dr. Femur diagnosed Sarah with acute osteomyelitis of the olecranon process and recommended surgery. Sarah agreed to the surgery and underwent a sequestrectomy, through a posterior incision, with a loose repair over drains ending the procedure. Dr. Femur sent a written report back to Sarah’s primary care physician along with the operative report. How would you report the procedure?
  2. 99244-57, 24138-RT
  3. 99214, 99244-57
  4. 24138-RT
  5. 99214, 23172-59
  1. How should you report a deep biopsy of soft tissue of the thigh or knee area?
  2. 27323
  3. 27324
  4. 20206
  5. 27328
  1. Mike had a bicycle accident and suffered deep hematomas in both knees. He underwent a bilateral incision and drainage. How would you report the procedure?
  2. 27301-50
  3. 10040
  4. 27303
  5. 27301-59
  1. A patient had a unilateral percutaneous intradiscal electrothermal annuloplasty on L3-L5 with fluoroscopic guidance for needle placement. How would you report this professional service procedure?
  2. 22526, 22527
  3. 22526, 22527, 77002-26
  4. 22899, 77002-51
  5. 22526, 22527, 77003-26
  1. What modifier is exempt from the following codes:20974, 61107, 93602, 95900, 94610?
  2. RT and LT
  3. 63
  4. 59
  5. 51
  1. Julie, a 28-year-old ESRD patient was seen by Dr. Jeri in an outpatient hospital facility for treatment of an obstructed hemodialysis AV graft. Dr. Jeri provided moderate conscious sedation to Julie for percutaneous transluminal balloon angioplasty of the venous portion of the graft. This procedure lasted 45 minutes. Julie had an excellent result and was released to home after recovery from the treatment. Dr. Jeri performed the professional radiological supervision and interpretation with this procedure. What code(s) capture this service?
  2. 35476, 75978-26
  3. 35460, 75962-26
  4. 36476, 92982, 75978-26
  5. 36476, 99144, 99145, 75878-26
  6. What code would you report for a cervical approach of a mediastinotomy with exploration, drainage, removal of foreign body, or biopsy?
  7. 39010
  8. 39000
  9. 39200
  10. 39400
  1. Roger had a rhinoplasty to correct damage caused by a broken nose. One year later he had a secondary rhinoplasty with major revisions. At the end of the second surgery the incisions were closed with a single layer technique. How would you report the second procedure?
  2. 30450
  3. 30450-78
  4. 30420, 12014
  5. 30430, 12014-59
  1. A surgeon started with a diagnostic thoracoscopy. During the same surgical session she completed a surgical thoracoscopy to control a hemorrhage. How would you report this procedure?
  2. 32601
  3. 32601, 32654-59
  4. 32500
  5. 32654
  1. Dr. Sacra performed a CABG surgery on Fred five months ago. Today, Dr. Sacra completed another coronary artery bypass using three venous grafts with harvesting of a femoropopliteal vein segment. How would Dr. Sacra report her work for the current surgery?
  2. 33512, 33530-51, 35572-51
  3. 33535, 35500-51, 33519
  4. 33512, 33530, 35572
  5. 33535, 33519, 33530-51, 35500
  1. What do the primary codes 33880 and 33881 include?
  2. Placement of all distal extensions, if required in the distal thoracic aorta
  3. Placement of all proximal extensions in the thoracic aorta
  4. Repair of extensions in the thoracic aorta
  5. Repositioning of all leads and extensions in the thoracic aorta
  1. Mrs. Reyes had a temporary ventricular pacemaker placed at the start of a procedure. This temporary system was used as support during the procedure only. How would you report the temporary system?
  2. 33210
  3. 33211
  4. 33207
  5. 33210, 33207-51, 33235-51
  1. Mr. Azeri, a 68-year-old patient, has a dual-chamber pacemaker. The leads in this system were recalled. The leads were extracted via transvenous technique, the generator was left in place, and new leads were inserted via transvenous technique. How would you report this procedure?
  2. 33214, 33215-51, 33208-51, 33218-51
  3. 33215, 33210-51, 33216-51
  4. 33208, 33235-51, 33217-51
  5. 33235, 33217-51
  1. A 35-year-old female patient with a venous catheter requires a blood sample for hematology testing. The sample is collected via her PICC catheter. How would you report this procedure?
  2. 36415
  3. 36592
  4. 36591
  5. 37799
  1. A patient underwent a secondary percutaneous transluminal thrombectomy for retrieval of a short segment of embolus evident during another percutaneous intervention procedure. How would you report this secondary procedure?
  2. 37184, 37186
  3. 37186 in addition to the primary procedure
  4. 37185, 76000
  5. 37187
  1. Lynn has a family history of colon cancer and is scheduled for a screening colonoscopy. During the procedure, three polyps were discovered and removed via hot biopsy forceps technique. The polyps were reported as benign. What diagnoses and procedure(s) codes capture these services?
  2. V76.51, V16.0, 45315, 45331
  3. V76.51, 211.3, V16.0, 45384
  4. 45378
  5. 2113.0, 45378, 45384
  1. Dr. Blue performs a secondary closure of the abdominal wall for evisceration (outside the postoperative period). He opens the former incision and removes the remaining sutures; necrotic fascia is debrided down to viable tissue. The abdominal wall is then closed with sutures. How would you report the closure?
  2. 11043
  3. This is a bundled procedure and not reported
  4. 39541
  5. 49900
  1. Heather lost her teeth following a motorcycle accident. She underwent a posterior, bilateral vestibuloplasty, which allows her to wear complete dentures. How would you report this procedure?
  2. 40845, 15002
  3. 40843-50
  4. 40844
  5. 40843
  1. Dr. Erin is treating a 58-year-old male patient with a history of chewing tobacco. Dr. Erin finds a 3.4 cm tumor at the base of his tongue. She places needles under fluoroscopic guidance for sub-sequential interstitial radioelement application. How would you report the professional services?
  2. 41019, 77002-26
  3. 41019, 77012-26, 77021-26
  4. 61770, 41019-59
  5. 77002
  1. An 88-year-old male patient suffering from dementia accidentally pulled out his gastrostomy tube during the night. Dr. Keys, an interventional radiologist, takes him into an angiography suite, administers moderate sedation (an independent observer was present during the procedure), probes the site with a catheter and injects contrast medium for assessment and tube placement. Dr. Keys finds that the entry site remains open and replaced the tube into the proper position. The intra-service time for the procedure took 45 minutes. How would Dr. Keys report his services?
  2. 49440, 99149, 99150
  3. 49440, 49450-59
  4. 49450, 99144, 99145
  5. 49450
  1. Katherine had a hernioplasty to repair a recurrent ventral incarcerated hernia with implantation of mesh for closure. The surgeon completed debridement for necrotizing soft tissue due to infection. How would you report this procedure?
  2. 49566, 11005-51, 49568
  3. 49565, 11005-51, 49568
  4. 49565
  5. 49525, 11006, 49568-51
  1. A 28-year-old patient underwent a proctosigmoidoscopy with ablation of five tumors under moderate sedation. The same provider performed the procedure and the sedation. The intra-service time for the procedure was 30 minutes. How would you report this procedure?
  2. 45320-P1
  3. 45320 x 5
