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Download link for Answer Keys of CPC Practice Papers

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150-CPC-Exam-2008-questions

CPC 2008 ANSWERS

150-CPC-Exam-2010-questions

CPC 2010 ANSWERS

150-CPC-Exam-2011-questions

CPC 2011 ANSWERS

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DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

 

Operative Note Practice Scenario – 7

Preoperative diagnoses: Rhegm atogenous retinal detachment and nuclear sclerotic cataract, both to the right eye.

Name of Procedures: A 25-gauge pars plana vitrectomy, retinal detachment repair, air fluid exchange, air gas exchange with SF6 24%, indirect ophthalmoscope-delivered laser, all to the right eye.

Description of Procedure: The patient was seen in the pre-operative holding area and all questions about the procedure answered. Right eye was identified as the correct operative site and informed consent was confirmed. The patient was rolled in the supine position to the operative suite where appropriate cardiac and pulmonary monitoring devices were applied per anesthesia. The patient was placed under general anesthesia without complication. Right eye was prepped and draped in normal sterile fashion. Sterile lid speculum was placed. A standard 3-port 25-guage vitrectomy unit was used after placing the infusion cannula 4 mm posterior to the infratemporal limbus. Correct position was visualized before turning it on. Additional 2 ports were placed without complication. Initial vitrectomy was performed and carried out into the periphery with the aid of scleral depression. A posterior vitreous detachment was already present. The retinal detachment extended from 12 o’clock temporally down to 6:30 o’clock. Directly temporally there was an old demarcation line with a small horseshoe retinal tear in the middle near the aura. This was trimmed free from vitreous. A drainage retinotomy was then created along the superior temporal arcade with electric diathermy. Air fluid exchange was then performed with drainage of subretinal fluid using a 25-guage backflush cannula. The retina was seen to lay flat. Plugs were placed and indirect ophthalmoscope was used to place laser retinopexy around the retinotomy site, the previously marked retinal hole and in a 360 degree retinopexy fashion. Drainage was performed one more time before placing SF6 24% into the posterior segment. Sclerotomy ports were removed in sequential fashion. All wounds were found to be airtight. The patient was given subconjunctival injections of Ancef and Decadron. A sterile led speculum was removed. A light pressure patch was placed. The patient was taken to recovery room in stable condition after being awakened form general anesthesia in stable condition. He was to remain face down overnight and follow up tomorrow for post-operative exam and instructions.

Codes:

Operative Note Practice Scenario – 6

Pre-operative diagnosis: Right knee medial meniscus tear

Post-operative diagnosis:

  1. Right knee medial meniscus tear
  2. Right knee lateral meniscus tear
  3. Tricompartmental arthritis of the knee

Name of Procedure: Video arthroscopy of right knee with arthroscopic partial medial and lateral meniscectomies and chondroplasty.

Description of Procedure: Once consent was obtained, the patient was brought to the operating theater and placed on the operating room table in the supine position. Following smooth induction of general anesthesia, a tourniquet was placed around the patient’s right thigh. The right lower extremity was then prepped and draped in the usual sterile orthopedic fashion. The extremity was elevated and exsanguinated and tourniquet was inflated. A superomedial portal was made as an outflow portal and a cannula was introduced in the knee. An anterolateral portal was made and the camera was placed in the knee. Upon inspecting the knee the patient was noted to have a large amount of synovitis throughout the knee. The patellofemoral joint was first visualized. The patient had outerbridge grade 3, fraying of the patella and 2 of the trochlea. There was some fraying of the cartilage there. The camera was then passed around the medial femoral condyle to the medial compartment of the knee. The patient had a grade 3 wear involving the entire medial femoral condyle and some of the tibial condyle as well. However, he did have a large complex fragmented tear of the posterior horn of the medial meniscus. The arthroscopic portal was made after localizing it with a spinal needle. Using a combination of biters, the shaver and the ArthroCare wand, the posterior horn of the medial meniscus was debrided to a stable base. The medial meniscus was sealed with ArthroCare wand to prevent further fraying. Next, the notch was visualized and the ACL was inspected. The ACL was intact. The knee was placed into a figure 4 position and the lateral compartment was visualized. The lateral femoral condyle was intact. However, there was some grade 2 wear of the lateral tibial plateau. The patient did have a tear of the lateral meniscus as well. This was debrided with the biter and the shaver. The knee was then extended and a chondroplasty of the patellofemoral joint was performed using the shaver. The free edge of the fibrillations was debrided to prevent any further fraying or breakdown of the articular cartilage. The instruments were then removed. The wound was infiltrated with Marcaine for postoperative analgesia and the arthroscopic portals were closed primarily with 4-0 Monocryl. Anesthesia was then reversed and the patient was awakened and taken to recovery room in stable condition

Codes:

Operative Note Practice Scenario – 5

Pre-operative diagnosis: Lipoma of right upper arm

Post-operative diagnosis: Lipoma of right upper arm

Name of procedure: Excision of lipoma from right upper arm with layered closure of 6 cm incision.

Indications: The patient is a 70 year-old female who has a mass on the upper right arm which has been present for several years and has slowly increased in size. She now comes in for elective resection.

