CPC- Musculoskeletal Exam System
Questions.
The patient has a torn medial meniscus of the left knee. An arthroscope was placed through the
B B B B B B B B B B B B B B B B
anterolateral portal for the diagnostic procedure. The patellofemoral joint showed some grade 2
B B B B B B B B B B B B B
chondromalacia on the patella side of the joint only, and this was debrided with the 4.0-mm shaver.
B B B B B B B B B B B B B B B B B
The medial compartment was also entered, and a complex posterior horn tear of the medial meniscus
B B B B B B B B B B B B B B B B
was noted. It was probed to define its borders. A meniscectomy was carried out back to a stable rim.
B B B B B B B B B B B B B B B B B B B
CPT® codes for this service are:
B B B B B B
A. 29882-LT
B
B. 29880-LT, 29877-59-LT
B B
C. 29870-LT, 29879-59-LT
B B
D. 29881-LT - ANS >> In the CPT® Index, look for Arthroscopy/Surgical/Knee. You are referred to
B B B B B B B B B B B B B B B
29866-29868, 29871-29889. Review the codes to choose appropriate service. 29881 is the correct
B B B B B B B B B B B B B
code because the tear was in the "medial meniscus" and a meniscectomy was performed. 29877 is
B B B B B B B B B B B B B B B B
not reported due to a parenthetical note under the code that states: "When performed with
B B B B B B B B B B B B B B B
arthroscopic meniscectomy, see 29880 or 29881." Also the code description for codes 29880 and
B B B B B B B B B B B B B B
29881 includes the debridement/shaving in the same or separate compartment(s) when performed.
B B B B B B B B B B B B
The surgery had started out as a "diagnostic procedure," but that changed when the physician
B B B B B B B B B B B B B B B
decided to perform surgical procedures on the knee, rather than only examining the knee for
B B B B B B B B B B B B B B B
diagnostic purposes.
B B
A 63-year-old man sustained a gunshot wound through the right maxillary sinus that penetrated
B B B B B B B B B B B B B
through the right neck. CT scan revealed no hard evidence of arterial injury but a bullet was directly
B B B B B B B B B B B B B B B B B B
in line with the internal jugular vein. He was sent to the operating room for neck exploration to rule
B B B B B B B B B B B B B B B B B B B
out vascular injury and injury to the aero digestive tract. A sternocleidomastoid incision was
B B B B B B B B B B B B B B
performed and carried down through the platysma muscle. There was no penetration of the internal
B B B B B B B B B B B B B B B
jugular vein, but a foreign body was identified resting on the internal jugular vein at approximately
B B B B B B B B B B B B B B B B
the level of the angle of the mandible and removed. The parotid gland was noted to have a blast
B B B B B B B B B B B B B B B B B B B
injury near the tail. This was not surgically repaired or resected. Once all bleeding was controlled, a
B B B B B B B B B B B B B B B B B
10 French round drain was placed in the wound. The wound was copiously irrigated. The platysma
B B B B B B B B B B B B B B B B
muscle was closed and the skin was closed - ANS >> In the CPT® Index, look for
B B B B B B B B B B B B B B B B B
Exploration/Neck/Penetrating Wound. You are referred to 20100. Review the code to verify accuracy.
B B B B B B B B B B B B B
20100 is the correct code since the patient was sent to the operating room to explore a gunshot
B B B B B B B B B B B B B B B B B B
(penetrating trauma) wound to identify damaged structures. The subsection guidelines for codes
B B B B B B B B B B B B
20100 - 20103 indicates these codes include removal of foreign bodies, ligation, or coagulation of
B B B B B B B B B B B B B B B
minor blood vessels, damaged tissue debrided and/or repaired, and wound closure.
B B B B B B B B B B B
, A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture
B B B B B B B B B B B B B B
while on vacation. The patient was put under general anesthesia and the elbow was reduced and was
B B B B B B B B B B B B B B B B B
stable. The medial elbow was held in the appropriate position and was reduced in acceptable position
B B B B B B B B B B B B B B B B
and elevated to treat non-surgically. A long arm splint was applied. The patient is referred to an
B B B B B B B B B B B B B B B B B
orthopedist when she returns to her home state in a few days. What procedure codes are reported?
