MEDICAL CODING AND BILLING FINAL EXAM UPDATED
QUESTIONS AND ANSWERS
Modifier -58, staged or related procedure or service by the same physician during
the postoperative period, is used to indicate _____.
That a subsequent surgery was planned at the time of the first surgery.
A 2-year-old boy was born with a cleft lip and nasal deformity. He was admitted to
the hospital and taken to the operating room. Dr. Mark Sloan performed a primary
complete plastic repair of the cleft lip and nasal deformity, unilateral.
40700
Mary Ellen, a 42-year-old female, was diagnosed with a malignant tumor of the
thyroid. She has been admitted to the hospital, brought to the operating room and
prepped in the usual fashion. Procedure performed: thyroidectomy, total for
malignancy, with radical neck resection.60254
60254
Katie, a 12-year-old, went in for a 2-year followup comprehensive ophthalmologic
exam. The physician fits and gives directions about her new contact lenses. She
is to follow up in 1 week to see how her contacts are working.
Correct Answer 92014, 92310
92014, 92310
An 18-year-old female patient presented to the hospital laboratory department for
drug testing. A basic three-panel drug screen for barbiturates using a self-
contained, cup type drug test screening kit is performed.80345
80345
The patient was taken to the Cardiac Catheterization Lab in a fasting condition.
Bilateral groin areas were prepped and draped in the usual sterile fashion and the
5-French sidearm sheath was introduced into the right femoral artery using a
modified Seldinger technique. A 5-French JL5 catheter was used for left coronary
angiography and a 5-French JR4 catheter was used for right coronary
angiography. Attempts were made for a 5-French pigtail catheter to pass the
aortic valve unsuccessfully, despite using stiff wire. Therefore, the decision was
made to exchange the 5-French sidearm sheath for a 6-French 45 cm sheath and
,a 5-French pigtail catheter was introduced into the left ventricle and LV-gram was
recorded. At the end of the procedure all catheters were removed, and manual
pressure followed by FemoStop and additional pressure were applied on the right
femoral artery site. Impression: Three-vessel coronary artery disease proximal
LAD 90%, D1 70%, D2 50%, left circumflex proximal 70%, and mid 80%, RCA mid
99% with collaterals from septal to PD and OM to PL.93458
93458
Right upper eyelid blepharoplasty. After preoperative markings and infiltration
with local anesthetic using lidocaine with epinephrine and regional block
anesthesia with Marcaine and epinephrine, the superfluous, excess skin that was
weighing down the lid was marked in an elliptical fashion, symmetrically from
side-to-side, leaving approximately 8 mm of skin above the lash line. The
superfluous skin was excised and closed under no significant tension using a
running intracuticular 5-0 Prolene suture. Only a very small slip of muscle in the
central portion was removed laterally. The patient understands those limitations
and the minimal improvement that could be done medially because of the contour
of her eyelid skin, in order to prevent excess scarring. The patient tolerated the
procedure well. Hemostasis was maintained meticulously throughout the surgery
using heat cautery. The patient tolerated the procedure well and was discharged
home. She was dosed with preoperative antibiotics and will follow up for suture
removal in about 10 days.
15823-E3
Penile warts. The patient had numerous lesions treated today with liquid nitrogen
for two freeze/thaw cycles for five to ten seconds to all. The patient tolerated the
procedure well and is aware of the sequelae. We have discussed condom use and
post care with liquid nitrogen to avoid any frictional or irritational activity to this
site. The patient should wait about two to three weeks, and then he should start
using Aldara cream on all of the warts q.h.s. for three nights per week, such as
Monday, Wednesday, and Friday. I gave him enough for six nights on a trial basis
since he is diabetic. This will help his system to fight off and cause the warts to
, regress. If he does not develop any irritation or reactions to the Aldara, this would
be a good way to have him use home therapy in the future.54065
54065
Open fracture dislocation, PIP joint. Manipulation reduction, wound debridement,
and immobilization. The patient's finger was originally inspected; anesthesia was
injected in a digital block form. After complete anesthesia was obtained, the
patient's finger was hyperextended and the PIP joint reduced. The wound was
then copiously irrigated. The small opening was extended in a volar Brunner type
fashion. The skin flaps were opened and wound was carefully debrided and
extensively irrigated. Gross sand and dirt material was identified and removed.
Flexor tendon sheath was opened and similarly cleansed. Tendons themselves
did not appear to be injured. The joint was opened and carefully inspected and
irrigated. No gross contamination was found in the joint itself or on the articular
surfaces. After copious irrigation, the volar plate was repaired. The incision was
repaired, but the wound was allowed to remain open. The joint was tested for
stability and fond to be stable in the radial and ulnar deviation and stable to
dorsal volar motion in a 30 degree flexed position. Full extension resulted in
some instability and therefore an extension-blocking splint was applied. Sterile
dressing was placed and the patient was discharged home to his own care.
26725, 26548-51, 11010-51
Steroid injection into deQuervain's tendinitis area and injection into separate
ganglion cyst. 20 mg of Kenalog were drawn up and diluted with equal amounts
of Marcaine and injected along the tendon sheath involving the deQuervain's
disease. After the injection was accomplished, a separate syringe containing 10
mg of Marcaine was used for injection into the cystic area or the lesion area of the
ganglion cyst area. First, the lesion was drained, and following this, injection of
10 mg of the Kenalog was injected into the cyst. The patient had no changes in
her history or physical exam. She will follow up p.r.n. if she has any problems or
if she has a recurrence.
