Integumentary (9 questions)
1. Sam had six actinic keratoses destroyed. How would you report this service?
- 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
- 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
- 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
- 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
- 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
- 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
- 8. According to CPT guidelines for repair (closure), which modifier is reported when more than one classification of wounds is repaired?
- a. -54 b. -25 c. -51 d. -59
- 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)
- 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?
- a. 20824 b. 20827 c. 20822
- d. 20808, 20824-59
- 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?
- a. 29866, 29868-59 b. 29868-RT
- c. 29868
- d. 29870-RT
- 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?
- a. 22527 x 3 b. 0095T x 3 c. 22534 x 3 d. 22585 x 3
- 13. When coding for spinal procedures, how is segmental instrumentation defined?
- a. Fixation at each end of the construct and no additional interposed bony attachment
- b. Fixation at each end of the construct and may span four vertebral segments with attachment to
the intervening segments
- c. Fixation at each end of the construct and at least one additional interposed bony attachment
- d. Fixation at each end of the construct and may span several vertebral segments without attachment
to the intervening segments
- 14. What is the appropriate code for application of a body cast including one thigh?
- a. 29035 b. 29450 c. 29044 d. 29000
- 15. A patient underwent a percutaneous repair of an Achilles tendon with graft. How would you report this?
- a. 27680, 20824-59 b. 27654
- c. 27652, 20824 d. 27652
- 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?
- a. 27840, 27562-51, 836.3, E884.9 b. 27566, 836.4, E880.0, E849.6
- c. 27562, 836.4
- d. 27566, 27560-51, 836.4, E880.0, E884.9
- 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?
- a. 20102
- b. 49000, 97602-51, 20102-59 c. 20100, 49000-59
- d. This procedure is bundled with the laparotomy
- 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?
- a. -76 b. -78 c. -58 d. -52
- 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?
- a. 22558, 22858-51, 22845-51, 20931-59 b. 63085, 22533, 22585-51, 22808-59
- c. 22612 x 2, 22808, 22840-51, 20931
- d. 63090, 22558-51, 22585, 22845, 20931
Respiratory/Cardiovascular Systems (10 Questions)
- 20. A patient had a dual temporary pacemaker inserted. Which code captures this service?
- a. 33210 b. 33211 c. 33212 d. 33213
- 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.
- a. 33208, 33217
- b. 33233, 33234-51, 33208-51 c. 33214
- d. 33214, 33208-51, 33233-51, 33234-51
- 22. If an electrode needed to be repositioned in the right ventricle, which code would describe this service?
- a. 33218 b. 33226 c. 33215
- d. This service is bundled with all pacemaker services
- 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?
- a. 33511, 35500, 33518, 33534
- b. 33535, 33518-51, 33530-51, 35600-51 c. 33511, 33518, 33530
- d. 33535, 33518, 33530, 35600
- Dr. Nector performed a direct thrombectomy to the iliac vein by abdominal and leg incision. How would Dr. Nector report her professional services?
- a. 34401 b. 34451 c. 34421 d. 34201
- 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?
- a. 36580
- b. 36589, 36580-51 c. 36581, 36589-59 d. 36578
- 26. What vascular order branch is the right internal carotid if the starting point of the catheterization is the aorta?
- a. First order branch
- b. Second order branch c. Third order branch
- d. Beyond the third order
- 27. A patient had a biopsy of the temporal artery. What is the appropriate code to identify this service?
- a. 37650 b. 37609 c. 37700 d. 37565
- 28. How many times can codes 38207–38215 be reported per day?
- a. Once per day
- b. As many times as the procedure is completed within one service day c. Twice per day
- d. None of the above
- 29. How would you report a diagnostic bronchoscopy with fluoroscopic guidance and a cervical approach mediastinotomy with biopsy?
- a. 39000, 31622-51
- b. 39000, 31622-51, 71034 c. 31635, 71034
- d. 39000, 31630-59, 71034
Digestive System (10 Questions)
- 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?
- a. 45320
- b. 45320, 99144, 99145
- c. 45309, 45320 x 3, 00810-P2 d. 45320 x 3
- 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.
- a. 47605
- b. 47562, 47605-51 c. 47563
- d. 47560, 47563-59
- 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?
- a. 49566, 11005-51, 49568-51 b. 49561, 49568
- c. 49566, 11005-51, 49568
- d. 49565, 11004-59, 49568
- 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?
- a. 30140, 42831-51
- b. 42835, 30999-51, 30901-50 c. 42830, 30140, 30901
- d. 42831, 30140-52, 30901-59-LT
- 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?
