CPC Practice Exam 1 UPGRADE A+

CPC Practice Exam 1 UPGRADE A+ 46 year-old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn out and a 15 blade scalpel was used for full excision of an 8 cm lesion. Layered closure was performed after the removal. The specimen was sent for permanent histopathologic examination. What are the CPT® code(s) for this procedure? A. 11626 B. 11626, 12004-51 C. 11626, 12044-51 D. 11626, 13132-51, 13133 - CORRECT ANSWER-According to CPT® guidelines "Repair of an excision of a malignant lesion requiring intermediate or complex closure should be reported separately". The intermediate repair code is reported because it was a layered closure. Answer C 30 year-old female is having 15 sq cm debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT® code should be reported? A. 11043 B. 11012 C. 11044 D. 11042 - CORRECT ANSWER-Debridement is not being performed on an open fracture/open dislocation eliminating multiple choice answer B. The ulcer was debrided all the way to the bone of the foot, making multiple choice answer C, the correct procedure. Answer C 64 year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 99283-25, 12014, 12034-59, 12002-59, 11042-51 B. 99283-25, 12053, 12034-59, 12002-59 C. 99283-25, 12014, 12034-59, 11042-51 D. 99283-25, 12053, 12034-59 - CORRECT ANSWER-To start narrowing your choices down, the hand and foot were closed with adhesive strips. The Section Guidelines in the CPT® manual for Repair (Closure) states: "Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code." Eliminating multiple choice answers A and B. The lacerations on the face are intermediate repairs, because debridement and glass debris was removed. The guidelines in the CPT® codebook for Repair (Closure) states: "Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair." Eliminating multiple choice answer C. The intermediate repair of the lacerations to the face totaled 6 cm (12053). The right arm and left leg had cuts measuring 5 cm each which totaled 10 cm requiring intermediate repair (12034). Answer D 52 year-old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT® and ICD-10-CM codes are reported? A. 21932, D17.39 B. 21935, D17.1 C. 21931, D17.1 D. 21925, D17.9 - CORRECT ANSWER-The mass growing turned out to be a lipoma found in the subcutaneous tissue of the flank. In the ICD-10-CM Alphabetic Index, look for Lipoma/subcutaneous/trunk. You are referred to code D17.1, eliminating multiple choice answers A and D. Because the 4 cm tumor was found in the subcutaneous tissue code 21931 is the correct CPT® code to report. Answer C PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room; anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal - CORRECT ANSWER-Patient had an open reduction, meaning an incision was made to get to the fracture, eliminating multiple choice answer B. The fracture site was the scaphoid of the wrist (carpal), eliminating multiple choices C and D. Answer A An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix® figure-of-eight plate was placed and checked with X-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl®. What procedure code is reported? A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50 - CORRECT ANSWER-Your keywords in the scenario to narrow your choices down to code 27485 are: "distal femur,""genu valgum," and "hemiepiphysiodesis." Answer D The patient is a 67 year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue - CORRECT ANSWER-Patient is having an Infuse-A-Port put in his chest to receive chemotherapy. The subclavian vein (central venous) is being tunneled for the access device, eliminating multiple choices A and D. The patient had a subcutaneous pocket created to insert the power port, eliminating multiple choice answer B. Code 77001 reports fluoroscopic guidance for a central venous access device. Modifier 26 denotes the professional service. Answer C A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This was estimated to be 800 cc in size and had an appearance of fluid on the CT Scan. A needle is used to puncture through the chest tissues and enter the pleural cavity to insert a guidewire under ultrasound guidance. A pigtail catheter is then inserted at the length of the guidewire and secured by stitches. The catheter will remain in the chest and is connected to drainage system to drain the accumulated fluid. The CPT® code is: A. 32557 B. 32555 C. 32556 D. 32550 - CORRECT ANSWER-The drainage of fluid from the pleural cavity was performed via needle (percutaneous) with insertion of an indwelling catheter to drain the fluid, eliminating multiple choice answers B and D. The procedure was performed under ultrasound guidance, eliminating multiple choice answer C. Answer A The patient is a 59 year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. He is taken to the operating room for re-do left carotid endarterectomy. The left neck was prepped and the previous incision was carefully reopened. Using sharp dissection, the common carotid artery and its branches were dissected free. The patient was systematically heparinized and after a few minutes, clamps were applied to the common carotid artery and its branches. A longitudinal arteriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastic balloon-tip shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima were removed and the endart - CORRECT ANSWER-The procedure involved removing plaque and the vessel lining from the carotid artery through a neck incision, eliminating multiple choice answers C and D. This was a re-operation (35390), as the original surgery was performed a year ago. Answer B A 52 year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting to the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a scope was placed into the abdomen. Three other ports were inserted under direct vision. The fundus of the gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was carried out to the right of this identifying a small cystic duct and artery, was clipped twice proximally, once distally and transected. The gallbladder was then taken down from the bed using electrocautery, delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port. What CPT® and ICD-10-C - CORRECT ANSWER-One way to narrow down your choices is by the diagnosis. The patient has chronic cholecystitis. In the ICD-10-CM Alphabetic Index, look for Cholecystitis/chronic, referring you to code K81.1. Verify code in the Tabular List for accuracy. This eliminates multiple choice A and C. The patient had a laparoscopic cholecystectomy, eliminating multiple choice answer D. Answer B A 70 year-old female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the area of the hernia where a small defect was clearly visualized. There was some omentum, which was adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect. What procedure code(s) is (are) reported? A. 49560, 49568 B. 49652 C. 49653 D. 49652, 49568 - CORRECT ANSWER-The patient is having a laparoscopic ventral hernia repair, eliminating multiple choice answer A. The hernia is not documented as being incarcerated or strangulated, eliminating multiple choice answer C. A parenthetical note under the code description for 49652 indicates that a mesh insertion (49568) is not reported with this code when performed; eliminating multiple choice answer D. Answer B The patient is a 50 year-old gentleman who presented to the emergency room with signs and symptoms of acute appendicitis with possible rupture. He has been brought to the operating room. An infraumbilical incision was made which a 5-mm VersaStep™ trocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar in the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture noted. The base of the appendix was then divided and placed into an Endo-catch bag and the 12-mm defect was brought out. Select the appropriate code for this procedure: A. 44970 B. 44950 C. 44960 D. 44979 - CORRECT ANSWER-Patient is having the surgery performed by a laparoscope, eliminating multiple choice answers B and C. The surgical procedure performed was an appendectomy, eliminating multiple choice D. Answer A 45 year-old male is going to donate his kidney to his son. Operating ports where placed in standard position and the scope was inserted. Dissection of the renal artery and vein was performed isolating the kidney. The kidney was suspended only by the renal artery and vein as well as the ureter. A stapler was used to divide the vein just above the aorta and three clips across the ureter, extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT® code is: A. 50543 B. 50547 C. 50300 D. 50320 - CORRECT ANSWER-This is a surgical laparoscopic procedure for removing the kidney (nephrectomy), eliminating multiple choice answers C and D. The whole kidney was taken out from a donor and put on ice (cold preservation), eliminating multiple choice answer A. Answer B 67 year-old female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy performed with a placement of a sling. An incision was made over the mid urethra dissected laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What CPT® code(s) is (are) reported? A. 57288 B. 57287 C. 57288, 52000-51 D. 51992, 52000-51 - CORRECT ANSWER-Removal or revision of the sling is not being performed, eliminating multiple choice answer B. The procedure was an open surgery, eliminating multiple choice answer D. Cystoscopy procedure code is a separate procedure. According to CPT® Surgery guidelines, The codes designated as a "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component." Meaning that the cystoscopy is included with the sling operation procedure because it was performed in the same surgical session. Answer A 16 day-old male baby is in the OR for a repeat circumcision due to redundant foreskin that caused circumferential scarring from the original circumcision. Anesthetic was injected and an incision was made at base of the foreskin. Foreskin was pulled back and the excess foreskin was taken off and the two raw skin surfaces were sutured together to create a circumferential anastomosis. Select the appropriate code for this surgery: A. 54150 B. 54160 C. 54163 D. 54164 - CORRECT ANSWER-The physician is not incising the membrane that attaches the foreskin to the glans and shaft of the penis (frenulum), eliminating multiple choice D. The patient is not having the circumcision for the first time, but needed a repair from a previous circumcision, eliminating multiple choice answers A and B. Answer C 5 year-old female has a history of post void dribbling. She was found to have extensive labial adhesions, which have been