CPC Medical Coding And Billing Exams Final Certification Exam – (150 Questions) Question And Answers [100% Correct] 2025/2026

CPC Medical Coding And Billing Exams Final Certification Exam – (150 Questions) Question And Answers [100% Correct] 2025/2026 What does the suffix "-ectomy" indicate? Surgical excision of a body part or tissue What does the acronym MRI stand for in medical imaging? Magnetic Resonance Imaging What surgical procedure involves the removal of both ovaries and fallopian tubes? Salpingo-Oophorectomy What process uses freezing to preserve biological materials? Cryopreservation What is the medical term for the removal of fluid from a body cavity? Paracentesis What is the procedure called when a surgeon makes an incision into the stomach? Gastrotomy In the term "myopathy," which part of the body is affected? Diseased muscle tissue What diseases are represented by the acronym MMRV? 1 Measles, Mumps, Rubella, and Varicella Which bone in the forearm is located on the thumb side? The Radius To which organ system does the spleen belong? The hemic and lymphatic system What part of the femur contributes to forming the knee joint? The end closest to the knee joint What does the midsagittal plane divide in anatomical terms? The exact middle plane of the body Which structure is not part of the small intestine? Cecum What type of muscle is classified as one of the six scapulohumeral muscles? Teres What is described by the term "cardia fundus"? The location where the esophagus connects to the stomach What does CPT code 24925 describe? Amputation of the arm through the humerus with secondary closure or revision What is the definition of medical necessity? The condition or need that supports medical services provided 2 Which procedural code is compatible with modifier 51? 45392 What is false regarding Medicare Part A? It assists in covering outpatient services What is a limitation of external cause codes in ICD-10? They apply only in the first encounter What is included in wound exploration codes? Exploration, removal of foreign objects, and debridement What ICD-10-CM codes are used for malignant hypertension with stage III kidney disease? I12.9, N18.3 What is the correct coding for a patient with a forearm laceration embedded with glass after a fall from a chair? S51.822A, W07.XXXA, W25.XXXA, Y93.E9, Y92.030 Which ICD-10 codes describe a patient treated for burns after falling into a bonfire? T20.30XA, T24.319A, T22.299A, T31.42, X03.0XXA What coding is accurate for a 38-week pregnant woman experiencing prolonged labor and delivering a healthy child? O63.0, O09.513, Z37.0 What is the code for a displaced tuft fracture caused by a sports injury? S62.632A, Y93.64, W51.XXXA, Y92.320 3 What is the correct coding for a male patient undergoing detoxification from amphetamine and alcohol abuse, also suffering from PTSD? F15.20, F10.20, F41.1, F43.10 What code applies to a patient with uncontrolled type II diabetes diagnosed with diabetic retinopathy? E11.319 Which code is used for an HIV-positive patient without documented symptoms? Z21 What code is assigned for second-degree solar radiation burns? L55.1 Should signs and symptoms routinely associated with a disease be coded additionally? True Which codes apply to specific sterile dressings used in a home care setting for burn wounds? A6252, A6219 What is the code for a short arm fiberglass cast applied to a 12-year-old with a hairline radius fracture? Q4010 Which code is used for 100 mg of Neosar administered intravenously for chemotherapy? J9070 What code range covers fittings for custom-molded shoes for diabetics? A5500-A5513 4 5 Which code describes a special wheelchair designed for a paraplegic patient? E1222 What is the correct code for a brief doctor’s visit involving a blood sugar check? 99211 What code applies to a 3-year-old admitted for observation after swallowing a penny? 99234 What is the correct coding for a 20-month-old with pneumonia and acute respiratory distress? 99471; J80; J18.9 What codes should be used for a pediatrician assisting at a high-risk delivery and resuscitating a newborn? 99360; 99465; 99460 What codes apply to a male patient’s annual physical exam followed by the evaluation of a suspicious mole? 99397, 99215 History, Exam, Medical Decision Making, Counseling, Coordination of Care, and Nature of Presenting Problem An E/M is made up of seven components six of which are used in defining the levels of E/M services. The seven components include History, Exam, Medical Decision Making, Counseling, Coordination of Care, Nature of Presenting Problem, and Time. Which six of these seven parts help define the level of the E/M service? The upper central region of the abdomen When a patient epigastric pain. Where is the pain located? 99382-25, 90471, 90710 A 2 year-old comes in for an initial WCE, Morn doesn't have the child's immunization record. She states the child's last shot was when he was 5 months old. Medical review and documentation of a new patient supports one element of HPI, five-elements of the ROS, and a complete PFSH. The examination was 8+ organ systems. The physician orders the immunizations to be given in the office today. Immunizations given subcutaneously: MMRV. What CPT codes are reported? Musculoskeletal Which system is given credit in the exam component when the provider documents "range of motion, strength, and stability" are adequate in both legs?" 99285 A 25 year-old male is brought in by the EMS to the ER for nausea and vomiting. The patient has elevated blood sugars per EMS. EMS and the physician are unable to get a history due to patient's altered mental status. The ED physician performed a comprehensive eight organ system exam and a high level MDM. Patient was transferred to ICU in stable condition. Total critical care time 25 minutes. What CPT code is reported? 00832 01829 The correct anesthesia code for a ventral hernia repair on a 13 month old child is A patient is placed under anesthesia to have an exploratory surgery done on her wrist. The surgeon utilizes a small fiber optic scope and investigates the radius, ulna, and surrounding wrist bones. What should the anesthesiologist code for? When the anesthesiologist begins preparing the patient for the induction of anesthesia does anesthesia time begin? 00561 When A five month old is brought into the operating room for open heart surgery. The surgeon performs a repair of a small hole that was found in the lining surrounding the patient's heart. Anesthesia was provided as well as the assistance of an oxygenator pump. Which is the correct code(s)? 01714-P3, 99100 A 72 year old male with a history of severe asthma is placed under anesthesia to have a long tendon in his upper arm repaired. Which is the correct code(s)? Capnography anesthesiologist? Which of the following procedures can be coded separately when performed by the 6 00126-P1 A healthy five year old male is placed under anesthesia to have a biopsy taken from his left ear drum. Which is the correct code(s)? 