CPC - Musculoskeletal System Exam Test 1.
This type of connective tissue attaches a muscle to a bone: - ANS >> Tendon
RATIONALE: Tendons attach muscles to bone, and ligaments attach bones to other bones.
In the CPT® codebook, 25000 and 25001 are for incisions in the tendon sheath on the wrist. Code 25000
is for the extensor tendon and 25001 is for the flexor tendon sheath. What is the difference between
extension and flexion? - ANS >> Extension causes straightening of the wrist; flexion causes bending of
the wrist.
RATIONALE: When muscles are named for their action, words like flexor and extensor are often included
in the name. Flexion is bending of a limb or body part and Extension is straightening of a limb or body
part.
How would you code a new pathological fracture of the right femur due to postmenopausal
osteoporosis? - ANS >> M80.051A
RATIONALE: Code M80.051A describes a pathological fracture of the right femur; In the ICD-10-CM
Alphabetic Index look up Fracture/ pathological/due to/osteoporosis/postmenopausal — see
Osteoporosis/postmenopausal/with pathologic fracture. You're directed to M80.00. In the Alphabetic
Index there is no listing for femur. Review the subcategories for M80.0 in the Tabular List. Subcategory
M80.05 is used to Identify current pathological fracture of femur. 6th character 1 is used for right femur
and 7th character A is used for the initial encounter.
What is the correct ICD-10-CM code for a new patient seen for a left-sided Nursemaid's elbow? - ANS >>
S53.032A
RATIONALE: Look up Nursemaid's elbow, S53.03-. Verification in Tabular List verifies code choice
S53.032A, for left elbow, initial encounter.
What is the code for a traumatic fracture of the fifth metacarpal shaft on the right hand with delayed
healing? - ANS >> S62.326G
RATIONALE: In ICD-10-CM Alphabetic Index look for Fracture/traumatic/metacarpal/fifth/shaft
(displaced) directing you to S62.32-. In the Tabular List subcategory S62.32 requires a 6th character for
laterality and a 7th character for type of encounter. S62.326G is the correct code. ICD-10-CM Guidelines
I.19.c states "A fracture not indicated as open or closed should be coded to closed. A fracture not
indicated whether displaced or not displaced should be coded to displaced".
The physician performs arthroscopic meniscus repair with partial medial and lateral repairs. What
procedure code is reported? - ANS >> 29883
RATIONALE: Code 29883 is for an arthroscopy, knee, surgical; with meniscus repair (medial AND lateral).
Look in the CPT® Index for Arthroscopy/Surgical/Knee, which gives a range of codes for procedures on
the knee that can be done with an arthroscope.
The patient has developed plantar fasciitis, a painful condition in his heel and the sole of his foot. He has
tried using shoe inserts and over-the-counter pain relievers, but is still having pain. His physician
performs an injection of the tendon sheath on the bottom of his foot. What procedure code is reported?
- ANS >> 20550
, RATIONALE: An injection of a single tendon sheath, or ligament, aponeurosis (for example: plantar
fascia) is coded with a 20550. Look in the CPT® Index for Tendon Sheath/Injection.
Julia tripped and fell down three stairs in her apartment. X-rays show a fracture of the metatarsal bone
of her left great toe, and the physician treats the fracture with a special orthotic boot. What procedure
code is reported? - ANS >> 28470-TA
RATIONALE: This is a closed treatment because no surgery was performed. The orthotic boot would be
coded separately by the DME supplier. Look in the CPT® Index for Fracture/Metatarsal/Closed
Treatment. Modifier TA is appended to indicate the left foot, great toe.
Joe was in a motorcycle accident, and fractured his right femur. The surgeon placed an intramedullary
locking implant (nail) through a buttock incision. What procedure code is reported? - ANS >> 27506-RT
RATIONALE: The surgery is an open treatment of a closed femoral shaft fracture with internal fixation
(intramedullary implant), and is reported 27506-RT. Look in the CPT® Index for
Fracture/Femur/Peritrochanteric/Intramedullary Implant Shaft. Report modifier RT to indicate right
femur.
Jeff is a 13-year-old boy who fractured his left radius and ulna while snowboarding. Three weeks after
the physician placed a long arm cast on Jeff, he was skateboarding and crushed the cast (without further
injury to the arm). The physician replaces the cast with a short-arm fiberglass cast. What procedure code
is reported for the services provided after the skateboard accident? - ANS >> 29075-58
RATIONALE: The first cast or splint is included as part of the initial fracture treatment; because this was a
replacement cast, it can be coded. Look in the CPT® Index for Cast/Elbow to Finger. Append modifier 58
to indicate this was a related procedure by the same physician during the postoperative period.
CASE 1
Operative Report
PREOPERATIVE DIAGNOSIS: Comminuted left proximal humerus fracture.
POSTOPERATIVE DIAGNOSIS: Comminuted left proximal humerus fracture. (The postoperative diagnosis
is used for coding.)
OPERATIVE PROCEDURE: Open treatment of left proximal humerus.(The working procedure until the
report is read.)
ANESTHESIA: General.(General anesthesia is used.)
IMPLANTS: DePuy GLOBAL® FX™, stem size 10 with a 48 x 15 humeral head.(This is an indication that a
prosthesis was introduced into the joint.)
INDICATIONS: The patient is a 66 year-old female who sustained a traumatic severe comminuted
proximal humerus fracture. (This is confirmation of the diagnosis. The proximal end of the humerus is
the shoulder area.) The risks and benefits of the surgical procedure were discussed. She stated that she
understood and desired to proceed.