unresponsive to topical medical management. She is brought to the operating suite in a supine position. Under general anesthesia the labia majora is retracted and the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent granulation tissue was excised on either side. What code should be used for this procedure? A. 58660 B. 58740 C. 57061 D. 56441 - CORRECT ANSWER-The key term to narrow your choices down is the removal of "labial adhesions". This is found in the code descriptive for multiple choice answer D, 56441. The patient is a 64 year-old female who is undergoing a removal of a previously implanted Medtronic pain pump and catheter due to a possible infection. The back was incised; dissection was carried down to the previously placed catheter. There was evidence of infection with some fat necrosis in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump pocket was incised and the pump was dissected from the anterior fascia. A 7-mm Blake drain was placed in the pump pocket through a stab incision and secured to the skin with interrupted Prolene. The pump pocket was copiously irrigated with saline and closed in two layers. What are the CPT® and ICD-10-CM codes for this procedure? A. 62365, 62350-51, T85.898A, Z46.2 B. 62360, 62355-51, T85.79XA C. 62365, 62355-51, T85.79XA D. 36590, I97.42, T85.898A - CORRECT ANSWER-This was a removal of an intrathecal catheter and pump, eliminating multiple choice answer D. The pump is not being implanted or replaced eliminating multiple choice answer B. Nor is the intrathecal catheter being implanted, revised or repositioned eliminating multiple choice answer A. Answer C The patient is a 73 year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt placement with Codman® programmable valve. What is the correct code for this surgery? A. 62220 B. 62223 C. 62190 D. 62192 - CORRECT ANSWER-This key word to choose the correct shunt being performed is "ventriculo-peritoneal", leading you to multiple choice answer B. Answer B What is the CPT® code for the decompression of the median nerve found in the space in the wrist on the palmar side? A. 64704 B. 64713 C. 64721 D. 64719 - CORRECT ANSWER-The key term to choose the correct answer is "median nerve", found in code 64721. Answer C 2 year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia. With a #11 blade the chalazion was incised and a small curette was then used to retrieve any granulomatous material on both lids. What CPT® code should be used for this procedure? A. 67801 B. 67805 C. 67800 D. 67808 - CORRECT ANSWER-There is more than a single chalazion to be removed, eliminating multiple choice answer C. The chalazion was on the upper and lower lid, eliminating multiple choice answer A. The patient was under general anesthesia, eliminating multiple choice answer B. Answer D 80 year-old patient is returning to the gynecologist's office for pessary cleaning. Patient offers no complaints. The nurse removes and cleans the pessary, vagina is swabbed with betadine, and pessary replaced. For F/U in 4 months. What CPT® and ICD-10-CM codes are reported for this service? A. 99201, Z46.89 B. 99211, Z46.89 C. 99202, Z46.9 D. 99212, Z46.9 - CORRECT ANSWER-Scenario documents patient returning to the gynecologist guiding you to the codes for established patient office visit. This eliminates multiple choices A and C. For this scenario, the patient did not have any complaints that required the presence of a physician. There was no examination or medical making decision performed for the patient guiding you to code 99211. There must be an order for the patient to come in for the office visit. For the diagnosis code, the pessary was removed for cleaning reporting Z46.89 Encounter for fitting and adjustment of other specified devices. (Refer to ICD-10-CM guideline I.A.9) Answer D Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision making of moderate complexity. Which E/M service is reported? A. 99285 B. 99284 C. 99221 D. 99222 - CORRECT ANSWER-According to CPT® guidelines: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (example, hospital emergency department, observation status in a hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date of service. Meaning for this scenario the patient's physician had come to the ER and also admitted the patient on the same date of service, eliminating multiple choices A and B. All three of the key components of an initial hospital care code must be met or exceeded. 99221 requires: detailed or comprehensive history, detailed or comprehensive examination, and straightforward or low complexity medical decision making. Because the lowest key component in the question is a detailed history, the highest level that can be reached is 99221. To report code 99222 you would need a comprehensive history. Answer C 20 day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct codes for the physician service. A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303-26 C. 99460-25, 31500, 94002, 93303-26 D. 99291-25, 93303-26 - CORRECT ANSWER-According to CPT® subsection guidelines under Inpatient Neonatal and Pediatric Critical Care: If the same physician provides critical care services for a neonatal or pediatric patient in both the outpatient and inpatient setting on the same day, report only the appropriate Neonatal or