00851-P5, 99140 A female who is 17 weeks pregnant is rushed into the OR due to a ruptured tubal pregnancy. She has a severe hemorrhage and has an emergency laparoscopic tubal ligation. Which is the correct code(s)? 12032, 12013-59, S51.802A, S41.001A, S01.81XA John was in a fight at the local bar and presents to the ER with multiple lacerations. The physician evaluates John and determines that he has a 2.5 cm gash to his left forearm and a 4cm gash on his right shoulder, both which require layered closure. He also has a simple 3cm laceration on his forehead that requires simple closure. What are the correct codes for the laceration repairs? 17273, 17000, 17110 A patient presents to her dermatologists office with three suspicious looking lesions. The dermatologist evaluates them and determines that the 1.3cm lesion of the scalp is benign and the 1.5cm lesion of the neck is premalignant. The 2.5 cm on the dorsal surface of the patient's hand is also evaluated and is determined to be malignant. The dermatologist chooses to ablate all three lesions using electrosurgery. Which is the correct code(s)? 19000 An 18 year old female presents with a cyst of her left breast and her physician performs a puncture aspiration. Which is the correct code(s)? 17311, 17315, 17312, 12002 OPERATIVE REPORT Preoperative Diagnosis: Basal Cell Carcinoma Postoperative Diagnosis: Basal Cell Carcinoma Location: Mid Parietal Scalp Procedure: Prior to each surgical stage, the surgical site was tested for anesthesia and re-anesthetized as needed, after which it was prepped and draped in a sterile fashion. The clinically-apparent tumor was carefully defined and de-bulked prior to the first stage, determining the extent of the surgical excision. With each stage, a thin layer of tumor-laden tissue was excised with a narrow margin of normal appearing skin, using the Mohs fresh tissue technique. A map was prepared to correspond to the area of skin from which it was excised. The tissue was prepared for the cryostat and sectioned. Each section was coded, cut and stained for microscopic examination. The entire base and margins of the excised piece of tissue were examined by the surgeon. Areas noted to be positive on the previous stage (if applicable) were removed with the Mohs technique and processed for analysis. No 7 tumor was identified after the final stage of microscopically controlled surgery. The patient tolerated the procedure well without any complication. After discussion with the patient regarding the various options, the best closure option for each defect was selected for optimal functional and cosmetic results. Preoperative Size: 1.5 x 2.9 cm Postoperative Size: 2.7 x 2.9 cm Closure: Simple Linear Closure, 3.5cm, scalp Total # of Mohs Stages: 2 Stage Sections Positive I 6 1 II 2 0 Which is the correct code(s)? 15120 A patient with a non-healing burn wound on her right cheek, and is admitted to the OR for surgery. The physician had the patient prepped with a Betadine scrub and draped in the normal sterile fashion. The cheek was anesthetized with 1% Lidocaine with 1:800,000 epinephrine (6 cc), and SeptiCare was applied. A skin graft of the epidermis and a small portion of the dermis was taken with a Goulian Weck blade with a six-thousands-of-an-inch-thick shim on the blade. The 25 sq cm graft was flipped and sewn to the adjacent defect with running 5-0 Vicryl. The wound was then dressed with Xeroform and the patient was taken to recovery. Which is the correct code(s)? 12042-F6, 11740-F7 A child is brought into the emergency department after having her fingers on her right hand closed in a car door. The physician evaluates the patient and diagnosis her with a 3cm laceration to her second finger and a subungual hematoma to her third finger. The physician then proceeds to cleanse the fingers with an iodine scrub and injects both digits with 2 mL of 1% lidocaine with epinephrine. The wound on the second finger was then irrigated with 500 cc of NS and explored for foreign bodies or structural damage. No foreign bodies were found, tendons and vessels were intact. The wound was then re-approximated. Three 5-0 absorbable mattress sutures were used to close the subcutaneous tissue and six 6-0 nylon interrupted sutures were used to close the epidermis. The finger was then wrapped in sterile gauze and placed in an aluminum finger splint. The physician then check that the digital block performed on the third finger was still effective. After ensuring the patient's finger was still numb he then proceeded to take an electronic cautery unit and created a small hole in the nail. Pressing slightly on the nail he evacuated the hematoma. The hole was then irrigated with 500cc of NS and the finger was wrapped in sterile gauze. The patient tolerated both procedures well without complaint. Which is the correct code(s)? 8 Adding together the lesion diameter and the narrowest margins necessary to adequately excise the lesion. The size of an excision of a benign lesion is determined by: True A simple, single layered laceration requires extensive cleaning due to being heavily contaminated. The code selected would come from code range . Allograft as a(n) A skin graft where the donor skin comes from another human (often a cadaver) is known 16035, 16036 x2 A patient is being treated for third degree burns to his left leg and left arm which cover a total of 18 sq cm. The burns are scrubbed clean, anesthetized, and three incisions are made with a #11 scalpel, through the tough leathery tissue that is dead, in order to expose the fatty tissue below and avoid compartment syndrome. The burns are then re-dressed with sterile gauze. Which is the correct code(s)? 29883 code(s)? Medial and lateral meniscus repair performed arthroscopically. Which is the correct , 25605-54-RT, 12031, S52.501B A patient comes into the emergency department complaining of sever wrist pain after falling onto her out stretched hands. The physician evaluates the patient taking a detailed history, a detailed exam, and medical decision making of moderate complexity. Upon examination the physician notes that there is a small portion of bone protruding through the skin. After ordering x-rays of the forearm and wrist the patient is diagnosed with an open distal radius fracture of the right arm. The physician provides an IV drip of morphine to the patient for pain and reduces the fracture. 5¬0 absorbable sutures were use to close the subcutaneous layer above the fracture and the surface was closed with 6-0 nylon interrupted sutures. Wound length was measured at 2.5 cm. It was then dressed with sterile gauze and the wrist was stabilized with a Spica fiberglass cast. The physician provided the patient with a prescription for Percocet for pain and instructions for her to follow up with her orthopedist in 7 days. Which is the correct code(s)? Repair, Revision, and/or Reconstruction 20552 A Scapulopexy is found under what heading A patient with muscle spasms in her back was seen in her physician's office for treatment. The area over the myofascial spasm was prepped with alcohol utilizing sterile technique. After isolating it between two palpating fingertips a 25-gauge 5" needle was placed in the center of the myofascial spasms and a negative aspiration was performed. Then 4 cc of Marcaine 0.5% was injected into three 9 points in the muscle. The patient tolerated the procedure well without any apparent difficulties or complications. The patient reported feeling full relief by the time the block had set. Which is the correct code(s)? 