Description of Procedure: The patient was taken to the operating room and placed in the supine position on the operating room table. The right arm was supported on a pillow and secured to the bed. The skin overlying the mass of the upper arm was prepped with Betadine and then draped in sterile fashion. The skin overlying the mass was then anesthetized with 1% lidocaine with epinephrine. A transverse 6 cm incision was made. Subcutaneous tissue was divided with electocautery down through subcutaneous fat until the capsule of the lipoma could be identified. The lipoma was then easily dissected free from all surrounding tissue. There was a feeder vessel exiting the deltoid muscle beneath it. This was treated with electrocautery. The mass was removed intact without problems and appeared to be a typical lipoma. The wound was inspected for hemostasis and with this assured, the subdermal tissues were closed with interrupted 3-0 Vicryl and the skin was closed with a running subcuticular stitch of 5-0 Monocryl. Steri-Strips, Telfa and Tegadem dressings were applied. The patient tolerated the procedure very well and was able to ambulate from the minor surgery room without difficulty.

Codes:

Operative Note Practice Scenario – 4

Pre-operative Diagnosis: Breast Cancer, Need for Chemotherapy

Post-operative Diagnosis: Same

Procedure Performed: Insertion of Infusaport

This 65-year-old patient was taken to the operation room and placed supine on the OR table. After adequate sedation, the area of the anterior chest and neck were prepped and draped in sterile fashion. Access to the right subclavian vein was done in posterior fashion, and the wire was visualized under fluoroscopy to be in the right atrium. A pocket was made on the lateral aspect of the right clavicle, and the pocket was developed. The catheter was guided from the site of the pocket to the exit site of the wire. The dilator and sheath were placed over the wire and the dilator and wire were both removed. The catheter was immediately inserted into the sheath. The sheath was separated and removed. The tip was pulled back to the superior vena cava/right atrial junction. The catheter was cut to length at the pocket site and attached to the Infusaport with the connector in a steadfast fashion. The port was placed in the pocket and anchored to the chest wall with 3-0 nylon sutures that were placed to immobilize ad anchor the port. Then antibiotic irrigation was done. The port was tested, and it flushed back blood and flushed heparinized saline without occurrence. The subcutaneous tissue and subcuticular tissue were reapproximated with 4-0 Vicryl suture in a running fashion. Steri-Strips and a sterile dressing were applied. The patient tolerated the procedure well.

The patient was sent for a post-operative chest x-ray.

Chest x-ray single view findings: Single view was taken of the chest in frontal position. This demonstrates proper placement of the catheter tip in the right atrium. No other findings.

Codes:

CPC Practice Paper 3

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

  1. Jill is a 29-year-old patient of Dr. Marks. She is seen by Dr. Marks for a cough with wheezing and yellow-colored mucus of three days’ duration, as well as four days of external bleeding hemorrhoids and diarrhea. Dr. Marks gives Jill Amoxicillin for acute viral bronchitis, instructions for care of external hemorrhoids, and a diet plan to assist with the diarrhea. What diagnoses should Dr. Marks use for this encounter?
  1. a. 0, 455.5, 787.91 b. 787.91, 466.11, 455.5 c. 466.11, 787.91, 455.2 d. 466.0, 455.8, 787.91
  1. What HCPCS Level II code describes Ensure HN therapy with an enteral infusion pump with alarm?
  1. a. B4150, B9002 b.  B4152, B9000 c.   B4150
  2. None of the above
  1. Which types of joints are considered synovial?
  1. a. Suture joint, medial joint, and articulation joint
  2. Ball-and-socket joint, hinge joint, and saddle joint c. Pivot joint, talus joint, and cranial joint
  3. Ball-and socket joint, nasal joint, and elevation joint
  1. A physician applied a cast and also provided all of the subsequent fracture care. The same physician may report the application of the cast separately from the fracture care.
  1. a. True b. False
  1. Immediately prior to inserting a permanent pacemaker and placing an electrode in the ventricle, the same physician surgically created a pocket to hold the pulse generator. How should the physician report the creation of the pocket?
  1. a. Skin pocket is included b.  33222
  2. c. 33222, 33215-51 d.  33233
  1. What modifier should be used for an incomplete colonoscopy when the patient was prepared for a full colonoscopy?
  1. a. 78 b. 52 c. 24
  2. None of the above
  1. A physician inserts a single temporary transvenous pacing catheter into the right atrium and connects the electrode to an external pulse generator. How should the physician report these services?
a. 33214
b. 33206
c. 33210
d. 33211-52
  1. A surgeon performs a diagnostic laparoscopy followed by a laparoscopic

nephrectomy (including partial ureterectomy). How should the physician report these services?

  1. a. 50546
  2. 49320, 50546-51 c. 49320
  3. 50549
  1. It is appropriate to separately report a visceral repair when a closure of an ureterovisceral fistula is performed during the same surgical session.
  1. a. True b. False
  1. A dermatologist excises a 3.5 cm benign lesion from a patient’s back. After the lesion is successfully removed, the dermatologist performs an intermediate 3.5 cm layered closure. How should you report these services?
a. 11404, 12031
b. 11404, 12032-51
c. 11404
d. 11404, 12032-57
  1. How would a physician report a bilateral diagnostic nasal endoscopy followed by endoscopic debridement of the nasal cavity during the same operative session?
a. 31240, 31237
b. 31254
c. 31237-50
d. 31237
  1. What is the name of a procedure that involves the passage of an endoscope down through the esophagus?
  1. a. Septoplasty b.  Sinusotomy
  2. c. Laryngoscopy d.  Esophagoscopy
  1. A physician excises a lesion from the iris of the right eye. How should the physician report these services?
  1. a. 66761-50 b. 66770-RT c. 66635-52 d.  66600-RT
  1. A patient presents to have corns removed from his foot. The physician performs paring to successfully remove four lesions. How should the physician report these services?
  1. a. 11056
  2. 11056, 12000 c.  11056 x 4
  3. 11704
  1. The subsection microbiology in the Pathology and Laboratory section of the CPT Manual includes codes for bacteriology, mycology, parasitology, and virology.
  1. a. True b.  False
  1. A 13-year-old patient suffering from end-stage renal disease received a full month of services, including growth and development assessment, parent counseling, and

monitoring of adequate nutrition. These services were completed in an outpatient facility. How would the physician report these services?