- a. 13132
- b. 40831, 13132-51 c. 40830
- d. 40831
- 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?
- a. 43260, 74330, 43262-52, 43267-59
- b. 43260, 43267-51, 43262-51, 74330-26 c. 43260, 99144, 74330-26
- d. 43259, 99144, 74330-26, 43260-51, 43267-59
- 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?
- a. A surgical endoscopy always includes a diagnostic endoscopy
- b. Code both procedures with a modifier -59 on the surgical endoscopy
- c. Code both procedures with a modifier -51 on the diagnostic endoscopy d. A surgical endoscopy always includes a diagnostic open excision
- 37. Select the appropriate CPT code(s) to report a laparoscopic surgical repair of an incisional reducible hernia with mesh.
- a. 49655 b. 49654
- c. 49654, 49568 d. 49560, 49568
- 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?
- a. 49450, 99144 b. 49450
- c. 49440, 99148
- d. 49440
- 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?
- a. -52 b. -59 c. -51 d. -58
Urinary System, Male and Female Genital Systems (11 Questions)
- 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?
- a. 52000, 52204-59
- b. 51720, 51715-51, 52000-59 c. 52204, 51720-51
- d. 51720
- 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?
- a. 50590
- b. 50590, 52310-51 c. 50590, 52315-59 d. 52317, 52310-51
- 42. What are the three distinct components of physician work for renal allotransplantation?
- a. Cadaver or living donor nephrectomy (unilateral or bilateral), backbench work, and recipient renal
- b. Cadaver donor nephrectomy (unilateral or bilateral), backbench work, and recipient renal
- c. No donor nephrectomy (unilateral or bilateral), backbench work, and recipient renal
- d. Cadaver donor nephrectomy (unilateral or bilateral), forward bench-set work, and recipient renal
- 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.
- a. 50250 x 2 b. 50593
- c. 50542 d. 50250
- 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?
- a. 58970, 58976-51 b. 58970, 58976-59 c. 58660, 58661-51 d. 58660, 58976-59
- 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?
- a. -51, TC b. -51, -26 c. -59, TC
- d. No modifiers are necessary
- 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?
- a. 55041 b. 55000 c. 55060 d. 54865
- 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?
- a. 56634 b. 56620 c. 56637 d. 56632
- 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?
- a. 59510, 59425-59, 59430-59 b. 59400
- c. 59618 d. 59510
- 49. A patient had a laparoscopic treatment of ectopic pregnancy with a salpingectomy and an oophorectomy.
Which code captures this procedure?
- a. 59150 b. 59136 c. 59120 d. 59151
- 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?
- a. 50020, 75989
- b. 50021, 75989-26 c. 50021, 75989-TC
- d. 50021, 50020-51, 75989-TC
Nervous System, Eye and Ocular Adnexa, and Auditory System (10 questions)
- 51. A patient had a 2 cm lesion excised from conjunctiva in the right eye. How would you report this procedure?
- a. 68135-RT b. 68115-RT c. 68330-RT d. 68110-RT
- 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?
- a. 66982
- b. 66982, 69990 c. 66984, 69990 d. 66984
- 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?
- a. One b. Two
- c. Three d. Four
- 54. How would you report an endolymphatic sac operation with shunt?
- a. 69806 b. 69801 c. 69949
- d. 69949, 69990-51
- 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?
- a. 69424- 47, 00120-P1 b. 69200-50
- c. 69424-50
- d. 69200, 00120-P1
- 56. The code range 65710–65757 should not be reported in conjunction with which of the following?
- a. Sensorimotor examination with single measurement, unilateral or bilateral, with interpretation
- b. Any codes in the E/M section
- c. Computerized corneal topography, unilateral or bilateral, with interpretation and report d. There is not a code for reporting a restriction
- 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?
- a. 64653 b. 64408 c. 64405 d. 64650
- Select the appropriate codes to report a supratentorial craniectomy for excision of a brain tumor and implantation of brain intracavitary chemotherapy agent.
- a. 61510, 61517 b. 61518, 61517
- c. 61512, 61517-59 d. 61510, 61316-59
- 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?
- a. 64490-50, 64491-50, 64479-59-RT
- b. 64490, 64491, 64483, 77003
- c. 64494, 64480-59-RT, 77003-26
- d. 64483-50, 54475, 64479-59-RT, 64480-59, 77003-26
- 60. Ted had a neuroplasty of the ulnar nerve at the elbow. How would you report this procedure?
- a. 64719 b. 64718 c. 64822 d. 64836