22554, 63081, 20931, 22845 OPERATIVE NOTE PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4- C5 and C5-C6. POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4-C5 and C5-C6. PROCEDURE PERFORMED: 1. Anterior discectomy, C5-C6. 2. Arthrodesis, C5-C6. 3. Partial corpectomy, C5. 4. Machine bone allograft, C5-C6. 5. Placement of anterior plate with a Zephyr C6. ANESTHESIA: General. ESTIMATED BLOOD LOSS: 60 mL. COMPLICATIONS: None. INDICATIONS: This is a patient who presents with progressive weakness in the left upper extremity as well as imbalance. He has a very large disc herniation that came behind the body at C5 as well and as well as a large disc herniation at C5-C6. Risks and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion, progressive spondylosis, and lack of improvement were all discussed. He understood and wished to proceed. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Preoperative antibiotics were given. The patient was placed in the supine position with all pressure points noted and well padded. The patient was prepped and draped in standard fashion. An incision was made approximately above the level of the cricoid. Blunt dissection was used to expose the anterior portion of the spine with carotid moved laterally and trachea and esophagus moved medially. I then placed needle into the disc spaces and was found to be at C5-C6. Distracting pins were placed in the body of C6. The disc was then completely removed at C5-C6. There was very significant compression of the cord. This was carefully removed to avoid any type of pressure on the cord. This was very severe and multiple free fragments noted. This was taken down to the level of ligamentum. Both foramen were then also opened. Part o 10 General: 22224-62 Neurosurgeon: 22224-62 A general surgeon and a neurosurgeon are performing an osteotomy on the L4 vertebral segment. The general surgeon establishes the opening using an anterior approach. While the neurosurgeon performs the osteotomy the general surgeon performs a discectomy. After completion the general surgeon closes the patient up. 29075 A patient comes into his physician's office with a prior diagnosis of a Colles type distal radius fracture. He complains that the cast he currently has on is too tight and is causing numbness in his f ingers. The physician removes the cast and ensures the patient's circulation is intact. He then re-applies a short arm fiberglass cast and checks the patient's neurovascular status several times during the procedure. The patient is given instructions to follow-up with his orthopedist within seven days. Which is the correct code(s)? 29819 A patient is brought into the OR for a diagnostic arthroscopy of the shoulder. The patient has been complaining of pain since his surgery 4 months ago. The surgeon explores the shoulder and discovers a metal clamp which had been left in from the prior surgery. The surgeon removed the clamp and closed the patient up. Which is the correct code(s)? 28292 This 59 year-old female was brought to the operating room and placed on the surgical table in a supine position. Following anesthesia, the surgical site was prepped and draped in the normal sterile fashion. Attention was then directed to the right foot where, utilizing a # 15 blade, a 6 cm. linear incision was made over the 1st metatarsal head, taking care to identify and retract all vital structures. The incision was medial to and parallel to the extensor hallucis longus tendon. The incision was deepened through subcutaneous underscored, retracted medially and laterally - thus exposing the capsular structures below, which were incised in a linear longitudinal manner, approximately the length of the skin incision. The capsular structures were sharply underscored off the underlying osseous attachments, retracted medially and laterally. Utilizing an osteotome and mallet the medial eminence of the metatarsal bone was removed and the head was remodeled with the Liston bone forceps and the bell rasp. The surgical site was then flushed with saline. The base of the proximal phalanx of the great toe was osteotomized approximately 1 cm distal to the base and excised to toto from the surgical site. There was no hemi implant used and Kirschner wire was used to hold the joint in place. Superficial closure was accomplished using Vicryl 5-0 in a running subcuticular fashion. Site was dressed with a light compressive dressing. The tourniquet was released. Excellent capillary refill to all the digits was observed without excessive bleeding noted. Which is the correct code(s)? Tendon, aponeuroses and directly to bone 33533, 33517, 35572 Operative Note Muscle is attached to bone by what method? 11 PREOPERATIVE DIAGNOSIS: Angina and coronary artery disease. POSTOPERATIVE DIAGNOSIS: Angina and coronary artery disease. PROCEDURE DETAILS: The patient was brought to the operating room and placed in the supine position upon the table. After adequate general anesthesia, the patient was prepped with Betadine soap and solution in the usual sterile manner. Elbows were protected to avoid ulnar neuropathy and phrenic nerve protectors were used to protect the phrenic nerve. All were removed at the end of the case. A midline sternal skin incision was made and carried down through the sternum which was divided with the saw. Pericardial and thymus fat pad was divided. The left internal mammary artery was harvested and spatulated for anastomosis. Heparin was given. The Femoropopliteal vein was resected from the thigh, side branches secured using 4-0 silk and Hemoclips. The thigh was closed multilayer Vicryl and Dexon technique. A Pulsavac wash was done, drain was placed. The left internal mammary artery is sewn to the left anterior descending using 7-0 running Prolene technique with the Medtronic off-pump retractors. After this was done, the patient was fully heparinized, cannulated with a 6.5 atrial cannula and a 2-stage venous catheter and begun on cardiopulmonary bypass and maintained normothermia. Medtronic retractors used to expose the circumflex. Prior to going on pump, we stapled the vein graft in place to the aorta. Then, on pump, we did the distal anastomosis with a 7-0 running Prolene technique. The right side graft was brought to the posterior descending artery using running 7-0 Prolene technique. Deairing procedure was carried out. The bulldog clamps were removed. The patient maintained good normal sinus rhythm with good mean perfusion. The patient was weaned from cardiopulmonary bypass. The arterial a 36556 A 50-year-old gentleman with severe respiratory failure is mechanically ventilated and is currently requiring multiple intravenous drips. With the patient in his Intensive Care Unit bed, mechanically ventilated in the Trendelenburg position, the right neck was prepped and draped with Betadine in a sterile fashion. A single needle stick aspiration of the right subclavian vein was accomplished without difficulty and the guide wire was advanced and a dilator was advanced over the wire. The triple lumen catheter was cannulated over the wire and the wire was then removed. No PVCs were encountered during the procedure. All three ports to the catheter were aspirated and flushed blood easily and they were all flushed with normal saline. The catheter was anchored to the chest wall with butterfly phalange using 3-0 silk suture. Betadine ointment and a sterile Op-Site dressing were applied. Stat upright chest x-ray was obtained at the completion of the procedure to ensure proper placement of the tip in the subclavian vein. Which is the correct code(s)? 