Practicode Cases Part 1 Exam Questions and
Correct Answers
Page 1 of 153
,Question 1
OPD7408 Case Year Version: 2024
Primary Diagnosis: M25.511
Secondary Diagnosis: M79.89, L53.9
E/M Level: 99283
Correct Answer
OPD7408 MEDICAL RECORD
EMERGENCY DEPARTMENT
SEX: FEMALE AGE: 7
DOS: 1/1/20XX
CHIEF COMPLAINT: Arm pain and swelling.
HPI: A 7-year-old female 1 day status post her 7-year-old shots brought in by family
complaining of right deltoid region pain and swelling. She received all of her 7-year
shots yesterday, some in the left arm and some in the right. Mother is not sure. She
believes that the TdaP was placed in the right deltoid region. This morning she
began complaining of pain in that area and mother noticed redness, some mild
swelling, and warmth from the deltoid region to the mid upper arm area. The
patient herself has otherwise been at her baseline. She is having no fevers. No chills.
Her p.o. intake has been normal. There has been no vomiting or any other specific
complaints.
PAST MEDICAL HISTORY: None.
PAST SURGICAL HISTORY: None.
FAMILY HISTORY: Noncontributory.
SOCIAL HISTORY: Lives at home with both parents.
MEDICATIONS: None.
ALLERGIES: NONE KNOWN.
PHYSICAL EXAM: VITAL SIGNS: Temp 99.1, pulse 111, BP 102/57, oxygen saturation
98% on room air which is within normal limits.
GENERAL: She is alert and oriented, appropriate to her age. She is in mild
discomfort but is nontoxic. She is smiling and joking with her parents.
ENT: Her hearing is normal. External ears appear normal. Nose is patent with no
epistaxis.
NECK: Supple. Full range of motion.
CARDIOVASCULAR: She has a regular rate and rhythm.
RESPIRATORY: She is in no respiratory distress. Her lungs are clear to auscultation
bilaterally.
ABDOMEN: Soft, nontender.
EXTREMITIES: She has full range of motion x4.
NEURO: Her behavior, coordination, and speech are normal for her age.
SKIN: She has prominent erythema and warmth from the right deltoid region
Page 2 of 153
, stretching down to about halfway to her elbow. It is mildly tender. It is warm. There
is no focal induration. There
Question 2
OPD7329 Case Year Version: 2025
Primary Diagnosis: S62.031A
CPT: 25628-RT
Correct Answer
OPD7329 MEDICAL RECORD
OPERATIVE REPORT SEX: MALE AGE: 19 DATE: 12/02/20XX PREOPERATIVE
DIAGNOSIS: Slightly displaced right scaphoid wrist fracture. POSTOPERATIVE
DIAGNOSIS: Slightly displaced right scaphoid wrist fracture. OPERATION: Open
reduction and internal fixation, right scaphoid fracture. Surgeon: Christopher
Thomas, M.D. OPERATIVE PROCEDURE: The patient was brought to the operating
room and was placed under block anesthesia, had the right hand prepped and
draped in the usual sterile fashion. Right arm tourniquet was elevated after Esmarch
exsanguination. Dorsal longitudinal incision was created over the fourth extensor
compartment. The fourth extensor retinaculum was released. Small dorsal
longitudinal capsulotomy was performed. The proximal aspect of the scaphoid was
identified as well as the scaphoid fracture. There was slight displacement of the
fracture. The fracture site was opened and fracture hematoma removed. An open
reduction was performed. Two 0.045 K-wires were used for provisional fixation. Also
K-wire was used as joystick for the distal pole. Following reduction of the fracture, a
standard Acutrak screw guide wire was used. Eventually, a 20-mm Acutrak screw
was used for internal fixation. Provisional wires were removed. Dorsal capsulotomy
was repaired, as was the extensor retinaculum. Skin was closed in layers. The patient
was then placed in a long-arm thumb spica splint and taken to recovery room in
stable condition. Christopher Thomas, MD Electronically signed byCHRISTOPHER
THOMAS, MD 1/1/20XX
Page 3 of 153
, Question 3
OPD7324 Case Yr: 2024
PDx: D22.61
SDx: D22.4, D22.62
CPT: 11420 x2, 11400 x2
Per CPT guidelines, simple closure is incl in lesion excision (not separately reported)
Lesions that require intermediate or complex closure can have the closure reported as
well. However, NCCI Coding Policy Manual (Ch 3.E.6) directs if there are multiple
lesions excised, the simple, intermediate, or complex repair may only be reported
when at least 1 of the lesions is >0.5 cm. All lesions are < 0.5, so the intermediate
repair is not reported. In the CPT Index, see Excision/Skin/Lesion, Benign. Codes are
selected by body area & lesion size. Based on the size of the lesions, report 11400 x2
for each shoulder lesions & 11420 x2 for each neck lesion. Each lesion removed is
reported separately. Lesions should be sequenced in descending order according to
RVUs. 3 of the lesions are removed with a punch tool but are fully removed, not
biopsied.
