CPC PRACTICE EXAM - 150
QUESTIONS WITH CORRECT
ANSWERS
20552 - Answer-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 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 - Answer-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
,General: 22224-62 Neurosurgeon: 22224-62 - Answer-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 - Answer-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 fingers. 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 - Answer-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 - Answer-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 - Answer-Muscle is attached to bone by
what method?
33533, 33517, 35572 - Answer-Operative Note
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 - Answer-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 - Answer-A patient with chronic emphysema has surgery to remove both
lobes of the left lung. Which is the correct code(s)?
39401 - Answer-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)?
31255, 31267 - Answer-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 - Answer-Operative Note
Approach: Left cephalic vein.
QUESTIONS WITH CORRECT
ANSWERS
20552 - Answer-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 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 - Answer-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
,General: 22224-62 Neurosurgeon: 22224-62 - Answer-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 - Answer-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 fingers. 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 - Answer-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 - Answer-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 - Answer-Muscle is attached to bone by
what method?
33533, 33517, 35572 - Answer-Operative Note
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 - Answer-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 - Answer-A patient with chronic emphysema has surgery to remove both
lobes of the left lung. Which is the correct code(s)?
39401 - Answer-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)?
31255, 31267 - Answer-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 - Answer-Operative Note
Approach: Left cephalic vein.