32440 A patient with chronic emphysema has surgery to remove both lobes of the left lung. Which is the correct code(s)? 39401 A thoracic surgeon makes an incision under the sternal notch at the base of the throat, introduces the scope into the mediastinal space and takes two biopsies of the mediastinal mass. He then retracts the scope and closes the small incision. Which is the correct code(s)? 12 31255, 31267 A patient has endoscopic surgery done to remove his anterior and posterior ethmoid sinuses. The surgeon dilated the maxillary sinus with a balloon using a transnasal approach, explored the frontal sinuses, remove two polyps from the maxillary sinus, and then performed the tissue removal. Which is the correct code(s)? 33208 Operative Note Approach: Left cephalic vein. Leads Implanted: Medtronic model 5076-45 in the right atrium, serial number PJN983322V. Medtronic 5076-52 in the right ventricle, serial number PJN961008V. Device Implanted: Pacemaker, Dual Chamber, Medtronic EnRhythm, model P1501VR, serial number PNP422256H. Lead Performance: Atrial threshold less than 1.3 volts at 0.5 milliseconds. P wave 3.3 millivolts. Impedance 572 ohms. Right ventricle threshold 0.9 volts at 0.5 milliseconds. R wave 10.3. Impedance 855. Procedure: The patient was brought to the electrophysiology laboratory in a fasting state and intravenous sedation was provided as needed with Versed and fentanyl. The left neck and chest were prepped and draped in the usual manner and the skin and subcutaneous tissues below the left clavicle were infiltrated with 1% lidocaine for local anesthesia. A 2-1/2-inch incision was made below the left clavicle and electrocautery was used for hemostasis. Dissection was carried out to the level of the pectoralis fascia and extended caudally to create a pocket for the pulse generator. The deltopectoral groove was explored and a medium-sized cephalic vein was identified. The distal end of the vein was ligated and a venotomy was performed. Two guide wires were advanced to the superior vena cava and peel-away introducer sheaths were used to insert the two pacing leads. The venous pressures were elevated and there was a fair amount of back-bleeding from the vein, so a 3-0 Monocryl figure-of-eight stitch was placed around the tissue surrounding the vein for hemostasis. The right ventricular lead was placed in the high RV septum and the right atrial lead was placed in the right atrial appendage. The leads were tested with a pacing systems analyzer and the results are noted above. The leads were then anchored in place with #0-silk around False If a surgeon is performing a surgical sinus endoscopy to control a nasal hemorrhage and chooses to perform a necessary sinusotomy while he's there, he can bill for each individual service. 36247, 37252, 37253 X2 A cardiologist manipulates a catheter through the patient's atrial system, starting in the femoral artery and manipulating to the third order, using intravascular ultrasound. The cardiologist performs radiological supervision and interpretation. Which is the correct code(s)? 13 True An indirect laryngoscopy, as described in code 31505, utilizes a mirror in which the physician can view the reflection of the larynx. A direct laryngoscopy, as described by code 31515, utilizes a scope in which the physician peers through and views the larynx. 38525 A patient was taken into the operating room where after induction of appropriate anesthesia, her left chest, neck, axilla, and arm were prepped with Betadine solution and draped in a sterile fashion. An incision was made at the hairline and carried down by sharp dissection through the clavipectoral fascia. The lymph node was palpitated in the armpit and grasped with a figure-of-eight 2-0 silk suture and by sharp dissection, was carried to hemoclip all attached structures. The lymph node was excised in its entirety. The wound was irrigated. The lymph node was sent to pathology. The wound was then closed. Hemostasis was assured and the patient was taken to recovery room in stable condition. Which is the correct code(s)? 43239 The patient was scheduled for an esophagogastroduodenoscopy. Upon arrival they were placed under conscious sedation and instructed to swallow a small flexible camera. The camera was then manipulated into the esophagus, and through the entire length of the esophagus. The esophagus appeared to be slightly inflamed, but there was no sign of erosion or flame hemorrhage. A small 2cm t issue sample was taken to look for gastroesophageal reflux disease. There was no stricture or Barrett mucosa. The bony and the antrum of the stomach were normal without any acute peptic lesions. Retroflexion of the tip of the endoscope in the body of the stomach revealed an abnormal cardia. There were no acute lesions and no evidence of ulcer, tumor, or polyp. The pylorus was easily entered, and the f irst, second, and third portions of the duodenum were normal. Which is the correct code(s)? 45378-53 After informed consent was obtained, the patient was placed in the left lateral decubitus position and sedated. The Olympus video colonoscope was inserted through the anus and was advanced in retrograde fashion through the sigmoid colon, descending colon, and to the splenic flexure. There was a large amount of stool at the flexure which appeared to be impacted. The physician decided not to advance to the cecum due to the impaction and the scope was pulled back into the descending colon and then slowly withdrawn. The mucosa was examined in detail along the way and was entirely normal. Upon reaching the rectum, retroflex examination of the rectum was normal. The scope was then straightened out, the air removed and the scope withdrawn. The patient tolerated the procedure well. Which is the correct code(s)? 