a. 90999
b. 97803, 90924
c. 90920
d. 90924
  1. A patient is admitted to the hospital for insertion of 15 interstitial radiation ribbons.

How would the facility report the radiology services?

  1. a. 77778
  2. 99222, 77763 c.  77777-TC
  3. 77762 x 15
  1. Mrs. Smith was seen by her family physician, Dr. Marks. Mrs. Smith complains she has had a sore throat, breathing problems, and a fever for five days. She is a diabetic patient and has been taking over-the-counter medications that have interfered with her insulin medication. Dr. Marks documented a detailed history, detailed examination, and moderately complex decision-making. Dr. Marks spent 35 minutes with the patient during the examination. How should the physician report this service?
a. 99215
b. 99204
c. 99205
d. 99214
  1. Pediatric critical care patient transport codes include vascular access procedures, blood gases, and review of information data stored in computer.
  1. a. True b.  False
  1. An anesthesiologist administers anesthesia for a male patient prior to the surgeon performing a total hip replacement. The patient is 75 years old and suffers from mild hypertension. How should you code the anesthesia services?
  1. a. 01214, 99100-59 b.  01214-47
  2. c. 01214-P2, 99100 d.  01214-P3

Answers to sample test questions for the CPC exam

  1. “a” Hemorrhoids are external with bleeding and the bronchitis is not specific to the type of virus.
  1. “a” Report both the supplement and the pump.
  1. “b” There are six types of freely moving or synovial joints: ball-and- socket, hinge, pivot, condyloid, saddle, and gilding joints.
  1. “b” When a physician applies the initial cast and assumes all of the subsequent fracture care, the physician cannot report the application of the cast separately because it is included in the treatment of the fracture.
  1. “a” This procedure is included with insertion of the pacemaker.
  1. “b” A colonoscopy is the examination of the entire colon from the rectum to the cecum, and may include the examination of the terminal ileum. You can find this description in the surgery section of the CPT Professional Edition under digestive endoscopy procedures.
  1. “c” Reports a temporary pacemaker.
  1. “a” The diagnostic laparoscopy is bundled into the surgical laparoscopy.
  1. “b” A visceral repair is included in a closure of a ureterovisceral fistula.

The code for this procedure is 50930.

  1. “b” The guidelines with excision–benign lesion provide directions to code additionally for intermediate and complex closures.
  1. “c” The guidelines for codes 31231–31294 report unilateral procedures unless otherwise stated.
  1. “d” Esophagoscopy
  1. “d” The surgical term for this procedure is iridectomy.
  1. “a” Code 11056 includes “two to four lesions.”
  1. “a” True. Review the subcategory guidelines of CPT Professional Edition

under microbiology.

  1. “c” The guidelines of CPT Professional Edition listed with Dialysis services clearly define inpatient and outpatient services.
  1. “a” The guidelines for clinical brachytherapy indicate that admission to the hospital is included with these services. There are definitions of simple, intermediate, and complex, with numbers of ribbons or sources.
  1. “d” This is an established visit. The documentation lists all three of the key components for a 99214 visit. Only two of the three key components must be met to qualify for this level of visit.
  1. “a” A list of codes and services included are listed in this subcategory guideline of the CPT Professional Edition.
  1. “c” Anesthesia codes must have a physical status modifier. This question has qualifying circumstances based on the patient age.

CPC Practice Questions

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

  1. Jill is a 29-year-old patient of Dr. Marks. She is seen by Dr. Marks for a cough with wheezing and yellow-colored mucus of three days’ duration, as well as four days of external bleeding hemorrhoids and diarrhea. Dr. Marks gives Jill Amoxicillin for acute viral bronchitis, instructions for care of external hemorrhoids, and a diet plan to assist with the diarrhea. What diagnoses should Dr. Marks use for this encounter?
  1. a. 0, 455.5, 787.91 b. 787.91, 466.11, 455.5 c. 466.11, 787.91, 455.2 d. 466.0, 455.8, 787.91
  1. What HCPCS Level II code describes Ensure HN therapy with an enteral infusion pump with alarm?
  1. a. B4150, B9002 b.  B4152, B9000 c.   B4150
  2. None of the above
  1. Which types of joints are considered synovial?
  1. a. Suture joint, medial joint, and articulation joint
  2. Ball-and-socket joint, hinge joint, and saddle joint c. Pivot joint, talus joint, and cranial joint
  3. Ball-and socket joint, nasal joint, and elevation joint
  1. A physician applied a cast and also provided all of the subsequent fracture care. The same physician may report the application of the cast separately from the fracture care.
  1. a. True b. False
  1. Immediately prior to inserting a permanent pacemaker and placing an electrode in the ventricle, the same physician surgically created a pocket to hold the pulse generator. How should the physician report the creation of the pocket?
  1. a. Skin pocket is included b.  33222
  2. c. 33222, 33215-51 d.  33233
  1. What modifier should be used for an incomplete colonoscopy when the patient was prepared for a full colonoscopy?
  1. a. 78 b. 52 c. 24
  2. None of the above
  1. A physician inserts a single temporary transvenous pacing catheter into the right atrium and connects the electrode to an external pulse generator. How should the physician report these services?
a. 33214
b. 33206
c. 33210
d. 33211-52
  1. A surgeon performs a diagnostic laparoscopy followed by a laparoscopic

nephrectomy (including partial ureterectomy). How should the physician report these services?

