AAPC CPC CHAPTER 8 EXAM |
COMPREHENSIVE QUESTIONS
AND ANSWERS
CPT® code: 27650-LT
ICD-10-CM codes: S86.012A, W50.0XXA, Y93.67, Y99.8 - Answer-CASE 9
PREOPERATIVE DIAGNOSIS: Left Achilles' tendon rupture.
POSTOPERATIVE DIAGNOSIS: Left Achilles' tendon rupture.
OPERATION PERFORMED: Open Left Achilles' tendon repair.
ANESTHESIA: General anesthesia
INDICATIONS: The patient is a 25 year-old male who was playing basketball when he
was hit by another player and felt a pop in the back of his ankle approximately two
months ago. Examination reveals a positive Thompson test, but no plantar flexion on
squeezing the calf. There is a palpable defect in the Achilles' tendon. There is swelling
in this region and neurovascular examination is intact. Given these clinical findings, the
patient is taken to the operating room for the aforementioned procedure.
DESCRIPTION OF PROCEDURE: Following induction of general anesthesia the
patient was placed prone on the operating table and all bony prominences were well-
padded. The patient received a 1g dose of Ancef. Under tourniquet control of 250
mmHg, a longitudinal incision was made followed by opening up the paratenon of the
Achilles' tendon. An obvious rupture was noted. The hematoma was evacuated and the
ends were then debrided with a Metzenbaum scissors. A No. 2 FiberWire® was placed
in a Bunnell-type fashion in both the proximal and distal portions of the Achilles' tendon.
A No. 2 Orthocord was then used and placed in a running fashion along the proximal
and distal portions of the Achilles' tendon. A total of four sutures were used. These were
then tied together to re-approximate the tendon with no significant tension on the repair.
A secure repair was noted. The ends of the repair were further augmented with a 2-0
Vicryl suture. The wound was thoroughly irrigated with antibiotic irrigation solution. The
fascial plane was closed with a 2-0 Vicryl suture, followed by closing the skin with a 2-0
in subcuticular fashion. Approxim
CPT® code: 27827-RT
ICD-10-CM code: S82.391A, W19.XXXA - Answer-CASE 10
PREOPERATIVE DIAGNOSIS: Right ankle triplane fracture
POSTOPERATIVE DIAGNOSIS: Right ankle triplane fracture
PROCEDURE: Open reduction and internal fixation (ORIF), right ankle triplane fracture
ANESTHESIA: General endotracheal
COMPLICATIONS: None
SPECIMEN: None
IMPLANT USED: Synthes 4.0 mm cannulated screws
INDICATIONS FOR PROCEDURE:
,The patient is a pleasant 15 year-old male who fell and sustained a right ankle triplane
fracture. This was confirmed on both X-ray and CT scan. The indications for ORIF were
explained to the patient, as well as the possible risks and complications, which include
infection, bleeding, stiffness, hardware pain, the need for hardware removal, and there
is no guarantee of a functional ambulatory result. The patient and family understood and
wished to proceed.
PROCEDURE IN DETAIL:
The patient was brought back to the operating room and placed on an operating table,
given a general anesthetic without any complications, and given preoperative antibiotics
per usual routine. He had the right lower extremity prepped and draped in the usual
sterile fashion with alcohol prep followed by routine Betadine prep.
Under X-ray guidance, a pointed reduction clamp was placed from the anterolateral
corner of the distal tibia to the medial side, and I reduced the triplane fracture. It was
confirmed on both AP and lateral X-ray images the gap was reduced. The patient then
had guidewires taken from the Synthes 4.0 mm cannulated screw set. One was placed
medially along the epiphysis on the anterior half of the epiphysis and parallel to the joint
to catch the lateral aspect of the epiphysis. One screw was placed above the physis
from anterior to posterior to capture that spike. Once the wires were in the appropriate
position, the length was measured and partially threaded 4.0 mm cancellous screws
were selec
A - Answer-Most of the codes in ICD-10-CM Chapter 13 Diseases of the
Musculoskeletal System and Connective Tissue have site and laterality designations.
According to ICD-10-CM guidelines what is considered the site?
A) The site may be the bone, joint or muscle involved.
B) The site is always the joint or bone involved.
C) The site is only the joint involved.
D) The site is only the muscle involved.
D - Answer-The acronym BKA means:
A) bilateral knee amputation
B) bursitis knee & arthritis
C) bilateral knee arthritis
D) below knee amputation
B - Answer-Hallux rigidus is a condition affecting what part of the body?