49505 Operative Note The 45 year old male patient was taken to the operative suite, placed on the table in the supine position, and given a spinal anesthetic. The right inguinal region was shaved, prepped, and draped in a routine sterile fashion. The patient received 1 gm of Ancef IV push. A transverse incision was made in the intraabdominal crease and carried through the skin and subcutaneous tissue. The external oblique fascia was exposed and incised down to, and through, the external inguinal ring. The spermatic cord and hernia 14 sac were dissected bluntly off the undersurface of the external oblique fascia exposing the attenuated f loor of the inguinal canal. The cord was surrounded with a Penrose drain. The sac was separated from the cord structures. The floor of the inguinal canal, which consisted of attenuated transversalis fascia, was imbricated upon itself with a running locked suture of 2-0 Prolene. Marlex patch 1 x 4 in dimension was trimmed to an appropriate shape with a defect to accommodate the cord. It was placed around the cord and sutured to itself with 2-0 Prolene. The patch was then sutured medially to the pubic tubercle, inferiorly to Cooper's ligament and inguinal ligaments, and superiorly to conjoined tendon using 2-0 Prolene. The area was irrigated with saline solution, and 0.5% Marcaine with epinephrine was injected to provide prolonged postoperative pain relief. The cord was returned to its position. External oblique fascia was closed with a running 2-0 PDS, subcu with 2-0 Vicryl, and skin with running subdermal 4-0 Vicryl and Steri-Strips. Sponge and needle counts were correct. Sterile dressing was applied. Which is the correct code(s)? True The vestibule is part of the oral cavity outside the dentoalveolar structures and includes the mucosal and submucosal tissue of the lips and cheeks. Gallbladder Which of the following organs is not part of the alimentary canal? 42821, J03.90, J35.03 A 13 year old child has his tonsils and adenoids removed due acute tonsillitis and chronic tonsilitis and adenoiditis. Which is the correct code(s)? 43246-62 Operative Note Preoperative Diagnosis: Protein-calorie malnutrition Postoperative Diagnosis: Protein-calorie malnutrition. Anesthesia: Conscious sedation per Anesthesia.. Complications: None EGD: Dr. Brown PEG Placement: Dr. Smith History: The patient is a 73-year-old male who was admitted to the hospital with some mentation changes. He was unable to sustain enough caloric intake and had markedly decreased albumin stores. After discussion with the patient and his son they agreed to place a PEG tube for nutritional supplementation. Procedure: After informed consent was obtained the patient was brought to the endoscopy suite. He was placed in the supine position and was given IV sedation by the Anesthesia Department. An EGD was performed from above by Dr. Brown who has dictated his finding separately. The stomach was 15 transilluminated and an optimal position for the PEG tube was identified using the single poke method. The skin was infiltrated with local and the needle and sheath were inserted through the abdomen into the stomach under direct visualization. The needle was removed and a guidewire was inserted through the sheath. The guidewire was grasped from above with a snare by Dr. Brown. It was removed completely and the Ponsky PEG tube was secured to the guidewire. The guidewire and PEG tube were then pulled through the mouth and esophagus and snug to the abdominal wall. There was no evidence of bleeding. Photos were taken. The Bolster was placed on the PEG site. A complete dictation for the EGD will be done separately by Dr. Brown. The patient tolerated the procedure well and was transferred to recovery room in stable condition. He will be started on tube feedings in 6 hours with aspiration and dietary precautions to determine his nutritional goal. What code(s) should Dr. Smith charge? 43753 An 18 year old female was found with a suicide note and an empty bottle of Tylenol. She was rushed into the emergency department where she had a large-bore gastric lavage tube inserted into her stomach and the contents were evacuated. Which is the correct code(s)? False All endoscopies performed on the digestive system (such as an esophagoscopy, a colonoscopy, a sigmoidoscopy, etc.) do not allow moderate sedation to be coded additionally because it is bundled into the code? 43771 Operative Note History of Present Illness: Ms. Moore is status post lap band placement, the band was placed just over a year ago and she is here for a lap band adjustment. She has a history of problems previously with her adjustments. She has been under a lot of stress recently due to a car accident she was in a couple of weeks ago. Since the accident she has been experiencing problems of "not feel full". She states that she is not really hungry but she does not feel full either. She also states that when she is hungry at night she is having difficulty waiting until the morning to eat. She also mentioned that she had a candy bar and that seemed to make her feel better. Physical Examination: On exam, her temperature is 98, pulse 76, weight 197.7 pounds, blood pressure 102/72, BMI is 38.5, she has lost 3.8 pounds since her last visit. She was alert and oriented in no apparent distress. Procedure: I was able to access her port. She does have an AP standard low profile. I aspirated 6 mL, I did add 1 mL, so she has got approximately 7 mL in her restrictive device, she did tolerate water post procedure. Assessment: The patient's status post lap band adjustments; doing well, has a total of 7 mL within her lap band, tolerated water pos procedure. She will come back in two weeks for another adjustment as needed. Which is the correct code(s)? 16 The CPT with a modifier 26 Some radiology codes include two components. Often a radiologist will use the radiology equipment, which is known as the technical component, and the physician will provide the second half of the CPT code by supervising and interpreting the study. When this occurs what should the physician report? 74178 A patient presents to the ER with intractable nausea and vomiting, and abdominal pain that radiates into her pelvis. The physician orders a CT scan of the abdomen, first without contrast and then followed by contrast, and a CT of the pelvis, without contrast. Which is the correct code(s)? 70150 A patient was in an MVA and his face struck the steering wheel. He had multiple contusions and facial swelling. The physician suspected a zygomatic-malar or maxilla fracture. The radiologist took an oblique anterior-posterior projection which showed the facial complex clearly. An anterior-posterior and lateral views were also taken. Which is the correct code(s)? True If a prior study is available but it is documented in the medical records that there was inadequate visualization of the anatomy, then a diagnostic angiography may be reported in conjunction with an interventional procedure if modifier 59 is appended to the diagnostic S&I (Supervision and Interpretation). 20225, 77012 A physician performed a deep bone biopsy of the femur. The trocar was visualized and guided using a CAT scan and interpretation was provided. Which is the correct code(s)? 