20550, 20612-51, J3301(3)
QUESTIONS AND ANSWERS
Modifier -58, staged or related procedure or service by the same physician during
the postoperative period, is used to indicate _____.
That a subsequent surgery was planned at the time of the first surgery.
A 2-year-old boy was born with a cleft lip and nasal deformity. He was admitted to
the hospital and taken to the operating room. Dr. Mark Sloan performed a primary
complete plastic repair of the cleft lip and nasal deformity, unilateral.
40700
Mary Ellen, a 42-year-old female, was diagnosed with a malignant tumor of the
thyroid. She has been admitted to the hospital, brought to the operating room and
prepped in the usual fashion. Procedure performed: thyroidectomy, total for
malignancy, with radical neck resection.60254
60254
Katie, a 12-year-old, went in for a 2-year followup comprehensive ophthalmologic
exam. The physician fits and gives directions about her new contact lenses. She
is to follow up in 1 week to see how her contacts are working.
Correct Answer 92014, 92310
92014, 92310
An 18-year-old female patient presented to the hospital laboratory department for
drug testing. A basic three-panel drug screen for barbiturates using a self-
contained, cup type drug test screening kit is performed.80345
80345
The patient was taken to the Cardiac Catheterization Lab in a fasting condition.
Bilateral groin areas were prepped and draped in the usual sterile fashion and the
5-French sidearm sheath was introduced into the right femoral artery using a
modified Seldinger technique. A 5-French JL5 catheter was used for left coronary
angiography and a 5-French JR4 catheter was used for right coronary
angiography. Attempts were made for a 5-French pigtail catheter to pass the
aortic valve unsuccessfully, despite using stiff wire. Therefore, the decision was
made to exchange the 5-French sidearm sheath for a 6-French 45 cm sheath and
,a 5-French pigtail catheter was introduced into the left ventricle and LV-gram was
recorded. At the end of the procedure all catheters were removed, and manual
pressure followed by FemoStop and additional pressure were applied on the right
femoral artery site. Impression: Three-vessel coronary artery disease proximal
LAD 90%, D1 70%, D2 50%, left circumflex proximal 70%, and mid 80%, RCA mid
99% with collaterals from septal to PD and OM to PL.93458
93458
Right upper eyelid blepharoplasty. After preoperative markings and infiltration
with local anesthetic using lidocaine with epinephrine and regional block
anesthesia with Marcaine and epinephrine, the superfluous, excess skin that was
weighing down the lid was marked in an elliptical fashion, symmetrically from
side-to-side, leaving approximately 8 mm of skin above the lash line. The
superfluous skin was excised and closed under no significant tension using a
running intracuticular 5-0 Prolene suture. Only a very small slip of muscle in the
central portion was removed laterally. The patient understands those limitations
and the minimal improvement that could be done medially because of the contour
of her eyelid skin, in order to prevent excess scarring. The patient tolerated the
procedure well. Hemostasis was maintained meticulously throughout the surgery
using heat cautery. The patient tolerated the procedure well and was discharged
home. She was dosed with preoperative antibiotics and will follow up for suture
removal in about 10 days.
15823-E3
Penile warts. The patient had numerous lesions treated today with liquid nitrogen
for two freeze/thaw cycles for five to ten seconds to all. The patient tolerated the
procedure well and is aware of the sequelae. We have discussed condom use and
post care with liquid nitrogen to avoid any frictional or irritational activity to this
site. The patient should wait about two to three weeks, and then he should start
using Aldara cream on all of the warts q.h.s. for three nights per week, such as
Monday, Wednesday, and Friday. I gave him enough for six nights on a trial basis
since he is diabetic. This will help his system to fight off and cause the warts to
, regress. If he does not develop any irritation or reactions to the Aldara, this would
be a good way to have him use home therapy in the future.54065
54065
Open fracture dislocation, PIP joint. Manipulation reduction, wound debridement,
and immobilization. The patient's finger was originally inspected; anesthesia was
injected in a digital block form. After complete anesthesia was obtained, the
patient's finger was hyperextended and the PIP joint reduced. The wound was
then copiously irrigated. The small opening was extended in a volar Brunner type
fashion. The skin flaps were opened and wound was carefully debrided and
extensively irrigated. Gross sand and dirt material was identified and removed.
Flexor tendon sheath was opened and similarly cleansed. Tendons themselves
did not appear to be injured. The joint was opened and carefully inspected and
irrigated. No gross contamination was found in the joint itself or on the articular
surfaces. After copious irrigation, the volar plate was repaired. The incision was
repaired, but the wound was allowed to remain open. The joint was tested for
stability and fond to be stable in the radial and ulnar deviation and stable to
dorsal volar motion in a 30 degree flexed position. Full extension resulted in
some instability and therefore an extension-blocking splint was applied. Sterile
dressing was placed and the patient was discharged home to his own care.
26725, 26548-51, 11010-51
Steroid injection into deQuervain's tendinitis area and injection into separate
ganglion cyst. 20 mg of Kenalog were drawn up and diluted with equal amounts
of Marcaine and injected along the tendon sheath involving the deQuervain's
disease. After the injection was accomplished, a separate syringe containing 10
mg of Marcaine was used for injection into the cystic area or the lesion area of the
ganglion cyst area. First, the lesion was drained, and following this, injection of
10 mg of the Kenalog was injected into the cyst. The patient had no changes in
her history or physical exam. She will follow up p.r.n. if she has any problems or
if she has a recurrence.
20550, 20612-51, J3301(3)
