CPC Practice Exam E
1. D. 19101, N64.51: The left breast was prepped and draped in a sterile fashion.
An incision from the 3 around to the 9 o'clock position on the areolar border on
its inferior aspect was made in the skin and extended to the subcutaneous tissue.
The breast mass was excised by sharp dissection. The mass was found to be
approximately 1.5 - 2 cm in maximum dimension. Hemostasis was made adequate
using electrocautery and the Argon beam coagulator. After this was accomplished,
the skin margins were reapproximated with running inverted 3-0 Vicryl subcuticular
suture. Select the procedure and diagnosis codes.
A. 19120, N63.20
B. 19301, D49.3
C. 19125, N60.82
D. 19101, N64.51
2. C.11606, 12034-51
According to CPT guidelines for excision-malignant lesions - Repair by in-
termediate or complex closure should be reported separately. The coding
scenario indicates that the closure was a layered closed reporting code 12034.
Modifier 51 is appended to indicate multiple procedures performed during the
same operative session.: A 50-year-old female saw her dermatologist for removal
of a basal cell carcinoma on her right arm. An 8.0 cm lesion that included the
margins was drawn out and a 15-blade scalpel was used for full excision of the
lesion. A layered closure was performed after the removal. The specimen was sent
for permanent histopathologic examination. What CPT coding is reported?
A. 11606
B. 11606, 12004-51
C. 11606, 12034-51
D. 11606, 13121-51, 13122
3. B. 24340
Tenodesis is suturing of the end a tendon to a bone. There is a ruptured distal
biceps tendon at the proximal end of the radius which is a tendon injured
around the elbow joint, eliminating multiple choice A. This also eliminates
multiple choice C, a long tendon bicep runs over the top of the humerus bone
(upper arm) and attaches to the top of the shoulder. There is no documentation
of a resection or transplantation of a bicep tendon, eliminating multiple D.: A
25-year-old male has a ruptured distal biceps tendon at the proximal end of the
radius. An incision is made overlying the antecubital fossa. The biceps tendon was
tagged using #1 Vicryl-suture. The second incision made on the superior border of
the ulna. The supinator was incised deep to expose the radial tuberosity. Drill holes
, CPC Practice Exam E
are made at the radial tuberosity in which sutures and the distal biceps tendon are
placed in the hole of the radial tuberosity. Two sutures are placed in the biceps tendon
in horizontal mattress type fashion pulled tight and secured. The distal biceps tendon
is reattached to the radius to restore elbow function. Closure was then accomplished
with sutures and staples. What is the correct code for this procedure?
A. 24342
B. 24340
C. 23430
D. 23440
4. D. 20553
Trigger point is your key term in this scenario, eliminating choice C. Trigger
points are coded by the number of muscles that the injections are performed
on, not by the number of trigger point injections. The scenario tells you that
six trigger points were injected into four muscle groups which lead you to the
procedure code 20553.: Patient complains of chronic/acute arm and shoulder pain
following bilateral carpal tunnel surgery. Patient is followed by pain management
for over a year. Physician finally diagnoses patient with reflex dystrophy syndrome
(RSD). Physician performs six trigger point injections into four muscle groups. How
is this encounter reported?
A. 20552
B. 20553 x 6
C. 20551 x 6
D. 20553
5. B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01
One way to start finding the correct answer is to look up the diagnosis in the
ICD-10-CM codebook. Look in the ICD-10-CM Alphabetic Index for Fracture,
traumatic/femur/shaft referring you to code S72.30-. In the Tabular List the
complete code is S72.301B, for right femur, type 1 open fracture eliminating
codes C and D. The only difference between choices A and B are the second
procedure codes. Code 11012 is the correct code because extensive debride-
ment was performed all the way to the bone on an open fracture.: A Grade I,
high velocity type 1 open right femur shaft fracture was incurred when a 15 year-old
female pedestrian was hit by a car. She was taken to the operating room within
four hours of her injury for thorough irrigation and debridement, including excision
of devitalized bone. The patient was then reprepped, redraped, and repositioned.
Intramedullary rodding was then carried out with proximal and distal locking screws.
What are the correct codes for this diagnosis and procedure?