77771 HDR internal radiation therapy was performed by using a remote controlled MultiSource afterloader which was connected to 3 catheters. The 6 Ir-192 radioactive wire sources were released from the containment unit and were delivered beside the tumor within the body cavity, as pre determined. After 15 minutes the sources were removed from the patient and placed back into the containment unit. Which is the correct code(s)? 78451, 93016 A patient has a myocardial perfusion imaging study which included quantitative wall motion, ejection fraction by gated technique, and attenuation correction. The study was done during a cardiac stress test which was induced by using dipyridamole. The physician supervised, the interpretation and report were completed by the cardiologist. Which is the correct code(s)? 17 76813, 76814 A 35 year old mother carrying twin gestations, who has a three year old child with Down syndrome, comes in for a prenatal screening. She is in her 12th week of pregnancy and the physician requests that the amount of fluid behind the necks of the fetuses be measured. A transabdominal approach was used. Which is the correct code(s)? 36598 A dialysis patient presents in the radiology department. His physician suspects that the tip of his Hickman's catheter in his left forearm may have migrated from its original placement. The vascular surgeon on-call injects radiopaque iodine into the patient's port and examines it under fluoroscopic imaging. Which is the correct code(s)? True A written report signed by the interpreting physician should be considered an integral part of the radiological procedure or interpretation. 80047, 84460, 84450, 84155, 84443 A physician orders a patient's blood be tested for levels of urea nitrogen, sodium, potassium, transferase alanine and aspartate amino, total protein, ionized calcium, carbon dioxide, chloride, creatinine, glucose, and TSH. Which is the correct code(s)? 88300 A specimen labeled "right ovarian cyst" is received for examination. It consists of a smooth walled, clear fluid filled cyst measuring 13x12x7 cm and weighing 1351 grams with fluid. Both surfaces of the wall are pink-tan, smooth and grossly unremarkable. No firm or thick areas or papillary structures are noted on the cyst wall externally or internally. After removal the fluid, the cyst weight 68 grams. The fluid is transparent and slightly mucoid. Which is the correct code(s)? 83874, 83874-91 x2, 84484, 84484-91 x2, 82550, 82550-91 x2 A patient presents to the ED with chest pain, shortness of breath, and a history of congestive heart failure. The physician performs a 12 lead EKG which indicates a myocardial infarction without ST elevations. The physician immediately orders myoglobin, quantitative troponin, and CK enzyme levels to be run once every hour for three consecutive hours. Which is the correct code(s)? 81025, 84702 A 17 year old female presents in her family physician's office complaining of nausea, vomiting, and weight gain. She has been experiencing these symptoms on and off for two weeks. An analysis of the urine reveals a positive pregnancy test and hCG levels of 12500 mIU/ml confirm she is in her sixth week of pregnancy. Which is the correct code(s)? 80305, 80345, 80361 An employee was randomly selected for a drug screen. According to the employer it is standard procedure to use a multiplex screening kit, using non-TLC procedures, and test 18 for barbiturates, cocaine, opiates, and methadone. Any drug with a positive result should be confirmed with a second, definitive test. The employee showed positive for barbiturates and opiates. Secondary tests were run on the two and levels came back with 350 ng/ml for barbiturates and 375 ng/ml for opiates. Which is the correct code(s)? hCG 89258 A CBC does not include which of the following: A couple that was unsuccessful at conceiving a child chooses to have in vitro fertilization done. The eggs and semen have been harvested and nine eggs were implanted with a sperm. The zygotes went through mitosis and produced embryos. Three embryos were then implanted in the woman and the other six were kept for later use. What codes(s) would the lab technician charge for her services in preserving the remaining six embryos? 82951 A patient in her 30th week of pregnancy has a high oral glucose reading and her physician orders a glucose tolerance test. Upon arrival the laboratory technician draws the patient's blood and the patient then ingests a glucose drink. Her blood is then drawn one, two, and three hours after the ingestion. As the patient was leaving the laboratory the technician informs her that the samples were incorrectly labeled and that the test needed to be repeated. The patient has her blood drawn again, ingested the glucose drink again, and has her blood re-drawn at one, two, and three hour intervals. Which is the correct code(s)? 80048, 80053, 80069 Carbon dioxide, total calcium, and sodium and all in what three panels? Which is the correct code(s)? True A qualitative hCG test will provide a positive or negative result while a quantitative hCH test will provide a specific amount of hCG in the specimen. S41.112A, S01.411A, Z20.3, 12032, 12013-51, 90460-51, 90675 A 5 year old is brought into the ER after being attacked by a stray dog. The stray was captured and tested positive for rabies. The patient has a 3cm laceration on his right cheek that requires simple closure and a 1cm and 4cm laceration on his upper left arm requiring layered repair. After discussing the benefits and risks with the patient's parents they decide to have an IM rabies vaccination administered by the physician, due to the patient's rabies exposure. Which is the correct code(s)? 93010, 96360, 96361 A 52 year old male is in the emergency department complaining of dizziness and states he passed out prior to arrival. The physician evaluates him, orders that a 12 lead EKG be 19 performed, and has the nurse infuse 2 liters of NS over a 1 hour and 45 minute time period under his supervision. The EKG results were reviewed by the physician and were normal. A report was written and the patient was diagnosed with syncope due to dehydration and released. In addition to the EM service what should the physician code for? 90970 x11 A 45 year old patient with end stage renal disease has in home dialysis services initiated on the 15th of the month. The physician provides dialysis every day. On the 19th the patient was admitted to the hospital and discharged on the 24th. The physician and patient began in-home dialysis again on the 25th and continued every day until the 31st. Which is the correct code(s)? 93297 x3, 93295, 93283 A patient with a dual lead implantable cardioverter-defibrillator has his physician initiate remote monitoring of the ICD and of cardiovascular monitor functionality (within the ICD), to help diagnosis the patient with what he suspects is left sided heart failure. Over the course of 90 days the physician remotely analyzes recorded data from the device, including left atrial pressure, ventricular pressure, and the patient's blood pressure. He also remotely analyzes data from the defibrillator, including the heart rhythms and pace. After analysis and review the physician compiles reports on both. During this time period there was also one in-person interrogation of the ICM device and one in-person encounter for programming and adjusting the ICD device to ensure test functions and to optimize programming. Which is the correct code(s)? 