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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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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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Answers – Practice Questions For CPC Exam 2017

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 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

How to Code – Excision of Lesions

Excision of Lesions

Excision is defined as a full thickness (through the dermis) excision of a lesion.

Treatment types for lesions:

  1. Paring – Peeling or scrapping
  2. Shaving – Slicing
  3. Excision – Cutting and removal
  4. Destruction (Ablation) – Laser, Electrocautery, freezing, burning , chemicals
Check while coding Excision –
  1. Site of lesion
  2. of lesions
  3. Size of excised lesions
  4. Type of lesion – Benign or malignant

Prior to excision, the greatest diameter of the lesion is measured. The measurement includes the margin (extra tissue taken from around the lesion) at its narrowest part.

Closure of lesions –

  1. Simple closure – Non layered closure
  2. Intermediate closure – Layered
  3. Complex closure – greater than layered

Simple closure is always included with excision code and not coded separately while intermediate and complex closure can be reported additionally.

The shaving of lesions requires no closure because no incision has been made.

Pairing or cutting – 11055 – 11057

For benign hyperkeratotic skin lesion such as a callus or corn. It includes removal by peeling and scraping.

Biopsy  –  11100 – 11101

Procedure of removing tissue for histopathology (study of microscopic tissue changes)

2 types – Incisional biopsy – (open, sharp, and partial removal ) – its not excision , CPT lesion biopsy codes, only a portion of the lesion and some of the surrounding tissue is removed.

Excisional biopsy – ( complete removal)  –  its biopsy with excision , code only excision here.

Do not code biopsy and excision separately as biopsy is always included in excision code.

Skin Tags – 11200 – 11201

Skin tags are flaps of skin (benign lesions) that can appear anywhere, but most often appear on the neck or trunk, especially in older people . Skin tags are removed in a variety of ways—scissors, blades, ligatures, electrosurgery, or chemicals.

Shaving  – 11300-11313

Performed by using a scalpel blade or other sharp instrument

EXCISION  :

Categorised on the basis of lesion type – whether benign or malignant. Codes are categorised as – site of excision and size of lesion ( ie excision diameter )

Site of Excision

Benign lesion – 11400-11471

  1. Trunk, arms, legs – 11400-11406
  2. Scalp, neck, hands feet, genitalia – 11420-11426
  3. Face, ears, eyelids, nose, lips, mucous membrane – 11440-11446

Malignant lesion – 11600 – 11646

  1. Trunk, arms, legs – 11600-11606
  2. Scalp, neck, hands, feet, genitalia – 11620-11626
  3. Face, ears, eyelids (skin only), nose, lips – 11640-11646
Size of Lesion ( ie excision diameter )

As per CPT®, “Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision.”

excised diameter equals the length of the lesion at its longest point, plus two times the narrowest margin. For example, if the lesion measures 1 cm at its greatest, and the surgeon removes a margin of 0.5 cm on all sides, the total excised diameter is 2.0 cm (1.0 cm + [2 x 0.5 cm]).

Coding Rules –

  1. First identify a lesion as either benign or malignant, as per pathology results before assigning a code (unless the diagnosis is confirmed in a previous biopsy of the lesion).
  2. When the surgeon removes multiple lesions, treat each as a separate procedure. Append modifier 59 Distinct procedural service to the second and subsequent codes for excisions in the same general location.
  3. If multiple lesions are treated, code the most complex lesion procedure first followed by the others using modifier -51If the code description includes multiple lesions (a stated number of lesions), modifier -51 is not necessary. For example, if the code states “2 to 4 lesions” or “more than 4 lesions,” modifier -51 is not required.
  4. Do not report Local anesthesia and simple closures (12001-12018) in addition to lesion excision.
  5. Intermediate (12031-12057) and complex (13100-13153) repairs and Reconstructive closure (15002-15261, 15570-15770) must be coded additionaly with excision.
  6. Do not report lesion excision in addition to Adjacent tissue transfer (14000-14350).

 

 

How to Code – Debridement

Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. The goal of debridement is to cleanse the wound, reduce bacterial contamination, and provide an optimal environment for wound healing or possible surgical intervention. The usual end point of debridement is removal of pathological tissue and/or foreign material until healthy tissue is exposed.

Techniques 

Debridement techniques include, among others, sharp and blunt dissection, curettement, scrubbing, and forceful irrigation. Surgical instruments may include a scrub brush, irrigation device, electrocautery, laser, sharp curette, forceps, scissors, burr, or scalpel Prior to debridement.