  1. a. 50546
  2. 49320, 50546-51 c. 49320
  3. 50549
  1. It is appropriate to separately report a visceral repair when a closure of an ureterovisceral fistula is performed during the same surgical session.
  1. a. True b. False
  1. A dermatologist excises a 3.5 cm benign lesion from a patient’s back. After the lesion is successfully removed, the dermatologist performs an intermediate 3.5 cm layered closure. How should you report these services?
a. 11404, 12031
b. 11404, 12032-51
c. 11404
d. 11404, 12032-57
  1. How would a physician report a bilateral diagnostic nasal endoscopy followed by endoscopic debridement of the nasal cavity during the same operative session?
a. 31240, 31237
b. 31254
c. 31237-50
d. 31237
  1. What is the name of a procedure that involves the passage of an endoscope down through the esophagus?
  1. a. Septoplasty b.  Sinusotomy
  2. c. Laryngoscopy d.  Esophagoscopy
  1. A physician excises a lesion from the iris of the right eye. How should the physician report these services?
  1. a. 66761-50 b. 66770-RT c. 66635-52 d.  66600-RT
  1. A patient presents to have corns removed from his foot. The physician performs paring to successfully remove four lesions. How should the physician report these services?
  1. a. 11056
  2. 11056, 12000 c.  11056 x 4
  3. 11704
  1. The subsection microbiology in the Pathology and Laboratory section of the CPT Manual includes codes for bacteriology, mycology, parasitology, and virology.
  1. a. True b.  False
  1. A 13-year-old patient suffering from end-stage renal disease received a full month of services, including growth and development assessment, parent counseling, and

monitoring of adequate nutrition. These services were completed in an outpatient facility. How would the physician report these services?

a. 90999
b. 97803, 90924
c. 90920
d. 90924
  1. A patient is admitted to the hospital for insertion of 15 interstitial radiation ribbons.

How would the facility report the radiology services?

  1. a. 77778
  2. 99222, 77763 c.  77777-TC
  3. 77762 x 15
  1. Mrs. Smith was seen by her family physician, Dr. Marks. Mrs. Smith complains she has had a sore throat, breathing problems, and a fever for five days. She is a diabetic patient and has been taking over-the-counter medications that have interfered with her insulin medication. Dr. Marks documented a detailed history, detailed examination, and moderately complex decision-making. Dr. Marks spent 35 minutes with the patient during the examination. How should the physician report this service?
a. 99215
b. 99204
c. 99205
d. 99214
  1. Pediatric critical care patient transport codes include vascular access procedures, blood gases, and review of information data stored in computer.
  1. a. True b.  False
  1. An anesthesiologist administers anesthesia for a male patient prior to the surgeon performing a total hip replacement. The patient is 75 years old and suffers from mild hypertension. How should you code the anesthesia services?
  1. a. 01214, 99100-59 b.  01214-47
  2. c. 01214-P2, 99100 d.  01214-P3

Answers to sample test questions for the CPC exam

  1. “a” Hemorrhoids are external with bleeding and the bronchitis is not specific to the type of virus.
  1. “a” Report both the supplement and the pump.
  1. “b” There are six types of freely moving or synovial joints: ball-and- socket, hinge, pivot, condyloid, saddle, and gilding joints.
  1. “b” When a physician applies the initial cast and assumes all of the subsequent fracture care, the physician cannot report the application of the cast separately because it is included in the treatment of the fracture.
  1. “a” This procedure is included with insertion of the pacemaker.
  1. “b” A colonoscopy is the examination of the entire colon from the rectum to the cecum, and may include the examination of the terminal ileum. You can find this description in the surgery section of the CPT Professional Edition under digestive endoscopy procedures.
  1. “c” Reports a temporary pacemaker.
  1. “a” The diagnostic laparoscopy is bundled into the surgical laparoscopy.
  1. “b” A visceral repair is included in a closure of a ureterovisceral fistula.

The code for this procedure is 50930.

  1. “b” The guidelines with excision–benign lesion provide directions to code additionally for intermediate and complex closures.
  1. “c” The guidelines for codes 31231–31294 report unilateral procedures unless otherwise stated.
  1. “d” Esophagoscopy
  1. “d” The surgical term for this procedure is iridectomy.
  1. “a” Code 11056 includes “two to four lesions.”
  1. “a” True. Review the subcategory guidelines of CPT Professional Edition

under microbiology.

  1. “c” The guidelines of CPT Professional Edition listed with Dialysis services clearly define inpatient and outpatient services.
  1. “a” The guidelines for clinical brachytherapy indicate that admission to the hospital is included with these services. There are definitions of simple, intermediate, and complex, with numbers of ribbons or sources.
  1. “d” This is an established visit. The documentation lists all three of the key components for a 99214 visit. Only two of the three key components must be met to qualify for this level of visit.
  1. “a” A list of codes and services included are listed in this subcategory guideline of the CPT Professional Edition.
  1. “c” Anesthesia codes must have a physical status modifier. This question has qualifying circumstances based on the patient age.