92014 History: Past ocular surgery history is significant for neurovascular age-related dry macular degeneration. Patient has had laser four times to the macula on the right and two times to the left. Exam: Established 63 year old female patient. On examination, lids, surrounding tissues, and palpebral f issure are all unremarkable. Conjunctiva, sclera, cornea and iris were all assessed as well. Palpitation of the orbital rim revealed nothing. Visual acuity with correction measured 20/400 OU. Manifest refraction did not improve this. There was no afferent pupillary defect. Visual fields were grossly full to hand motions. Intraocular pressure measured 17 mm in each eye. Vertical prism bars were used to measure ocular deviation and a full sensorimotor examination to evaluate the function of the ocular motor system was performed. A slit-lamp examination was significant for clear corneas OU. There was early nuclear sclerosis in both eyes. There was a sheet like 1-2+ posterior subcapsular cataract on the left. Dilated examination by way of cycloplegia showed choroidal neovascularization with subretinal heme and blood in both eyes. Magnified inspection was obtained with a Goldman 3-mirror lens and the retina, optic disc, and retinal vasculature were visualized. Macular degeneration was present in both the left and right retinas. Assessment/Plan: Advanced neurovascular age-related macular degeneration OU, this is ultimately visually limiting. Cataracts are present in both eyes. I doubt cataract removal will help increase visual acuity; however, I did discuss with the patient, especially in the left, that cataract surgery will help us better visualize the macula for future laser treatment so that her current vision can be maintained. We discussed her current regiments and decided to continue with the high doses of the vitamins A, C a 20 True Some procedures or services are commonly carried out as an integral component of another total service or procedure and are identified by the inclusion term "separate procedure". Codes with this inclusion term should not be reported in addition to the total procedure code or service to which it is considered an integral part, unless it is independently carried out or considered unrelated. If performed independently or as an un-related procedure it may be coded with modifier 59 appended to it. 99601 x13, 99602 x13, 99509 x4 A 73 year old group home resident with end stage renal disease has a nurse come in on Mondays, Wednesdays, and Fridays to perform peritoneal dialysis. Each dialysis session lasts three hours. Once a week, (on Friday), the nurse also assists the patient with his meals, cleaning, and grocery shopping. What should the nurse charge for a month (30 days) of services if the 1st of the month landed on a Monday? 93922-52 The physician performs a non-imaging physiological recording of pressure on the left leg with Doppler analysis of blood flow in both directions. ABIs were taken at the back and front lower aspect of the tibial and tibial/dorsalis pedis arteries. In addition 2 levels of plethymography volume and oxygen tension were taken. Which is the correct code(s)? 91020 Due to a suspected gastric outlet obstruction a manometric study is performed. Using nuclear medicine the physician monitors the time it takes for food to move through the patient's stomach, the time it take the patient's stomach to empty into the small intestine, and how fully it empties. Which is the correct code(s)? 90664 50590 Which of the following drugs is not pending FDA approval. A patient was brought to the OR and sedated. She was then placed in the supine position on a water filled cushion. The C-Arm image intensifier was positioned in the correct anatomical location above the left renal and a total of 2500 high energy shock waves were applied from the outside of the body. Energy levels were slowly started and O2 increased up to 7. Gradually the 2.5cm stone was broken into smaller pieces as the number of shocks went up. The shocks were started at 60 per minute and slowly increased up to 90 per minute. The patient's heart rate and blood pressure were stable throughout the entire procedure. She was transported to recovery in good condition. Which is the correct code(s)? 57156 A patient recently underwent a total hysterectomy due to ovarian cancer, which has metastasized. She is now having cylinder rods placed for clinical brachytherapy treatment. Treatment will 21 consist of high dose rate (HDR) brachytherapy once correct placement of the rods have been confirmed. Which is the correct code(s)? 55250 The patient was brought to the suite, where after oral sedation; the scrotum was prepped and draped. 1% lidocaine was used for local anesthesia. The vas was identified, skin was incised, and no scalpel instruments were used to dissect out the vas. A segment about 3 cm in length was dissected out. It was clipped proximally and distally, and then the ends were cauterized after excising the segment. Minimal bleeding was encountered and the scrotal skin was closed with 3-0 chromic. The identical procedure was performed on the contralateral side. The patient tolerated the procedure well. He was discharged from the surgical center in good condition with Tylenol with Codeine for pain. Which is the correct code(s)? 59618, 59620-51, O75.81, O30.013, O60.14X0, O66.41, O82, Z37.2, Z3A.36 A 26 year old patient who is Gravida 2 Para 1 presents to the ER in her 36th week of pregnancy with twin gestations who are monochorionic and monoamniotic. She is in active labor, 6 cm dilated, and her water is intact. Her OBGYN, who provided 12 antepartum visits, admitted her to labor & delivery. Although the patient had a previous cesarean during her first pregnancy the physician allowed her to attempt a vaginal birth. After pushing for three hours the patient was exhausted and taken to the OR for a cesarean delivery with a transverse incision. Two healthy newborns were born 15 minutes later. During the hospital stay and afterward the same physician provided the postpartum care to the mother. Which is the correct code(s)? 55700, 76942 A 74 year old male with a weak urinary stream had his PSA tested. Results read 12.5 and he was scheduled for a biopsy to determine whether he had a malignancy or BPH. He arrived for surgery and was placed in the left lateral decubitus position and he was sedated. The surgeon used ultrasonic guidance to percutaneously retrieve 3 biopsies, using the transperineal approach. The biopsies were examined and the patient was diagnosed with secondary prostate cancer with the primary site unknown. He was directed to schedule a PET scan and discharged in good condition. 