A) Ankle
B) Foot
C) Knee
D) Spine
A - Answer-___________ fixation with pins, screws, plates, or wires is placed directly on
or in the bone to immobilize a fractured bone and to maintain alignment while it heals.
A) Internal
B) Manipulation
C) Reduction
, D) Casting
A - Answer-Which statement is TRUE regarding code selection for lumbago in ICD-10-
CM?
A) Codes exist to indicate whether sciatica is present with the low back pain.
B) Codes for lumbago with sciatica do not further specify laterality.
C) There is only one generalized code for lumbago that cannot be further specified.
D) Lumbago is not assigned an ICD-10-CM code; instead, the code for the cause of the
lumbago is assigned.
C - Answer-A 49 year-old presents with an abscess of the right thumb. The physician
incises the abscess and purulent sanguineous fluid is drained. The wound is packed
with iodoform packing. What CPT® code is reported?
A) 10060-F5
B) 26011-F5
C) 26010-F5
D) 10061-F5
B - Answer-A 22 year-old female has a retained Kirschner wire in the left little finger.
Using local anesthesia, the left upper extremity was thoroughly cleansed with Betadine.
The end portion of the little finger was opened with a transverse incision through the
subcutaneous tissue to the bone. The retained Kirschner wire was located within the
distal phalanx. It was removed and the skin was closed with sutures. What CPT® code
is reported?
A) 10121-F4
B) 20680-F4
C) 10120-F4
D) 20670-F4
A - Answer-This 45 year-old male presents to the operating room with a painful mass of
the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient's
shoulder was noted. The mass appeared to be benign in nature. With deep blunt
dissection and electrocautery, the mass was removed and sent to pathology. What
CPT® code is reported?
A) 23075-RT
B) 23030-RT
C) 23076-RT
D) 23066-RT
D - Answer-A 14 year-old status post injury over one year ago to her left wrist presented
with recurrent wrist pain. The patient was taken to the operating room and placed under
general anesthesia. She was placed in wrist traction. The radiocarpal joint was entered
endoscopically through sharp skin incisions and blunt dissection into the joint. There
was found to be mild synovitis in the dorsal ulnar aspect of the wrist. This was debrided
arthroscopically with a shaver. There was a peripheral tear of the triangular
fibrocartilage. This area was shaved to promote healing. Using outside-in technique, a
COMPREHENSIVE QUESTIONS
AND ANSWERS
CPT® code: 27650-LT
ICD-10-CM codes: S86.012A, W50.0XXA, Y93.67, Y99.8 - Answer-CASE 9
PREOPERATIVE DIAGNOSIS: Left Achilles' tendon rupture.
POSTOPERATIVE DIAGNOSIS: Left Achilles' tendon rupture.
OPERATION PERFORMED: Open Left Achilles' tendon repair.
ANESTHESIA: General anesthesia
INDICATIONS: The patient is a 25 year-old male who was playing basketball when he
was hit by another player and felt a pop in the back of his ankle approximately two
months ago. Examination reveals a positive Thompson test, but no plantar flexion on
squeezing the calf. There is a palpable defect in the Achilles' tendon. There is swelling
in this region and neurovascular examination is intact. Given these clinical findings, the
patient is taken to the operating room for the aforementioned procedure.
DESCRIPTION OF PROCEDURE: Following induction of general anesthesia the
patient was placed prone on the operating table and all bony prominences were well-
padded. The patient received a 1g dose of Ancef. Under tourniquet control of 250
mmHg, a longitudinal incision was made followed by opening up the paratenon of the
Achilles' tendon. An obvious rupture was noted. The hematoma was evacuated and the
ends were then debrided with a Metzenbaum scissors. A No. 2 FiberWire® was placed
in a Bunnell-type fashion in both the proximal and distal portions of the Achilles' tendon.
A No. 2 Orthocord was then used and placed in a running fashion along the proximal
and distal portions of the Achilles' tendon. A total of four sutures were used. These were
then tied together to re-approximate the tendon with no significant tension on the repair.