  4. 45320
  5. 45320, 99144
  1. Harry had a sphincterotomy and an ERCP with a stent placed into the bile duct. How would you report this procedure?
  2. 43268, 43262
  3. 43262
  4. 43260, 43268
  5. 43264
  1. Incidental appendectomy during an intra-abdominal surgery does not usually warrant a separate identification. If it is necessary to report a separate identification, what modifier should you add?
  2. 52
  3. 59
  4. 51
  5. 57
  1. Sharon had a laparoscopic cholecystectomy with cholangiography. How would you report this procedure?
  2. 47605, 47570-59
  3. 47605
  4. 47563
  5. 47579
  1. A patient had a renal auto-transplantation extracorporeal surgery, re-implantation of a kidney, and a partial nephrectomy. How would you report this procedure?
  2. 50340, 50380, 50240-51
  3. 50543, 50370-52
  4. 50380, 50240-51
  5. 50380, 50240-59
  1. Bill, a 52-year-old male patient, was admitted to the hospital and treated for prostatic malignancy. His doctor dictated a detailed history, detailed exam, and straightforward medical decision-making for admission. He was treated with interstitial transperineal prostate brachytherapy, including implantation of 51 iodine-125 seeds. His doctor visited him the day after the procedure. How would you report the professional service by the therapeutic radiologist who did both the implantation and brachytherapy?
  2. 99222, 55876, 77763 x 51
  3. 55875, 77778
  4. 99221, 58715, 77783
  5. 58346, 77799 x 125
  1. Harry had a couple of stones in both kidneys. He was taken into the lithotripsy unit and placed on the lithotripsy table in a supine position with the induction of anesthesia. The stones were well visualized and the patient received a total of 3,500 shocks with a maximum power setting of 3.0. The treatment was successful. How would you report this procedure?
  2. 50590
  3. 50561
  4. 50060
  5. 50080
  1. Tom was placed under general anesthesia (by an anesthesiologist) for an excision of a local lesion of the epididymis. How would you report the surgeon’s services?
  2. 54861-50
  3. 54860-47
  4. 54830, 00920-51
  5. 54830
  1. Alex suffered several injuries to his upper leg muscles and penis when he fell onto the bar of his touring bicycle. The day of the accident, Dr. Green completed muscle repair surgery to Alex’s upper legs. Today, three days after the leg surgeries, Dr. Green took Alex back to the operating suite to complete an unrelated repair to the penis. Dr. Green completed a plastic repair to correct the penal injury. What code(s) would capture today’s procedure?
  2. 54440-79
  3. 27385, 54440-59
  4. 27393, 54620-79
  5. 54440-26
  1. Heather had a bilateral laparoscopic occlusion of her fallopian tubes using a Falope ring. How would you report this procedure?
  2. 58615
  3. 58671
  4. 58671-50
  5. 58679-50
  1. A 65-year-old male patient has an indwelling nephroureteral double-J stent tube replaced to treat a ureteral obstruction caused by a stricture from postoperative scarring. His stent tube is exchanged every two months to prevent occlusion in the stent, UTI, and loss of kidney function. Dr. Mott did this procedure via a transurethral approach under conscious sedation and provided the radiological supervision and interpretation. How would you report this procedure?
  2. 50605, 50382
  3. 50385, 52283, 99143
  4. 50385
  5. 0084T
  1. Dr. Blue provided interpretation and results for a needle electromyography for anal sphincter function. How would you report this service?
  2. 51784
  3. 51784, 51785-51
  4. 55875
  5. 51785-26
  1. A 48-year-old patient with BPH has his prostate removed via a laser enucleation. During this procedure he also has a vasectomy. What code(s) would report this procedure?
  2. 52648
  3. 52649
  4. 52649, 55250-51
  5. 52647
  1. What code series would you refer to for patients who have had a previous cesarean delivery and now present with the expectation of a vaginal delivery?
  2. 59400–59141
  3. 59618–59622
  4. 59610–59614
  5. 59610–59622
  1. How would you report a bilateral cadaver donor nephrectomy with cold preservation?
  2. 50300-50
  3. 50320-50
  4. 50234
  5. 50300
  1. An infant born at 33 weeks underwent five photocoagulation treatments to both eyes due to retinopathy of prematurity at six months of age. The physician used an operating microscope during these procedures. These treatments occurred once per day for a defined treatment period of five days. How would you report all of these services?
  2. 67229 -50
  3. 67229 x 5
  4. 67229, 69990
  5. 67229
  1. Todd had a tumor removed from his left temporal bone. How would you report this service?
  2. 61563
  3. 61500
  4. 69979, 69990-51
  5. 69970
  1. Jennifer was admitted to the hospital for an aspiration of two thyroid cysts. Her physician completed this procedure with CT guidance of the needle including interpretation and report. How would you report the professional services?
  2. 60300-26, 76942-26
  3. 60300 x 2, 77012-26
  4. 10021, 60300-51, 77012-26
  5. 60300
  1. Baby Smith was diagnosed with meningitis. His physician placed a needle through the fontanel at the suture line to obtain a spinal fluid sample on Monday. The needle was withdrawn and the area bandaged. The baby required another subdural tap bilaterally on Wednesday. How would you report Wednesday’s service?
  2. 61001
  3. 61000, 61001
  4. 61070
  5. 61001-50
  1. Max had a bilateral revision fenestration operation. How would you report this procedure?
  2. 69840
  3. 69840-50
  4. 69820
  5. Both a and c
  1. Dr. Martin performed an excision at the middle cranial fossa for a vascular lesion. This procedure was completed in an intradural fashion with dural repair and graft. His partner, Dr. Sutter, performed an infratemporal approach with decompression of the auditory canal. How should Dr. Martin report her services?
  2. 61590, 61606-51
  3. 61606-62
  4. 61606
  5. 61601
  1. After a snow skiing accident, Barry had a cervical laminoplasty to four vertebral segments. How should you report this procedure?
  2. 63050 x 4
  3. 22600, 63051-51
  4. 22842, 63045, 63050
  5. 63050
  1. How is a neuroplasty procedure described in the CPT Professional Edition?
  2. The decompression or freeing of intact nerve from scar tissue, including external neurolysis and/or transposition
  3. The surgical repair of nerves using only microscopic techniques
  4. The position of nerves tested one or more anatomic digits
  5. The decompression or freeing of an intact vein from scar tissue, including external neurolysis and/or transposition
  1. Phyllis fell down on the ice and fractured her leg. The fall also caused severe injury to the muscles and tore several nerves. Her physician completed suturing of two major peripheral nerves in her leg without transposition and shortened the bone. After the surgery she was seen by a physical therapist for ongoing treatment and gait training. How would you report the surgical procedure?
  2. 64857, 64859-51, 64876-51
  3. 64856, 64857
  4. 64857, 64859, 64876
  5. 64858, 64857, 64859, 64876
  1. John was hospitalized for a repair of a laceration to his left conjunctiva by mobilization and rearrangement. How should you report this procedure?
  2. 65273-LT
  3. 67930
  4. 65272
  5. 67930-LT

