AAPC CPC CHAPTER 8 EXAM
QUESTIONS AND ANSWERS WITH
RATIONALE
A 63 year-old man sustained a gunshot wound through the right maxillary sinus
penetrating into the right neck. CT scan revealed no hard evidence of arterial injury but
a bullet was directly in line with the internal jugular vein. He was sent to the operating
room for neck exploration to rule out vascular injury and injury to the aero digestive tract
(respiratory and digestive tracts). A sternocleidomastoid incision was performed and
carried down through the platysma muscle. There was no penetration of the internal
jugular vein, but a foreign body was identified resting on the internal jugular vein at
approximately the level of the angle of the mandible and it was removed. The parotid
gland was noted to have a blast injury near the tail. This was not surgically repaired or
resected. Once all bleeding was controlled, a 10 French round drain was placed in the
wound. The wound was copiously irrigated. The platysma muscle - Answer- 20100
Rationale: In the CPT® Index, look for Exploration/Neck/Penetrating Wound. You are
referred to 20100. Review the code to verify accuracy. 20100 is the correct code
because the patient was sent to the operating room for exploration of a gunshot
(penetrating trauma) wound to identify damaged structures. The category guidelines for
Wound Exploration-Trauma indicate that these codes include removal of foreign bodies,
ligation or coagulation of minor subcutaneous and muscular blood vessels, damaged
tissue debridement, repair and wound closure.
A 63 year-old man presents with a neck mass to be excised. The neck mass was
palpated and an incision was then made and carried down through the dermis with
electrocautery. The subcutaneous tissue of the skin was opened encountering an
organized mass with a benign appearance of a lipoma. Using careful blunt and sharp
dissection, the mass measuring 5 cm was completely excised around its entire
circumference leaving the capsule intact. The mass was removed from its posterior
attachments using electrocautery. What CPT® code is reported for this procedure? -
Answer- 21552
Rationale: In the CPT® Index, look for Neck/Tumor/Excision. You are referred to 21552-
21558. Review the codes to choose the appropriate service. 21552 is the correct code
to report the excision of a 5 cm mass where the surgeon incised the subcutaneous
tissue to remove the mass. Codes 11426 and 11626 are reported for removal of a
benign or malignant lesion, not an internal mass.
, An 85 year-old has developed a lump in her right groin. An incision over the lesion was
made and tissue was dissected through the skin and subcutaneous tissue going deep
through the femoral fascia. Sharp dissection of the mass was performed, freeing it from
surrounding structures. The 3 cm mass was isolated and excised. The incision was
closed, the area was cleaned and dried, and a dressing applied. What CPT® code is
reported? - Answer- 27048
Rationale: In the CPT® Index look for Excision/Tumor/Pelvis. You are referred to 27043,
27045, 27047, 27048, 27049 and 27059. Review the codes to choose the appropriate
service. 27048 is the correct code to report the removal of the 3 cm mass below the
fascia.
A patient presented with a right ankle fracture. After induction of general anesthesia, the
right leg was elevated and draped in the usual manner for surgery. A longitudinal
incision was made parallel and posterior to the fibula. It was curved anteriorly to its
distal end. The skin flap was developed and retracted anteriorly. The distal fibula
fracture was then reduced and held with reduction forceps. A lag screw was inserted
from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then
applied to the lateral contours of the fibula with cortical and cancellous bone screws.
Final radiographs showed restoration of the fibula. The wound was irrigated and closed
with suture and staples on the skin. Sterile dressing was applied followed by a posterior
splint. What CPT® code is reported? - Answer- 27792-RT
Rationale: In the CPT® Index look for Fracture/Fibula/Open Treatment and you are
referred to 27784, 27792, 27814. Code 27784 reports open treatment of a proximal
fibular fracture or shaft fracture. The correct code is 27792 for the open treatment and
internal fixation. Modifier RT is appended to indicate the procedure is performed on the
right side.
A 16 year-old female was hit by a car while crossing a two-lane highway. She was taken
to the hospital by ambulance. She was found to have an open wound of the left lower
thigh, just above the knee and a displaced fracture of the left femoral neck. She was
taken to the operating room within four hours of her injury. She was given general
endotracheal anesthesia and was prepped and draped in sterile fashion. Debridement
including excision of devitalized skin and muscle was performed on the lateral thigh.