CPT Questions – Surgery Section

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

Integumentary (9 questions)

1. Sam had six actinic keratoses destroyed. How would you report this service?

  • 17004
  • 17000, 17003
  • 17000, 17003  x 5
  • 17110, 17111  x 5

2. History: A 41-year-old male with an open wound to the left upper leg presents for debridement and preparation of the skin graft site, followed by a split-thickness skin graft.

Procedure: After informed consent was obtained, the patient was taken to the operating room, where he

was prepped and draped in a sterile fashion. The VAC machine was disconnected. The wound was malodorous. Tissue was debrided on the surface, and some of the hypertrophic skin around the edge was also debrided. The total size is now 150 sq cm prepped and ready. Skin was harvested at 15/1000ths of an inch, at the patient’s request, from the trunk. An epinephrine-soaked gauze, 1/10,000 dilution, as well as Marcaine 0.5% with

1:200,000 dilution of epinephrine, was applied to the wound. Injection around the donor site was carried out with the same Marcaine solution. Marcaine 0.5% with 1:200,000 dilution of epinephrine was infiltrated around the left upper leg. Next, the skin graft was meshed at a 1.5:1 ratio. The skin graft, 150 sq cm, was applied to the left upper leg, and a 4-0 chromic suture was used. Next, the VAC sponge was placed over the skin graft. The skin graft area was secured with Stomahesive dressing around the edge. The patient’s donor site was dressed with Xeroform gauze and a Telfa, Kerlix gauze, ABD, and tape. The patient tolerated the procedure well and left the operating room in good condition. Needle and sponge counts were correct.

How would you report the professional services for this case?

  • a. 15004, 15005-51, 15170-51, 15171-59
  • b.   15002, 15100, 15101-51
  • c. 15004, 15005, 15170, 15171
  • d. 15100, 15101, 15002-51, 15003
  1. 3. A patient had a left breast reconstruction with free flap. The surgeon used a microsurgical technique, requiring an operating microscope during the procedure. How would you report this procedure?
  • a. 19364 -LT, 69990
  • b. 19357
  • c. 19361, 69990
  • d.   19364 -LT
  1. 4. A patient underwent an incision and drainage of a seroma without imaging and guidance. How would you report these professional services?
  • a. 10140, 76942-26
  • b. 10140
  • c.   10080
  • d. 10060, 76942-26
  1. 5. Dr. Shars took skin biopsies of three lesions from Laura’s back. How would you report Dr. Shars’ services?
  • a. 11100, 11101-51
  • b. 11056, 11100, 11101-51
  • c.   11100, 11101  x 2
  • d. Biopsy codes are not reported unless the lesions are removed
  1. 6. Dr. Dan excised a lesion from Sara’s left arm and one from her right leg. The excised diameter lesion on the arm was 2 cm and the excised diameter lesion on the leg was 2 cm. How would you report this service?
  • a. 11406, 11402-59
  • b. 11406
  • c. 11602, 11606-59
  • d. 11406, 11402
  1. 7. Dr. Dan completed a 4 cm simple defect closure to the excision on the arm and a 10.4  cm intermediate wound defect closure to the leg. How would the closures be reported?
  • a. 12034, 12002-59
  • b.   12034
  • c. 12002, 12045
  • d. All closures are bundled  with excision procedures
  1. 8. According to CPT guidelines for repair (closure), which modifier is reported when more than one classification of wounds is repaired?
  1. a. -54 b. -25 c.   -51 d.   -59
  1. 9. Dr. Craig completed a malignant lesion removal and an adjacent tissue transfer on the trunk of a patient. The lesion defect was 1 sq cm and the transfer defect was 2 sq cm. How would you report this procedure?
  • a. 11400
  • b. 11601, 11400-51
  • c.   11601, 11400-59
  • d.   11402, 11401

Musculoskeletal System (10 Questions)

  1. 10. A patient amputated her thumb in an automobile accident. A surgeon performed a replantation of the thumb, including carpometacarpal joint to the MP joint. How would you report this procedure?
  1. a. 20824 b. 20827 c.   20822
  2. d. 20808, 20824-59
  1. 11. A patient underwent a right surgical arthroscopic medial meniscal transplant, which required a remnant of the meniscus to be removed. How would you report this procedure?
  1. a. 29866, 29868-59 b.   29868-RT
  2. c. 29868
  3. d. 29870-RT
  1. 12. A patient had four artificial cervical discs removed by total disc arthroplasty in an anterior approach. What is the appropriate code to report the three additional interspaces?
  1. a. 22527  x 3 b.   0095T  x 3 c.   22534  x 3 d.   22585  x 3
  1. 13. When coding for spinal procedures, how is segmental instrumentation defined?
  1. a. Fixation  at each end of the construct and no additional interposed bony attachment
  2. b. Fixation at each end of the construct and may span four vertebral segments with attachment to

the intervening  segments

  1. c. Fixation at each end of the construct and at least one additional interposed bony attachment
  2. d. Fixation at each end of the construct and may span several vertebral segments without attachment