Debridement CPT Codes  : 11000 – 11047

  1. 11000 & 11001 – For Eczematous Debridement
  2. 11004 – 11006 – For debridement of Soft tissue infection(i.e. upto skin, subcutaneous tissue and muscle,fascia level)
  3. 11010 – 11012 – Excisional Debridement
  4. 11042 – 11047 – Wound Debridement

Excisional Debridement

defined as the “surgical removal or cutting away of devitalized tissue, necrosis, or slough,” which could be performed in the operating room, emergency room, or at the patient’s bedside.

Some surgical procedure codes include debridement as a part of the service. You may report a debridement as a separate service when the medical record indicates that a greater than usual debridement was provided. For example, if an extensive debridement of an open fracture was performed when usually a simple debridement would be performed, you report the additional service using a debridement code from the 11010-11012 range.

Divided according to location:

11010 – skin and subcutaneous level

11011 – Muscle , Fascia level

11012 – Bone level

Wound Debridement

11042 – 11047 – Wound Debridement

Divided according to – Depth of tissue –

11042 – skin and subcutaneous level

11043 – Muscle , Fascia level

11044 – Bone level

Diveded according to Surface Area –

11042,11043,11044 – upto 20 sq cm

11045, 11046 – More than 20 Sq cm

Coding tips –  When reporting one wound, report the depth of the deepest level of tissue removed. When reporting multiple wounds, sum the surface area of the wound at the same depth. Do not combine sums of different depths.

Other Important Points to Remember while coding for debridement

  1. These debridement codes do not apply to debridement of burned surfaces. For debridement of burned surfaces, CPT codes 16000-16036 are reported.
  2. Do not assign additional codes for debridement when these procedures are an integral part of the total procedure performed. A debridement carried out in conjunction with another procedure is often, but not always, included in the code for the procedure.
  3. Do not use these codes for pressure ulcers, for Pressure ulcers – code 15920-15999
In Patient coding

Reporting Additional Diagnoses for Inpatient Services

Reporting Additional Diagnoses for Inpatient, Short-Term, Acute Care and Long- Term Care Hospital Records

For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring clinical evaluation, or therapeutic treatment, or diagnostic procedures, or extended length of hospital stay, or increased nursing care and/or monitoring.

The following guidelines are to be applied in designating “other diagnoses” when neither the Alphabetic Index nor the Tabular List in ICD-9-CM provides direction.   The listing of the diagnoses in the patient record is the responsibility of the attending physician.

Previous Conditions:

If the physician has included a diagnosis in the final diagnostic statement, such as the discharge summary or the face sheet, it should ordinarily be coded.  However, history codes (V10 – V19) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.

Abnormal Findings:

Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the physician indicates their critical significance.

Please note: This differs from the coding practices in the outpatient setting for coding encounters for diagnostic tests that have been interpreted by a physician.

Uncertain Diagnosis:

If the diagnosis documented at the time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, code the condition as if it existed or was established.  The basis for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.

Diagnostic Coding and Reporting for Inpatient Services

Selection  of  Principal  Diagnosis(es) for  Inpatient,  Short-Term,  Acute Care, and Long-Term Care Hospital Records

The circumstances of inpatient admission always govern the selection of principal diagnosis.  The principal diagnosis is  defined in  the Uniform Hospital Discharge Data Set (UHDDS) as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”The UHDDS definitions are used by acute care short-term hospitals to report inpatient data elements in a standardized manner.  These data elements and their definitions can be found in the July 31,1985 Federal Register (Vol. 50, No. 147), pp. 31038-40.

In determining principal diagnosis the coding conventions in the ICD-9-CM, Volumes I and II take precedence over these official guidelines.The importance of consistent, complete documentation in the medical record cannot be overemphasized.  Without such documentation the application of all coding guidelines is a difficult, if not impossible, task.

  1. Code for symptoms, signs and ill-defined conditions.  Codes, symptoms, signs and ill- defined conditions from chapter 16, are not to be used as principal diagnosis when a related definitive diagnosis has been established.
  2. Two or more interrelated conditions, each potentially meeting the definition for  principal diagnosis. When there are two or more interrelated conditions potentially  meeting the definition  of  principal  diagnosis,  either  condition  may  be  sequenced  first,  unless  the circumstances of the admission, the therapy provided, the Tabular List, or the  Alphabetic Index indicate otherwise.
  3. Two or more diagnoses that equally meet the definition for principal diagnosis.  In the unusual  instance  when  two  or  more  diagnoses  equally  meet  the  criteria  for  principal diagnosis  as  determined  by  the  circumstances  of  admission,  diagnostic  workup  and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding guideline does not provide sequencing direction, any one of the diagnoses may be sequenced first.
  4. Two or more comparative or contrasting conditions. In those rare instances when two or more contrasting or comparative diagnoses are documented as “either/or”, they are coded as if the diagnosis was confirmed and the diagnoses are sequenced according to the circumstances of the admission.   If no further determination can be made as to which diagnosis should be principal, either diagnosis may be sequenced first.
  5. When a symptom(s) is followed by contrasting/comparative diagnoses, the symptom code is sequenced first. All the contrasting/comparative diagnoses should be coded as additional diagnoses.
  6. Sequence as  the  principal  diagnosis  the  condition,  which  after  study  occasioned  the admission to the hospital, even though treatment my not have been carried out due to unforeseen circumstances.
  7. When the admission is for treatment of a complication resulting from surgery or other medical care, the complication code is sequenced as the principal diagnosis.  If the complication is classified to the 996–999 series, an additional code for the specific complication may be assigned.
  8. If the diagnosis documented at the time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, code the condition as if it existed or was  established.    The  basis  for  these  guidelines are  the  diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.