Section 2

Number of questions from each code range:

  • Evaluation and management (12 questions)
  • Anesthesia (six questions)
  • Radiology (nine questions)
  • Laboratory and pathology (10 questions)
  • Medicine (10 questions)
  1. How does the CPT Professional Edition define a new patient?
  2. A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past two years.
  3. A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.
  4. A new patient is one who has received professional services from the physician or another physician of the same specialty within the last two years for the same problem.
  5. A new patient is one who has received hospital services but has never been seen in the clinic by the reporting physician.
  1. James, a 35-year-old new patient, received 45 minutes of counseling and risk factor reduction intervention services from Dr. Kelly. Dr. Kelly talked to James about how to avoid sports injuries. Currently, James does not have any symptoms or injuries and wants to maintain this status would you report this.This was the only service rendered. How service?
  2. 99213
  3. 99203
  4. 99385
  5. 99403
  1. Andrea, a 52-year-old patient, had a hysterectomy on Monday morning. That afternoon, after returning to her hospital room, she suffered a cardiac arrest. A cardiologist responded to the call and delivered one hour and 35 minutes of critical care. During this time the cardiologist ordered a single view chest x-ray and provided ventilation management. How should you report the cardiologist’s services?
  2. 99291, 99292
  3. 99291, 99292, 71010, 94002
  4. 71010, 94002, 99231
  5. 99291, 99292, 99292-52
  1. Brandon was seen in Dr. Shaw’s office after falling off his bunk bed. Brandon’s mother reported that Brandon and his sister were jumping on the beds when she heard a “thud.” Brandon complained of knee pain and had trouble walking. Dr. Shaw ordered a knee x-ray that was done at the imaging center across the street. The x-ray showed no fracture or dislocations. Dr. Shaw had seen Brandon for his school physical six months ago. Today, Dr. Shaw documented a detailed examination and decision-making of moderate complexity. He also instructed Brandon’s mother that if Brandon had any additional pain or trouble walking he should see an orthopedic specialist. How should Dr. Shaw report her services from today’s visit?
  2. 99204
  3. 99394, 99214
  4. 99214
  5. 99203
  1. Adam, a 48-year-old patient, presented to Dr. Crampon’s office with complaints of fever, malaise, chills, chest pain, and a severe cough. Dr. Crampon took a history, did an exam, and ordered a chest x-ray. After reviewing the x-ray, Dr. Crampon admitted Adam to the hospital for treatment of pneumonia. After his regular office hours, Dr. Crampon visited Adam in the hospital where he dictated a comprehensive history, comprehensive examination, and decision-making of moderate complexity. How would you report Dr. Crampon’s services?
  2. 99214
  3. 99222
  4. 99204, 99222-51
  5. 99223, 99214-21
  1. Why are the following codes not reported with continuing intensive care services (99478–99480): 36510, 36000, 43752, 51100, 94660, or 94375?
  2. These codes are deleted from the 2008 edition.
  3. These codes are included with continuing intensive care services.
  4. These codes are only add-on codes and should be reported with a modifier -51
  5. These codes are Category III Codes and should never be reported with Category I codes.
  1. Larry is being managed for his warfarin therapy on an outpatient basis. Dr. Nancy continues to review Larry’s INR tests, gives patient instructions, dosage adjustment as needed, and ordered additional tests. How would you report the initial 90 days of therapy including 8 INR measurements?
  2. 99363
  3. 0074T
  4. 99214
  5. This services is bundled with evaluation and management services
  1. Dr. Jane admitted a 67-year-old woman to the coronary care unit for an acute myocardial infarction. The admission included a comprehensive history, comprehensive examination, and high complexity decision-making. Dr. Jane visited the patient on days two and three and documented (each day) an expanded problem focused examination and decision-making of moderate complexity. On day four, Dr. Jane moved the patient to the medical floor and documented a problem focused examination and straightforward decision-making. Day five, Dr. Jane discharged the patient to home. The discharge took over an hour. How would you report the services from day one to day five?
  2. 99213, 99232, 99231, 99239 x 2
  3. 99221, 99222, 99223, 99238
  4. 99231, 99232, 99355, 99217
  5. 99223, 99232, 99232, 99231, 99239
  1. Which code range would describe services for a critically ill patient who is 23 days old as a out patient?
  2. 99291–99292
  3. 99293–99294
  4. 99295–99296
  5. None of the above
  1. Mr. Johnson, a 38-year-old established patient is being seen for management of his hypertension, diabetes, and weight control. On his last visit, he was told he had a diabetic foot ulcer and needed to be hospitalized for this condition. He decided to get a second opinion and went to see Dr. Myers. This was the first time Dr. Myers had seen Mr. Johnson. Dr. Myers documented a comprehensive history, comprehensive examination, and decision-making of high complexity. He concurred with hospitalization for the foot ulcer and sent a report back to Mr. Johnson’s primary care doctor. How would you report Dr. Myers visit?
  2. 99245
  3. 99205
  4. 99215
  5. 99255
  1. How does the CPT Professional Edition define an emergency department?
  2. An organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.
  3. An organized hospital-based facility for the provision of scheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.
  4. An organized hospital-based facility for the care and treatment of chronically ill patients who present for services. The facility must be available on weekends and holidays.