A. 27506, 11044-51, S72.301B, V03.90XXA, Y93.01
B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01
, CPC Practice Exam E
C. 27507, 11012-51, S72.301A, V03.90XXA, Y93.01
D. 27507, 11044-51, S72.91XA, V03.90XXA, Y93.01
6. C. 30620
The multiple choice answers are between a rhinoplasty and septoplasty for
which you will need to know the difference. Rhinoplasties are performed on
patients that are having cosmetic surgery, restorative, or reconstruction on
the nose. This patient is coming in to correct a deviated septum, which falls
under a septoplasty which is removing a portion of the deviated septum
and straightening the septum to correct airway obstruction. You eliminate
multiple choice answers B and D. C is incorrect because the patient is not
coming in for a dermatoplasty, which is surgical replacement of destroyed
skin.: This 25-year-old male presents with deviated nasal septum. After intubation,
a left hemitransfixion incision was made with elevation of the mucoperichondrium.
Cartilage from the bony septum was detached and the nasoseptum was realigned
and removed in a piecemeal fashion from the obstructed perpendicular plate of the
ethmoid. Thereafter, 4-0 chronic was used to approximate mucous membranes. A
small amount of silver nitrate cautery was used to achieve hemostasis. A dressing
consisted of a fold of Telfa with a ventilating tube for nasal airway on each side
achieved good hemostasis, patient went to recovery in good condition. What is the
correct CPT code for this procedure?
A. 30520
B. 30420
C. 30620
D. 30450
7. D. 33533-53
The procedure code with an appropriate modifier needs to be reported be-
cause the patient had been prepared for surgery, received anesthesia, and
the procedure had already started. An indication in guiding you to choose the
correct modifier is that the procedure was stopped due to the patient's drop
in blood pressure, which threatens the well-being of the patient. Procedure
was not performed in the out-patient hospital or ambulatory surgery center
setting.: A 67-year-old female has CAD, atrial fibrillation, claudication and several
chronic conditions that have been marginally controlled with medication. The doctor
decided that the benefits outweigh the risks for her having a single vessel cardiopul-
monary bypass using an arterial graft. Her medication Heparin has been stopped
for several days. She was admitted in the hospital a day before the surgery. In the
operating room, general anesthesia was administered. After the chest is opened the
patient begins to hemorrhage and drops in blood pressure. The decision is made to
stop the procedure and close the chest. How is this service coded?
1. D. 19101, N64.51: The left breast was prepped and draped in a sterile fashion.
An incision from the 3 around to the 9 o'clock position on the areolar border on
its inferior aspect was made in the skin and extended to the subcutaneous tissue.
The breast mass was excised by sharp dissection. The mass was found to be
approximately 1.5 - 2 cm in maximum dimension. Hemostasis was made adequate
using electrocautery and the Argon beam coagulator. After this was accomplished,
the skin margins were reapproximated with running inverted 3-0 Vicryl subcuticular
suture. Select the procedure and diagnosis codes.
A. 19120, N63.20
B. 19301, D49.3
C. 19125, N60.82
D. 19101, N64.51
2. C.11606, 12034-51
According to CPT guidelines for excision-malignant lesions - Repair by in-
termediate or complex closure should be reported separately. The coding
scenario indicates that the closure was a layered closed reporting code 12034.
Modifier 51 is appended to indicate multiple procedures performed during the
same operative session.: A 50-year-old female saw her dermatologist for removal
of a basal cell carcinoma on her right arm. An 8.0 cm lesion that included the
margins was drawn out and a 15-blade scalpel was used for full excision of the
lesion. A layered closure was performed after the removal. The specimen was sent
for permanent histopathologic examination. What CPT coding is reported?
A. 11606
B. 11606, 12004-51
C. 11606, 12034-51
D. 11606, 13121-51, 13122
3. B. 24340
Tenodesis is suturing of the end a tendon to a bone. There is a ruptured distal
biceps tendon at the proximal end of the radius which is a tendon injured
around the elbow joint, eliminating multiple choice A. This also eliminates
multiple choice C, a long tendon bicep runs over the top of the humerus bone
(upper arm) and attaches to the top of the shoulder. There is no documentation
of a resection or transplantation of a bicep tendon, eliminating multiple D.: A
25-year-old male has a ruptured distal biceps tendon at the proximal end of the
radius. An incision is made overlying the antecubital fossa. The biceps tendon was
tagged using #1 Vicryl-suture. The second incision made on the superior border of
the ulna. The supinator was incised deep to expose the radial tuberosity. Drill holes
, CPC Practice Exam E
are made at the radial tuberosity in which sutures and the distal biceps tendon are
placed in the hole of the radial tuberosity. Two sutures are placed in the biceps tendon
in horizontal mattress type fashion pulled tight and secured. The distal biceps tendon
is reattached to the radius to restore elbow function. Closure was then accomplished
with sutures and staples. What is the correct code for this procedure?