Diagnostic Coding and Reporting for Outpatient Services

Coding guidelines for inconclusive diagnoses (probable, suspected, rule out, etc.) were developed for inpatient reporting and do not apply to outpatients.

Selection In the outpatient setting, the term “first-listed diagnosis” is used in lieu of principal diagnosis. Diagnoses often are not established at the time of the initial encounter/visit. It may take two or more visits before the diagnosis is confirmed.

Code Range The appropriate code(s) from 001.0   – V83.89 must be used to identify diagnoses, symptoms, conditions, problems, complaints or other reasons for the encounter/visit.

Accurate Reporting For  accurate  reporting  of  ICD-9-CM  diagnosis  codes,  the  documentation should  describe  the patient’s condition, using the terminology, which includes specific diagnoses as well as symptoms, problems or reasons for the encounter. There are ICD-9-CM codes to describe all of these.

Code Selection The selection of codes 001.0 – 999.9 will frequently be used to describe the reason for the encounter. These codes are from the section of ICD-9-CM for the classification of diseases and injuries (e.g., infectious & parasitic diseases; neoplasms; symptoms, signs and ill-defined conditions, etc.)

Symptoms, and Signs Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been established (confirmed) by the physician.

Circumstances Other Than Disease or Injury The Supplementary Classification of Factors Influencing Health Status and Contact With Health Services (V01.0 –V83.89) is provided to deal with occasions when circumstances other than disease or injury are recorded as diagnoses or problems.

Code Specificity ICD-9-CM is composed of codes with either 3, 4, or 5 digits. Codes with 3 digits are included in the heading of a category of codes that may be further subdivided by the use of fourth or fifth digits, which provide greater specificity. A code is invalid if it has not been coded to the full number of digits required for that code.

Code Sequence List first the ICD-9-CM code for the diagnosis, condition, problem, or other reason for the encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describe any coexisting conditions.

Uncertain Diagnosis Do  not  code  diagnoses documented as  “probable,” “suspected,” “questionable,” “rule  out”,  or “working diagnosis.”    Rather,  code  the  condition(s) to  the  highest  level  of  certainty  for  that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.

Please Note: This differs from the coding practices used by hospital medical record departments for coding the diagnosis of acute care, short-term hospital inpatients.

Chronic Disease Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s).

Coexisting Conditions Code all documented conditions that exist at the time of the encounter/visit and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist. History codes (V10-V19) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.

Diagnostic and Therapeutic Services For  patients  receiving  diagnostic  services  only  during  an  encounter/visit,  sequence  first  the diagnosis, condition, problem, or other reason for the encounter/visit in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit.  Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses. For outpatient encounters for diagnosis tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses.

Note:  This differs from the coding practice in the hospital setting regarding abnormal findings on test results. For  patients  receiving  therapeutic  services  only  during  an  encounter/visit,  sequence  first  the diagnosis, condition, problem or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit.  Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses.

The only exception to this rule is that when the primary reason for the admission/encounter is chemotherapy, radiation therapy, or rehabilitation, the appropriate V code for the service is listed first, and the diagnosis or problem for which the service is being performed listed second.

Preoperative Evaluations For patients receiving preoperative evaluations only, sequence a code from category V72.8, Other Specified Examinations, to describe the preoperative consultations.  Assign a code for the condition to describe the reason for the surgery as an additional diagnosis.  Code also any findings related to the preoperative evaluation.

Ambulatory Surgery For  ambulatory  surgery,  code  the  diagnosis  for  which  the  surgery  was  performed.    If  the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding, since it is the most definitive.

Prenatal Visits For routine outpatient prenatal visits when no complications are present, codes V22.0, supervision of normal first pregnancy, and V22.1, supervision of other normal pregnancy, should be used as principal  diagnoses.    These  codes  should  not  be  used  in  conjunction with  Chapter  11  codes (Complications of Pregnancy, Childbirth, and the Puerperium (630-677).