This type of connective tissue attaches a muscle to a bone: - ANS >> Tendon
RATIONALE: Tendons attach muscles to bone, and ligaments attach bones to other bones.
In the CPT® codebook, 25000 and 25001 are for incisions in the tendon sheath on the wrist. Code 25000
is for the extensor tendon and 25001 is for the flexor tendon sheath. What is the difference between
extension and flexion? - ANS >> Extension causes straightening of the wrist; flexion causes bending of
the wrist.
RATIONALE: When muscles are named for their action, words like flexor and extensor are often included
in the name. Flexion is bending of a limb or body part and Extension is straightening of a limb or body
part.
How would you code a new pathological fracture of the right femur due to postmenopausal
osteoporosis? - ANS >> M80.051A
RATIONALE: Code M80.051A describes a pathological fracture of the right femur; In the ICD-10-CM
Alphabetic Index look up Fracture/ pathological/due to/osteoporosis/postmenopausal — see
Osteoporosis/postmenopausal/with pathologic fracture. You're directed to M80.00. In the Alphabetic
Index there is no listing for femur. Review the subcategories for M80.0 in the Tabular List. Subcategory
M80.05 is used to Identify current pathological fracture of femur. 6th character 1 is used for right femur
and 7th character A is used for the initial encounter.
What is the correct ICD-10-CM code for a new patient seen for a left-sided Nursemaid's elbow? - ANS >>
S53.032A
RATIONALE: Look up Nursemaid's elbow, S53.03-. Verification in Tabular List verifies code choice
S53.032A, for left elbow, initial encounter.
What is the code for a traumatic fracture of the fifth metacarpal shaft on the right hand with delayed
healing? - ANS >> S62.326G
RATIONALE: In ICD-10-CM Alphabetic Index look for Fracture/traumatic/metacarpal/fifth/shaft
(displaced) directing you to S62.32-. In the Tabular List subcategory S62.32 requires a 6th character for
laterality and a 7th character for type of encounter. S62.326G is the correct code. ICD-10-CM Guidelines
I.19.c states "A fracture not indicated as open or closed should be coded to closed. A fracture not
indicated whether displaced or not displaced should be coded to displaced".
The physician performs arthroscopic meniscus repair with partial medial and lateral repairs. What
procedure code is reported? - ANS >> 29883
RATIONALE: Code 29883 is for an arthroscopy, knee, surgical; with meniscus repair (medial AND lateral).
Look in the CPT® Index for Arthroscopy/Surgical/Knee, which gives a range of codes for procedures on
the knee that can be done with an arthroscope.
The patient has developed plantar fasciitis, a painful condition in his heel and the sole of his foot. He has
tried using shoe inserts and over-the-counter pain relievers, but is still having pain. His physician
performs an injection of the tendon sheath on the bottom of his foot. What procedure code is reported?
- ANS >> 20550
, RATIONALE: An injection of a single tendon sheath, or ligament, aponeurosis (for example: plantar
fascia) is coded with a 20550. Look in the CPT® Index for Tendon Sheath/Injection.
Julia tripped and fell down three stairs in her apartment. X-rays show a fracture of the metatarsal bone
of her left great toe, and the physician treats the fracture with a special orthotic boot. What procedure
code is reported? - ANS >> 28470-TA
RATIONALE: This is a closed treatment because no surgery was performed. The orthotic boot would be
coded separately by the DME supplier. Look in the CPT® Index for Fracture/Metatarsal/Closed
Treatment. Modifier TA is appended to indicate the left foot, great toe.
Joe was in a motorcycle accident, and fractured his right femur. The surgeon placed an intramedullary
locking implant (nail) through a buttock incision. What procedure code is reported? - ANS >> 27506-RT
RATIONALE: The surgery is an open treatment of a closed femoral shaft fracture with internal fixation
(intramedullary implant), and is reported 27506-RT. Look in the CPT® Index for
Fracture/Femur/Peritrochanteric/Intramedullary Implant Shaft. Report modifier RT to indicate right
femur.
Jeff is a 13-year-old boy who fractured his left radius and ulna while snowboarding. Three weeks after
the physician placed a long arm cast on Jeff, he was skateboarding and crushed the cast (without further
injury to the arm). The physician replaces the cast with a short-arm fiberglass cast. What procedure code
is reported for the services provided after the skateboard accident? - ANS >> 29075-58
RATIONALE: The first cast or splint is included as part of the initial fracture treatment; because this was a
replacement cast, it can be coded. Look in the CPT® Index for Cast/Elbow to Finger. Append modifier 58
to indicate this was a related procedure by the same physician during the postoperative period.
CASE 1
Operative Report
PREOPERATIVE DIAGNOSIS: Comminuted left proximal humerus fracture.
POSTOPERATIVE DIAGNOSIS: Comminuted left proximal humerus fracture. (The postoperative diagnosis
is used for coding.)
OPERATIVE PROCEDURE: Open treatment of left proximal humerus.(The working procedure until the
report is read.)
ANESTHESIA: General.(General anesthesia is used.)
IMPLANTS: DePuy GLOBAL® FX™, stem size 10 with a 48 x 15 humeral head.(This is an indication that a
prosthesis was introduced into the joint.)
INDICATIONS: The patient is a 66 year-old female who sustained a traumatic severe comminuted
proximal humerus fracture. (This is confirmation of the diagnosis. The proximal end of the humerus is
the shoulder area.) The risks and benefits of the surgical procedure were discussed. She stated that she
understood and desired to proceed.