Correct Answer
OPD7324 MEDICAL RECORD
OPERATIVE REPORT SEX: FEMALE AGE: 42 ENCOUNTER: Office Surgery DATE OF
OPERATION: 01/1/20XX SURGEON: Dr. Cohen Andrews SKIN OTHER SYMPTOMS -
four small growths/nevi. Removed today in office.
HISTORY OF PRESENT ILLNESS: The patient comes in today to have four small skin
lesions removed as they are either irritated by her bra or jewelry.
CURRENT MEDICATIONS: Reviewed Medications. OXYCODONE HCI 10 MG TAB
PROVENTIL HFA 108 MCG
VITAMIN D 5000 UNITS CAPS
Tests: • Blood pressure was high - 20XX.
ALLERGIES: • Compazine TABS, reaction: heart races. • Penicillins, reaction: skin
rashes/hives. • Reglan TABS, reaction: hallucinations/depression. • Squash, reaction:
migraines.
OBJECTIVE:
Pre-Op Dx: four skin lesions.
Post-Op Dx: same.
Procedure: Excision of left shoulder nevus 0.5 cm. Excision of two left neck skin
lesion each about 0.3 cm and excision of right shoulder skin lesion 0.4 cm.
Anesthesia: 1% lidocaine with epinephrine.
Specimen: left shoulder, left neck x2 and right shoulder.
PROCEDURE NOTE: The left shoulder nevus was excised first. The area was prepped
with betadine and then draped. The skin was infiltrated with local and then an
elliptical incision was made around the lesion and it was carried down into the
subcutaneous tissue. The wound was closed with 3-0 Vicryl in the subcutaneous
Page 4 of 153
Correct Answers
Page 1 of 153
,Question 1
OPD7408 Case Year Version: 2024
Primary Diagnosis: M25.511
Secondary Diagnosis: M79.89, L53.9
E/M Level: 99283
Correct Answer
OPD7408 MEDICAL RECORD
EMERGENCY DEPARTMENT
SEX: FEMALE AGE: 7
DOS: 1/1/20XX
CHIEF COMPLAINT: Arm pain and swelling.
HPI: A 7-year-old female 1 day status post her 7-year-old shots brought in by family
complaining of right deltoid region pain and swelling. She received all of her 7-year
shots yesterday, some in the left arm and some in the right. Mother is not sure. She
believes that the TdaP was placed in the right deltoid region. This morning she
began complaining of pain in that area and mother noticed redness, some mild
swelling, and warmth from the deltoid region to the mid upper arm area. The
patient herself has otherwise been at her baseline. She is having no fevers. No chills.
Her p.o. intake has been normal. There has been no vomiting or any other specific
complaints.
PAST MEDICAL HISTORY: None.
PAST SURGICAL HISTORY: None.
FAMILY HISTORY: Noncontributory.
SOCIAL HISTORY: Lives at home with both parents.
MEDICATIONS: None.
ALLERGIES: NONE KNOWN.
PHYSICAL EXAM: VITAL SIGNS: Temp 99.1, pulse 111, BP 102/57, oxygen saturation
98% on room air which is within normal limits.
GENERAL: She is alert and oriented, appropriate to her age. She is in mild
discomfort but is nontoxic. She is smiling and joking with her parents.
ENT: Her hearing is normal. External ears appear normal. Nose is patent with no
epistaxis.
NECK: Supple. Full range of motion.
CARDIOVASCULAR: She has a regular rate and rhythm.
RESPIRATORY: She is in no respiratory distress. Her lungs are clear to auscultation
bilaterally.
ABDOMEN: Soft, nontender.
EXTREMITIES: She has full range of motion x4.
NEURO: Her behavior, coordination, and speech are normal for her age.