to the intervening  segments

  1. 14. What is the appropriate code for application of a body cast including one thigh?
  1. a. 29035 b. 29450 c.   29044 d.   29000
  1. 15. A patient underwent a percutaneous repair of an Achilles tendon with graft. How would you report this?
  1. a. 27680, 20824-59 b.   27654
  2. c. 27652, 20824 d.   27652
  1. 16. While shopping at the mall, Renee dislocated her patella when she fell from the escalator. The surgeon documented an open dislocation and performed an open treatment with total patellectomy to repair the patella. How would you code this treatment and diagnosis?
  1. a. 27840, 27562-51, 836.3,  E884.9 b.   27566, 836.4,  E880.0,  E849.6
  2. c. 27562, 836.4
  3. d. 27566, 27560-51, 836.4, E880.0, E884.9
  1. 17. A patient suffered a penetrating wound to his abdomen when he fell into a plate glass window. A surgeon performed wound exploration with enlargement, debridement, and removal of glass from the site. The surgeon decided a laparotomy procedure was not necessary at this time. How would this procedure be reported?
  1. a. 20102
  2. b. 49000, 97602-51, 20102-59 c.   20100, 49000-59
  3. d. This procedure is bundled  with the laparotomy
  1. 18. Dr. Roberts’ patient suffered an open fracture to his left elbow. The elbow was repaired surgically with several pins. Two weeks after the repair, Dr. Roberts had to re-reduce the fracture. Which modifier would describe this procedure?
  1. a. -76 b. -78 c.   -58 d.   -52
  1. 19. Tom suffered a burst fracture to his lumbar spine when he fell from a ladder at work. Dr. Bill performed  a partial corpectomy to L2 by a transperitoneal approach, followed by anterior arthrodesis of L1–L3. He also positioned anterior instrumentation and placed a structural allograft to L1–L3. How would Dr. Bill report this procedure?
  1. a. 22558, 22858-51, 22845-51, 20931-59 b.   63085, 22533, 22585-51, 22808-59
  2. c. 22612  x 2, 22808, 22840-51, 20931
  3. d. 63090, 22558-51, 22585, 22845, 20931

Respiratory/Cardiovascular Systems (10 Questions)

  1. 20. A patient had a dual temporary pacemaker inserted. Which code captures this service?
  1. a. 33210 b. 33211 c.   33212 d.   33213
  1. Alice’s heart condition is worsening and she is scheduled for an upgraded system change from a single to a dual chamber system. Today, Dr. Smith removed Alice’s single chamber pacemaker, pulse generator, and electrodes. He then inserted a dual chamber system with insertion of new electrodes. Assign the correct code(s) for today’s service.
  1. a. 33208, 33217
  2. b. 33233, 33234-51, 33208-51 c.   33214
  3. d. 33214, 33208-51, 33233-51, 33234-51
  1. 22. If an electrode needed to be repositioned in the right ventricle, which code would describe this service?
  1. a. 33218 b. 33226 c.   33215
  2. d. This service is bundled  with all pacemaker services
  1. 23. Three years after a double bypass, Tom’s heart condition deteriorated and he had to have another bypass surgery. Today, he had a triple arterial and a double venous graft surgery with harvesting of a radial artery. How would today’s procedure be reported?
  1. a. 33511, 35500, 33518, 33534
  2. b. 33535, 33518-51, 33530-51, 35600-51 c.   33511, 33518, 33530
  3. d. 33535, 33518, 33530, 35600
  1. Dr. Nector performed a direct thrombectomy to the iliac vein by abdominal and leg incision. How would Dr. Nector report her professional services?
  1. a. 34401 b. 34451 c.   34421 d.   34201
  1. 25. A 62-year-old patient had her non-tunneled, centrally inserted  CVAD without a port or pump replaced with the same type of system. The removal and replacement was completed through the same access site. How would you report this procedure?
  1. a. 36580
  2. b. 36589, 36580-51 c.   36581, 36589-59 d.   36578
  1. 26. What vascular order branch is the right internal carotid if the starting point of the catheterization is the aorta?
  1. a. First order  branch
  2. b. Second order  branch c.   Third  order  branch
  3. d. Beyond the third  order
  1. 27. A patient had a biopsy of the temporal artery. What is the appropriate code to identify this service?
  1. a. 37650 b.   37609 c.   37700 d.   37565
  1. 28. How many times can codes 38207–38215 be reported per day?
  1. a. Once per day
  2. b. As many times as the procedure is completed  within  one service day c.   Twice per day
  3. d. None  of the above
  1. 29. How would you report a diagnostic bronchoscopy with fluoroscopic guidance and a cervical approach mediastinotomy with biopsy?
  1. a. 39000, 31622-51
  2. b. 39000, 31622-51, 71034 c.   31635, 71034
  3. d. 39000, 31630-59, 71034

Digestive System (10 Questions)