A. 24342
B. 24340
C. 23430
D. 23440
4. D. 20553
Trigger point is your key term in this scenario, eliminating choice C. Trigger
points are coded by the number of muscles that the injections are performed
on, not by the number of trigger point injections. The scenario tells you that
six trigger points were injected into four muscle groups which lead you to the
procedure code 20553.: Patient complains of chronic/acute arm and shoulder pain
following bilateral carpal tunnel surgery. Patient is followed by pain management
for over a year. Physician finally diagnoses patient with reflex dystrophy syndrome
(RSD). Physician performs six trigger point injections into four muscle groups. How
is this encounter reported?
A. 20552
B. 20553 x 6
C. 20551 x 6
D. 20553
5. B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01
One way to start finding the correct answer is to look up the diagnosis in the
ICD-10-CM codebook. Look in the ICD-10-CM Alphabetic Index for Fracture,
traumatic/femur/shaft referring you to code S72.30-. In the Tabular List the
complete code is S72.301B, for right femur, type 1 open fracture eliminating
codes C and D. The only difference between choices A and B are the second
procedure codes. Code 11012 is the correct code because extensive debride-
ment was performed all the way to the bone on an open fracture.: A Grade I,
high velocity type 1 open right femur shaft fracture was incurred when a 15 year-old
female pedestrian was hit by a car. She was taken to the operating room within
four hours of her injury for thorough irrigation and debridement, including excision
of devitalized bone. The patient was then reprepped, redraped, and repositioned.
Intramedullary rodding was then carried out with proximal and distal locking screws.
What are the correct codes for this diagnosis and procedure?
A. 27506, 11044-51, S72.301B, V03.90XXA, Y93.01
B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01
, CPC Practice Exam E
C. 27507, 11012-51, S72.301A, V03.90XXA, Y93.01
D. 27507, 11044-51, S72.91XA, V03.90XXA, Y93.01
6. C. 30620
The multiple choice answers are between a rhinoplasty and septoplasty for
which you will need to know the difference. Rhinoplasties are performed on
patients that are having cosmetic surgery, restorative, or reconstruction on
the nose. This patient is coming in to correct a deviated septum, which falls
under a septoplasty which is removing a portion of the deviated septum
and straightening the septum to correct airway obstruction. You eliminate
multiple choice answers B and D. C is incorrect because the patient is not
coming in for a dermatoplasty, which is surgical replacement of destroyed
skin.: This 25-year-old male presents with deviated nasal septum. After intubation,
a left hemitransfixion incision was made with elevation of the mucoperichondrium.
Cartilage from the bony septum was detached and the nasoseptum was realigned
and removed in a piecemeal fashion from the obstructed perpendicular plate of the
ethmoid. Thereafter, 4-0 chronic was used to approximate mucous membranes. A
small amount of silver nitrate cautery was used to achieve hemostasis. A dressing
consisted of a fold of Telfa with a ventilating tube for nasal airway on each side
achieved good hemostasis, patient went to recovery in good condition. What is the
correct CPT code for this procedure?
A. 30520
B. 30420
C. 30620
D. 30450
7. D. 33533-53
The procedure code with an appropriate modifier needs to be reported be-
cause the patient had been prepared for surgery, received anesthesia, and
the procedure had already started. An indication in guiding you to choose the
correct modifier is that the procedure was stopped due to the patient's drop
in blood pressure, which threatens the well-being of the patient. Procedure
was not performed in the out-patient hospital or ambulatory surgery center
setting.: A 67-year-old female has CAD, atrial fibrillation, claudication and several
chronic conditions that have been marginally controlled with medication. The doctor
decided that the benefits outweigh the risks for her having a single vessel cardiopul-
monary bypass using an arterial graft. Her medication Heparin has been stopped
for several days. She was admitted in the hospital a day before the surgery. In the
operating room, general anesthesia was administered. After the chest is opened the
patient begins to hemorrhage and drops in blood pressure. The decision is made to
stop the procedure and close the chest. How is this service coded?