  5. An organized outpatient-based facility for the care and treatment of unscheduled patient who present for immediate medical attention. The facility must be available 24 hours a day.
  1. Lucus, a three-year-old new patient is seen for a well-child examination. The doctor documents an age appropriate history, examination, anticipatory guidelines, risk factor reduction intervention, and indicates Lucus’ immunizations are up to date. How would you report this service?
  2. 99392
  3. 99213-25, 99385
  4. 99203
  5. 99382
  1. An anesthesiologist provides general anesthesia for a 72-year-old patient with mild systemic disease who is undergoing a ventral hernia repair. How would you report the anesthesia service?
  2. 00834-P2, 99100
  3. 00832-P2, 99100
  4. 49560, 00834, 91000-P2
  5. 00832
  1. Dr. Member performed a transesophageal echocardiography for a congenital cardiac condition on a 16-year-old patient. Prior to the probe placement, moderate conscious sedation was administered. The probe was placed, images acquired, interpretation and reports were completed in the provider’s office. This procedure lasted 45 minutes. What code(s) capture the services performed by Dr. Member?
  2. 93315, 99144, 99145
  3. 00320, 99144, 99145
  4. 93315
  5. 93315-P1
  1. Katherine is a 77-year-old patient with a severe hypertensive disease. She underwent a cataract surgery to both eyes under general anesthesia. Dr.Sharon, the anesthesiologist, performed the anesthesia. Prior to induction of anesthesia Dr. Sharon completed a preoperative visit and documented a detailed history, detailed examination, and low complexity decision-making on this new patient. How would you report Dr. Sharon’s services?
  2. 99203, 00142-P2, 99100
  3. 66820, 00144
  4. 00140-P1, 99116-59
  5. 00142-P3, 99100
  1. A surgeon performed a cervical approach esophagoplasty with repair of a tracheosophageal fistula under general anesthesia. The surgeon performed both the procedure and the anesthesia. How would you report these services?
  2. 00500, 43305
  3. 43305-47
  4. 00500-47
  5. Both A and C
  1. Which service is not included with anesthesia services?
  2. Swan-Ganz monitoring
  3. Administration of blood
  4. Blood pressure
  5. Mass spectrometry
  1. A patient was placed under general anesthesia to have a simple incision and removal of a foreign body from the subcutaneous tissue. This procedure usually requires local anesthesia. Due to unusual circumstances, which required general anesthesia, what modifier would best describe this situation?
  2. 47
  3. 22
  4. 23
  5. P6
  1. Erin, a 45-year-old, asymptomatic female comes in for her annual bilateral screening mammography. Her physician ordered a computer- aided detection along with the mammography. The procedure was performed in a hospital. How would you report the professional services for this study?
  2. 77057-26, 77052-26
  3. 77056-26, 77051-26-59
  4. 77059-26, 77057-51
  5. 77057, 77052-51
  1. A patient presents to a freestanding radiology center and had ultrasonic guidance needle placement with imaging supervision and interpretation of two separate lesions in the left breast. The procedure required several passes to complete. How would you report the imaging procedure?
  2. 76930 x 2
  3. 76941
  4. 76942 x 2-LT
  5. 76942-LT
  1. Sally had a DXA bone density study for her hips, pelvis, and spine. The procedure was performed in a hospital. How would you report for the professional services of this study?
  2. 77078-26, 77080-26
  3. 77080-26
  4. 77082-26
  5. 77081-26, 77080-26
  1. How is proton beam treatment delivery defined?
  2. Simple, Complex, and Compound
  3. Simple, Complex, and Intermediate
  4. Superficial, Deep Vein, and Distal
  5. Simple, Complicated, and Comprehensive
  1. A patient had a myocardial perfusion imaging single study at rest with quantification, ejection fraction, and wall motion study. The procedure was performed in the nuclear medicine department of the hospital. How would you report the professional services for this study?
  2. 78473-26
  3. 78451-26
  4. 78452-26
  5. 78453-26
  1. Which of the following codes are unlisted procedures?
  2. 76498, 78199, 76496, 77799
  3. 75600, 75801, 76506, 76830
  4. 74181, 74280, 75564, 75600
  5. 75810, 75801, 75860, 75983
  1. How does cardiac magnetic imaging differ from a traditional MRI?
  2. In its ability to provide a physiologic evaluation of cardiac function
  3. In its ability to provide a measurement of the cardiac output
  4. In its ability to provide only a one dimensional view of the heart
  5. In its ability to provide only mapping points for cardiac regurgitation.23
  1. Jim is received two fractions of high dose electronic brachytherapy at a free-standing oncology center. What code(s) report this service?
  2. 77776, 0182T x 2
  3. 77761 x 2
  4. 0182T x 2
  5. 77799
  1. What is the correct CPT description of code 78135?
  2. Differential organ/tissue kinetics (e.g., splentic and/or hepatic sequestration)
  3. Bone marrow imaging; limited area
  4. Red cell survival study; differential organ/tissue kinetic (e.g., splentic and/or hepatic sequestration)
  5. None of the above
  1. In the Pathology and Laboratory section, what additional items may be included with special reports?
  2. Complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, follow-up care
  3. Signs and symptoms, final diagnosis, follow-up care, concurrent problems, drug testing, pathology findings
  4. Complexity of symptoms, final diagnosis, pathology findings, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, follow-up care
  5. Complexity of symptoms, final diagnosis, testing time, consultations notes, follow-up car
  1. Brent had the following lab tests:
  • Calcium, ionized
  • Carbon dioxide
  • Chloride
  • Creatinine
  • Glucose
  • Potassium
  • Sodium
  • Urea Nitrogen (BUN)