55041 Procedure: Hydrocelectomy A scrotal incision was made and further extended with electrocautery. Once the hydrocele sac was reached we then opened and delivered the testis which drained clear fluid. There was moderate amount of scarring on the testis itself from the tunica vaginalis. The hydrocele sac was completely removed. A drain was then placed in the base of the scrotum and then the testis was placed back into the scrotum in the proper orientation. The same procedure was performed on the left. The skin was then sutured with a running interlocking suture of 3-0 Vicryl and the drains were sutured to place with 3-0 Vicryl. Bacitracin dressing, ABD dressing, and jock strap were placed. The patient was in stable condition upon transfer to recovery. Which is the correct code(s)? 22 51729-26, 51797-26 A urologist performs a cystometrogram with intra-abdominal voiding pressure studies in a hospital using calibrated electronic equipment that is provided for his use. He interprets the study and diagnosis the patient with neurogenic bladder. Which is the correct code(s)? 58970, 76948 Transvaginal sonographically controlled retrieval of a 26 year old female's eggs by piercing the ovarian follicle with a very fine needle. Which is the correct code(s)? Malleus, incus, and stapes The hammer, anvil, and stirrup are the English terms for the three auditory ossicles, whose Latin names are: 61107 Operative Note Pre-operative Diagnosis: Increased intracranial pressure and cerebral edema due to severe brain injury. Post-operative Diagnosis: Increased intracranial pressure and cerebral edema due to severe brain injury. Procedure: Scalp was clipped. Patient was prepped with ChloraPrep and Betadine. Incisions are infiltrated with 1% Xylocaine with epinephrine 1:200000. Patient did receive antibiotics post procedure and was draped in a sterile manner. The incision made just to the right of the right mid-pupillary line 10 cm behind the nasion. A self-retaining retractor was placed. A hole was then drilled with the cranial twist drill and the dura was punctured. A brain needle was used to localize the ventricle and it took 3 passes to localize the ventricle. The pressure was initially high. The CSF was clear and colorless. The CSF drainage rapidly tapered off because of the brain swelling. With two tries, the ventricular catheter was then able to be placed into the ventricle and then brought out through a separate puncture site; the depth of catheter was 7 cm from the outer table of the skull. There was intermittent drainage of CSF after that. The catheter was secured to the scalp with #2-0 silk sutures and the incision was closed with Ethilon suture. The patient tolerated the procedure well. No complications. Sponge and needle counts were correct. Blood loss is minimal. Which is the correct code(s)? 63040 Using the posterior approach the surgeon made a midline incision above the underlying vertebrae and dissected down to the paravertabral muscles and retracted then. The ligamentum flavum, lamina, and fragments of a ruptured C3-C4 intervertebral disc were all removed. The surgeon also removed a portion of the facet to relieve the compressed nerve of the C4 vertebrae. He then placed a free-fat graft over the exposed nerve and the paravertabral muscles were repositioned. The patient was then closed using layered sutures and taken to recovery. Which is the correct code(s)? 65765 A procedure in which corneal tissue from a donor is frozen, reshaped, and implanted into the anterior corneal stroma of the recipient to modify refractive error. Which is the correct code(s)? 23 Lymph nodes Which of the following organs is not part of the endocrine system 67107 Using an operating microscope the ophthalmologist places stay sutures into the rectus muscle. A cold probe is then placed over the sclera and is depressed sealing the choroid to the retina at the original tear site. He then performs a sclerotomy and places mattress sutures across the incision. Subretinal fluid is then drained. Next a silicone sponge, followed by a silicone band, are placed around the eye and sutured into place to help support the healing scar. Rectus sutures are removed. Which is the correct code(s)? 61315 Following a motor vehicle collision a 28 year old male was given a CT scan of the brain which indicated an infratentorial hematoma in the cerebellum. The patient was taken to the OR where the neurosurgeon, using the CT coordinates, incised the scalp and drilled a burr hole into the cranium above the hematoma. Under direct visualization he then evacuated the hematoma using suction and irrigated with NS. Hemorrhaging was controlled and the dura was closed. The skull piece was then placed back into the drill hole and screwed into place. The scalp was closed and the patient was sent to recovery. Which is the correct code(s)? 64721 An incision was made right in the mid palm area between the thenar and hypothenar eminence. Meticulous hemostasis of any bleeders was done. The fat was identified. The palmar aponeurosis was identified and cut and this was traced down to the wrist. There was severe compression of the median nerve. Additional removal of the aponeurosis was performed to allow for further decompression. After this was all completed, the area was irrigated with saline and bacitracin solution and closed as a single layer using Prolene 4-0 as interrupted vertical mattress stitches. Dressing was applied. The patient was brought to the recovery. Which is the correct code(s)? 69667-50, 69990 A postauricular incision is made on the right ear. With the use of an operating microscope the surgeon visualizes and reflects the skin flap and posterior eardrum forward. A small leak from the middle ear into the round window is noted. The surgeon then roughens up the surface of the window and packs it with fat. Upon retraction the eardrum and skin flap are replaced and the canal is packed. The surgeon then sutures the postauricular incision. He then repeats the procedure on the left ear. Which is the correct code(s)? As a primary code Pancreatic Islets Code 60512 should not be used: Which cells produce hormones to regulate blood sugar? 24 H52.222, H54.52 The patient has a significant low visual impairment due to regular astigmatism in the left eye. It is corrected with glasses the right eye has normal vision. Code the patient's diagnosis code(s) based on this information. Ureter Urine is transported from the kidneys to the urinary bladder by which structure? $100 or 25% of cost patient? LCD The amount on an ABN should be within how much of the cost to the What is an NCD interpreted at the MAC level considered? Part D A Medicare patient is receiving chemotherapy at her oncologist's office. While the patient is receiving chemotherapy, the oncologist calls in a prescription for pain medication to a pharmacy in the same building. The pharmacy delivers the medication to the patient in the oncologist's office for the patient to take home. What part of Medicare should be billed for the pain medication by the pharmacy? Protected Health Information Fraud What is PHI Intentional billing of services not provided is considered 25