A secure repair was noted. The ends of the repair were further augmented with a 2-0
Vicryl suture. The wound was thoroughly irrigated with antibiotic irrigation solution. The
fascial plane was closed with a 2-0 Vicryl suture, followed by closing the skin with a 2-0
in subcuticular fashion. Approxim
CPT® code: 27827-RT
ICD-10-CM code: S82.391A, W19.XXXA - Answer-CASE 10
PREOPERATIVE DIAGNOSIS: Right ankle triplane fracture
POSTOPERATIVE DIAGNOSIS: Right ankle triplane fracture
PROCEDURE: Open reduction and internal fixation (ORIF), right ankle triplane fracture
ANESTHESIA: General endotracheal
COMPLICATIONS: None
SPECIMEN: None
IMPLANT USED: Synthes 4.0 mm cannulated screws
INDICATIONS FOR PROCEDURE:
,The patient is a pleasant 15 year-old male who fell and sustained a right ankle triplane
fracture. This was confirmed on both X-ray and CT scan. The indications for ORIF were
explained to the patient, as well as the possible risks and complications, which include
infection, bleeding, stiffness, hardware pain, the need for hardware removal, and there
is no guarantee of a functional ambulatory result. The patient and family understood and
wished to proceed.
PROCEDURE IN DETAIL:
The patient was brought back to the operating room and placed on an operating table,
given a general anesthetic without any complications, and given preoperative antibiotics
per usual routine. He had the right lower extremity prepped and draped in the usual
sterile fashion with alcohol prep followed by routine Betadine prep.
Under X-ray guidance, a pointed reduction clamp was placed from the anterolateral
corner of the distal tibia to the medial side, and I reduced the triplane fracture. It was
confirmed on both AP and lateral X-ray images the gap was reduced. The patient then
had guidewires taken from the Synthes 4.0 mm cannulated screw set. One was placed
medially along the epiphysis on the anterior half of the epiphysis and parallel to the joint
to catch the lateral aspect of the epiphysis. One screw was placed above the physis
from anterior to posterior to capture that spike. Once the wires were in the appropriate
position, the length was measured and partially threaded 4.0 mm cancellous screws
were selec
A - Answer-Most of the codes in ICD-10-CM Chapter 13 Diseases of the
Musculoskeletal System and Connective Tissue have site and laterality designations.
According to ICD-10-CM guidelines what is considered the site?
A) The site may be the bone, joint or muscle involved.
B) The site is always the joint or bone involved.
C) The site is only the joint involved.
D) The site is only the muscle involved.
D - Answer-The acronym BKA means:
A) bilateral knee amputation
B) bursitis knee & arthritis
C) bilateral knee arthritis
D) below knee amputation
B - Answer-Hallux rigidus is a condition affecting what part of the body?
A) Ankle
B) Foot
C) Knee
D) Spine
A - Answer-___________ fixation with pins, screws, plates, or wires is placed directly on
or in the bone to immobilize a fractured bone and to maintain alignment while it heals.
A) Internal
B) Manipulation
C) Reduction
, D) Casting
A - Answer-Which statement is TRUE regarding code selection for lumbago in ICD-10-
CM?
A) Codes exist to indicate whether sciatica is present with the low back pain.
B) Codes for lumbago with sciatica do not further specify laterality.
C) There is only one generalized code for lumbago that cannot be further specified.
D) Lumbago is not assigned an ICD-10-CM code; instead, the code for the cause of the
lumbago is assigned.
C - Answer-A 49 year-old presents with an abscess of the right thumb. The physician
incises the abscess and purulent sanguineous fluid is drained. The wound is packed
with iodoform packing. What CPT® code is reported?
A) 10060-F5
B) 26011-F5
C) 26010-F5
D) 10061-F5
B - Answer-A 22 year-old female has a retained Kirschner wire in the left little finger.
Using local anesthesia, the left upper extremity was thoroughly cleansed with Betadine.
The end portion of the little finger was opened with a transverse incision through the
subcutaneous tissue to the bone. The retained Kirschner wire was located within the
distal phalanx. It was removed and the skin was closed with sutures. What CPT® code
is reported?
A) 10121-F4
B) 20680-F4
C) 10120-F4
D) 20670-F4
A - Answer-This 45 year-old male presents to the operating room with a painful mass of
the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient's
shoulder was noted. The mass appeared to be benign in nature. With deep blunt
dissection and electrocautery, the mass was removed and sent to pathology. What
CPT® code is reported?
A) 23075-RT
B) 23030-RT
C) 23076-RT
D) 23066-RT
D - Answer-A 14 year-old status post injury over one year ago to her left wrist presented
with recurrent wrist pain. The patient was taken to the operating room and placed under
general anesthesia. She was placed in wrist traction. The radiocarpal joint was entered
endoscopically through sharp skin incisions and blunt dissection into the joint. There
was found to be mild synovitis in the dorsal ulnar aspect of the wrist. This was debrided
arthroscopically with a shaver. There was a peripheral tear of the triangular
fibrocartilage. This area was shaved to promote healing. Using outside-in technique, a