How should you report Brent’s lab work?

  1. 80048
  2. 80047-52
  3. 82310, 82374, 82435, 82565, 82947, 84132, 84295, 84520
  4. 80047
  1. Dr. Lee performed an intra-operative consultation on a bile duct tumor requiring frozen section and cytological evaluation to a bladder tumor. How would you report his professional services?
  2. 88329
  3. 88331-26, 88334-26
  4. 88331, 88332 x 2
  5. 88331-26, 88333-26
  1. Which modifier would you use to report with code 88239 if the test was looking for hereditary breast cancer?
  2. OB
  3. 59
  4. 91
  5. OA
  1. Marvin had a breath alcohol test completed at the hospital after the police arrested him for racing his four-wheeler past a McDonald’s drive through window. Marvin’s breath alcohol test was mathematically calculated. How would you report the calculation on this test?
  2. 82075
  3. 82075 x 2
  4. 82075, 82355
  5. 82355
  1. Dr. Monday provided a comprehensive clinical pathology consultation at the request of Dr. Adams. This request was regarding a patient with various infections, drug allergies, skin rash, and Down’s syndrome. The patient is in the hospital intensive care unit being treated with intravenous antibiotics. Dr. Monday did not see the patient but he reviewed the patient’s history, complex medical records, and provided a written report back to Dr. Adams regarding his findings and recommendations for further treatment. How would Dr. Monday report his services?
  2. 80502
  3. 99244
  4. 99244-25, 80502
  5. 99255-25, 80500
  1. A patient had a semi-quantitative urinalysis for infectious agent detection. How should you report this test?
  2. 81050
  3. 81005
  4. 81099
  5. 81005, 83518
  1. Code 3011F describes which diagnostic or screening process?
  2. Lipid panel results including total cholesterol, HDL-C, triglycerides, calculated LDL-C
  3. Lipid panel results including total cholesterol
  4. Lipid panel results including cholesterol, triglycerides, lipoprotein
  5. Lipid panel results including cholesterol, triglycerides, carbon dioxide, glucose, potassium
  1. A 58-year-old male patient with abdominal pain and episodes of bright red blood in his stool reports to his physician’s office for a check-up. His physician performs a digital rectal exam and tests for occult blood. Dr. Smith documents this blood occult test was done for purposes other than colorectal cancer screening. How would you report the occult blood test?
  2. 82270
  3. 82274
  4. 82271
  5. 82272
  1. Kathy has had intermittent abdominal pain, occasional diarrhea, stool frequency, and bloating. Her symptoms have worsened over the past two months. Her physician orders a fecal Calprotectin test to check for Crohn’s disease. How should you report the lab test?
  2. 82270
  3. 82272, 83993
  4. 83993
  5. 82271, 82272
  1. Colin had a comprehensive audiometry threshold evaluation and speech recognition testing to the left ear. What code(s) capture this procedure?
  2. 92557-52
  3. 92553, 92556
  4. 92557
  5. 92700-59
  1. An adult patient had the following immunizations with administration:
  • Yellow fever vaccine, subcutaneous injection
  • Hepatitis B (adult dose) vaccine, intramuscular injection
  • Plague vaccine, intramuscular injection