  1. 30. A 45-year-old female patient with mild hypertension underwent a proctosigmoidoscopy with ablation of three lesions under moderate sedation. Dr. Terry performed the procedure and the sedation in her office suite. The intraservice time for the procedure was 45 minutes. How would you report these services?
  1. a. 45320
  2. b. 45320, 99144, 99145
  3. c. 45309, 45320  x 3, 00810-P2 d.   45320  x 3
  1. 31. Juan, a 42-year-old healthy male patient, had a laparoscopic cholecystectomy with cholangiography. Select the appropriate CPT code(s) to report these services.
  1. a. 47605
  2. b. 47562, 47605-51 c.   47563
  3. d. 47560, 47563-59
  1. 32. Jennifer underwent a hernioplasty to repair a strangulated, recurrent ventral hernia, which required implantation of mesh for successful closure. Additionally, the surgeon completed debridement for necrotizing soft tissue due to infection. How would the professional services be reported in this procedure?
  1. a. 49566, 11005-51, 49568-51 b.   49561, 49568
  2. c. 49566, 11005-51, 49568
  3. d. 49565, 11004-59, 49568
  1. 33. A 16-year-old patient underwent an adenoidectomy. During the same surgical session, his chronic nose bleeding on the left side was addressed. The surgeon found an abnormal vasculature in this area and cauterized using suction cautery in the left nasal septum to control this problem. Next, the inferior turbinates were reduced using the Coblation device. How would you report these procedures?
  1. a. 30140, 42831-51
  2. b. 42835, 30999-51, 30901-50 c.   42830, 30140, 30901
  3. d. 42831, 30140-52, 30901-59-LT
  1. 34. How would Dr. Ross report a 2 cm complex closure for a laceration to the vestibule of the mouth that he completed on a 12-year-old patient?
  1. a. 13132
  2. b. 40831, 13132-51 c.   40830
  3. d. 40831
  1. 35. Dr. Manual completed the following service for a 22-year-old male:

Preoperative note: The patient has a history of diabetes, smokes, and does not exercise. However, the patient states that he is in excellent health. Prior to the surgery, the patient signed consent forms and indicates that he understands the surgery and risks.

Procedure: The patient was prepped and taken into the operating room, where a diagnostic endoscopic retrograde cholangiopancreatography with endoscopic retrograde and insertion of nasobiliary drainage tube were completed. Within the same operative session, we also performed a sphincterotomy. I completed the radiological supervision and interpretation with this procedure.

How would Dr. Manual report her professional services?

  1. a. 43260, 74330, 43262-52, 43267-59
  2. b. 43260, 43267-51, 43262-51, 74330-26 c.   43260, 99144, 74330-26
  3. d. 43259, 99144, 74330-26, 43260-51, 43267-59
  1. If a diagnostic esophagoscopy is completed on the same patient, for the same condition, in the same session as a surgical esophagoscopy,  how is it coded?
  1. a. A surgical endoscopy  always includes a diagnostic  endoscopy
  2. b. Code both  procedures with a modifier -59 on the surgical endoscopy
  3. c. Code both  procedures with a modifier -51 on the diagnostic  endoscopy d.   A surgical endoscopy  always includes a diagnostic  open excision
  1. 37. Select the appropriate CPT code(s) to report a laparoscopic surgical repair of an incisional reducible hernia with mesh.
  1. a. 49655 b.   49654
  2. c. 49654, 49568 d.   49560, 49568
  1. 38. A 22-year-old patient pulled out his gastrostomy tube while trying to fix it. An interventional radiologist, Dr.

Milk, took him into an angiography suite, administered moderate sedation where she probed the site with a catheter, and injected contrast medium to provide assessment and tube placement. Dr. Milk documented that the entry site was open, and she replaced the tube in the proper position. This procedure was completed via the same percutaneous access site. The intraservice time for the procedure was 30 minutes. How would you report the professional services for this case?

  1. a. 49450, 99144 b.   49450
  2. c. 49440, 99148
  3. d. 49440
  1. 39. Usually, an incidental appendectomy during an intra-abdominal surgery is not coded separately. However, if it is necessary to report this as a separate procedure, which modifier best describes this situation?
  1. a. -52 b.   -59 c.   -51 d.   -58

Urinary System, Male and Female Genital Systems (11 Questions)

  1. 40. Indication for procedure: The patient has a known history of bladder tumor. She presents today for bladder biopsy and fulguration, as well as instillation of Mitomycin C. She understands the treatment and risks and agrees by signed consent to the procedure.

Procedure: The patient was taken to the operating room and induced under general anesthesia with appropriate lines and monitoring placed. The patient was in a dorsal lithotomy position. A 23-French cystourethroscope was advanced per urethra into the bladder. The bladder was carefully inspected, with no evidence of abnormalities noted other than two previously noted lesions for transitional cell carcinoma—one near the right ureteral orifice and one inferior to the left ureteral orifice. These lesions were biopsied and cauterized without difficulty. The lesions were noted at approximately 7–8 mm in size. A 20-French Foley catheter was inserted per urethra into the bladder without difficulty and noted to be draining clear urine. Next, instillation of Mitomycin  C was completed with a plan

to keep in place for 45–50  minutes. The patient tolerated the procedure well. There were no complications. She was taken from the operating room to recovery in satisfactory condition. How would you report this procedure?