SKIN: She has prominent erythema and warmth from the right deltoid region
Page 2 of 153
, stretching down to about halfway to her elbow. It is mildly tender. It is warm. There
is no focal induration. There
Question 2
OPD7329 Case Year Version: 2025
Primary Diagnosis: S62.031A
CPT: 25628-RT
Correct Answer
OPD7329 MEDICAL RECORD
OPERATIVE REPORT SEX: MALE AGE: 19 DATE: 12/02/20XX PREOPERATIVE
DIAGNOSIS: Slightly displaced right scaphoid wrist fracture. POSTOPERATIVE
DIAGNOSIS: Slightly displaced right scaphoid wrist fracture. OPERATION: Open
reduction and internal fixation, right scaphoid fracture. Surgeon: Christopher
Thomas, M.D. OPERATIVE PROCEDURE: The patient was brought to the operating
room and was placed under block anesthesia, had the right hand prepped and
draped in the usual sterile fashion. Right arm tourniquet was elevated after Esmarch
exsanguination. Dorsal longitudinal incision was created over the fourth extensor
compartment. The fourth extensor retinaculum was released. Small dorsal
longitudinal capsulotomy was performed. The proximal aspect of the scaphoid was
identified as well as the scaphoid fracture. There was slight displacement of the
fracture. The fracture site was opened and fracture hematoma removed. An open
reduction was performed. Two 0.045 K-wires were used for provisional fixation. Also
K-wire was used as joystick for the distal pole. Following reduction of the fracture, a
standard Acutrak screw guide wire was used. Eventually, a 20-mm Acutrak screw
was used for internal fixation. Provisional wires were removed. Dorsal capsulotomy
was repaired, as was the extensor retinaculum. Skin was closed in layers. The patient
was then placed in a long-arm thumb spica splint and taken to recovery room in
stable condition. Christopher Thomas, MD Electronically signed byCHRISTOPHER
THOMAS, MD 1/1/20XX
Page 3 of 153
, Question 3
OPD7324 Case Yr: 2024
PDx: D22.61
SDx: D22.4, D22.62
CPT: 11420 x2, 11400 x2
Per CPT guidelines, simple closure is incl in lesion excision (not separately reported)
Lesions that require intermediate or complex closure can have the closure reported as
well. However, NCCI Coding Policy Manual (Ch 3.E.6) directs if there are multiple
lesions excised, the simple, intermediate, or complex repair may only be reported
when at least 1 of the lesions is >0.5 cm. All lesions are < 0.5, so the intermediate
repair is not reported. In the CPT Index, see Excision/Skin/Lesion, Benign. Codes are
selected by body area & lesion size. Based on the size of the lesions, report 11400 x2
for each shoulder lesions & 11420 x2 for each neck lesion. Each lesion removed is
reported separately. Lesions should be sequenced in descending order according to
RVUs. 3 of the lesions are removed with a punch tool but are fully removed, not
biopsied.
Correct Answer
OPD7324 MEDICAL RECORD
OPERATIVE REPORT SEX: FEMALE AGE: 42 ENCOUNTER: Office Surgery DATE OF
OPERATION: 01/1/20XX SURGEON: Dr. Cohen Andrews SKIN OTHER SYMPTOMS -
four small growths/nevi. Removed today in office.
HISTORY OF PRESENT ILLNESS: The patient comes in today to have four small skin
lesions removed as they are either irritated by her bra or jewelry.
CURRENT MEDICATIONS: Reviewed Medications. OXYCODONE HCI 10 MG TAB
PROVENTIL HFA 108 MCG
VITAMIN D 5000 UNITS CAPS
Tests: • Blood pressure was high - 20XX.
ALLERGIES: • Compazine TABS, reaction: heart races. • Penicillins, reaction: skin
rashes/hives. • Reglan TABS, reaction: hallucinations/depression. • Squash, reaction:
migraines.
OBJECTIVE:
Pre-Op Dx: four skin lesions.
Post-Op Dx: same.
Procedure: Excision of left shoulder nevus 0.5 cm. Excision of two left neck skin
lesion each about 0.3 cm and excision of right shoulder skin lesion 0.4 cm.
Anesthesia: 1% lidocaine with epinephrine.
Specimen: left shoulder, left neck x2 and right shoulder.
PROCEDURE NOTE: The left shoulder nevus was excised first. The area was prepped
with betadine and then draped. The skin was infiltrated with local and then an
elliptical incision was made around the lesion and it was carried down into the
subcutaneous tissue. The wound was closed with 3-0 Vicryl in the subcutaneous
Page 4 of 153