The area was approximately 15 sq cm. After debridement and thorough copious
irrigation, the wound was closed with layer sutures and a dressing was applied and then
covered with adhesive plastic. The patient was then prepped and draped for the fracture
and turned on her right side. We all rescrubbed. An 8 inch incision was made over the
left hip and the head of the femur was exposed. Multiple fragments from the neck an -
Answer- 27236-LT, 11043-59-LT
Rationale: The main procedure is repair of a right femoral neck fracture. Look in the
CPT® Index for Fracture/Femur/Neck/Open referring you to 27236. Modifier LT is
appended to show the left side. Next look in the CPT® Index for
Debridement/Skin/Subcutaneous Tissue referring you to 11042-11047. The correct
QUESTIONS AND ANSWERS WITH
RATIONALE
A 63 year-old man sustained a gunshot wound through the right maxillary sinus
penetrating into the right neck. CT scan revealed no hard evidence of arterial injury but
a bullet was directly in line with the internal jugular vein. He was sent to the operating
room for neck exploration to rule out vascular injury and injury to the aero digestive tract
(respiratory and digestive tracts). A sternocleidomastoid incision was performed and
carried down through the platysma muscle. There was no penetration of the internal
jugular vein, but a foreign body was identified resting on the internal jugular vein at
approximately the level of the angle of the mandible and it was removed. The parotid
gland was noted to have a blast injury near the tail. This was not surgically repaired or
resected. Once all bleeding was controlled, a 10 French round drain was placed in the
wound. The wound was copiously irrigated. The platysma muscle - Answer- 20100
Rationale: In the CPT® Index, look for Exploration/Neck/Penetrating Wound. You are
referred to 20100. Review the code to verify accuracy. 20100 is the correct code
because the patient was sent to the operating room for exploration of a gunshot
(penetrating trauma) wound to identify damaged structures. The category guidelines for
Wound Exploration-Trauma indicate that these codes include removal of foreign bodies,
ligation or coagulation of minor subcutaneous and muscular blood vessels, damaged
tissue debridement, repair and wound closure.
A 63 year-old man presents with a neck mass to be excised. The neck mass was
palpated and an incision was then made and carried down through the dermis with
electrocautery. The subcutaneous tissue of the skin was opened encountering an
organized mass with a benign appearance of a lipoma. Using careful blunt and sharp
dissection, the mass measuring 5 cm was completely excised around its entire
circumference leaving the capsule intact. The mass was removed from its posterior
attachments using electrocautery. What CPT® code is reported for this procedure? -
Answer- 21552
Rationale: In the CPT® Index, look for Neck/Tumor/Excision. You are referred to 21552-
21558. Review the codes to choose the appropriate service. 21552 is the correct code
to report the excision of a 5 cm mass where the surgeon incised the subcutaneous
tissue to remove the mass. Codes 11426 and 11626 are reported for removal of a
benign or malignant lesion, not an internal mass.
, An 85 year-old has developed a lump in her right groin. An incision over the lesion was
made and tissue was dissected through the skin and subcutaneous tissue going deep
through the femoral fascia. Sharp dissection of the mass was performed, freeing it from
surrounding structures. The 3 cm mass was isolated and excised. The incision was
closed, the area was cleaned and dried, and a dressing applied. What CPT® code is
reported? - Answer- 27048
Rationale: In the CPT® Index look for Excision/Tumor/Pelvis. You are referred to 27043,
27045, 27047, 27048, 27049 and 27059. Review the codes to choose the appropriate
service. 27048 is the correct code to report the removal of the 3 cm mass below the
fascia.
A patient presented with a right ankle fracture. After induction of general anesthesia, the
right leg was elevated and draped in the usual manner for surgery. A longitudinal
incision was made parallel and posterior to the fibula. It was curved anteriorly to its
distal end. The skin flap was developed and retracted anteriorly. The distal fibula
fracture was then reduced and held with reduction forceps. A lag screw was inserted
from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then
applied to the lateral contours of the fibula with cortical and cancellous bone screws.
Final radiographs showed restoration of the fibula. The wound was irrigated and closed
with suture and staples on the skin. Sterile dressing was applied followed by a posterior
splint. What CPT® code is reported? - Answer- 27792-RT
Rationale: In the CPT® Index look for Fracture/Fibula/Open Treatment and you are
referred to 27784, 27792, 27814. Code 27784 reports open treatment of a proximal
fibular fracture or shaft fracture. The correct code is 27792 for the open treatment and
internal fixation. Modifier RT is appended to indicate the procedure is performed on the
right side.
A 16 year-old female was hit by a car while crossing a two-lane highway. She was taken
to the hospital by ambulance. She was found to have an open wound of the left lower
thigh, just above the knee and a displaced fracture of the left femoral neck. She was
taken to the operating room within four hours of her injury. She was given general
endotracheal anesthesia and was prepped and draped in sterile fashion. Debridement
including excision of devitalized skin and muscle was performed on the lateral thigh.
The area was approximately 15 sq cm. After debridement and thorough copious
irrigation, the wound was closed with layer sutures and a dressing was applied and then
covered with adhesive plastic. The patient was then prepped and draped for the fracture
and turned on her right side. We all rescrubbed. An 8 inch incision was made over the
left hip and the head of the femur was exposed. Multiple fragments from the neck an -
Answer- 27236-LT, 11043-59-LT
Rationale: The main procedure is repair of a right femoral neck fracture. Look in the
CPT® Index for Fracture/Femur/Neck/Open referring you to 27236. Modifier LT is
appended to show the left side. Next look in the CPT® Index for
Debridement/Skin/Subcutaneous Tissue referring you to 11042-11047. The correct
