CPC Practice Exam A-D Finals 2025|
Latest Update 2025|
Indication/Procedure Rationale Q&A
The provided cases and their CPT codes are accurate as follows:
Case 1: Hypertrophic Scar with Skin Graft
Indication: Hypertrophic scar excision and split-thickness skin graft.
CPT Codes: 15100, 15002
Rationale:
- 15100: Covers the split-thickness autograft harvested from the thigh and applied to a defect less
than 100 sq cm.
- 15002: Accounts for the surgical preparation of the recipient site by excising the hypertrophic
scar to create a viable bed for the graft.
Case 2: Complex and Layered Laceration Repairs
Indication: Multiple lacerations, some requiring layered or complex closure.
CPT Codes: 13132, 13133 x 3, 13101, 13102, 12052
Rationale:
- 12052: Layered closure of the chin laceration (4 cm).
- 13132: Complex repair of the forehead and cheeks combined (18.1 cm).
1
,- 13133 x 3: Each additional increment of 5 cm or less beyond the first 7.5 cm for the forehead
and cheeks.
- 13101: Complex closure of the chest laceration (first 7.5 cm).
- 13102: For the additional 5 cm of the chest laceration.
Case 3: Destruction of Benign and Premalignant Lesions
Indication: Destruction of 3 benign lesions on the face and 5 actinic keratoses on the left arm.
CPT Codes: 17000, 17003 x 4, 17110
Rationale:
- 17000: Destruction of the first premalignant lesion (actinic keratosis).
- 17003 x 4: Destruction of each additional premalignant lesion (4 remaining lesions).
- 17110: Destruction of 1–14 benign lesions (reported once for the 3 benign facial lesions).
These CPT codes accurately reflect the services rendered in each scenario.
Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac
injection at an ambulatory surgery center. After sterile prep, the patient is placed prone position.
A needle is placed under fluoroscopic guidance into the SI joint and a mixture of 20 mg of
Celestone and Marcaine is injected for pain relief.
Report the CPT code(s). 27096
Rationale :
2
,27096 is the correct code because a steroid injection (Celestone and Marcaine) is placed into the
sacroiliac (SI) joint.
Fluoroscopic and computed tomography (CT) guidance is included and is not reported
separately. There is a parenthetical note under the code description that states: (27096 is to be
used only with CT or fluoroscopic imaging confirmation of the intra-articular needle
positioning).
The patient is seen in the hospital's outpatient surgical area with a diagnosis of a displaced
comminuted closed fracture of the lateral condyle, right elbow. An ORIF procedure was
performed, which included the following techniques: An incision was made in the area of the
lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily
exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees. It was
possible to manually reduce this quite easily, and the manipulation resulted in an almost
anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut
off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for
the skin. Dressings and a long arm cast were applied.
Which are the correct ICD-10-CM and CPT code assignments? 24579-RT, S42.451A
Rationale :
3
, The fracture of the lateral condyle is closed because the scenario does not mention that it is an
open fracture or documents that a piece of bone has broken through the skin and is exposed.
In the ICD-10-CM Alphabetic Index, look for Fracture, traumatic/humerus/lower
end/condyle/lateral (displaced). You are referred to code S42.45-.
Go to the Tabular List to report the 6th and 7th characters.
The seventh character extenders for this code are listed under category code S42. The fracture is
closed.
The next step is to figure out if the CPT fracture care is an opened or closed treatment. Hint: The
surgeon made "an incision" to get to the fracture site.
Code 24579 is the correct code because this was an open treatment due to the surgeon making an
incision to get to the fracture site and performing an internal fixation (two pins).
Open reduction and internal fixation (ORIF) is also an indication that an open approach is used
to perform the surgery.
A 35-year-old female patient presents with acute onset of severe pain since October. Her workup
has revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative
findings were consistent with two large fragments of free disk fragments in the foramen at C5-C6
4
Latest Update 2025|
Indication/Procedure Rationale Q&A
The provided cases and their CPT codes are accurate as follows:
Case 1: Hypertrophic Scar with Skin Graft
Indication: Hypertrophic scar excision and split-thickness skin graft.
CPT Codes: 15100, 15002
Rationale:
- 15100: Covers the split-thickness autograft harvested from the thigh and applied to a defect less
than 100 sq cm.
- 15002: Accounts for the surgical preparation of the recipient site by excising the hypertrophic
scar to create a viable bed for the graft.
Case 2: Complex and Layered Laceration Repairs
Indication: Multiple lacerations, some requiring layered or complex closure.
CPT Codes: 13132, 13133 x 3, 13101, 13102, 12052
Rationale:
- 12052: Layered closure of the chin laceration (4 cm).
- 13132: Complex repair of the forehead and cheeks combined (18.1 cm).
1
,- 13133 x 3: Each additional increment of 5 cm or less beyond the first 7.5 cm for the forehead
and cheeks.
- 13101: Complex closure of the chest laceration (first 7.5 cm).
- 13102: For the additional 5 cm of the chest laceration.
Case 3: Destruction of Benign and Premalignant Lesions
Indication: Destruction of 3 benign lesions on the face and 5 actinic keratoses on the left arm.
CPT Codes: 17000, 17003 x 4, 17110
Rationale:
- 17000: Destruction of the first premalignant lesion (actinic keratosis).
- 17003 x 4: Destruction of each additional premalignant lesion (4 remaining lesions).
- 17110: Destruction of 1–14 benign lesions (reported once for the 3 benign facial lesions).
These CPT codes accurately reflect the services rendered in each scenario.
Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac
injection at an ambulatory surgery center. After sterile prep, the patient is placed prone position.
A needle is placed under fluoroscopic guidance into the SI joint and a mixture of 20 mg of
Celestone and Marcaine is injected for pain relief.
Report the CPT code(s). 27096
Rationale :
2
,27096 is the correct code because a steroid injection (Celestone and Marcaine) is placed into the
sacroiliac (SI) joint.
Fluoroscopic and computed tomography (CT) guidance is included and is not reported
separately. There is a parenthetical note under the code description that states: (27096 is to be
used only with CT or fluoroscopic imaging confirmation of the intra-articular needle
positioning).
The patient is seen in the hospital's outpatient surgical area with a diagnosis of a displaced
comminuted closed fracture of the lateral condyle, right elbow. An ORIF procedure was
performed, which included the following techniques: An incision was made in the area of the
lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily
exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees. It was
possible to manually reduce this quite easily, and the manipulation resulted in an almost
anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut
off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for
the skin. Dressings and a long arm cast were applied.
Which are the correct ICD-10-CM and CPT code assignments? 24579-RT, S42.451A
Rationale :
3
, The fracture of the lateral condyle is closed because the scenario does not mention that it is an
open fracture or documents that a piece of bone has broken through the skin and is exposed.
In the ICD-10-CM Alphabetic Index, look for Fracture, traumatic/humerus/lower
end/condyle/lateral (displaced). You are referred to code S42.45-.
Go to the Tabular List to report the 6th and 7th characters.
The seventh character extenders for this code are listed under category code S42. The fracture is
closed.
The next step is to figure out if the CPT fracture care is an opened or closed treatment. Hint: The
surgeon made "an incision" to get to the fracture site.
Code 24579 is the correct code because this was an open treatment due to the surgeon making an
incision to get to the fracture site and performing an internal fixation (two pins).
Open reduction and internal fixation (ORIF) is also an indication that an open approach is used
to perform the surgery.
A 35-year-old female patient presents with acute onset of severe pain since October. Her workup
has revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative
findings were consistent with two large fragments of free disk fragments in the foramen at C5-C6
4