How would you report these services?

  1. 90465, 90466 x 2, 90717-51, 90746-51, 90727-51
  2. 90471, 90472 x 2, 90717, 90746, 90727
  3. 90473, 90474 x 2, 90746, 90727, 90717
  4. 90471, 90472 x 2, 90727-51, 90746-51, 90717-51
  1. Sally suffered from dehydration after running a marathon. She was taken into her primary care doctor’s office. Dr. Small checked Sally and ordered hydration therapy with normal saline. The hydration lasted 45 minutes. How would you report this service?
  2. 96365, 96361
  3. 96369
  4. 96360
  5. 96360, 96361
  1. A patient had a bronchoscopy with destruction for relief of stenosis by laser therapy. During this procedure photodynamic therapy by endoscopic application of light was used to ablate abnormal tissue via activation of photosensitive drugs. The photodynamic therapy lasted 60 minutes. How would you report this procedure?
  2. 31645, 96567
  3. 96567 x 2
  4. 31643, 96570-51, 96571-51
  5. 31641, 96570, 96571 x 2
  6. Dr. George asked the local pharmacist to review Ann’s new medications with her when she picked them up. Ann is a new patient who just moved into the area and required several new medications. Ann is hard of hearing and had a difficult time understanding Dr. George when he called her. The pharmacist spent 35 minutes with Ann and documented a review of her history, recommendations for improving health outcomes, and treatment compliance. The pharmacist faxed this note back to Dr. George’s office. How would the pharmacist report his services?
  7. 99605, 99607×2
  8. 99605, 99607
  9. 99607 x 3
  10. 99213
  1. What code would report an internet assessment and management service provided by a qualified non-physician healthcare professional to an established patient not originating from a related assessment and management service provided within the previous seven days?
  2. 96150
  3. 99444
  4. 98969
  5. 96151
  1. Code 95904 could describe studies to which of the following nerves?
  2. Lateral antebrachial cutaneous sensory nerve and posterior femoral cutaneous sensory nerve
  3. Medial calcaneal sensory nerve and radial sensory nerve to digit one
  4. Both A and B
  5. None of the above
  1. Jane has a family history of skin melanoma. Her primary care doctor asked for a consult with Dr. John. During Jane’s first visit with her new dermatologist, Dr. John, he documented a comprehensive history, comprehensive examination, and medical decision-making of moderate complexity. Dr. John also performed a whole body integumentary photography for monitoring of Jane’s skin. Dr. John sent a report back to her PCP and told Jane she should return in one year or before then if anything should change on her skin. What code(s) would you use to report Dr. John’s services?
  2. 99244-25, 96904
  3. 99213
  4. 96904
  5. 99204, 96904
  1. What services can you report in addition to the general ophthalmological services or evaluation and management services?
  2. Intermediate ophthalmological services
  3. Special ophthalmological services
  4. Only new patient general ophthalmological services
  5. Only established patient general ophthalmoligical services
  1. Jim underwent a percutaneous transluminal coronary atherectomy with a balloon to the left main coronary artery. During the same session his physician placed three drug coated stents in the left circumflex artery. What code(s) should you use to report these services?
  2. 92980 x 3
  3. 92981, 92996-51
  4. 92980, 92996
  5. 92995, 92982, 92981 x 3

Section 3

Number of questions from each topic:

  • Medical terminology (13 questions)
  • Anatomy (nine questions)
  • ICD-9-CM (11 questions)
  • HCPCS Level II (five questions)
  • Coding guidelines (five questions)
  1. What term could describe an inflammation of the plantar, causing foot or heel pain when walking or running?
  2. Plantar fascitis
  3. Tenodesis
  4. Tenolysis
  5. Tendon fascitis
  1. Blephroplasty describes what type of a procedure?
  2. Surgical reduction of the upper/lower eyelids to remove excess fat, skin, and muscle
  3. Treatment for spider veins with injections of sclerosing solution
  4. Replacement of damaged skin with healthy tissue taken from a donor
  5. Destruction of tissue by burning or freezing
  1. Which autoimmune disorder will eventually destroy the thyroid gland?
  2. Hayem-Farber disease
  3. Alzheimer’s thyroiditis
  4. Lou Gehrig’s disease
  5. Hashimoto’s thyroiditis
  1. Which of the following statements best describes a rheumatologist?
  2. A specialist who provides medical care and drug treatments focused on mental and cognitive disorders.
  3. A specialist who provides treatment to women during pregnancy, childbirth, and their aftercare
  4. A specialist who provides the diagnosis and treatment of disease characterized by inflammation of the connective tissues.
  5. A specialist who provides the diagnosis and surgical treatment of bone disorders
  1. A patient suffered a burn that involved the epidermis, dermis, and subcutaneous layers with some muscle involvement. What degree of burn would describe this injury?
  2. First-degree, superficial with blisters
  3. Second-degree, partial thickness with muscle
  4. Third-degree, full thickness
  5. None of the above
  1. In which part of the body would you find the choroid?
  2. Brain
  3. Eyeball
  4. Muscles of the hand
  5. Spinal column
  1. Which combining form refers to the small intestine?
  2. enter/o
  3. gastr/o
  4. celi/o
  5. col/o
  1. An ERG is what type of a procedure?
  2. Electroretinography
  3. Electrorenalography
  4. Electroretinograph
  5. Electrorhidogram
  1. Which term refers to the anus, rectum, and the cecum?
  2. rectal
  3. anorectal
  4. esophageal
  5. ilium
  1. Which term does not refer to a level of consciousness?
  2. Syncope
  3. Stupor
  4. Coma
  5. Sciatica
  1. What type of condition describes a patient diagnosed with oligospermia?
  2. Knots is the varicose veins
  3. An inflammation of the prostate gland
  4. An abnormally low number of sperm in the semen
  5. Failure to ovulate
  1. What does the term cystopexy mean?
  2. Inflammation of the spinal cord and brain
  3. Surgical fixation of the urinary bladder
  4. Surgical suture of the knee joints
  5. Crushing procedure to remove cysts
  1. What is an episiotomy and why would a patient need to have this procedure?
  2. Surgical suturing of the rectum caused by extensive tissue damage following a bowel repair
  3. Surgical incision of the vulva to facilitate delivery of a baby
  4. Surgical puncture of the cervix to remove fluid
  5. Surgical creation of an opening into the small intestine to provide relief of excessive gastritis
  1. What direction describes raising the foot, pulling the toes toward the shin?
  2. Protraction
  3. Dorsiflection
  4. Plantar flexion
  5. Pronation
  1. Which artery opens to allow oxygen-rich blood to pass from the left ventricle into the aorta where the blood is delivered to the rest of the body?
  2. Renal
  3. Aortic
  4. Superior vena cava
  5. Inferior vena cava
  1. What syndrome is a condition caused by abnormal production of the hormone gastrin?
  2. Vogt-Koyanagi
  3. Silvestroni-Bianco
  4. Sudeck-Leriche
  5. Zollinger-Ellison
  1. How can air pass through the upper respiratory tract?
  2. Via the nose, nasal cavity, nasopharynx, oropharynx, laryngopharynx, and larynx into the lower respiratory system.
  3. Via the nose, larynx, and bronchus
  4. Via nose, larynx, bronchus, and trachea
  5. Via nose, larynx, bronchus, trachea, and pleura
  1. What is the uvula?
  2. A receptacle for urine before it is voided.
  3. A female organ used to contain and nourish the embryo and fetus from the time the fertilized egg is implanted to the time of birth of the fetus.
  4. A small soft structure hanging from the free edge of the soft palate in midline above the root of the tongue. It is composed of muscle, connective tissue, and mucous membrane.
  5. A canal, used for the discharge of urine, that extends from the bladder to the outside of the body.
  1. What bones make up the axial skeleton?
  2. Skull, rib cage, and spine
  3. Spine, collar bones, and arms
  4. Shoulder bones, pelvic bones, arms, and legs
  5. Coccyx, ulna, femur, and tibia
  1. What term refers to white blood cells?
  2. Erythrocytes
  3. Monocytes
  4. Lymphocytes
  5. Leukocytes
  1. Which statement(s) describe a passive natural acquired immunity process?
  2. Use of immunoglobulin harvested from a donor who developed resistance against specific antigens
  3. The passage of antibodies through the placenta or breast milk
  4. Immunization that uses a greatly weakened form of the antigen, thus enabling the body to develop antibodies in response to this intentional exposure
  5. Both A and C
  1. What does the olecranon process refer to?
  2. The elbow
  3. Excision of a tumor in the large intestine
  4. Plasma membranes
  5. Use of a surgical endoscope in the knee
  1. Lucy, a 69-year-old patient, was admitted to a nursing home with cellulitis of the right foot, excluding the toes. She was placed on IV therapy for the cellulitis and is now recovering nicely. She plans to return to her home upon discharge. She has a history of Type I diabetes with no complications. She is being treated for both the cellulitis and the diabetic condition. How would you report these diagnoses?
  2. 682.7, 250.01
  3. 681.9, 250.00
  4. 250.03, 682.7
  5. 682.7, 250.71
  1. If the type of diabetes mellitus is not documented in the medical record what is the default type you should assign?
  2. There are no guidelines to determine the type assignment.
  3. Type I and Type II
  4. Type I
  5. Type II
  1. Cynthia is 28 years old and pregnant. She presents to the emergency room complaining of diarrhea with watery bowel movements with incontinence, cramps, nausea, and vomiting for the past 12 hours. She is unable to keep anything down, including liquids. She has been eating a healthy diet and does not feel this problem is based on something she ate. After testing, she was found to have enteritis due to Clostridium difficile. She was admitted for hydration and further treatment. In what order should you report the diagnoses codes for Cynthia’s condition?
  2. There are no sequencing rules that would apply to code this case
  3. Symptoms, Signs, and Ill-Defined Conditions codes only (Chapter 16)
  4. Complications of Pregnancy, Childbirth and Puerperium (Chapter 11) codes first, followed by Infectious and Parasitic codes (Chapter 1)
  5. Infectious and Parasitic codes (Chapter 1), followed by Complications of