B B B B B B B B B B B B B B B B B
A. 24575-54-RT, 24615-54-51-RT
B B
B. 24576-54-RT, 24620-54-51-RT
B B
C. 24577-54-RT, 24600-54-51-RT
B B
D. 24565-54-RT, 24605-54-51-RT - ANS >> In the CPT® Index, look for
B B B B B B B B B B B
Fracture/Humerus/Epicondyle/Closed Treatment. You are referred to code 24560-24565. Review the
B B B B B B B B B B
codes to choose the appropriate service. 24565 is the correct code to report an epicondyle fracture
B B B B B B B B B B B B B B B B
that was manipulated (reduced) without surgically incising to perform the procedure. In the CPT®
B B B B B B B B B B B B B B
Index, look for Dislocation/Elbow/Closed Treatment. You are referred to 24600-24605. Review the
B B B B B B B B B B B B
codes to choose appropriate service. 24605 is the correct code because patient was put under
B B B B B B B B B B B B B B B
general anesthesia to perform the procedure. Modifier 54 is used to report the physician performed
B B B B B B B B B B B B B B B
the surgical portion. The patient is referred to an orthopedist for follow up care. Modifier 51 is used
B B B B B B B B B B B B B B B B B B
to report that multiple procedures were performed.
B B B B B B B
A 52-year-old female has a mass growing on her right flank for several years. It has finally gotten
B B B B B B B B B B B B B B B B B
significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive
B B B B B B B B B B B B B B B B B
excision. An incision was made directly overlying the mass. The mass was down into the
B B B B B B B B B B B B B B B
subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4
B B B B B B B B B B B B
centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery.
B B B B B B B B B B B B B
What CPT® and ICD-10-CM codes are reported?
B B B B B B B
A. 21932, D17.39
B B
B. 21935, D17.1
B B
C. 21931, D17.1
B B
D. 21925, D17.9 - ANS >> C
B B B B B B
The mass growing turned out to be a lipoma found in the subcutaneous tissue of the flank. In the ICD-
B B B B B B B B B B B B B B B B B B B
10-CM Alphabetic Index, look for Lipoma/subcutaneous/trunk. You are referred to code D17.1,
B B B B B B B B B B B
eliminating multiple choice answers A and D. Because the 4 cm tumor was found in the subcutaneous
B B B B B B B B B B B B B B B B B
tissue code 21931 is the correct CPT® code to report.
B B B B B B B B B B
An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur
B B B B B B B B B B B B B B B B B
hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the
B B B B B B B B B B B B B B B B
Questions.
The patient has a torn medial meniscus of the left knee. An arthroscope was placed through the
B B B B B B B B B B B B B B B B
anterolateral portal for the diagnostic procedure. The patellofemoral joint showed some grade 2
B B B B B B B B B B B B B
chondromalacia on the patella side of the joint only, and this was debrided with the 4.0-mm shaver.
B B B B B B B B B B B B B B B B B
The medial compartment was also entered, and a complex posterior horn tear of the medial meniscus
B B B B B B B B B B B B B B B B
was noted. It was probed to define its borders. A meniscectomy was carried out back to a stable rim.
B B B B B B B B B B B B B B B B B B B
CPT® codes for this service are:
B B B B B B
A. 29882-LT
B
B. 29880-LT, 29877-59-LT
B B
C. 29870-LT, 29879-59-LT
B B
D. 29881-LT - ANS >> In the CPT® Index, look for Arthroscopy/Surgical/Knee. You are referred to
B B B B B B B B B B B B B B B
29866-29868, 29871-29889. Review the codes to choose appropriate service. 29881 is the correct
B B B B B B B B B B B B B
code because the tear was in the "medial meniscus" and a meniscectomy was performed. 29877 is
B B B B B B B B B B B B B B B B
not reported due to a parenthetical note under the code that states: "When performed with
B B B B B B B B B B B B B B B
arthroscopic meniscectomy, see 29880 or 29881." Also the code description for codes 29880 and
B B B B B B B B B B B B B B
29881 includes the debridement/shaving in the same or separate compartment(s) when performed.
B B B B B B B B B B B B
The surgery had started out as a "diagnostic procedure," but that changed when the physician
B B B B B B B B B B B B B B B
decided to perform surgical procedures on the knee, rather than only examining the knee for
B B B B B B B B B B B B B B B
diagnostic purposes.