  1. a. 52000, 52204-59
  2. b. 51720, 51715-51, 52000-59 c.   52204, 51720-51
  3. d. 51720
  1. 41. Steven, a 52-year-old male patient, underwent an extracorporeal shockwave lithotripsy and cystourethroscopy with removal of a double-J stent. How would you report this procedure?
  1. a. 50590
  2. b. 50590, 52310-51 c.   50590, 52315-59 d.   52317, 52310-51
  1. 42. What are the three distinct components of physician work for renal allotransplantation?
  1. a. Cadaver or living donor nephrectomy (unilateral or bilateral), backbench work, and recipient renal

allotransplantation

  1. b. Cadaver donor nephrectomy (unilateral or bilateral), backbench work, and recipient renal

autotransplantation

  1. c. No donor nephrectomy (unilateral or bilateral), backbench work, and recipient renal

allotransplantation

  1. d. Cadaver donor nephrectomy (unilateral or bilateral), forward bench-set work, and recipient renal

allotransplantation

  1. 43. A patient had an open cryosurgical ablation of two renal mass lesions. The surgeon used an intraoperative ultrasound for the procedure. Select the appropriate code for this procedure.
  1. a. 50250  x 2 b.   50593
  2. c. 50542 d.  50250
  1. 44. Sally has been unable to become pregnant and has undergone extensive testing. She is now scheduled for an in vitro fertilization procedure. She underwent a follicle puncture to retrieve 12 eggs. The surgeon then injected one egg into the right fallopian tube. Which codes capture this procedure?
  1. a. 58970, 58976-51 b.   58970, 58976-59 c.   58660, 58661-51 d.   58660, 58976-59
  1. 45. Which modifiers should be appended when multiple investigative procedures are performed in the same urodynamic session and the physician only interprets the results and/or operates the equipment?
  1. a. -51, TC b. -51, -26 c.   -59, TC
  2. d. No modifiers are necessary
  1. 46. A 65-year-old male patient underwent a repair of the tunica vaginalis hydrocele, Bottle type. Which CPT code is appropriate to report this procedure?
  1. a. 55041 b. 55000 c.   55060 d.   54865
  1. 47. A patient had a vulvectomy with removal of greater than 80% of the vulvar area and a bilateral inguinofemoral lymphadenectomy. Which CPT code is appropriate to report this procedure?
  1. a. 56634 b. 56620 c.   56637 d.   56632
  1. 48. Dr. Level delivered a healthy baby boy via routine cesarean delivery. He also provided all the antepartum and postpartum care for this patient. How would you report this procedure?
  1. a. 59510, 59425-59, 59430-59 b.   59400
  2. c. 59618 d.   59510
  1. 49. A patient had a laparoscopic treatment of ectopic pregnancy with a salpingectomy and an oophorectomy.

Which code captures this procedure?

  1. a. 59150 b. 59136 c.   59120 d.   59151
  1. 50. A physician inserts a catheter into a renal abscess using radiologic guidance, then drains the abscess. How would you code the physician’s professional services?
  1. a. 50020, 75989
  2. b. 50021, 75989-26 c.   50021, 75989-TC
  3. d. 50021, 50020-51, 75989-TC

Nervous System, Eye and Ocular Adnexa, and Auditory System (10 questions)

  1. 51. A patient had a 2 cm lesion excised from conjunctiva in the right eye. How would you report this procedure?
  1. a. 68135-RT b. 68115-RT c.   68330-RT d.   68110-RT
  1. 52. A patient underwent a phacoemulsification extra-capsular cataract extraction with an Alcon 0 mm optic 21.6 diopter posterior chamber intraocular lens inserted into the capsular bag. This procedure was completed with a surgical microscope. How would you report this service?
  1. a. 66982
  2. b. 66982, 69990 c.   66984, 69990 d.   66984
  1. 53. A patient had four prophylaxis photocoagulation treatments for lattice degeneration. These treatments were completed over a one-week time period. How many units of code 67145 would be reported?
  1. a. One b.   Two
  2. c. Three d.   Four
  1. 54. How would you report an endolymphatic sac operation with shunt?
  1. a. 69806 b. 69801 c.   69949
  2. d. 69949, 69990-51
  1. 55. Bob, a healthy 12-year-old patient, had bilateral removal of ventilating tubes. An anesthesiologist administered general anesthesia for the procedure. How would the surgeon report her services?
  1. a. 69424- 47, 00120-P1 b.   69200-50
  2. c. 69424-50
  3. d. 69200, 00120-P1
  1. 56. The code range 65710–65757 should not be reported in conjunction with which of the following?
  1. a. Sensorimotor examination with single measurement, unilateral or bilateral, with interpretation

and report

  1. b. Any codes in the E/M section
  2. c. Computerized corneal topography, unilateral or bilateral,  with interpretation and report d.   There is not a code for reporting a restriction
  1. 57. Dr. Smith injected 12 cc of 5% Marcaine in the occipital nerve for a patient suffering from occipital neuralgia/

headache. How would you report this professional service?

  1. a. 64653 b. 64408 c.   64405 d.   64650
  1. Select the appropriate codes to report a supratentorial craniectomy for excision of a brain tumor and implantation of brain intracavitary chemotherapy agent.
  1. a. 61510, 61517 b.   61518, 61517
  2. c. 61512, 61517-59 d.   61510, 61316-59
  1. 59. A patient with spondylosis and lumbar degenerative disc disease underwent bilateral steroid paravertebral facet joint injections to L3 and L4. Additionally, a transforaminal epidural injection of anesthetic was done to the right side at T2. These procedures were completed under fluoroscopic guidance. How would you report these professional services?
  1. a. 64490-50, 64491-50, 64479-59-RT
  2. b. 64490, 64491, 64483, 77003
  3. c. 64494, 64480-59-RT, 77003-26
  4. d. 64483-50, 54475, 64479-59-RT, 64480-59, 77003-26
  5. 60. Ted had a neuroplasty of the ulnar nerve at the elbow. How would you report this procedure?
  1. a. 64719 b. 64718 c.   64822 d.   64836