CPC Practice Exam D
Indication :
The patient has a hypertrophic scar on the posterior side of the left leg, at the level of the knee. This has
begun to restrict his mobility. His physical therapy trial was unsuccessful.
Procedure :
After the proper induction of anesthesia, the subcutaneous tissue of the patient's left leg beneath the
scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was
then excised down to viable dermis. Hemostasis was obtained with epinephrine soaked pads.
Skin was harvested from the patient's thigh in a split thickness fashion and was used to cover the 90 sq
cm defect created by the surgery. The graft was secured with skin staples, and then dressed with fine
mesh gauze followed by medication-soaked gauze. The donor site was dressed with mesh followed by
Adaptic, followed by a dry dressing and an Ace wrap.
What are the CPT codes? - Answer-15100, 15002
Rationale :
,The physician is taking a split-thickness skin autograft from the thigh and grafting it to the patient's left
leg, which needs repair.
Look in the CPT® Index for Split/Grafts, you are referred to 15100-15101, 15120-15121.
Code 15100 is the correct code because there was less than 100 sq cm taken from the leg (thigh).
The second procedure 15002 is reported because the patient had a hypertrophic scar on the leg and the
physician is preparing the recipient's site by excising the scar, which left a 90 sq cm defect, to provide
healthy blood vessels onto which the skin graft will be placed.
The physician is called in to perform repairs for a 17 year-old girl involved in a motor vehicle accident.
She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm
laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm laceration to her chest. The
wound on her chin required a layered closure. All other wounds required complex closure.
The CPT codes to report are: - Answer-13132, 13133 x 3, 13101, 13102, 12052
Rationale :
First, list all lacerations by the anatomical site and/or the type of wound closure. The only site that has a
layered closure is the chin (4 cm), which is coded 12052.
The remaining repairs are complex: (Forehead) 8.6 cm + (RT and LT cheek) 9.5 cm = 18.1 cm, which is
coded 13132, 13133 x 3 (13132 for the first 7.5 cm and 13133 x 3 for the remaining 10.6 cm).
The last site is the chest at 12.5 cm, which is coded 13101, 13102.
,A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions on his face are
destroyed and five actinic keratoses on his left arm are destroyed.
The CPT code(s) to report is (are) : - Answer-17000, 17003 x 4, 17110
Rationale :
Keywords in this scenario are "actinic keratoses," of which there are five.
Code 17000 is the correct code because the code description gives an example of what a "premalignant
lesion" is in parenthesis and it is reported for the first lesion being destroyed.
Code 17003 has the word "each" in its code description, which indicates each of the four remaining
actinic keratoses lesions is reported separately.
Code 17110 is the correct code for the destruction of the three benign lesions. Code 17110 is not
reported by each lesion separately destroyed because the code description shows to report it once for
destroying 1-14 lesions.
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). - Answer-27096
Rationale :
, 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? - Answer-24579-RT, S42.451A
Rationale :
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.
Indication :
The patient has a hypertrophic scar on the posterior side of the left leg, at the level of the knee. This has
begun to restrict his mobility. His physical therapy trial was unsuccessful.
Procedure :
After the proper induction of anesthesia, the subcutaneous tissue of the patient's left leg beneath the
scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was
then excised down to viable dermis. Hemostasis was obtained with epinephrine soaked pads.
Skin was harvested from the patient's thigh in a split thickness fashion and was used to cover the 90 sq
cm defect created by the surgery. The graft was secured with skin staples, and then dressed with fine
mesh gauze followed by medication-soaked gauze. The donor site was dressed with mesh followed by
Adaptic, followed by a dry dressing and an Ace wrap.
What are the CPT codes? - Answer-15100, 15002
Rationale :
,The physician is taking a split-thickness skin autograft from the thigh and grafting it to the patient's left
leg, which needs repair.
Look in the CPT® Index for Split/Grafts, you are referred to 15100-15101, 15120-15121.
Code 15100 is the correct code because there was less than 100 sq cm taken from the leg (thigh).
The second procedure 15002 is reported because the patient had a hypertrophic scar on the leg and the
physician is preparing the recipient's site by excising the scar, which left a 90 sq cm defect, to provide
healthy blood vessels onto which the skin graft will be placed.
The physician is called in to perform repairs for a 17 year-old girl involved in a motor vehicle accident.
She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm
laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm laceration to her chest. The
wound on her chin required a layered closure. All other wounds required complex closure.
The CPT codes to report are: - Answer-13132, 13133 x 3, 13101, 13102, 12052
Rationale :
First, list all lacerations by the anatomical site and/or the type of wound closure. The only site that has a
layered closure is the chin (4 cm), which is coded 12052.
The remaining repairs are complex: (Forehead) 8.6 cm + (RT and LT cheek) 9.5 cm = 18.1 cm, which is
coded 13132, 13133 x 3 (13132 for the first 7.5 cm and 13133 x 3 for the remaining 10.6 cm).
The last site is the chest at 12.5 cm, which is coded 13101, 13102.
,A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions on his face are
destroyed and five actinic keratoses on his left arm are destroyed.
The CPT code(s) to report is (are) : - Answer-17000, 17003 x 4, 17110
Rationale :
Keywords in this scenario are "actinic keratoses," of which there are five.
Code 17000 is the correct code because the code description gives an example of what a "premalignant
lesion" is in parenthesis and it is reported for the first lesion being destroyed.
Code 17003 has the word "each" in its code description, which indicates each of the four remaining
actinic keratoses lesions is reported separately.
Code 17110 is the correct code for the destruction of the three benign lesions. Code 17110 is not
reported by each lesion separately destroyed because the code description shows to report it once for
destroying 1-14 lesions.
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). - Answer-27096
Rationale :
, 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? - Answer-24579-RT, S42.451A
Rationale :
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.