B B
A 63-year-old man sustained a gunshot wound through the right maxillary sinus that penetrated
B B B B B B B B B B B B B
through the right neck. CT scan revealed no hard evidence of arterial injury but a bullet was directly
B B B B B B B B B B B B B B B B B B
in line with the internal jugular vein. He was sent to the operating room for neck exploration to rule
B B B B B B B B B B B B B B B B B B B
out vascular injury and injury to the aero digestive tract. A sternocleidomastoid incision was
B B B B B B B B B B B B B B
performed and carried down through the platysma muscle. There was no penetration of the internal
B B B B B B B B B B B B B B B
jugular vein, but a foreign body was identified resting on the internal jugular vein at approximately
B B B B B B B B B B B B B B B B
the level of the angle of the mandible and removed. The parotid gland was noted to have a blast
B B B B B B B B B B B B B B B B B B B
injury near the tail. This was not surgically repaired or resected. Once all bleeding was controlled, a
B B B B B B B B B B B B B B B B B
10 French round drain was placed in the wound. The wound was copiously irrigated. The platysma
B B B B B B B B B B B B B B B B
muscle was closed and the skin was closed - ANS >> In the CPT® Index, look for
B B B B B B B B B B B B B B B B B
Exploration/Neck/Penetrating Wound. You are referred to 20100. Review the code to verify accuracy.
B B B B B B B B B B B B B
20100 is the correct code since the patient was sent to the operating room to explore a gunshot
B B B B B B B B B B B B B B B B B B
(penetrating trauma) wound to identify damaged structures. The subsection guidelines for codes
B B B B B B B B B B B B
20100 - 20103 indicates these codes include removal of foreign bodies, ligation, or coagulation of
B B B B B B B B B B B B B B B
minor blood vessels, damaged tissue debrided and/or repaired, and wound closure.
B B B B B B B B B B B
, A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture
B B B B B B B B B B B B B B
while on vacation. The patient was put under general anesthesia and the elbow was reduced and was
B B B B B B B B B B B B B B B B B
stable. The medial elbow was held in the appropriate position and was reduced in acceptable position
B B B B B B B B B B B B B B B B
and elevated to treat non-surgically. A long arm splint was applied. The patient is referred to an
B B B B B B B B B B B B B B B B B
orthopedist when she returns to her home state in a few days. What procedure codes are reported?
B B B B B B B B B B B B B B B B B
A. 24575-54-RT, 24615-54-51-RT
B B
B. 24576-54-RT, 24620-54-51-RT
B B
C. 24577-54-RT, 24600-54-51-RT
B B
D. 24565-54-RT, 24605-54-51-RT - ANS >> In the CPT® Index, look for
B B B B B B B B B B B
Fracture/Humerus/Epicondyle/Closed Treatment. You are referred to code 24560-24565. Review the
B B B B B B B B B B
codes to choose the appropriate service. 24565 is the correct code to report an epicondyle fracture
B B B B B B B B B B B B B B B B
that was manipulated (reduced) without surgically incising to perform the procedure. In the CPT®
B B B B B B B B B B B B B B
Index, look for Dislocation/Elbow/Closed Treatment. You are referred to 24600-24605. Review the
B B B B B B B B B B B B
codes to choose appropriate service. 24605 is the correct code because patient was put under
B B B B B B B B B B B B B B B
general anesthesia to perform the procedure. Modifier 54 is used to report the physician performed
B B B B B B B B B B B B B B B
the surgical portion. The patient is referred to an orthopedist for follow up care. Modifier 51 is used
B B B B B B B B B B B B B B B B B B
to report that multiple procedures were performed.
B B B B B B B
A 52-year-old female has a mass growing on her right flank for several years. It has finally gotten
B B B B B B B B B B B B B B B B B
significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive
B B B B B B B B B B B B B B B B B
excision. An incision was made directly overlying the mass. The mass was down into the
B B B B B B B B B B B B B B B
subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4
B B B B B B B B B B B B
centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery.
B B B B B B B B B B B B B
What CPT® and ICD-10-CM codes are reported?
B B B B B B B
A. 21932, D17.39
B B
B. 21935, D17.1
B B
C. 21931, D17.1
B B
D. 21925, D17.9 - ANS >> C
B B B B B B
The mass growing turned out to be a lipoma found in the subcutaneous tissue of the flank. In the ICD-
B B B B B B B B B B B B B B B B B B B
10-CM Alphabetic Index, look for Lipoma/subcutaneous/trunk. You are referred to code D17.1,
B B B B B B B B B B B
eliminating multiple choice answers A and D. Because the 4 cm tumor was found in the subcutaneous
B B B B B B B B B B B B B B B B B
tissue code 21931 is the correct CPT® code to report.
B B B B B B B B B B
An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur
B B B B B B B B B B B B B B B B B
hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the
B B B B B B B B B B B B B B B B