Pediatric Critical Care codes for all critical care services provided on that day. This eliminates multiple choice answers C and D. The baby is 20 days-old and you cannot bill intubation (31500) and ventilation management with the neonatal and pediatric critical care codes, eliminating multiple choice B. Answer C A 42 year-old with renal pelvis cancer receives general anesthesia for a laparoscopic radical nephrectomy. The patient has controlled type 2 diabetes otherwise no other comorbidities. What is the correct CPT® and ICD-10-CM code for the anesthesia services? A. 00860-P1, C64.9, E11.9 B. 00840-P3, C65.9, E11.9 C. 00862-P2, C65.9, E11.9 D. 00868-P2, C79.02, E11.9 - CORRECT ANSWER-The patient receives anesthesia for a laparoscopic radical nephrectomy. Look the CPT® Index, for Anesthesia/Nephrectomy. You are referred to 00862. Review the code in the numeric section to verify accuracy. The patient has controlled type 2 diabetes which supports the use of P2. The patient has renal pelvis cancer. The distinction of secondary cancer is not made so the cancer is coded as a primary neoplasm. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/kidney/pelvis/Malignant Primary column. You are referred to C65.-. Complete code in the Tabular List, C65.9. The patient also has controlled type 2 diabetes. Look in the ICD-10-CM Alphabetic Index for Diabetes/type 2 referring you to E11.9. Answer C A healthy 32 year-old with a closed distal radius fracture received monitored anesthesia care for an ORIF of the distal radius. What is the code for the anesthesia service? A. 01830-P1 B. 01860-QS-P1 C. 01830-QS-P1 D. 01860-QS-G9-P1 - CORRECT ANSWER-The patient receives monitored anesthesia care also known as MAC which is reported with HCPCS Level II modifier QS. There is no indication the patient has a history of cardiopulmonary condition so G9 would not be appropriate. Look in the CPT® Index for Anesthesia/Forearm. You are referred to multiple codes (00400, , ). Refer to these codes in the numeric section to determine the correct code using the code descriptions. The procedure was open and performed on the distal radius. The appropriate code is 01830. Answer C A 10 month-old child is taken to the operating room for removal of a laryngeal mass. What is (are) the appropriate anesthesia code(s) to report? A. 00320 B. 00326 C. 00320, 99100 D. 00326, 99100 - CORRECT ANSWER-The patient receives general anesthesia for the removal of a laryngeal mass. Look in the CPT® Index for Anesthesia/Larynx. You are referred to 00320 and 00326. Review the code descriptions in the numeric section. Code 00326 is the correct code to indicate the procedure is performed on a patient younger than one year. 99100 is not reported because the patient's age range is included in the description of the anesthesia code. There is a parenthetical note under 00326 that indicates the code should not be reported with 99100. Answer B A catheter is placed in the left common femoral artery which was directed into the right the external iliac (antegrade). Dye was injected and a right lower extremity angiogram was performed which revealed patency of the common femoral and profunda femoris. The catheter was then manipulated into the superficial femoral artery (retrograde) in which a lower extremity angiogram was performed which revealed occlusion from the popliteal to the tibioperoneal artery. What are the procedure codes that describe this procedure? A. 36217, 75736-26 B. 36247, 75716-26 C. 36217, 75658-26 D. 36247, 75710-26 - CORRECT ANSWER-Selecting the correct answer can be tackled two ways. (1) A third order selective catheter placement in the brachiocephalic system was not performed, eliminating multiple choice answers A and C. Bilateral angiography of the lower extremities was not performed, eliminating multiple choice answer B. Arterial access was the left common femoral artery and the catheter was directed into the right common iliac (36245 - first order) into right external iliac (36246-second order). The catheter was then directed to the common femoral into the superficial femoral artery (36247-third order). Report only the highest level of catheter placement 36247. Angiography for the right extremity is 75710. Modifier 26 denotes the professional service. OR (2) A right lower extremity angiogram was performed. Code 75736 is eliminated because that is for the pelvis. Code 75716 is eliminated because that is if both extremities had an angiogram. Code 75658 is eliminated because that is for the brachial artery. Code 75710 is the correct angiography code. Answer D 56 year-old female is having a bilateral mammogram with computer aid detection conducted as a screening because the patient has had a previous cyst in the right breast. What radiological services are reported? A. 77065 x 2 B. 77065, 77066 C. 77067 D. 77066 - CORRECT ANSWER-The radiological service is a screening mammogram of both breasts eliminating multiple choices A, B and D. Note: If this was a bilateral diagnostic mammogram you only report code 77066 because the code is specifically for both breasts. You will not report 77065 and 77066, or report 77065 twice or with a modifier 50. Code 77066 also does not have modifier 50 appended because the code description already indicates that it is a bilateral code. Answer C