CPC Practice Exam B
PRE OP DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of Breast
PROCEDURE: Automated Stereotactic Biopsy Left Breast
FINDINGS: Lesion is located in the lateral region, just at or below the level of the nipple on the 90-degree
lateral view. There is a sub-glandular implant in place. I discussed the procedure with the patient today
including risks, benefits, and alternatives. Specifically discussed was the fact that the implant would be
displaced out of the way during this biopsy procedure. The possibility of injury to the implant was
discussed with the patient. The patient has signed the consent form and wishes to proceed with the
biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged from the
inferior approach. The lesion of interest is in the anterior portion of the breast away from the implant
which was displaced back toward the chest wall. After i - Answer-19081
Rationale :
To start narrowing your choices was the biopsy performed percutaneously or by an open incision? The
operative note documents that a "SenoRx needle" was used to obtain the biopsy, which is
percutaneous.
Code 19283 is reported only for the placement of the localization device. Stereotactic image was used to
perform the needle biopsy and placement of the clip.
,Code 19081 is the only code reported for the operative note because its code description reports both
the biopsy and the placement of the clip under stereotactic imaging.
A 53-year-old male is in the dermatologist's office for the removal of 2 lesions located on his lower lip
and nose. Lesions were identified and marked. The lower lip lesion of 4 mm in size was shaved to the
level of the superficial dermis. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area.
What are the CPT codes for these procedures? - Answer-11310, 11104-59
Rationale :
The first procedure performed was the lesion on the lower lip removed by the shaving technique,
reported with code 11310.
The punch biopsy is performed on the lesion located on the nose, reported with code 11104.
Add-on code 11105 is only reported with codes 11104 or 11106, refer to the parenthetical instructional
note under add-on code 11105.
Modifier 59 indicates that the biopsy was totally separate performed on another lesion, otherwise it is
bundled with 11310.
A 76-year-old has dermatochalasis on bilateral upper eyelids. The condition does not interfere with the
function of the eyelids. The patient agrees to surgery. The patient is here for a bilateral blepharoplasty.
A lower incision line was marked at approximately 5 mm above the lid margin along the crease. Then
using a pinch test with forceps the amount of skin to be resected was determined and marked. An
elliptical incision was performed on the left eyelid and the skin was excised. In a similar fashion, the
same procedure was performed on the right eye. The wounds were closed with sutures.
, What CPT coding is reported? - Answer-15822-50
Rationale :
Patient is having a blepharoplasty done on the upper eyelids.
The patient's condition is not interfering with function of the eyelids and there is no indication in the
scenario that excessive skin had to be excised.
Modifier 50 is appended to indicate the procedure was performed on both eyelids.
A 42-year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the
glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes,
about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was
inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The
rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted. Adhesions were destroyed with electrocautery and the
Bovie. The superior glenohumeral ligament, the middle glenohumeral ligament, and the tendinous
portion of the subscapularis were released. The arthroscope was placed anteriorly, adhesions were
destroyed and the shaver was used to debride some of the posterior capsules and the posterior capsule
was release - Answer-29825-LT
Rationale :
To narrow down your choices decide if the procedure is an open procedure or performed with an
arthroscope?
The diagnostic arthroscopy (29805) is a separate procedure, and according to CPT Surgery Guidelines :
"The codes designated as "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 code 29806 already includes the diagnostic arthroscopy code, so you only report code 29806.
PRE OP DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of Breast
PROCEDURE: Automated Stereotactic Biopsy Left Breast
FINDINGS: Lesion is located in the lateral region, just at or below the level of the nipple on the 90-degree
lateral view. There is a sub-glandular implant in place. I discussed the procedure with the patient today
including risks, benefits, and alternatives. Specifically discussed was the fact that the implant would be
displaced out of the way during this biopsy procedure. The possibility of injury to the implant was
discussed with the patient. The patient has signed the consent form and wishes to proceed with the
biopsy. The patient was placed prone on the stereotactic table; the left breast was then imaged from the
inferior approach. The lesion of interest is in the anterior portion of the breast away from the implant
which was displaced back toward the chest wall. After i - Answer-19081
Rationale :
To start narrowing your choices was the biopsy performed percutaneously or by an open incision? The
operative note documents that a "SenoRx needle" was used to obtain the biopsy, which is
percutaneous.
Code 19283 is reported only for the placement of the localization device. Stereotactic image was used to
perform the needle biopsy and placement of the clip.
,Code 19081 is the only code reported for the operative note because its code description reports both
the biopsy and the placement of the clip under stereotactic imaging.
A 53-year-old male is in the dermatologist's office for the removal of 2 lesions located on his lower lip
and nose. Lesions were identified and marked. The lower lip lesion of 4 mm in size was shaved to the
level of the superficial dermis. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area.
What are the CPT codes for these procedures? - Answer-11310, 11104-59
Rationale :
The first procedure performed was the lesion on the lower lip removed by the shaving technique,
reported with code 11310.
The punch biopsy is performed on the lesion located on the nose, reported with code 11104.
Add-on code 11105 is only reported with codes 11104 or 11106, refer to the parenthetical instructional
note under add-on code 11105.
Modifier 59 indicates that the biopsy was totally separate performed on another lesion, otherwise it is
bundled with 11310.
A 76-year-old has dermatochalasis on bilateral upper eyelids. The condition does not interfere with the
function of the eyelids. The patient agrees to surgery. The patient is here for a bilateral blepharoplasty.
A lower incision line was marked at approximately 5 mm above the lid margin along the crease. Then
using a pinch test with forceps the amount of skin to be resected was determined and marked. An
elliptical incision was performed on the left eyelid and the skin was excised. In a similar fashion, the
same procedure was performed on the right eye. The wounds were closed with sutures.
, What CPT coding is reported? - Answer-15822-50
Rationale :
Patient is having a blepharoplasty done on the upper eyelids.
The patient's condition is not interfering with function of the eyelids and there is no indication in the
scenario that excessive skin had to be excised.
Modifier 50 is appended to indicate the procedure was performed on both eyelids.
A 42-year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the
glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes,
about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was
inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The
rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted. Adhesions were destroyed with electrocautery and the
Bovie. The superior glenohumeral ligament, the middle glenohumeral ligament, and the tendinous
portion of the subscapularis were released. The arthroscope was placed anteriorly, adhesions were
destroyed and the shaver was used to debride some of the posterior capsules and the posterior capsule
was release - Answer-29825-LT
Rationale :
To narrow down your choices decide if the procedure is an open procedure or performed with an
arthroscope?
The diagnostic arthroscopy (29805) is a separate procedure, and according to CPT Surgery Guidelines :
"The codes designated as "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 code 29806 already includes the diagnostic arthroscopy code, so you only report code 29806.