Pregnancy, Childbirth and Puerperium (Chapter 11) codes

  1. A patient is suffering with acute respiratory failure, viral pneumonia, atrial fibrillation, and alcoholic liver cirrhosis. What codes describe these conditions?
  2. 414.0, 518.81, 572.2, 427.32, 571.8
  3. 571.3, 491.0, 571.2, 480.1
  4. 518.81, 480.9, 427.31, 571.2
  5. 518.83, 482.40, 491.0, 571.2
  1. A 44-year-old male was spraying weeds in his backyard. He accidentally got some of the weed killer in his ice tea. After drinking the ice tea and working for several hours, he told his wife he felt “funny” and started to vomit. She drove him to the emergency room for treatment. How would you report this scenario?
  2. 787.03, 989.4, E863.5
  3. 989.4, 787.03, E863.5
  4. 787.01, E950.6, E980.7
  5. 989.4, 787.03
  1. Pam’s infant son, who weighs 2,321 grams, is considered underweight for his gestational age without mention of fetal malnutrition. How would you report this case?
  2. 995.52
  3. 764.19
  4. 656.51
  5. 764.08
  1. How would you report a case of a patient with a non-healing burn?
  2. Acute burn
  3. Chronic burn
  4. Third degree burn
  5. Traumatic burn
  1. Jim lost control of his car while driving on an icy highway and hit a parked car. He was transported to a local emergency room for treatment. He suffered a greenstick fracture of six ribs and atelectasis. How would you report this?
  2. E812.0, 518.20, 624.01, 807.03, 518.0
  3. E812.0, E849.5, 807.00, 518.02
  4. E849.5, 807.05, 518.00, E812.0
  5. 807.06, 518.0, E812.0, E849.5
  1. Laurie has a malignant secondary tumor of the Bartholin’s gland. Her doctors do not know where this cancer started in Laurie’s system. She is coming in today for radiation of the secondary site. How would you report her diagnoses for today’s treatment?
  2. V58.0, 198.82, 199.1
  3. 198.82, V58.0
  4. 184.1, 198.82
  5. 239.5, 198.82, V58.0, 199.1
  1. What is the correct external cause code for the therapeutic use of wintergreen oil?
  2. 976.3
  3. E946.3
  4. E980.4, 976.3
  5. E858.7, E962.0
  1. Nancy has been suffering with abdominal cramping pain in the belly area, persistent watery diarrhea, fever, and fatigue. She underwent a colonoscopy and was diagnosed with Crohn’s disease of the large bowel and colon. How would you report the diagnosis from the colonoscopy?
  2. 789.00, 787.91, 780.79, 780.6
  3. 555.1
  4. 789.00, 555.9
  5. 556.9, 787.91, 780.79, 780.6, 789.00
  1. A patient received a 12 sq. cm. dermal tissue substitute of human origin, dermagraft. This treatment was completed due to a burn on the abdomen. How would you report the supply?
  2. Q4107x12
  3. Q4105 x12
  4. Q4106x12
  5. Q4111x12
  1. During an emergency room visit, Sally was diagnosed with pneumonia.

She was admitted to the hospital observation unit and treated with 500 mg of

Zithromax through an IV route. How would you report the supply of this drug?

  1. J0456
  2. Q0144
  3. J1190 x 2
  4. J2020 x 2
  1. Alice had to have a replacement for her soft interface in her protective helmet. How would you report this supply?
  2. A8004
  3. A8000
  4. A8001
  5. A8002
  1. Which code describes an addition to the lower extremity, knee disarticulation, and leather socket?
  2. L5624
  3. L5640
  4. L5105
  5. L5850
  1. A nursing home’s x-ray machine was not working. A portable x-ray machine and personnel was transported to the nursing home to test nine patients. How would you report the transportation of equipment?
  2. 76499
  3. S9999
  4. R0070 x 9
  5. R0075
  1. What modifier would best describe a blepharoplasty to the upper right eyelid?
  2. E1
  3. 51
  4. E3
  5. RT
  1. When using the CPT index to locate procedures, which of the following are considered primary classes for main entries?
  2. Procedure or service; organ or other anatomic site; condition; synonyms, eponyms, and abbreviations
  3. Abbreviations; signs and symptoms, anatomic site; and code assignment
  4. Conventions; code ranges; modifying terms
  5. Procedure or service; modifiers; clinical examples; and definitions
  1. Which of the following code and modifier combinations are correct?
  2. 0165T-25
  3. 15003-21
  4. 93571-51
  5. None of the above
  1. How are the diagnoses sequenced when coding for multiple fractures?
  2. Multiple fractures are sequenced according to anatomic location.
  3. Multiple fractures are sequenced in accordance with the severity of the fracture.
  4. Multiple fractures are sequenced in accordance with the longest bone first.
  5. Multiple fractures are always sequenced with pathologic fractures.
  1. When coding for a liver transplantation, what are the three distinct components of the physician’s work?
  2. Cadaver biopsy, cholecystectomy, reconstruction of the liver graft
  3. Cadaver/living donor hepatectomy, backbench work, recipient liver allotransplantation
  4. Preparations of the common bile duct, trisegment split, management of liver hemorrhage with re-exploration of post operative abscess
  5. Hemorrhoidopexy, ligation and hepatectomy, cholecystectomy